I’ve written a couple guest posts for my friend and colleague, Stacy Green, over at Get Twisted on the topic of psychopaths. In those posts, I talked about how they develop and how they are different from narcissists.
Another question people often ask is how treatable psychopaths are. Can they be cured?
The short answer is ‘No.’ But have you all ever known me to settle for a short answer. 🙂
The official diagnosis given to a psychopath is antisocial personality disorder (ASPD).
Personality disorders in general are hard to treat for two reasons. One, they are so ingrained in the person’s make-up. The person has grown up in an environment (and in the case of ASPD, with a genetic predisposition) that has shaped their personality in a warped way. So when treating personality disorders, one is truly trying to change the leopard’s spots!
Two, with many personality disorders the person with the disorder thinks they are okay and the rest of the world is crazy or stupid. To their thinking, being extremely rigid or paranoid or emotionally reactive or egocentric (these are the hallmark symptoms of four different personality disorders) is normal. Or they view their personalities as an acceptable alternative to normal; they just march to a different drummer. They don’t get it that their behaviors and ways of thinking are maladaptive.
With the other personality disorders, there is some hope, however. If you can show the person how their behavior is causing problems in their lives and/or hurting the people they care about, you may be able to get them motivated to try to change. It will still be an uphill battle because the symptoms are so ingrained, but it’s worth a try.
For ASPD, the hallmark symptoms are egocentrism, thrill-seeking, lack of remorse, lack of empathy for others and lack of fear of consequences for their behavior.
The three “lack of’s” are a major problem when trying to get a psychopath to change. They have no motivation to do so. If you feel no guilt for your behavior, don’t really care how you’re hurting others, and don’t care what negative consequences you may suffer for your behavior, well, why would you want to change?
Fighting the thrill-seeking is equivalent to fighting a hard-core addiction. They are addicted to the adrenaline rush. And again, they have no motivation to give it up since they experience little or no fear of consequences (see The Making of a Psychopath for an explanation of why they are thrill-seeking and feel so little fear).
Usually the only way to make any inroads toward change in psychopaths is to play on their ‘what’s in it for me’ attitude. The therapeutic approach with them is tough love, minus the love. You get in their faces and show them what a dumbf**k they are for doing what they’re doing.
Don’t try this at home! This approach is used mainly when they are in jail, i.e. when they are locked up in a cage and cannot follow you home and kill you for dissing them.
IF you can show them that it is in their own self-interest to change, then they MIGHT be motivated to do so. But you’re still up against that deeply ingrained issue.
Two caveats here. First, ASPD, like all psychological disorders, exists on a continuum. People with milder cases are easier to reach than those in the middle or toward the more hard-core end of that continuum.
Second, kids with Oppositional Deviant Disorder and/or Conduct Disorder (the childhood precursors to ASPD) can possibly be reached if the intervention is early enough and the right kind of approach (see The Making of A Psychopath for an example of this).
But once an adult is showing blatant signs of full-blown ASPD, don’t hold your breath that they are ever likely to change all that much.
Have you ever known anyone that you suspect may be a psychopath? Did you see any motivation in them to change? In the case of criminals with this disorder, do you think this diagnosis should play into sentencing and parole decisions?
Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She writes the Kate Huntington mystery series.
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Marcy KennedyJuly 23, 2013 at 11:30 am
Knowing that the chances of them changing are slim must be very frightening for anyone who’s related to someone with ASPD. You’d never want to make them angry, and you certainly wouldn’t want them near your children or pets.
Kassandra LambJuly 23, 2013 at 11:59 am
Most definitely, Marcy. An even scarier thing that I didn’t mention in this post is that they can be quite charming. So they can wheedle their way into your life without you realizing what they are really like at first.
Renee Schuls-JacobsonJuly 23, 2013 at 12:43 pm
I dated a very dangerous man. He possessed all of the “lack ofs” to which you refer. After we broke up, he went on to wreck the lives of many other women, each if whom found me via Facebook. Because he’d told all if them that I had been the “perfect girlfriend.” The thing is? He was a terrible boyfriend. I’m so glad I got away from him when I did. Sadly, he’s gotten worse over the years. Do you think the use if drugs can exacerbate this stuff? Illegal drugs and steroids, too? He really is worse now than when we went out 25 years ago. Scary to think I dated a psychopath in the making – and so glad these women escaped.
And yes, he was very charming. In the beginning. Now I see this as a warning sign.
Kassandra LambJuly 23, 2013 at 2:04 pm
Most psychopaths use drugs (thrill-seeking and no fear of consequences) and certainly the drugs warp their minds even more. Especially steroids, which can take a mild case and send it all the way to the other end of the continuum.
I am extremely glad that you, and the other women, got away from him, Renee.
Catie RhodesJuly 23, 2013 at 1:51 pm
I’ve known three people–at separate times in my life–who I now realize had some sort of personality disorder.
One was a boss I had. She had no empathy whatsoever for other people. She spent all day every day manipulating situations to her advantage. She did no work that I could see. Her behavior had served her well. She had risen to a high position at the place we were both employed. I had what I now suspect was a nervous breakdown while working for her. I was always on edge never knowing when she would attack. Rather than creating clear guidelines for me to follow, she’d let me screw up so she could chew me out.
Another was a young lady who married a friend of mine and my husband’s. This young lady was a thrill-seeker who had no fear of consequences. She had no empathy for others. She had a baby boy (he was really a toddler, I guess). She wouldn’t potty train him because she was too lazy. She would leave him in dirty diapers until he got a skin irritation. Then, he’d cry every time she had to change him because it hurt. She emotionally abused her husband’s daughters. Finally, after haranguing her husband into building them a big fancy house, she orchestrated a soap opera worthy scene where she revealed she was cheating on him. After that, she left. For months, our friend “discovered” different puzzle pieces about her and ways she’d been lying to him. I think he was glad when it was all over.
The last one (and by far the worst) was a relative. I’d prefer not to say anything about her publicly. But I’d be glad to regale anybody with stories about her privately. 😉
All three of these women were attractive and charming (until you got to know them.)
Kassandra LambJuly 23, 2013 at 2:09 pm
Oh, Catie, lucky you! ASPD is relatively rare in women (around 1% of the population) and you’ve managed to cross paths with three women who have it. The wife of your friend sounds like she has elements of a couple other personality disorders as well. No wonder he was relieved when it was over!
Beverly DiehlJuly 25, 2013 at 7:56 pm
Father was a narcissist. Basically a psychopath without the thrill seeking. Always about me, Me, ME all the time.
My last was OCPD, though it took me a while to figure that out. I thought, because of my dysfunctional childhood, that maybe he was right when he told me I was doing everything wrong. Eventually I figured it out. He had hoarding issues, too, although our home was never “goat paths” bad.
I would second that they can be very charming. The honeymoon/courting stage is/was WONDERFUL. These kind of people remember every detail, say all the right things, are very good at the romantic gestures, maybe even mean them. But the good behavior wears off.
Kassandra LambJuly 25, 2013 at 8:57 pm
Ack! OCPD is really hard to live with, often the epitome of ‘I’m normal, everyone else is wrong.’
My father was also a narcissist, Beverly. There is some slim hope with them however, because usually buried deep under the egocentrism is some capacity for remorse and empathy. But it is SO HARD to get them to look at themselves and their behavior. In the post I did on the differences for Stacy’s blog, I use the analogy of having to smack them up side of the head with a two-by-four. I mean that metaphorically of course, but sometimes one is so tempted… 😉
Beverly DiehlJuly 25, 2013 at 9:09 pm
My father died at 91, totally thinking he was a great guy, selfish to the end, having outlived three wives and ending with only one of three daughters will to talk to him (and her grudgingly so).
Kassandra LambJuly 25, 2013 at 11:01 pm
My dad died thinking he was a great guy too. There’s a saying about that; let me see if I can remember it correctly. “When denial is really working, you don’t know it’s there.” Seems applicable.
Beverly DiehlJuly 25, 2013 at 9:17 pm
I’d love it if you would do a future post on narcissists vs. ocpd, and or ocpd vs. ocd. There’s a lot of buzz out around ocd, and I suspect people get the two mixed up, and ALL these personality disorders make for interesting fictional characters, if not so much fun as a life partner.
Kassandra LambJuly 25, 2013 at 11:00 pm
LOL Yes, they do make much better characters (especially antagonists) than they do life partners!
Hmm, differences between OCPD and OCD would make a great post. I’ll have to work on that.
Differences between a narcissist and someone with OCPD is a little simpler. Those with OCPD aren’t so much self-centered as they are rigid. They really think that their obsessive ways of dealing with life are correct and are perplexed that no one else seems to get it that if you just color-code everything and keep things in neat little rows than life will be manageable (or in the case of hoarders, keep EVERYTHING, period).
They too are capable of empathy but, like narcissists, they’re pretty obtuse about other people’s feelings. It’s real hard to get them to look at how their behavior is a problem for others, maybe even more so than with narcissists.
Thriller Thursday: Can Psychopaths Be Cured? | Stacy Green – Get Twisted!August 1, 2013 at 8:12 am
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