---
author: Big Think
date: '2026-03-03'
guest: ''
layout: post.njk
source: https://www.youtube.com/watch?v=P2pU9UCxlKY
speaker: Big Think
tags:
  - psychopathy
  - antisocial-personality-disorder
  - mental-health
title: 了解精神病人：区分精神病和反社会性人格障碍
summary: 精神病和反社会性人格障碍常常被混淆，但它们是不同的。精神病是一种科学和临床上的术语，指的是一种特定的心理障碍，而反社会性人格障碍则是指一种更广泛的行为模式。了解这两者的区别对于治疗和预防至关重要。
insight: ''
draft: true
series: ''
category: psychology
area: society-thinking
project: []
people:
  - Abigail Marsh
companies_orgs:
  - Big Think
products_models:
  - psychopathyis.org
media_books:
  - The Mask of Sanity
status: evergreen
---
### 了解精神病人：区分精神病和反社会性人格障碍

精神病和反社会性人格障碍是两个常常被混淆的术语，但它们实际上是不同的。精神病是一种科学和临床上的术语，指的是一种特定的心理障碍，而反社会性人格障碍则是指一种更广泛的行为模式。了解这两者的区别对于治疗和预防至关重要。

<details>
<summary>Original English</summary>

- I get asked a lot, what's the difference
between the term psychopath and sociopath?
The main difference is
that the term psychopath
or psychopathy is a
scientific and clinical term,
and the term sociopath
or sociopathy is not.
- [Narrator] Psychopathy
explained, traits and treatments.
- For some reason, it's sticky.
People really like the term.
And so you do see it
used a lot in book titles
and lots of media coverage,
but there's really no scientific
definition of sociopathy.
There's no sort of clinical set
of traits that constitute it
and no agreed upon definition
of what it even means.
The most common thing that is meant
by the term sociopath is
somebody who is diagnosed
with antisocial personality disorder.
So that is a disorder
in the Diagnostic and Statistical Manual
or the DSM-5,
which psychiatrists and psychologists use
to diagnose any psychological disorder.
And once upon a time it was
pretty common to call people
who had a diagnosis
of antisocial personality
disorder a sociopath.
I don't think anybody does
that anymore, I don't think.
I hope not.
However, that's just not
accepted terminology really
in any group of professionals.
By contrast, the term psychopathy
is an established scientific term.
It has very clearly
delineated sort of symptoms
and a well understood definition.
There are scientific societies
that study psychopathy.
You'll see thousands of mentions of it
in the scientific literature.
You'll see no mentions
of sociopathy in the
scientific literature.
And so I wish people would
use just the term psychopathy.
And I think the reason they don't is A,
it's a really annoyingly confusing term.
It sounds a lot like psychopathology,
which means any kind of
psychological disorder.
It also has really negative connotations.
People associate the term
psychopath was the old idea
of like the bad seed people
who were just born bad,
which seems I think needlessly pejorative.
And for a while, the
term sociopath caught on
maybe 40 or 50 years ago
because beliefs about the origins
of antisocial personality traits changed.
And for a while people assumed
that all antisocial personality
traits were the result
of social experiences.
So you would develop these traits
not because you were a bad seed,
but because you would've
been exposed to abuse
or maltreatment or trauma.
And the term sociopath is
sometimes used to signify
that origin of anti-social behavior.
Now we know it's a lot more complicated.
You can never ask the
question is some outcome
the result of nature or nurture
because they're always
acting in combination.
I think it would be helpful
to banish the term sociopaths,
mostly because I get a little frustrated
by the euphemism treadmill
that we sometimes get on
for stigmatized disorders.
That really happens with psychopathy.
There's this attempt to
keep coming up with new
sort of less stigmatized
names for the concept
that we are studying.
But what I've noticed
is that this makes life
a lot more difficult for the people
and their families affected
by these disorders.
It makes it really hard
to find information out
about what the disorder
is, how is it diagnosed,
how do you treat it if
you're not even sure,
like what the disorder's
name is and sort of
what to look for, what to ask about.
And so I would prefer if we all just stuck
with one word, psychopathy,
which has a really well accepted meaning
and is already the focus of tons
and tons of scientific research.
I don't think adding another term in
is really helping anybody.
Adding layers to the confusion
is the fact that in the DSM,
there is a diagnosis called
antisocial personality disorder
that has a lot of
overlap with psychopathy.
At core, they both refer to
people who engage in persistent
and fairly severe antisocial behavior,
don't seem to care about other
people's welfare, et cetera.
The difference is that
people who were psychopathic
may or may not engage in any
criminal behavior, right?
You can be an uncaring
person and not break the law.
And it's really much more
about a person's personality
and their sort of internal traits
whereas antisocial personality disorder
is much more about external
behaviors in particular crime.
So almost anybody who's
committed more than one crime
has a very high likelihood of a diagnosis
of antisocial personality disorder.
And I think that's inappropriate
and also unhelpful.
Most psychological disorders
are really focused on
how is the person feeling, what
is the way that they engage
with the world around them,
not coming up with a
checklist of behaviors
that they engage in necessarily.
And I think it would be better
if we did that for disorders
of aggression and anti-social
as well, like psychopathy.
Psychopathy is obviously a very
popular topic for the media.
It's a thrilling sensationalistic topic.
And so there are a lot of
really compelling psychopaths
in the media
that I think unfortunately
causes people to develop
a lot of false impressions
about what psychopathy really is
and what it's about.
So unfortunately, most people
do have a lot of false beliefs
about the reality of psychopathy.
One is that it's extremely rare, it's not.
The estimate is that about 1%
of adults have clinical levels
of psychopathy, which is just
as common as schizophrenia
or bipolar disorder
or some other relatively common disorders.
Another is that people
who are psychopathic
are sort of born, not made.
And that's not 100% true
because we now know that
psychopathy results from a mix
of genetic and environmental,
just like every other
psychological disorder.
Interestingly, other people
have the alternate false belief,
which is that psychopathy is
100% about life experiences,
not about anything that
you bring to the world.
That's also untrue.
And I think it's a really
pernicious myth that the only way
to end up psychopathic
is if you were abused
or maltreated as a child
because many families of children
who end up psychopathic are
too ashamed to come forward
with their problems because
they assume everybody
will blame them and often they do.
Another common myth about psychopathy
is that it's a disorder
exclusively seen in men,
which is also not true.
These numbers are always a
little bit fuzzy because again,
they're continuous and we draw the line.
But however, it is true
that men are more likely
to have high levels of psychopathy
with men being roughly twice as likely
to have a clinical assessment
of psychopathy as women are.
And when they are a
psychopathic, it's more likely
to manifest in violence
or physical aggression.
Women can also be psychopathic
and sometimes can be violent
or aggressive, although
they're more likely
to show behaviors like
emotional aggression,
threatening, emotional blackmail,
bullying and ostracizing
to manipulate people or
to get what they want.
That's a very common myth
that conflates psychopathy
with violence that
assumes that psychopathy
and for example, serial
killers are basically
the same thing.
That's definitely not true.
Although people who are
psychopathic are more likely
to be violent than the average person,
especially if they're men,
there are plenty of reasons
that people can be violent
that have nothing to do with psychopathy.
And there's some evidence that most people
who have high levels of
psychopathy are not violent.
They may not always do the nicest things,
but their disorder doesn't always manifest
as physical aggression.
Another myth is that
psychopathy is untreatable.
A lot of people believe that
if you are psychopathic,
then that's that and you can never change.
Psychopathy is difficult to treat
because often people with
psychopathy don't believe
they need treatment and
sometimes don't want treatment.
But if they can come
to believe correctly
that their own behavior
and the way they treat people
is blowing up their own life
and they are the root
cause of those problems,
you have to use validated
treatment approaches,
which sometimes involve medication
and sometimes involve psychotherapy
to help them learn new ways to behave
and new ways to engage with other people,
which we know can help both
them and the people around them.
Some of the medications
that seem to help people
with psychopathy include psychostimulants
that are used to treat ADHD, for example.
It seem to reduce the impulsiveness
and disinhibitedness of
people with psychopathy.
There's some evidence that
antipsychotic medication
can also help, not because
people with psychopathy
are psychotic unnecessarily,
although some are also psychotic,
but antipsychotic medications
act on the dopamine system
as well as other
neurotransmitters that also seem
to be implicated in the behavior
of people with psychopathy.
So this medication may help them as well.
Forms of psychotherapy that
seem to be effective in adults
include cognitive behavioral therapy,
which involves simply
learning new behaviors,
learning that there are other
ways to respond to situations
that crop up in your life
and new ways of thinking about the world
that involve overcoming false assumptions
about other people.
For example, many people who
are at risk for aggression
have what's called a
hostile attribution bias.
That means they interpret other
people's ambiguous behavior
as hostile, which makes you more likely
to respond aggressively as a result.
And you can retrain people
so that they don't interpret
other people's behavior
through that hostile lens.
When it comes to children, the
very best forms of treatment
for children at risk for
psychopathy are various forms
of parent management training.
So the therapist trains the
parents to use new approaches
to managing their child's
disruptive behavior.
There's a form of therapy called
parent management training.
There's another very
effective therapy called PCIT
that coaches parents on ways
to reduce their child's disruptive
and aggressive behavior.
I think the most effective resource
for learning about effective
ways to treat psychopathy
is to go to the psychopathyis.org website.
And we have a whole section
for clinicians and for parents
and for adults affected by psychopathy on
what the effective forms
of treatment out there are.
The way we think about psychopathy
now derives from the work
of a psychiatrist named Hervey Cleckley,
who was a really legendary
clinician who spent many,
many years studying people
with psychopathy in psychiatric hospitals.
And he wrote a book
called The Mask of Sanity.
And I think that title
perfectly captures what it is
that makes people with psychopathy unique,
which is that they outwardly
appear completely normal,
even super normal.
They seem just like anybody else,
but that really is a
mask that's concealing
inner profound deficits in emotion
and the way that they
engage with other people.
In particular, a true lack of caring
about other people's welfare.
Some people would refer
to that as a real deficit
in the ability to love
other people the way
that we usually think of love
as truly caring about
other for their own sake.
And that I think is the most useful way
to think about psychopathy.
It's a disorder that results in people
having this outwardly charming, agreeable,
pleasant demeanor often,
but being really unable to connect
with other people on a deep level
or experience certain emotions
like fear or like love.
In its extreme form, psychopathy can drive
some of the most serious
antisocial behavior
and violence that we see.
So for example, the
serial killer Gary Ridgway
is somebody that the FBI
profiler, Mary Ellen O'Toole,
has called perhaps the
most psychopathic criminal
she has ever interviewed.
And it's clear from his
behavior he killed dozens
of young women over the
course of a few decades.
We'll probably never
know exactly how many.
And also the way he talked about them
and the way he responded when asked about
what he had done made it clear
just how little he valued their welfare.
He didn't think that they
mattered, he didn't think
that there was any reason
that he should restrain his sexual urges
just because it would result
in these women's suffering and deaths.
And that is unfortunately the
most extreme manifestation
that you sometimes see in
people with psychopathy.
The thing that I think
unnerves people the most
about serial killers like Gary Ridgway
or like the BTK killer
is just how normal they seem
to everybody around them.
They had families, they were known members
of their community that were
not caught for many years,
in part because nobody suspected
that they could be doing
such horrible things
under the surface.
And that's a really good
example of The Mask of Sanity.
There's somebody doing
things that are so awful
under the surface that you would think
there must be some sign of it externally.
But in the case of some
people with psychopathy,
there really isn't.
It's very difficult to
know whether the person
you're interacting with is psychopathic
just from a brief interaction.
There's some people who will tell you
there are certain tells
relating to the way
they use eye contact or things,
but I've never found that to be true.
I've often said that
if you were to line up
all the adolescents that I've studied
who have psychopathic traits
next to all the healthy
adolescents I've studied
and asked you to pick out who's
who, you'd never be able to.
However, what you're looking
for to try to identify somebody
with psychopathy is patterns
of behaviors that people
with psychopathy engage in.
The first one is a tendency
to exploit other people.
So people who are psychopathic, again,
they just don't value
other people's welfare.
And so they will do things
that exploit other
people without any sense
of remorse or guilt.
So they'll steal things from people,
they'll steal things
from stores, they'll lie,
and they'll lie often easily
and not really even for any reason.
Like it doesn't bother
them to know that somebody
who thinks that they care about them
has been deceived and might
feel betrayed by that.
They will cheat in romantic relationships
frequently and again without
any particular care about it.
They're more likely to cheat on exams,
they're more likely to commit fraud.
They're certainly more likely to engage
in various forms of aggression,
especially when that aggression
is aimed at achieving a goal.
So aggression can be divided
into two broad categories.
Reactive aggression, which
is the kind of aggression
you show when somebody has made you mad,
when you've been threatened,
when you're frustrated.
And then there's proactive
aggression, which is aggression
that's not really out of a spontaneous
sort of rage or frustration.
It's deliberate aggression
aimed at achieving a goal.
So you threaten to hurt somebody
in order to take their money
or to take something that belongs to them.
You threaten to reveal somebody's secrets
so that they do what you want them to do.
That kind of aggression is
really uniquely psychopathic.
However, because people
who are psychopathic
are also disinhibited and impulsive,
they also show the other
kind of aggression,
which is reactive aggression.
So you've been frustrated
or you've been irritated by somebody
and you lash out in response.
That's a much more
common form of aggression
that people with psychopathy also show.
I've spent many years conducting research
and brain scans in adolescents
who were psychopathic.
And some of the stories
that they've told me over the
years are really astonishing
and I think really illustrate
the nature of their disorder.
One girl I worked with was
really good at crying on cue
to get outta trouble.
She could feign emotions
really, really well
to manipulate people.
And she said that she would size up adults
to see whether they would be more likely
to let her off the hook for,
for example, shoplifting
or cheating in school, if
she used really big words
and sound really grown up, or if she cried
and seemed really remorseful.
And she told a story about
one time when her mother
had caught her shoplifting from the mall.
And it so happened
that her mother had also found in her bag
a printout from the
internet that was a list
of instructions on how to shoplift.
So her mom knew that this was not just a
sort of random spontaneous
thing, it had been planned out,
which is characteristically psychopathic.
The girl did not know her
mom had seen this printout.
So when she was caught
shoplifting, she burst into tears
and said how sorry she was.
And because her mother knew
what had actually happened,
she said, oh, come off it,
she just didn't have
the time for the tears.
And she said, what was so
unnerving was that when she said,
I'll come off it, the girl's tears stopped
like a switch had been turned off.
It had been completely a
false display of emotion.
The same girl took her
parents' car joy riding.
On one occasion,
she just decided she was
looking for a thrill,
stole the parents' car keys,
took the car off speeding
on country roads so
fast and out of control
'cause she was too young to drive
that she eventually careened off the road,
crashed into a tree and flipped the car.
And when the police came
across the accident,
sometime later, they assumed that whoever
had been in the car had died
because the accident was so awful.
And they tracked down the parents' house
from the car's registration,
knocked on the door prepared to tell them,
we think that whoever
took this car is dead
and there was the girl sitting
on the couch eating Doritos,
like nothing at all had happened, right?
Completely unfazed by the whole incident.
It's unnerving to hear
stories like this from a girl
who outwardly is very
appealing, very smart,
very well spoken,
and there's nothing at all to reveal
the kinds of things that she's capable of
in brief conversations.
So it is hard to work with
people who are psychopathic
and not start to get a little
paranoid or a little cynical
because of the really extreme disjunction
between what's on the outside
and what's on the inside.
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