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Medication used to treat sociopathy/psychopathy

It turns out that Sandy Brown, M.A. is quite correct in stating that any talk of treatment of sociopathy makes people (particularly women) reluctant to give up on a dangerous relationship. We received a note this week from a woman asking for more info about treatment and wanting to know if there was any hope for her man. He was the only man she had ever loved and she was actually still grappling with the meaning of his diagnosis.

This week, I will discuss medications that can be used to treat sociopathy. But before I do I want to make it clear that I encourage people to break away from sociopaths. Remember that the sociopath’s doctor and therapist will want you to stay with the sociopath to assist in the treatment. Sociopaths “do better” with treatment and when they stay married. So let me explain what “do better” means. Also this discussion will help you if you are still grappling with the meaning of your sociopath’s diagnosis.

One of the ways to assess sociopathy is with the Psychopathy Check List-Revised, developed by Dr. Robert Hare (PCL-R). The PCL-R is a 20 item psychological evaluation that professionals with training complete on a person using an interview and a review of criminal/ psychiatric records. When someone scores above 30 on the PCL-R that person is “a psychopath.” Most people who psychiatrists would consider “sociopaths” score above 20 on the PCL-R.

Researchers have used the PCL-R to evaluate large numbers of people. They have found that some items of the 20 item test are correlated with each other. That means that say a person who scores high on item 1 is also likely to score high on items 2, 4, 5, but not necessarily item 20. On the basis of these item correlations, researchers have grouped the items into two “factors” each having two “facets.” I will use these factors and facets to discuss with you what aspects may respond to medication. Two items of the PCL-R do not belong to either Factor 1 or 2. These are Item 11, Sexual Promiscuity and Item 17, Many short term marital relationships. These items stay part of the PCL-R because they are so integral to psychopathy as you already know!

Factor 1
Interpersonal/Affective

Factor 2
Lifestyle/Criminality

Facet 1 Interpersonal Symptoms

Facet 3 Lifestyle

1. Glibness/superficial charm

2. Grandiose sense of self worth

4. Pathological Lying

5. Conning/manipulative

3. Need for Stimulation

9. Parasitic Lifestyle

13. Lack of realistic long term goals

14. Impulsivity

15. Irresponsible Behavior

Facet 2 Affective (emotional) symptoms

Facet 4 Criminal Behavior

6. Lack of Remorse/Guilt

7. Shallow Affect

8. Callous/Lack of Empathy

16. Failure to accept responsibility for actions

10. Poor behavior controls

12. Early Behavior Problems

18. Juvenile Delinquency

19. Revocation of conditional release

20. Criminal versatility

Look at the Table above and consider that you are interested in the two items that are not part of either factor and Factor 1. These are the symptoms that are most concerning to family members. The criminal justice system and professionals are most interested in Factor 2.

Look at the list again and imagine a person with a great deal of energy either because he or she is manic or because he or she is on speed. In that case Items 1, 2, 5, 3, 13, 14, 15, 10, 19, 20 and 11 would be most affected. In fact this is why there is overlap between bipolar disorder and psychopathy.

Anything that increases a sociopath’s energy level makes him or her worse. Anything that reduces his or her drive leads to “improvement.” That is why, medications for mania like lithium, anticonvulsants and antipsychotic drugs have been used “successfully” to treat sociopathy. In this case success is defined in terms of fewer arrests and aggressive acts.

Also look at the list and notice that Items 3, 14 , 15, 10, 19 and 11 are related to poor impulse control. These symptoms may respond to antidepressants that work on the serotonin system. Defects in the serotonin system are thought to underlie impulsivity. The problem is that many people become manic when they take antidepressants so these can also make a sociopath worse.

Okay, now see what was left off the list, and you will conclude with me that medication will not turn your sociopath into someone you want to spend your life with. Many people say that the sociopath’s energy and spontaneity are what they find attractive. If that is the case for you, then medication which reduces a sociopath’s energy level will make him or her less attractive to you. All the “fun” part of the sociopath may disappear, leaving you with a boring parasite.

Nothing will make a sociopath loving and empathetic or build a conscience. A loving person takes care of his/her family, is trustworthy and doesn’t lie. Medication cannot make a person loving; it can only reduce dangerousness. Focus on the use of the term reduce, as I did not say eliminate dangerousness. In a hypothetical research study, a 50% reduction in the battering of family members and a 50% reduction in arrests would be considered “improvement.” That does not mean sociopaths are turned into people you want to share your life with.

So why do I even discuss treatment? Only to keep you informed and for those who for whatever reason choose to share life with a sociopath.

Next week psychotherapy for sociopathy.



172 Comments on "Medication used to treat sociopathy/psychopathy"

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  1. newstepmom says:

    Hi again, regarding the badger / none comments (it took me too long to understand that comparison, I just took you literally! Sorry…).

    So though, I think none may be my husband’s ex wife, being what I’ve seen for these two years, argumentative, circular logic, justifying, etc.

    My husband is now, perhaps like none (seeing counselor, meds), looking into these behaviors of his at their my urging. DH claims to be, and I have seen behavior improvements, and just a tiny smidge when I am irritated. This, and when I ask for him to be nice seem to be the “triggers” that makes him angry typically, and he runs away versus simply answering a non-normally-threatening question. It’s my impression this could be a sort of PTSD due to witnessing and being subject of his abusive 1st marriage, potentially to none, and his mom’s abusive treatment of his sister and his father her husband. That said, as someone has noted, his psych treatment is not MY repsonsibility, it is what he owes me and is soley his own. He refuses to go, of course, though tried to insist his spath ex go. *sigh* It’s so ugly, this cycle [of abuse].

    DH writes out contracts on behavior requirements, but justifies his breaking it if I do not keep to it as well (I haven’t slipped in yelling or mocking as he has, but have slipped in not giving enough statements of appreciation). He will only do it IF I do it, and even if I do, yes, he fails. There’s my frustration.

    That said, is there any link to how well folks with extremely damaged senses of morality / normalcy and self-respect CAN fare (best case?)? I know that I have seen that narcissists can improve though it’s hard. Is there a success/fail rate? Is a narcissist the same as a PTSD sufferer, at a certain point, maybe after a certain length of time suffering from these hyper sensitive levels of defensiveness?

    I have been good keeping my own boundaries intact, no pregnancy will occur, I am keeping to treating everyone nicely, not mocking or snapping. Simply making requests.

    I am surprised to be called stepford wife here, given it’s name-calling. Like in this marriage I was surprised by that the first couple weeks, by DH and his spath ex, given names seem more suited to really young kids than to very successful adults. Here, I think that a supportive less dramatic RUN commentary would be what I would see.

    I do also [is this planned?] feel guilty thinking of leaving due to effects on kids. One extra by spath mom they don’t know about. I try pretty hard to model good emotional intelligence, speaking my feelings, making requests, giving apologies if I do snap (before my new resolve), etc. I only otherwise see the abuse cycle continuing. Even though they’re not my kids… goodness, I feel like I could help. I do worry that my mere presence is enough for them to “buy” spath mom’s approach of attackign me as “the” way to behave. Maybe my presence is harming them by its effect on bonkers mom?

    Writing it out, so thanks for the forum, it seems obvious I need to do more than just request, finally. Too however, I feel like my own practicing solely respectful behavior IS good for me. And to learn to keep much stronger boundaries than I have in my past. If I can do it here, heck, I should be able to see it and do it in -any- future relationship.

    And yes, depressingly DH also spins. Just now he ran away from my asking if he thought he owed me 1 week (for pete’s sake) of keeping to a behavior contract, no put downs, etc. DH’s “trigger” seems to be my asking him for kindness or respect or to be reliable to me. In my eyes, a refusal is like I live in the Mean Rubber Room. Frustrating.

    Anyway, if there are is any good information about how really damaged psych instabilities can be worked through and how likely they can work out, I’d be thrilled to see them here. For example, I am a big fan of Harvard’s Daniel Gilbert who I first saw in This Emotional Life series on PBS. I have read that PTSD can be a result of witnessing and living through abusive situations (DH’s past), and that that can be treated. And that, if a now-abuser -wants- to change, there is -some- hope anyway.

    Thoughts? Does the gravity of “infractions” matter? It IS just all abusive behaviors though, whether on the far right end (murder/thievery), or midstream put downs etc. Which psych conditions are work-outable, anyway? Yes, after this being THE subject of the whole marriage so far, yes, I see it’s a waste of my time, anyway, if not for DH and his spath-ex’s future lives, perhaps.

    • SocioSugar says:

      Newstepmom-
      Definitely never stay in any kind of abusive relationship verbally or whatever. If you believe that he is abusive verbally or emotionally because of the abuse that his ex-wife caused him, that does not give him the right to abuse you in return.

      We have very similar situations, I am married to a wonderful man and his ex-wife is a sociopath also. She has tried everything she could to destroy me and she has somewhat affected me but she def hasn’t destroyed me by far. I don’t care anymore or worry about it anymore. The reason I don’t care or worry is because my husband is so supportive of me and loves me so much that the ex-wife has absolutely no control over him whatsoever. I ask him to establish the no contact rule and he did that and ever since he has never responded to a text, a phone call or an email or anything she says or does because the kids are now old enough that they can communicate with him on their own.

      She had a lot of power over him when we first met. But after we married and he was able to see that her intentions were very bad. Now she has no power over him at all. he gives her a child support check and that is all. But when the kids are with us anything they need we get for them. But she will ask him “oh I need this for this child ” and he will not give her the money he will go pay it to the school or to the Sylvan learning Center, whatever it is he will not give her money because he knows now that any money he gives her that she says is for the kids – will not be spent on the kids it will be spent on drugs or junk or what ever she does.

      I do wish you the best and I hope that you get your situation figured out as I have figured mine out. And hopefully your husband will see the light and appreciate you more for being able to put up with his crazy ex-wife and his kids and being so supportive. I know that my husbands ex-wife caused us a lot of conflict in the very beginning of our marriage, but now she DOES NOT CAUSE ANY problems. That is because my husband and I work together as a team, and not against each other. In order to deal with a sociopath that is an ex spouse of your new spouse – you and your new spouse have to work together as a team to fight the “monster”. I am sure it would give my husbands ex-wife great joy to know she caused us any kind of suffering. But I think she knows now that she is a non-factor in our lives and she definitely knows that my husband does not care about her. I think that she believed that because she was the mother of his children she would always be able to control him. The problem is the children get older and become more independent and they can see the mother for who she is and therefore they don’t need her, my husband sure doesn’t need her and all the drama she tries to start. And she’s realizing now that she has lost all control over him and to a sociopath to lose control is like the worst thing that could ever happen to them besides being exposed.

      And even though we do not care or worry about the ex-wife anymore. It’s something that does affect your mind and that you think about. But try not to overthink it because it will just drive you crazy. Try to think of the better things in life and the positive things that you and your husband think can create together.

  2. Ox Drover says:

    newstepmom,

    DH’s behavior sounds to me like verbal abuse and it is NEVER ACCEPTABLE. Not even if he has PTSD from his previous relationship, he must step up and assume responsibility for his behavior, and YOU must step up and keep your own contractual agreements.

    You are NOT responsible for those kids, he is and their mom, and if mom won’t step up to the plate and demand that the kids behave reasonably to you, then DH needs to do so.

    If DH refuses to go to therapy, then go alone. I think you are in a very VERY dysfunctional situation with a P x wife, a verbally abusive MIL, step kids that are abusive and that’s enough to drive a sane person insane.

  3. newstepmom says:

    Hi, yes, the kids actually are okay w me though I see them both adopting abusive behaviors (cruelty to others from one by just talking rudely/meanly, and lying and manipulation and refusing absolutely to admit it by the other). I think they think I’m okay, somehow, in spite of my having been mocked and put down by every other adult there, but for, maybe, his ex’s new husband. But yes, the kids are picking up these behaviors and at least hide them from me but for the lying / manipulative things. I have told that one they hurt me and I want to trust them while they trust me, that that is what family is for. I’ve wanted and asked DH to ask his ex and mom to treat me respectfully, which he acts like he’s going to the electric chair if I insist. He did once, by one to call before they walk into the house. And never when either put me down to others by lying about me. Yes yes yes, I definitely need individual therapy. While had been in relationships w non respectful folks in my past re cheating, never this daily put down nonsense. It really is laughable, and I should just do that given how juvenile it is while I ask him to figure it out, while I”m here anyway. He can be pretty nice IF I’m not irritated or asking him to be kind, but as soon as I do either, he is absolutely triggered and then puts me down/yelling/mocking, and I don’t see how a marriage can be sustainable either way. I’m very depressed about having to face this, actually, sleeping a lot. I first reported this to DH in month… 3-4 of the marriage, and he got mad at me. Atypically, at least in my naive mind. To me someone feeling down = you try to be kind to them and make them feel good, and then powerful, and believing in them self. I enjoy doing that to friends, or heck anyone I hear is feeling down. *sigh*

  4. NeverUnderestimate says:

    Yes, i guess you could say that. My husband has an ex wife who has been stalking me and slandering me online and she calls my child’s school to tell them what a horrible mother I am .

    • fightforwhatsright says:

      Hi Neverunderestimate:

      Do you mind if I ask if you are new? The person here you believe is doing this, has been here a long time. If you are new here and, as you have written, believe you have “discovered” her here, could it be best for you to not join this group? If what you say is accurate, then read a lot about sociopaths. If you are tracking down a sociopath to this website which is what you have expressed here, you are inviting problems you don’t need with this person and following HER around.

      People can impersonate others here and no one would know the difference because typically no one is allowed to use real names. If there is a person here who is telling your story, we don’t know you and we wouldn’t know the difference. If that is how she is having fun as a sociopath, that would mean less time she would have to bother you and your family.

      If you aren’t tracking her down, you wouldn’t know the difference. This is an anonymous web site. But, if you are trying to find a particular sociopath infiltrating this web site and pretending to be you as you have written, you are now overtly pursuing HER when she is leaving you alone during any time she spends here.

      If what you say is accurate about this member whom has been here for a while, I would like to gently suggest that the best option is for YOU to decide upon no confrontation and not come to the site again and let her do what she wants. If she breaks the rules here, that is handled swiftly. However, it could be harmful to you to be looking up IP addresses and copying her posts as you stated you had done yesterday.

      You also wrote that no contact is best and that you and your husband are very happy and he is not a psychopath and she is pretending to be you and pretending he is her husband and he is a psychopath. None of us are bothered by that as long as she doesn’t break the rules here.

      If you are happy, then it might be better for you to just be happy. Why would you need to be spying on her IP address somehow here and keeping records of stuff she posts here? No one here knows who you are. No one here needs to know her real name and we don’t care. Let her do whatever she wants to do and stay away from her. Have no contact to save yourself. Why spend time hacking IP addresses and copying things you can do nothing bout?

      People can lie online all of the time. We could be comforting and encouraging people here who are making up things. But, as long as they follow the rules of the site, there is nothing anyone can do about that. To protect yourself and your family, it would be healthy to let someone do it until they get bored. You would never know about it if you weren’t pursuing it.

      I just am having difficulty understanding why you are following this person around. I also wonder why and how you are spying on her internet activity somehow. It makes it look more like you are stalking even if everything you are saying is completely true.

      Do you see my viewpoint on this? Protect your family if this person tries to invade your life. But, if she is out writing things on various websites, who cares unless she mentions your names? She has mentioned no names as far as I have seen and the person in charge here does not allow anyone else to mention names.

      Why wouldn’t you just focus on your happy family, handle her if she is aggressive towards you or your child, and stop looking for her? The more she is here writing, the less time she has to bother you. If she is leaving others alone, I don’t care if she lies to me about her ex-husband on here. I don’t her. I don’t know you. I just try to encourage people and let them share. I don’t know who they are. She is anonymous. If she is a problem to you, why follow her around? You won’t ever be able to stop her and she is getting negative attention from you which sociopaths love.

      If what you are saying is true, the best thing for you to do according to the experts we study, is to not search for her, and act as if she doesn’t exist unless she invades YOUR privacy or does harm to your family.

      Don’t get me wrong. If you are dealing with someone who would impersonate you online and calls your child’s school (you could file a protective order for your child by the way), that is terrible. However, you will ruin your own happy life following her around. There isn’t anything you can do about websites that are anonymous. You CAN do something about protecting your child while he/she is at school. But, you are upsetting yourself about someone who isn’t going to stop and you would be better off ignoring.

      • NeverUnderestimate says:

        I do see your view point on this. And I agree with you. My husband has said DONT look at what she is saying what she is doing, etc.. Because it is only to upset you to react. Then you look like the crazy one. I have just been on an emotional roller coaster because I did move to this town when I married, not knowing anyone, and she has ruined my reputation and i have gone crazy trying to do damage control, and somehow she turns the table to make me look like the bad guy. I have no proof that it was her. I apologize for jumping to conclusions so fast before contacting web admin. I have actually been on this site a long time, I rarely make post, but it has comforted me to hear others stories and know I am not alone, there are people who have it ALOT worse than me. When I came across some of the post and it was so exact to everything that at that time was going on and every post was so accurate except for the successful executive job. That I over reacted. And one thing I should know by now is if something is going on and she is doing something, never react, think it over, and process it. She did make a website in my name pretending to be me. And it was a horrible portrayal tho. Like I said I feel I jumped to conclusions. I am not the laid back person I use to be. I have been thru so much that no one seems to understand because it isn’t my ex husband or boyfriend. It’s another woman, my husband ex. I have never been thru anything like this. I don’t know how to handle It. All I really want is peace of mind. Sorry if I upset or offended anyone. I think I am probably going insane or losing my mind after almost 5 years of this. I am definitely not the person I was before I became this woman’s target.
        And no contact is right. I do know if I want to find peace I can’t be paranoid, thinking OMG that’s her stalking me, impersonating me again, and I can’t look at her blog, I just have too let it go. She is going to do what she is going to do. So it doesn’t matter. Sorry if I upset anyone. And for reacting inappropriately

        • lost everything says:

          Hello Never,

          Fight gave you great advice. Your husband’s ex is alive, if the ex wife over stepped the boundaries, go see a lawyer and get professional advice. Let someone who knows the law in your location, tell you what can be done about her.

          We don’t know where you live, nor should we. I have nothing to fear saying that I live in the greater NYC area, not in Manhattan. I could live anywhere in New York other than the City, or New Jersey or Connecticut; I am one of about 20 million people. No one here can give me specific advice as they don’t know exactly where I live. We can do virtual hand holding, support, share ‘horror’ stories, and give general helpful ideas. Stay here, read and learn.

          Whatever the charge for legal advice you get is inexpensive, down right cheap, for peace of mind.

        • Tea Light says:

          No problem Never, I can relate to the extreme stress stalking causes, and clearly if your harasser is in contact with your partner as the mother of his children, then strict no contact just isn’t going to be easy or even possible. I would suggest that the best course of action, to protect yourself, is to continue as you are doing, setting firm boundaries and not engaging in anything other than need to know information exchange discussions about this person with your husband, for example, when he is picking up and returning his kids.

          I assume she is not allowed to visit your home, and that you don’t have face to face contact with her.

          It’s a very difficult situation , granted, but emotional no contact – keeping m,entions of her fact based, relating only to access arrangements, and keeping any emotion out of the discussions, will help.

          As you know yourself, following her around on the internet is not going to do you any favours at all. She will say and do as she pleases, and unless or until she breaks the law and you chose to take legal action, it’s best to surrender to that fact and shrug it off. I’m sure people who know her realise she is unstable and destructive.

        • FFWR says:

          Hi Never: I was just confused because I had been talking back and forth between another member here and then there was a verbal altercation. I didn’t know who was who. Hopefully, both you and the other member are legitimate and you were experiencing hypervigilance which everyone her understands.

          I can understand second-hand what you are discussing as I know someone who divorced her husband and she was fine with getting rid of him as he was an alcoholic. Then, when he remarried, his new wife became obsessed with her and did everything she could to make her miserable. When her child reached the age of 14 and was considered capable of making her own decision according to the court, the second wife began buying her gifts and bribed her into moving in with her and the father. It was terrible. I wish there was some way you could move to the next town over to create some distance.

          I am assuming that Donna handled the situation where people who belong here are here and not here to cause trouble or harass anyone.

          I have actually changed my name today and will keep it that way because yesterday, I did exactly what I posted we shouldn’t do and let my name on websites slip out to someone and I don’t want anyone to know it. I didn’t tell what the name of the website was, but still….not very protective of myself. It can be searched and looked up. I googled my nickname I’ve been using here and a lovefraud article popped up on the first search page showing my nickname and comments.

          I wish you well and hope that my reading the articles and sharing, you will be able to detach from the sociopath mentally if not physically.

          • NeverUnderestimate says:

            FF- I am so sorry to hear that for your friend. It’s very good tho that she left an abusive alcoholic. I feel horrible for your situation after reading it. I am sorry to see you suffering. I understand and I guess all of us on this site relate in some way, having been victims of a sociopath. I hope your friends situations gets better. Because her ex husbands new wife sounds very dangerous. And the poor child that is in that mess.. That’s what upsets me is the way these people put the children in it and manipulate to hurt them. I am actually very fortunate, my husband got sole custody of their 2 kids and they are safe with us, which they were taken away from her, neighbor called CPS. I don’t really know situation. That was before I met my husband. When I met him he had the kids full time. Things were bad, but they have gotten better for us. Now that their mom is allowed supervised visitation once a week. They are happy to see her. That’s their mom and they love her unconditionally. We just want to do what’s right by the kids and provide them a stable life. Sorry for the misunderstanding. I do appreciate hearing everyone’s advice. As I need it very much. Raising 3 kids has been tough with our situation. We make the best of it. Best of luck to you. And thanks

          • FFWR says:

            Thank you, Never. So newstepmom was not who you thought, right? I hope she comes back.

          • FFWR says:

            Hi Never:

            I wondered if it was hypervigilance which is very common.

            If you contact Donna (see contact link above), she can contact newstepmom privately and explain your situation and let her know that you are bothered by what happened and want to convey that to her.

      • SocioSugar says:

        Fight – your comments are unsupportive. Anyone being stalked is afraid. Especially if they have children. I wouldn’t shrug off a sociopath! If you have ever been targeted by one. You would know how destructive their behavior is. And how scary life can be. Or how their lies and rumor spreading can lead a person to isolation. Being stalked by a sociopath has actually affected me and my children… I comment to post that I relate with. I think giving your two cents is ok. If it is helpful. Nut advice to move on,… Ok, of course… If it was that easy – wouldn’t we all just move on… Usually we are not allowed to move on, because the sociopath isn’t done punishing us.

  5. NeverUnderestimate says:

    FF – definatly was wrong about newstepmom. I feel horrible I hope she comes back too. Her story is similar to mine so I over reacted. Then I realized that after reading her post. It was not who I thought. And I felt bad because we should all feel safe on this site.

  6. NeverUnderestimate says:

    FFf- i have talked to donna and the situation is ok. I think it’s best not to keep bringing it up in order to let it go. Newstepmom knows I have been stalked by a sociopath and her situation is similar to mine and I’m sure she understands. As I have apologized.

  7. Tea Light says:

    I’m sure newstepmom will understand and accept your obviously genuine apology Never.

    Fightsie what is going on with your username changes! Lol. I’m sticking with fightsie, if that’s alright with you.

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