Editor’s note: The American Psychiatric Association is in the process of updating its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is the main reference book used by mental health professionals. Back in February, Lovefraud invited you, our readers, to complete a survey on issues related to the new DSM-5.
We will be preparing a full scientific paper on the results of the survey. In the meantime, following is Lovefraud’s comment to the DSM-5 committee, which includes the basic survey results.
To read the revised definition of antisocial personality disorder in the draft of the DSM-5, click the following link. (The working group has recommended changing the name of the disorder to “Antisocial/Psychopathic Type” personality disorder.) Also, feel free to submit your own comments to the committee. The deadline for comments is April 20, 2010.
COMMENT ON THE PROPOSED DSM-5 DEFINITION OF ANTISOCIAL PERSONALITY DISORDER CONTRIBUTED BY LOVEFRAUD.COM
Lovefraud.com is a website that teaches people how to recognize and recover from people with antisocial personality disorder – we use the term “sociopaths.” Lovefraud was launched in 2005 and now averages 3,000 visits per day. Our writers include a journalist, a psychiatrist and a marriage and family counselor. Readers are also invited to tell us their stories of entanglements with sociopaths. We have collected nearly 1,900 cases related to sociopaths in the community, only a small minority of whom have extensive criminal records. Most of our readers were victimized by “professional” con artists who use “love” to prey on victims and who have evaded prosecution.
Lovefraud readers have all learned about sociopaths the hard way—through being deceived and destroyed by them. Many of our readers believe that knowledge of antisocial personality disorder and the existence of people who are “without conscience” could have helped prevent their victimization. The biggest reason our readers fell into the relationships is ignorance of the personality disorder and its symptoms. Therefore, Lovefraud’s primary goal is public education.
The proposed DSM-5 definition for antisocial personality disorder is, in our view, a vast improvement over the language in DSM-IV. However, we have three concerns with the new definition. They are:
1. Although the traits described in the first paragraph—arrogance, entitlement, manipulation, superficial charm, etc.—are accurate, these traits are frequently not apparent upon meeting a sociopathic individual or early in a relationship. In a community setting, the only way a clinician would find out about the traits is through interviewing the people around the sociopath. Many of our readers tell us that sociopaths successfully con mental health professionals and the legal system.
2. The second paragraph of the definition includes the following sentence: “Their emotional expression is mostly limited to irritability, anger, and hostility; acknowledgement and articulation of other emotions, such as love and anxiety, are rare.” This is incorrect. The vast majority of Lovefraud readers have experienced sociopaths professing their love and devotion, quite convincingly. We’ve seen them cry at the thought of losing us. It is only when the sociopaths have drained us of everything they could and discarded us, that we learned it was all an act.
3. The public is extremely confused about the name and definition of this disorder. The suggested name, “Antisocial/Psychopathic Type,” only muddies the water further. From a communications perspective, it is unsuitable for educating the public about this disorder. And education is the only way of preventing more people from falling victim to these individuals.
Lovefraud conducted an online survey of our readers in order to provide evidence and documentation for our point of view. We received 1,378 responses. Readers were questioned regarding their observations of the abusive individual—78% of them identified the individual as a romantic partner or spouse. Respondents were also asked questions related to the emotional expression issue, and their understanding of the terms used to describe this personality disorder.
We are writing a scientific research paper to describe the complete survey results, which we will send to the DSM-5 committee when it is finished. However, for the purposes of this comment, we include the following highlights.
WERE OUR RESPONDENTS INVOLVED WITH INDIVIDUALS WHO FIT THE SOCIOPATHIC PROFILE?
We know from the many narrative stories we receive that our readers have been involved with highly antisocial individuals who enter relationships with the aim of predation. Respondents were asked to rate how closely the individual they were involved with matched the scale in the new DSM-5 criteria for antisocial personality disorder. Here are the results:
1. Antagonism: Callousness
Very little or mildly like that: 3.7%
Moderately like that: 14.5%
Extremely like that: 81.9%
2. Antagonism: Aggression
Very little or mildly like that: 18.1%
Moderately like that: 24.7%
Extremely like that: 57.3%
3. Antagonism: Manipulativeness
Very little or mildly like that: 2.2%
Moderately like that: 8.7%
Extremely like that: 89.0%
4. Antagonism: Hostility
Very little or mildly like that: 18.4%
Moderately like that: 24.0%
Extremely like that: 57.6%
5. Antagonism: Deceitfulness
Very little or mildly like that: 2.5%
Moderately like that: 11.0%
Extremely like that: 86.5%
6. Antagonism: Narcissism
Very little or mildly like that: 8.4%
Moderately like that: 17.4%
Extremely like that: 74.3%
7. Disinhibition: Irresponsibility
Very little or mildly like that: 15.0%
Moderately like that: 18.0%
Extremely like that: 67.0%
8. Disinhibition: Recklessness
Very little or mildly like that: 21.2%
Moderately like that: 23.5%
Extremely like that: 55.3%
9. Disinhibition: Impulsivity
Very little or mildly like that: 17.2%
Moderately like that: 22.7%
Extremely like that: 60.1%
Respondents were asked when they first noticed each of the above traits in the individual. The choices were: right away, within the first month, within the first six months, within the first year and after one year. For every single trait above, the timeframe selected most often was “after one year.”
Conclusion: Lovefraud readers were indeed involved with individuals who seem to possess the characteristics of the antisocial/psychopathic type. However, these individuals were almost always able to keep their true natures disguised until the relationship was well-established.
WAS THE ARTICULATION OF EMOTIONS SUCH AS LOVE AND ANXIETY RARE?
Following are survey questions related to the issue of love and anxiety, and the answers.
Did the individual you were involved with verbally express love or caring for you?
If the person verbally expressed love or caring to you, how often?
From time to time: 24.9%
After a period of time, was the person’s emotional expression mostly limited to irritability, anger and hostility, and acknowledgement and articulation of other emotions, such as love or anxiety, became rare?
Did the person you were involved with display charm and concern in public, but hostility and anger in private?
Did the person you were involved with express fear or anxiety?
Conclusion: Antisocial individuals do indeed express love, although they are acting. Unfortunately, it is an extremely convincing act. When asked to describe how the person expressed love, comments from the survey included:
“He used expressions of loving and caring to lure me into a relationship with him and to keep me from leaving the relationship. Therefore, he did express love and/or caring throughout the relationship, although in hindsight I know that these were calculated performances designed to fit my own needs.”
“It was the greatest game for him — totally adoring, expressing love in every way imaginable until he had ‘conquered’ and was sure of me which took some time to get me into the trap completely, but once that happened, he changed and as I became more aware of his lies, his imagination, he then found another.”
“A convincing way of expressing love, such that I was 100% sure she experienced it.”
“He would say, ‘I only do and say these things because I love you.’ I became confused about what love really means.”
Recent news stories have included con artists like “Clark Rockefeller” who was evaluated by a psychiatrist, found to be antisocial and yet claimed to “love” his family. The judge in this case acknowledged the defendant’s “love for” his daughter, whom he kidnapped. It is our concern that if this statement remains in the DSM, the presence of professed love will be interpreted as “ruling out” this personality type.
Lovefraud recommends that the sentence, “Their emotional expression is mostly limited to irritability, anger, and hostility; acknowledgement and articulation of other emotions, such as love and anxiety, are rare,” be ELIMINATED FROM THE DEFINITION. We are concerned that if it remains, a clinician, hearing a sociopath talk about his/her love for partner or family, or his/her fear and anxieties, will fail to diagnose the personality disorder when, in fact, this diagnosis is appropriate.
In fact, people with this disorder negatively, and often tragically, affect their spouses, romantic partners and other family members. Perhaps this fact should be included in the description of the disorder.
WHAT SHOULD THIS DISORDER BE CALLED?
The public does not understand antisocial personality disorder. This is an extremely dangerous situation. Antisocial individuals are social predators at worst, and parasites at best, who live by exploiting others. We find that once a person becomes entangled with a sociopath, there is virtually no support from institutions such as law enforcement and the courts. Therefore the only way to protect the public from sociopaths in the community is to teach people what this disorder is all about, so that if they start seeing the signs, they can escape before serious damage is done.
The survey asked the following questions:
Before your involvement with this disordered individual, what did you understand the term “sociopath” to mean?
Serial killer: 19.4%
Someone who was delusional: 6.4%
Person without empathy or a conscience: 19.7%
I didn’t know what it meant: 35.3%
Before your involvement with this disordered individual, what did you understand the term “psychopath” to mean?
Serial killer: 51.2%
Someone who was delusional: 13.4%
Person without empathy or a conscience: 8.9%
I didn’t know what it meant: 11.5%
In your view, what term should be used to describe this disorder?
Antisocial personality disorder: 10.9%
Antisocial/Psychopathic Type personality disorder: 43.0%
Conclusion: If we are going to educate the public about this disorder, we cannot use the term “psychopath.” Probably due to mass media, most people believe that a psychopath is a serial killer. This cultural bias is simply too strong to overcome.
People are confused about the term “antisocial”—people tend to believe it refers to someone who doesn’t want to be around others, like a hermit. This is certainly not the case with the individuals we are discussing—they love being around people, although they view every social interaction as a feeding opportunity.
Although 43% of our survey respondents approved of the term “antisocial/psychopathic type personality disorder,” from a communications perspective, this terminology is a disaster. In order to educate, we need to be able to identify the individual. What do we call this person? An “antisocial slash psychopathic type personality disordered person”? The suggested term obfuscates the definition. We need clarity.
Lovefraud recommends using the second-place term—“sociopath.” The word is already in the lexicon, but it doesn’t have the cultural baggage of “psychopath” and the misunderstanding of “antisocial.” The fact that most people are unsure of what “sociopath” means gives us an opportunity to teach them. “Sociopath” is one word—a word that can be defined. Remember, in 1930, Dr. Partridge made very strong arguments against the use of the term “psychopath.” His arguments remain valid today.
This is perhaps the only disorder in the DSM where the very criteria imply victimization of others. Therefore, the need for victim and public education should be taken into consideration as the disorder is renamed and described. Perhaps professional societies such as the Society for the Scientific Study of Psychopathy should be consulted to arrive at a consensus name for this disorder. Then, once the disorder is officially renamed, issue a press release and actively discourage the use of other terms. Confusion was created when mainstream psychiatry had valid reasons for changing the name of the disorder from psychopathy to sociopathy, but since there was no real consensus, many continued to use the term “psychopath.” The use of multiple terms has thwarted efforts to educate people about this disorder. These many terms also give the false impression that there is more than one categorical disorder, one that is largely genetic and another that is entirely environmental in origin.
If any member of the DSM-5 committee would like to discuss Lovefraud’s findings, the needs of victims and family members, and our recommendations further, we are available.
Donna Andersen, author of Lovefraud.com
Liane J. Leedom, M.D., contributing author to the Lovefraud Blog