Your Neighbor May Be a Psychopath. Don’t Lose Sleep Over It

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“Always treat everyone with respect. You never know who is secretly a psychopath.” — Alex Wayne

As a psychologist, I have treated very few psychopaths, mainly because they have little to gain from psychotherapy. They tend not to be interested in introspection and have little motivation for change. A notable exception to this rule are patients who are court-ordered to attend counseling. Psychopaths do tend to run afoul of the law more than the average citizen due to impulsivity and antisocial behavior.

In my first clinical job, I worked at a community mental health center where several patients were court-ordered to attend therapy. One had been charged with domestic violence, another with a sexual crime, and a third with weapons charges. These patients were more motivated to attend because they were invested in getting something from me: a letter saying they had successfully completed treatment. That letter enabled them to satisfy an important piece of their probation. In other words, therapy was one step closer to freedom for them. I remember one patient, with whom I had worked for several months. I thought we had a good working relationship despite his mandatory attendance, and I thought we made some good progress together. He barely said goodbye once I gave him the letter documenting his completion of counseling.

What I learned through these experiences was that psychopaths are more common than we might wish to believe. The American Psychological Association (APA) estimates that about 1.2% of men and 0.3%-0.7% of women in the United States have clinically significant traits of psychopathy. While this is not a huge portion of the American population, it does suggest that there are very likely several to many psychopaths in your neighborhood or city, depending on its size. Location matters also, as some data suggests that psychopaths cluster more heavily in the Northeastern part of the U.S.

In 2019, Ryan H. Murphy, a Senior Research Fellow at the O'Neil Center for Global Markets and Freedom at Southern Methodist University, made a splash by combining two existing studies that examined psychopathy. Murphy looked at a cross-section of the “Big Five” personality traits as they are estimated to exist by state. He then looked at the specific personality profile suggesting psychopathy. The result? A state-by-state analysis of the prevalence of psychopathy.

This was one contest in which I wished my city did not come out on top, but win we did. Washington, DC was given the dubious distinction of having the most psychopaths per capita than any other state or territory in the contiguous United States (Alaska and Hawaii were excluded). Maine and Connecticut rounded out the top 3. So, should residents of these states all pack up and move to North Carolina, the least psychopathic state in the study? The quick answer is “no,” but it would help to define some often-confusing terms.

Neither sociopath nor psychopath is a psychiatric diagnosis. Many believe the distinction is that psychopaths are born (nature) and sociopaths are made by their environment (nurture, specifically the lack thereof). Professionals rely on the diagnosis of Antisocial Personality Disorder (ASPD) which actually captures qualities of both sociopathy and psychopathy. The key point to remember in order to sleep better is that these individuals are not necessarily violent. Common hallmarks of this disorder are regularly flouting the law; lying/deception; being prone to aggressiveness; and not experiencing remorse or guilt. It is also difficult for those with antisocial personality disorder to form meaningful emotional attachments or experience deep empathy. So unfortunately, no, they do not make great neighbors.

So why does the District of Columbia come up so high? The author posits that because DC is a seat of power, psychopaths are drawn here. It might also be helpful to look at careers that draw the highest proportion of psychopaths. According to research by Kevin Dutton, a British psychologist, these professions are CEOs, lawyers, media, sales, surgeons, journalists, police officers, clergy, chefs, and civil servants. The link between these professions (besides their prevalence in DC) is that they require a strong degree of detachment. Of course, this does not mean that you should look askance at a neighbor who might have one of these professions.

So, what should you do if you come in contact with someone you expect has Antisocial Personality Disorder? There are a few ways to limit negative encounters:

Trust your gut. There are often warning signs when you are dealing with a person who has antisocial traits. They may ask you for more favors or special treatment than they are willing to reciprocate. Their emotions may be “off,” or they may show little interest in you or your life. You may just feel uncomfortable around them without knowing why. If you experience any of these feelings, you will probably wish to distance yourself.

Set Boundaries. It is important that the sociopathic individual knows that you are onto them. This way they realize that they cannot manipulate or take advantage of you. It will also be important not to share overly personal information which can later be used against you. Instead, keep interactions bland and superficial.

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Avoid Confrontation. An individual with ASPD can be impulsive and vindictive. If they feel wronged or challenged, things can escalate quickly. And since they worry less about social consequences and do not experience remorse, their actions can be dangerous.

To end on a more hopeful note, a colleague at Georgetown University, Abigail Marsh, wrote a book based on her expertise in social and affective neuroscience called The Fear Factor: How One Emotion Connects Altruists, Psychopaths, and Everyone In-Between. I had the opportunity to hear about her work in a Psychiatry Grand Rounds a few years ago. It might be comforting to know that there are people on the far other end of the spectrum: extreme altruists. These are individuals who would willingly donate a kidney to a stranger without thinking twice, simply because they “do not need two.” Likely, these neighbors would be quicker to help shovel your walk or give you a cup of sugar.