There has been much confusion and debate over the issue of psychopathy and antisocial personality disorder (ASPD) in recent years. The term psychopath has been used in everyday conversation to describe a person who deviates from the norms of society. While this term may be suitable for conversation it adds a degree of confusion when speaking in psychological terms. This term is not only confused by laypersons, but can be confused by clinical psychologists. Some psychologists and psychiatrists have used the terms psychopath and ASPD interchangeably in recent years. This is a likely source of confusion.

Hervey Cleckley initially described the term psychopath in clinical terms in his book The Mask of Sanity, first published in 1941. Cleckley described the primary traits of a psychopath as the tendency to say one thing and do another, incapacity for love, guiltlessness, impulsivity, emotional shallowness, superficial social charm, and the inability to profit from life experiences. This early conceptualization of the psychopath lead to work by Otto Kernberg, Aaron Beck, Robert Hare, and others. Hare has done the most extensive research concerning psychopathy and has developed the Psychopathy Checklist-Revised (PCL-R). The PCL-R is a highly scientific screening device that is widely used throughout North America and Europe. Hare's concept of the psychopath is similar to the one proposed by Cleckley, but with some additions. In addition to Cleckley's description, Hare states that psychopaths have a narrow range of emotion, lead a parasitic lifestyle, have a grandiose sense of self-worth, are criminally versatile, lack realistic long term plans, are pathological liars, are highly manipulative, lack impulse control, are prone to boredom, and are superficially charming. As one may imagine a psychopath is not an easy person to get along with.

ASPD is a mental disorder that is officially recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Psychopathy, at this time, is not recognized as a formal mental disorder. The diagnostic criteria for a diagnosis of ASPD indicates that there must be a pattern of disregard for the rights of others evident before the age of 15. This disregard must be manifest by impulsivity, aggressiveness, repeated lying for personal pleasure or profit, reckless behavior, consistent irresponsibility, or lack of remorse for hurting others. To be diagnosed with ASPD the patient must be at least 18 years old and there must be evidence of a conduct disorder before 15 years of age. As one can see, people with ASPD are also difficult patients. The model of a typical psychopath is really an extreme form of ASPD. For example, the lying that an ASPD patient does is manipulative, but the psychopath lies pathologically. The typical psychopath has several more "active" lies at one time than the typical ASPD patient. They often carry themselves in a nature that makes others think that they truly care and have sympathy for others. This cannot be further from the truth. Psychopaths have been known to manipulate others into marriage or business deals with the sole purpose of living off the generosity of their partners and then taking every hard-earned penny from their bank account. This not only has financial implications but emotional ones as well. The psychopath's victim often feels manipulated, belittled, and emotionally raped.

The major reason the legal system would want to differentiate between these groups is because of recidivism. Research has shown that psychopaths are highly recidivistic criminals. Their crimes are more violent, cost the public and victims more money, and require more of the court's time. In Canada, where the PCL-R was developed, every inmate entering the prison system is screened to see if they meet the criteria for a psychopath. This allows the parole board and the jail the ability to better meet the needs of society, other inmates, and the imprisoned psychopath. Another reason for identifying psychopaths is that they are seen by most people as untreatable. The nature of the psychopath hinders that alliance created between the patient and treating therapist. Therapy will not be productive without a certain degree of honesty. As mentioned earlier, the psychopath is a pathological liar and is unwilling to give up this behavior. Identifying psychopaths would prevent the wasting of human and financial resources on trying to treat the untreatable population.

The issue of psychopathy v. ASPD is still a hotly debated topic in psychology and legal circles and probably will be for years to come. It is vital, when dealing with difficult patients, to know what to expect. This task is often difficult when dealing with ASPD and psychopaths, but when the clinician, court, and attorneys involved are aware of the difference between ASPD and psychopathy this task can be simplified. The general rule of thumb is to expect the unexpected, keep your guard up, and be wary of people presenting themselves in a pleasant nature. The person in front of you that is saying the right things and acting politely may be a psychopath and setting you up for a huge loss!