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The Difference Between Psychopathy & Psychosis

Updated on November 13, 2009

People tend to use the words psychopath and psychotic interchangeably. However, many people are unaware of what a psychopath actually is. When asking people to give me their definition of what a psychopath is, they tend to give a definition that actually describes someone who is psychotic. This article will attempt to explain the distinct difference between a Psychopath and a Psychotic individual.


1According to the Diagnostic and Statistical Manual of Mental Disorders (2000), text revision (DSM-IV-R), there is not a universal acceptance of the term psychotic, however the DSM-IV-R's definition refers to the existence of specific symptoms such as delusions, prominent hallucinations, disorganized speech, disorganized or catatonic behavior. In layman's terms a psychotic individual could be described as someone who is "insane."


For all those who are unaware, the DSM-IV-R is a manual that classifies and describes in great detail all mental disorders and is highly used in clinical, educational, and research settings. The manual further describes all of the psychotic disorders in greater detail. Those disorders are: Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder, Shared Psychotic Disorder, Psychotic Disorder Due to a General Medical Condition, Substance-Induced Psychotic Disorder, and Psychotic Disorder Not Otherwise Specified. Schizophrenia is probably the one that most people are familiar with because it is seen most commonly in society and in the clinical setting. Schizophrenia is characterized as being a psychotic disorder that has to last for at least 6 months and include two or more of active phase symptoms (i.e. hallucinations or delusions) for at least 1 month. Schizophreniform Disorder is very similar to Schizophrenia except that it lasts from 1 to 6 months and also there doesn't have to be a decline in functioning. Schizoaffective Disorder is characterized by an individual having a mood episode and the active phase symptoms of Schizophrenia at the same time. Also there must have been at least 2 weeks of delusions or hallucinations (without mood symptoms) before or after the occurrence of them together. An individual with Delusional Disorder must have had at least 1 month of non-bizarre symptoms without any other active phase symptoms. Brief Psychotic Disorder must last more than 1 day and goes away by 1 month. An individual with Shared Psychotic Disorder has delusions that have been influenced by someone else who has similar delusions. A Psychotic Disorder Due to a General Medical Condition is due to direct relation from a physiological condition (i.e. psychosis due to lime disease from a tick bite). A Substance-Induced Psychotic Disorder are due to a direct physiological condition from medication, drug abuse, or toxin exposure. Psychotic Disorder Not Otherwise Specified is included in this section to describe all Psychotic Disorders that do not fit into any of the above criteria or when there is not enough information or contradictory information provided.


Individuals exhibiting psychotic symptoms are as follows: 1) A man who has paranoid delusions that he is being followed by the Government 2) A woman who believes she is being attacked by all of the plants in her home, 3) A woman who hears voices telling her to harm herself or someone else, 4) A disheveled homeless man wearing multiple layers of clothes in the Summer who appears incoherent and shouts at people randomly, 5) A young man who has a flat affect (no eye contact/unresponsive) and if asked a question may respond with a brief, empty reply repeatedly.

(Note: The above examples are only some common symptoms of psychotic behavior and NOT INTENDED for anyone to try to diagnose someone else. More information would be needed and diagnosing is intended only for trained mental health professionals).


2Psychopathy is defined as a personality disorder in which the following traits or exhibited: 1) Glib and superficial charm, 2) Grandiose exaggeration of self, 3) Need for stimulation, 4) Pathological lying, 5) Cunning and manipulativeness, 6) Lack of remorse or guilt, 7) Shallow affect, 8) Callousness and lack of empathy, 9) Parasitic lifestyle, 10) Poor behavioral controls 11) Sexual promiscuity, 12) Early behavior problems, 13) Lack of realistic long-term goals, 14) Impulsivity, 15) Irresponsibility, 16) Failure to accept responsibility for own actions, 17) Many short-term marital relationships, 18) Juvenile delinquency, 19) Revocation of conditional release, 20) Criminal versatility. Furthermore, Psychopaths typically do not show signs of having a conscience and are highly intelligent individuals.

Dr. Robert D. Hare is a renowned researcher in the field of Psychopathy and also the developer of the Psychopathy Checklist Revised (PCL-R) which is a clinical rating scale designed to tests the above personality traits. The scores range from 0 to 40 with a score of 30 or higher indicating Psychopathy. (On a side note: I actually attended Part 1 of the PCL-R Training Workshop given by Dr. Hare where we practiced administering, scoring, and interpreting results of the PCL-R. I actually did really good!)

Dr. Hare is also responsible for authoring and co-authoring several books relating to Psychopathy. One of his most infamous book is: Without a Conscience: The Disturbing World of the Psychopaths Among Us,and it indeed takes us through their world. Great book, and I highly recommend it for gaining more insight into Psychopathy! It is also important to mention Hervey Cleckley, a psychiatrist in the 1930s who can be considered as sort of a founding father in the introduction of Psychopathy. He authored The Mask of Sanity which is another highly recommended book.

Psychopathy is actually not found in the DSM-IV-R and in fact Antisocial Personality Disorder which is found in the DSM-IV-R is closest related to Psychopathy. 3Furthermore, it is important to note that although very similar Psychopathy is not synonmous with Antisocial Personality Disorder or Sociopathy. The difference between Psychopathy and Sociopathy is that Sociopaths may actually have a conscience, experience guilt, empathy and loyalty, and additionally their behavior is attributed to their environment. The difference between Psychopathy and Antisocial Personality Disorder is that Psychopathy entails personality traits such as lack of empathy or grandiosity that is NOT required for a diagnosis of Antisocial Personality Disorders. Antisocial Personality Disorder, however, is much more prevalent than Psychopathy and the diagnosis is given to many individuals in prison. Psychopaths are only found in about 1% of the population, but the destruction they can cause can be tremendous! Additionally, not all Psychopaths are considered to be criminals. Some of them may never commit a crime at all, but they definitely have the potential to. Dr. Hare co-authored another book with Dr. Paul Babiak, Snakes in Suits: When Psychopaths Go to Work in which they discuss Psychopathy in the Corporate World. They describe the manipulative, charming, deceitful ways that a Psychopath works his way up the ladder to achieve power, status, control, and money.


Individuals exhibiting psychopathic traits are as follows: 1) A man who fakes the education portion of his resume to obtain a position of high authority and further uses charm to secure the position. 2) A child who is oppositionally defiant, deliberately sets fires in the house and tortures and kills the neighborhood animals. 3) A convicted serial killer who appeared to others before being discovered as nice, charming, attractive, well-spoken, and above-average intelligence. 4) A man who is very self-confident and stuck on himself, but is very irresponsible and doesn't have any realistic goals in life. 5) A drunk driver who after becoming sober discovered he has killed several people and shows absolutely no remorse.

(Note: The above examples are only some common traits of psychopathic behavior and NOT INTENDED for anyone to try to diagnose someone else. More information would be needed and diagnosing is intended only for trained mental health professionals).

After reading the above material, I hope that is clear for everyone to see the distinct difference between Psychosis and Psychopathy. Furthermore, it is important to note that not all psychotic or psychopathic individuals are murderers, serial killers, or even involved in a life of crime at all. Many people with psychotic disorders such as Schizophrenia who receive treatment actually live normal lives (i.e. John F. Nash, Jr.). However, when they do get involved in a life of crime and/or don't receive treatment (i.e. Seung-Hui Cho, perpetrator of Virginia Tech Massacre) the damage can be devastating. Importantly, there is not any treatment for Psychopathy because it is a disorder of the personality so if a psychopathic individual gets imprisoned for murder parole is probably NOT an option.

1American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

2Hare, R. D. (1993). Without conscience: The disturbing world of the psychopaths among us.New York: The Guilford Press.

3Babiak, P., & Hare, R.D. (2006) Snakes in suits: When psychopaths go to work. New York: HarperCollins.

The following examples of serial killers are names you may have heard of but may have never known their motive. Many people tend to just write them off as "crazy" or "psycho" but as you can see these individuals are in two different categories: Psychotic and Psychopath and now you know the difference between the two.

*These examples are ONLY intended to help show the clear and distinct difference between Psychopathy and Psychosis and in fact many people with these disorders do not commit to a life of crime at all.*

Examples of Psychotic Serial Killers

Click thumbnail to view full-size
David Berkowitz also known as the "Son of Sam" was a serial killer in the 1970s who believed he was told to kill by a demon that possessed a dog.Ed Gein a serial killer in the late 1940s and 1950s was eventually found Guilty but Insane.
David Berkowitz also known as the "Son of Sam" was a serial killer in the 1970s who believed he was told to kill by a demon that possessed a dog.
David Berkowitz also known as the "Son of Sam" was a serial killer in the 1970s who believed he was told to kill by a demon that possessed a dog.
Ed Gein a serial killer in the late 1940s and 1950s was eventually found Guilty but Insane.
Ed Gein a serial killer in the late 1940s and 1950s was eventually found Guilty but Insane.

Examples of Psychopathic Serial Killers

Click thumbnail to view full-size
Ted Bundy was a classic psychopath who appeared to be  an upstanding citizen but actually killed over 30 women in the 1970s.Kenneth Bianchi also known as one of the "Hillside Stranglers" was a serial killer in the 1970s who tried to fake having Dissociative Identity Disorder (A.K.A. Multiple Personality Disorder)
Ted Bundy was a classic psychopath who appeared to be  an upstanding citizen but actually killed over 30 women in the 1970s.
Ted Bundy was a classic psychopath who appeared to be an upstanding citizen but actually killed over 30 women in the 1970s.
Kenneth Bianchi also known as one of the "Hillside Stranglers" was a serial killer in the 1970s who tried to fake having Dissociative Identity Disorder (A.K.A. Multiple Personality Disorder)
Kenneth Bianchi also known as one of the "Hillside Stranglers" was a serial killer in the 1970s who tried to fake having Dissociative Identity Disorder (A.K.A. Multiple Personality Disorder)

Dr. Robert Hare Discusses Psychopathy in Relation to Corporations


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    • profile image

      Michael Kavanagh 

      7 years ago

      Great article

    • profile image


      7 years ago

      David Berkowitz was not psychotic - he was, however, a psychopath. He was faking it, and that has been common knowledge for many years. Ed Gein is a good example of a psychotic person, though by most definitions he was not technically a serial killer.

      Also worth considering are serial killers who were both psychotic and psychopathic. Staying with serial killers, Richard Ramirez would be the classic example of a psychotic psychopath. Herbert Mullin could well be another famous example, though many regard him as psychotic only.

    • profile image


      8 years ago

      My son has had 7 long years of this behavior. These symptoms began shortly after high school. I now know that his father had been shooting him with steroids and this made me think back of the aggressive behaviors he displayed. We had to put him out a total of 5 times. I placed him with relatives, brother, sister, mother/father, aunts, friends out of town, uncles and his friends are no longer around. He's in jail at this time for assault with bodily harm and finally his public defender is getting some help for his mental status. I'm learning more about this disease and will teach family members. Thanks for the post. I need him to take his medications, he's 23 and I can't force him. So sad.

    • profile image


      8 years ago

      i can't help but wonder if it's possible to suffer from both psychosis and psychopathy simultaneously.

    • profile image


      8 years ago

      Thank you for the great article. Actually I was looking forwards reading more, but oh well! Haha

    • Hendrika profile image


      8 years ago from Pretoria, South Africa

      Psychopaths can actually ruin family member's lives because of their behavior. If you do not know about it and it goes by without anyone noticing the harm done to siblings can be very big, ask me, my brother was one!

    • profile image


      9 years ago

      i have bipolar disorder 1 w/psychotic features onset by PTSD. i'm glad to see someone explain that there is a difference between psycopathic and psychotic. i have been living with it and the ramifications of it for over seven years. i have lost friends because of this, all because they didn't know what the difference is and didn't give me the chance to explain it.even so, they proved the true level of friendship, and at the same time made me feel like an outcast and that hurts.i wish more people would choose to get educated about the truth of these disorders. my father was paranoid schizophrenic.he had taken his own life eight years ago and that's where my PTSD got it's start. and to sue, i know how you feel as i have lost several things in my life because of not taking responsibility for my own actions as much as possible. no matter what, though, life is always worth living, i have had the idea of just ending it and it seemed so easy but the times i do get to see my kids makes all the hell i go through just to survive till the next visit is all worth it. you may have lost a lot but there is always more to gain from life. like they say when one door closes, two more open. i hope that life starts treating you better than it has.

    • profile image


      9 years ago

      This is a wonderful article that is very informative. Although i must say David Berkowitz (Son of Sam) was not psychotic. The whole "demon dog" story was something he concocted in hopes of securing the insanity plea.

    • profile image


      10 years ago

      for years wad traeted for schizoaffective disorder now through couselling have discovered i have a personality disorder being going on 22yrs now i accept its me can take resposibilty for my actions includind morbid jelousy have lost husand kids and home job trying to sort out weather to live this life i am not liked by others dont understand why

    • veracity83 profile imageAUTHOR


      10 years ago from Northern Virginia

      Gonat, I must say I apologize if I offended you. Secondly, I must thank you for your feedback. Your comment made me realize that I didn't explain why I used serial killers in my article. I wish I would have gotten your feedback earlier actually. The reason why I used such extreme examples such as serial killers was to aid in showing the clear and distinct difference between the two entities. I never said that people with these symptoms would automatically become serial killers and go to prison. In fact, I explained in the last paragraph that many people in both categories actually live normal lives. This article was ONLY written to explain the difference between Psychosis and Psychopathy as MANY people don't know the difference. Furthermore, everything written in this article was based on facts. That is why I cited throughout the entire article. The examples given were derived from symptoms directly from credible sources such as the DSM-IV and real life experiences. Thanks again for your valuable feedback. I will be sure to update my article.

    • profile image


      10 years ago

      Tiffany, good to know that one episode of mental illness would have me locked up like a serial killer in your world.

      Maybe you could form an opinion based on fact before glibly squirting your stream of stinking consciousness out on to the internet.

    • profile image


      11 years ago

      No Problem. Thanks for the the advice Rita!

    • profile image

      Rita Lions 

      11 years ago

      It’s about time someone gave a full explanation of the difference between psychopathy and psychosis as some people think it doesn’t matter what’s in a name, while others may take real offence to a word misused, or used to loosely to express an individuals character. So this is very helpful. Maybe you would like to give some full explanations to other words that are used in mental health. E.g. Delusional, Delirious, Psychotic, Manic, etc as I think people would be interested in your hub by doing this.


    • profile image


      11 years ago

      great job.

    • profile image


      11 years ago

      Trivia indeed! Great read. I was thinking of so many people that fit so many of those character traits. But I'm no doctor. Thanks again. Very enlightening.

    • profile image


      11 years ago

      Great article Trvi...u and my husband luv digging into this psych suff! Like I've always said....crazy is crazy, there's no need to classify it any further! Luv ya.


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