534K subscribersWatch exclusive video series featuring Dr. Ramani on personality disorders HERE: https://bit.ly/2xAvojx Psychopath, sociopath, or just arrogant? Few people understand the science behind the psychopath and the sociopath. In this full-length masterclass video, clinical psychologist and personality disorder expert Dr. Ramani Durvasula does a deep dive on the psychopath, the sociopath, and everything you need to know about antisocial personality disorder (ASPD). There’s a fine line between someone who is overly-confident and someone who has antisocial personality disorder, which is the clinical diagnosis behind psychopathy and sociopathy. Not only are ASPD symptoms and behaviors difficult to spot, it’s also far more common than most people realize. Some of what Dr. Ramani covers…. – What causes antisocial personality disorder (ASPD) – nature or nurture? – What goes on in the brain of a psychopath or sociopath – and whether they can feel remorse or empathy – A deep-dive of the signs and symptoms of a psychopath and a sociopath – How to tell if your friend, coworker, or even your spouse is a psychopath or sociopath – The latest findings and research on ASPD, psychopaths, and sociopaths – How to handle a child who is showing signs of ASPD – How to cope with a parent, co-worker, boss, sibling, or family member who has psychopathic or sociopathic traits – Whether someone with antisocial personality disorder can recover / be cured “There is no ‘average’ person with antisocial personality disorder. You can find people with antisocial personality disorder everywhere from death row to the best table at the best restaurant in Los Angeles.” – Dr. Ramani Durvasula Get exclusive video series with Dr. Ramani by visiting the link above.
SHOW MOREAdd a public comment…Pinned by MedCircleHave you met anyone with these personality traits? Let us know in the comments below – we want to hear your story. Watch exclusive video series featuring Dr. Ramani on personality disorders HERE: https://bit.ly/320r2yRNo one roasts a narcissist like Dr. Ramani. 😀She sounds like she has an IQ of 200. So lucid and articulate. Awesome.I massively appreciate that this Doctor was willing to spend over 2 hours explaining something. Shows she cares about educating people.The most useful advice she gave was “Respond don’t React”.When she mentions careers that could be phsycopaths she needs to include politicians.She is so educated in every facet of psychology that she doesn’t even pause to gather her thoughts when asked these questions. She immediately has such a well versed and thorough explanation in nearly every response. She’s such a joy to listen to and so incredibly gifted with communication.This was really interesting. When I was in college I dated a guy for a month. I saw my first sign he was trouble and dumped him on the spot. He told me he was the only man who would ever love me so I should marry him. I was transferring to my dream school in a few months. He followed me there in order to terrorize me. He was text book dangerous stalker. I had a lot of proof I could take to our female Dean. I went to her office and cried and begged her to do something. She refused to see my evidence or do anything. He was even honest with a lot of people about how he was hurting me. I was a straight A student and he was failing every class because of his obsession. Once she realized that she asked me to come back. I told her I’ve never loved a school more but if she wasn’t going to protect the women on campus I had no interest in returning. I had to basically go into hiding. I told him I wouldn’t tell my closest friends where I was going (because I feared for their safety). I didn’t tell them for a year just in case. Because of that I met my husband. He is the most wonderful man I’ve ever know. He esteems me in everyway. It’s been 10 years and we only grown in love with eachother every year. Women pay very close attention to red flags. They can save your life and your happiness
I once heard it said: “You can judge the character of a person by the way they treat people who can’t do anything for them”. It’s something that always stuck w/ me,. When i’m entering a new relationship or friendship i make a point of observing how that person tends to treat other people, and it’s interesting and instructive how often it is radically different from how they interact w/ me.
There is one thing that concerns me: her warning to parents whose child isolates himself (or herself) and doesn’t want to socialize with the family. There are so many other potential reasons for self-isolation. A child may simply be an introvert, which is a personality characteristic but not a disorder. The child may have few or no interests in common with the rest of the family. The child may be exceedingly shy or have social anxiety. The child could be autistic. Or, indeed, the child might be undergoing bullying or abuse from one or more other children (perhaps in the family, perhaps in school) or adults. That is potentially a sign that there may be a psychopath or sociopath somewhere in the child’s environment, but not necessarily the child himself. Now, I think Dr. Ramani was giving those warnings of self-isolation or lack of social interest in the context of a child who shows other signs of antisocial personality disorder — but I’m a little concerned that some people may miss that and think that self-isolation is in itself a warning sign for ASPD. I suspect she would be one of the first to say that that is a misinterpretation.
Gaslighting is so traumatizing. I’m glad she said she won’t gaslight her patients.Gosh, I wish she was my therapist.Love her! She is so smart and insightful.They should of showed this in my college psychology class.Interesting how she says she avoids charming people at parties. I used to live in a lot of shared accomodation situations where we would interview lots of people as potential roommates. It got to the point that I would not allow exceedingly charismatic people to move in, because I had at various times in the past found these types of people to more likely be manipulative and users.
Thank you. I was told by a therapist she has patients with bigger problems so I should be happy and that I was staying with my abusive boyfriend at the time for the sex. Totally gaslightingIt is not just romantic partners who cause damage, please talk about the 80% of society who excercize control in the work invironments (cultures, covert actions, and the failed systems that ignore this).“When a signal is given to you, it’s only useful if you’re willing to heed it.” Dr. Ramani“…..anything that feels like a hustle, is probably a hustle!” 👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾1:38:01 Seek help for domestic violence. Domestic violence services offer no help. The staff at these places are not professional and provide limited resources. I wish more therapists understood how little help there is out there for women who have been victims. Referring an abused women to in therapy to local domestic violence resources as the out is wrong. The therapist should help a women with a safety plan and teacher her how to gather evidence and help her cope with the Battered women’s syndrome.
Transcript00:00[Music]00:04we’ve covered how to spot a psychopath00:07or sociopath before but we’ve never gone00:09this in-depth on the clinical diagnosis00:12behind them antisocial personality00:15disorder00:15welcome to the med circle series00:17antisocial personality disorder00:19psychopaths sociopaths and how to spot00:22them it’s just so great to sit down with00:25you I love talking with you sometimes we00:27talk about some topics that I think are00:30really really dreadful and hurtful yeah00:34and I think this series is going to be00:36more in that Lane yes it is it is yeah00:38you brought up the cluster B yeah00:40personality disorders I think it’s so00:42I’m so glad we’re doing this having this00:44conversation because a lot of folks out00:47there are trying to make sense of these00:48difficult patterns and they put in all00:50kinds of words into search engines00:52online00:53cluster B is a something that comes out00:55and a lot of people don’t know how to00:56make sense of it so let me give you some00:58historical background this word cluster00:59B it comes from how the personality01:02disorders were traditionally organized01:04in the diagnostic manual of psychiatry01:07and psychology called the DSM the DSM01:10are organized personality disorders01:12there were ten of them into three groups01:14cluster a cluster B and cluster C and01:17they organized the disorders based on01:19their manifestations now back in01:21graduate school we we would remember01:24these three clusters by calling them mad01:27bad and sad that’s how we that we sort01:30of memorized them and by mad it was sort01:32of that traditional like a madman like01:34you know person who’s just really off01:35and almost like you know very disturbed01:38bad meant almost badly behaved and01:40that’s our cluster B’s and sad were01:42people who are more anxious and avoid01:43him that the cluster B disorders are01:47also termed dramatic and erratic now01:50these these disorders again are grouped01:52by sort of how they affect a person01:54today we’re going to focus on cluster B01:55the cluster B disorders are the01:57difficult disorders they’re antagonistic01:59they’re interpersonally challenging02:02these are folks who as a rule almost02:04always lack empathy they tend to be02:07entitled so it’s almost like narcissism02:10becomes a nice sort of like the midpoint02:12of a lot of these to sort02:13like most of them have qualities of02:15narcissism in different ways and as you02:17said the four disorders that hang out in02:20cluster B are antisocial personality02:23disorder borderline personality disorder02:26narcissistic personality disorder and02:28something called histrionic Personality02:30Disorder these are probably the most02:33clinically vexing patterns we see in02:36psychology and psychiatry because they02:38can make for very difficult clients02:40these patterns can interfere with us02:42treating other issues the person may02:44have like substance abuse bipolar02:46disorder major depression anxiety02:48disorders eating disorders the list goes02:50on if you have a cluster B disorder and02:52these other things it really you’re02:54constantly sort of like it’s like you’re02:56trying to like fight two different02:58battles at the same time and it’s really03:00one big kind of war if you will so it is03:03a challenge and it’s a challenge for03:05people not only living with the cluster03:06B patterns but also a challenge for the03:09people living with those people who have03:11cluster B patterns so that’s what03:13cluster B is dramatic erratic emotional03:16antagonistic combative lacking empathy03:22oftentimes internally very chaotic they03:25can’t regulate their emotions very03:26easily and some of these are really03:28clinically demanding borderline03:29personality for example is very03:30clinically challenging condition03:33narcissistic histrionic clients they03:35don’t even tend to end up in therapy03:36that often an antisocial personality03:38disorder those folks often end up in03:41prison we’ve talked about specific03:43personality disorders but what is a03:45personality disorder in general a03:47personality disorder is a maladaptive03:50pattern of behavior and relating that03:54cuts across all situations in the03:57person’s life relationships work social04:01functioning and even their sense of self04:03it’s the long-standing stability that04:07makes these be called personality04:08disorders because personality is04:10considered to be a stable trait but04:12their personality styles cause the04:15person problems in all areas of their04:18life but it’s the maladaptive consistent04:21and stable nature of these problematic04:23personality patterns that lead to them04:25being called personality disorder04:28can someone be diagnosed as having04:31cluster B disorder no yeah so you just04:35have one of them and that’s yeah you04:37what would end up happening is like for04:39example I as you know I do research on04:41psychopathology and mental illness and04:43mental health so when we analyze our04:45data because these disorders are common04:47sometimes we’ll combine these patterns04:49to see if we see any patterns there so04:51partly it serves a sort of a research04:52kind of an approach it becomes a04:55shorthand for clinicians but we as04:57clinicians have to be really really04:59careful about using that term because05:01cluster B is code for difficult patient05:04and there’s a that’s really big yeah05:07muster B is code for difficult patient05:10now yeah I can already hear people05:11though saying well I’m watching that my05:15therapist said I have cluster B now I’m05:18that’s rude why would you say it can’t05:19feel good that’s what I’m saying we have05:21to be very careful with these labels05:22it’s really meant it’s almost like again05:24it’s an organizational scheme if we see05:26because what may happen Kyle as a person05:28may not meet the full diagnostic05:31criteria for any one pattern of those05:33disorders we chose four disorders they05:35men have a little bit this a little bit05:37of that and we might call it this sort05:39of has a cluster B pattern to it it05:41means that we might use very specific05:43kinds of therapeutic techniques or05:45realize that these patterns may05:47interfere with the treatment of other05:50disorders if you will but it does imply05:53typically somebody whose interpersonally05:55difficult I’ll be honest with you I mean05:57those of us in mental health will05:58sometimes he even use that as shorthand05:59in our own lives like I’m going to06:01Thanksgiving it’s going to be difficult06:03to have cluster B relatives there you06:05know anyone in the in the business will06:07know like AHA she’s got some really06:08difficult family members but it’s it’s06:10beyond difficult it’s antagonistic and06:12and almost like they often don’t get it06:15is it almost often that they don’t want06:18the help not necessarily I think you06:22know because cluster B disorders taken06:24so much territory I work with many06:27clients of borderline personality06:28disorder they desperately want help they06:31desperately want help in fact sometimes06:33need more help than even they can get in06:35sort of like one or two weekly therapy06:37sessions and many clients with06:39borderline personalities sort are very06:41vested in getting that help but it’s06:43difficult for them they feel so06:44internally chaotic and frightened that06:46therapy can be challenging not only for06:48them but for the therapists who’s trying06:50to sort of sue this patient obviously06:52when you’re dealing with somebody with06:53narcissistic personality you don’t think06:55anything’s wrong so they’re often gonna06:57think I don’t even need help and then06:59you know histrionic Personality Disorder07:00actually they’re thinking of removing07:02that from the diagnostic manual these07:04are people who are dramatic and07:06attention seeking and seductive and look07:08at me how come I’m not getting all the07:09attention07:10kind of thing they almost also never end07:13up seeking out treatment for that07:15particular pattern the folks with07:17antisocial personality disorder also07:18almost never seek out treatment they get07:20in trouble for something and then07:22they’re sometimes forced into treatment07:24briefly describe what antisocial07:26personality disorder is because that07:27name is so misleading antisocial07:29personality disorder is one of the most07:32important one of the most unfortunately07:34named diagnoses out there it throws my07:37students off it throws off trainees it07:40throws off lay people antisocial07:42personality disorder is actually quite07:45dangerous it can be quite dangerous it07:47doesn’t mean what we think a lot of07:48people take the antisocial to mean oh07:50these are people who don’t want to be07:52with other people almost as though07:53they’re socially anxious not at all the07:56unfortunate term historically came from07:59this idea that these were people who08:01were anti society they were anti the08:05norms of society they would break the08:08rules of society that was really08:10anti-social came from like I said such08:13an unfortunate name because we use and08:14say antisocial to mean someone who08:16doesn’t want to socialize what would you08:17call it I would call it psychopathic08:19personality disorder yes that’s what I08:22would term it an antisocial personality08:23disorder is the diagnostic term for08:28things that are called psychopathy and08:31sociopathy in the popular literature in08:35the media at large in all kinds of other08:39writing in criminology writing but not08:42it’s not a diagnose those are not08:44diagnostic terms but those two terms08:46definitely ascribe more to antisocial08:49personality disorder now what is it08:51antisocial personality disorder is08:54pattern whereby a person not only lacks08:58empathy but they think the rules do not09:00apply to them they do not adhere to them09:02they break moral codes social codes09:06legal codes they have a failure to take09:09any kind of responsibility09:11they’re very deceitful they exploit09:14other people to achieve their ends09:16they will take risks that will put other09:17people in danger so they’re dangerous09:20they’re dangerous and here’s the wringer09:22here’s the wringer I personally think09:25that to really hit to really call it09:29antisocial personality disorder you’re09:31talking about someone who lacks remorse09:34for the bad things they do and that’s09:37where it gets scary can they faster it09:39gets scary09:40I’m sorry can they fake it can can a09:42person fake can they fake remorse oh09:44absolutely you can fake anything a fake09:46empathy you can fake remorse you can09:48fake anything and they do they will when09:50they’re finally hauled in front of the09:52press conference they’ll cry crocodile09:54tears and a year later they’ll do it09:56again09:56that’s antisocial personality disorder09:59which clusters of disorders do you think10:01are most common in terms of the10:03personality disorders overall I actually10:06think that the cluster B disorders may10:12be more common and the only reason I10:14think I’m gonna say that is because when10:16we do research on these disorders10:17they’re the ones that are more10:19clinically compelling so we may see more10:22clients with these patterns because10:24especially in the case of borderline10:25personality they’re more likely to get10:27help that’s right in the case of10:28antisocial personality disorder they’re10:30more likely to end up in prison so10:31they’re these two groups of folks we10:33study a lot because of the this sort of10:35the distress we see in borderline10:37personality and the danger that can be10:38created by antisocial personality so10:41fewer the end there’s four disorders in10:42that group too so it’s gonna up your10:44your yes your a number up a little bit I10:46think that the cluster B disorders10:48probably are the ones that are have the10:50highest prevalence rates across the10:52three groups overall yeah well you have10:54more disorders and people are having to10:57go get help so they’re more disruptive10:58who that’s who you’re gonna see I’d say11:00if you were if you were working in the11:02mental health business you’ll see that a11:03lot in cluster C there’s things like11:05avoidant personality disorder which is11:07it almost looks like a social link11:08disorder so you will see that sometimes11:11but sometimes we don’t even know which11:12variant we’re seeing social anxiety or11:14avoidant personality and with the11:16cluster a disorders the schizoid this11:19gets a typo the paranoid personalities11:21these are people who actually look quite11:23severely mentally oh they’re incredibly11:25either socially withdrawn or they appear11:27as so odd they almost look psychotic11:28there sometimes over-represented in11:30residentially unstable like homeless11:32populations or people who are in and out11:34of long-term psychiatric facilities is11:37there hope for people who are in the11:40cluster be damned in terms of hope for11:43cluster B clients it varies it varies11:46well hold it we don’t hear that answer a11:49lot11:49oh it varies yeah and that’s the problem11:51that speaks to how heterogeneous the11:53disorders that make up this cluster if I11:55talk about bipolar disorder and I talk11:57about anxiety depression ADHD the doctor12:01cross for me will say there’s so much of12:03no very variable I would say that the12:06most good research on treatment outcomes12:09and best practices can be found for12:11borderline personality disorder I12:13believe firmly that if you have a client12:15with borderline personality disorder and12:17you can give them trauma focused care12:20dialectical behavioral therapy whatever12:23psychiatric medications they may need to12:25manage other sorts of conditions they12:27have and other kinds of adjunctive12:30therapies that will help them with their12:31symptoms the treatment literature can12:34really show some good long-term outcomes12:36but the treatment has to be consistent12:38in long term and that’s often passed12:40beyond the financial ability of a lot of12:43people that’s what’s so unfortunate12:44because I think there is tremendous hope12:46for people with borderline personality12:47if they get the kinds of treatment and12:50if the client won’t cooperate with the12:51treatment then all bets are off with12:54narcissistic personality disorder you12:55know what I say about that you’re not12:56going to see much change and when you do12:59it’s glacial and the amount of change13:01you see is often not enough for the13:03people around them to feel like things13:05are better but with antisocial13:08personality disorder that disorder might13:10be the most hopeless of all these are13:13folks who will try to outwit and outfox13:15a therapist who will fake it and often13:18court-ordered to go to therapy as a13:21condition of13:22or probation or something like that and13:24so they’ll sit there for ten sessions13:25and say I don’t need to say anything I13:27just need to sign that documents that I13:29came here for ten sessions so you can13:31get a lot of resistance and they often13:33try to intimidate a therapist you have13:35to be a very specially trained therapist13:37to work with that population13:39particularly those who have very very13:41difficult criminal histories and if13:43you’re dealing with sort of the more13:44neat and tied up antisocial personality13:47sort of like the CEO variant they’re13:49they’re very manipulative they can be13:52very exploitative again they will often13:54try to outwit the therapist they’re13:56really not motivated to change because13:58they really truly don’t think there’s13:59anything to change so if anything14:02they’re just really out to gain the14:04system that’s not progress so I would14:05say definitely for them of all groups14:07they’ll have the worst outcomes what14:09percentage of your clients do you think14:11fall in the cluster B category Oh with14:14some cluster B symptomatology well up14:16mean well over 50% maybe yeah maybe even14:19a little less oh heck no no no no14:24actually that’s what I choose to focus14:26in but maybe forty percent forty percent14:28you know yeah that’s that is good though14:30because now at least people are getting14:33help or at in the space to get home and14:34there are people out there who14:35specialize in this like people who14:37specialize in dialectical behavioral14:38therapies we call DBT I’d say they see14:4090 percent because they’re working with14:43clients who have a lot of borderline14:44personality sorts of symptoms people who14:46work in prisons are probably seeing14:48antisocial personality and the level of14:5060 70 percent but I’d say almost half of14:52the clients I work with I choose to do14:54that though because like I said although14:56I would say maybe even all right I’ll be14:5835% because the majority of clients I15:00work with are trying to negotiate a15:02family or other relationship with a15:05person with a cluster B disorder a solid15:07third of them are struggling with these15:09with these issues well that leads15:10perfectly into my next question knowing15:12that if somebody has watched this video15:14this far they have been likely given a15:17diagnosis of a disorder in the cluster B15:20family or they knows anybody who has15:23what what could I ask them on their15:27behalf that you would think would be15:28most beneficial for them to hear I would15:31you know I think that the big question15:33people have is15:35from the person there’s two sides of it15:37from the side of the person who’s15:39experiencing it is what do I do15:42I’m not only always miserable I feel15:45like I’m making people miserable you15:48know and then from the other side I15:50think the question would be what do I do15:53I feel like nothing I say to this person15:55ever makes things better in fact all I15:57do is feel like things get worse and I15:59feel like I’m always walking on16:00eggshells what do I do16:01what do I do yeah answer to that I meet16:05them for the people who are experiencing16:07the symptomatology you got to get16:09therapy you’re not you’re not gonna16:10think your way out of this one16:11you’re not gonna meditate your way out16:13of this one you got to get therapy and16:15with somebody who is trained in things16:17like DBT and working with these kinds of16:20patterns okay that’s that they have to16:23yes you know dr. Yip is one of the16:26nation’s leading experts on OCD and I16:28interviewed her for our OCD series she16:31really drove home the point of don’t16:34just go get therapy because then the16:36therapist said yeah I treat OCD go find16:39the person who that’s what they do16:41that’s what they do they are OCD right16:43so with these people16:45you know I feel bad for someone who16:46might have gone to a therapist who said16:48they could treat it but they did it once16:4910 years ago and they had a bad16:51experience yeah yeah I think that you16:53especially with now again but something16:55like narcissistic personality disorder16:57if you actually do get them to therapy16:59you can use a combination of some DBT17:02techniques but also some cognitive17:03behavioral work some humanistic work17:06rapport building it’s a lot of its17:08relationship building you need a strong17:09therapist to work with those clients17:11because they will try to outfox you and17:14so you’ve got if you almost have to be17:15one step ahead of them like you can’t17:16fall for the charm you have to be almost17:18charming you and our charm proof to work17:20with the narcissistic clients and with17:23the auntie’s you know so it’s all about17:25expertise but the borderline clients are17:27the ones who are most likely to actually17:28seek out therapy and for them to say17:31like I said you do it right what do you17:33do you need to get help from somebody17:35who knows what they’re doing and it17:36might even be a team of people who know17:38what they’re doing in fact DBT is best17:40delivered in a team approach with a17:42combination of group therapy and17:43individual therapy and some medication17:46management17:46on the other side of it if somebody in17:49your life is experiencing these cluster17:52B patterns it’s going to be difficult17:54I’m telling you that right now and17:56you’re not a bad person for thinking17:58it’s difficult because a lot of you I18:00feel guilty there’s actually something18:01happening to them how dare I think that18:03this is difficult because it is because18:05the nature of these patterns is somewhat18:07antagonistic that that’s again it may be18:10that they’re feeling insecure or chaotic18:13inside and that’s why they’re lashing18:14out at the end of the day it doesn’t18:15matter when somebody lashes out it18:17doesn’t feel good regardless of the18:19reason and so I will tell people if you18:22are and you are with somebody who’s18:24experiencing cluster B patterns18:26definitely seek out individual therapy18:28you may need to manage your expectations18:30of that person and then ask yourself18:33what would the landscape of a18:34relationship look like with this person18:36if things don’t change in the cases yeah18:38it may not change those are really good18:40three takeaways real quick for people18:44watching explain briefly what DBT yes18:47DBT is dialectical behavioral therapy18:49dialectical behavior therapy was18:52developed by someone named dr. Marsha18:54Linehan and she developed DBT actually18:59specifically to address the crisis of19:02suicidality in people who had borderline19:05personality disorder because that’s the19:07dangerous issue people with borderline19:10personality are experiencing so much19:12inner pain and turmoil that they want to19:14silence that pain they truly do believe19:17often there are burden to others that19:18they don’t or they’re not worthy to live19:20it’s really it’s really agonizing for19:22them and for the people around them who19:23care for them and so DBT was initially19:26really developed as a way for the person19:30living with borderline personality19:30disorder to see how they life always19:34feels like a crisis to them how19:36everything is black or white and so the19:38dialectic is really to bring those two19:40sides those two perspectives together19:42and find that gray in the middle the19:45other thing that dr. Linehan brought19:46into this work was a real focus on19:48mindfulness people with borderline19:50personality disorder tend to react19:52instead of responding sponding is a more19:55thoughtful approach reacting is like you19:56jump right in through DBT using19:59mindfulness and sort20:00catching yourself you help people20:02construct more responsive rather than20:05reactive kinds of approaches when20:09they’re faced with a stressor you know20:11because the reacting often means20:12people’s feelings get hurt people get20:14angry but to help them deal with that20:16crisis and the fears that overtake a20:19person with borderline personality sort20:21of such as things like that they’re20:22going to be left that they’re going to20:24be alone that they can’t take care of20:25themselves20:26many people with borderline personality20:28disorder engage in a lot of negative20:29self-talk dialectical behavioral therapy20:31also draws from cognitive behavioral20:33therapy where you push back and say you20:36know it’s interesting you say all these20:37terrible things about yourself because20:38my experience and you really do point20:40out to them the good things and the20:41strengths and you do some resilience20:43building with them so and you have them20:45do homework assignments between sessions20:47so they do a lot more monitoring so they20:49can help they can start seeing their own20:50patterns20:50DBT has been shown to reduce the the20:54rate of suicidal thoughts suicidal20:57actions in people with borderline20:59personality disorder and it’s really the21:01only evidence-based treatment we know of21:03right now that has any consistently good21:05outcomes in person with persons with21:07borderline personality I just want to21:09touch on two things you said that really21:10struck a chord with me the first one is21:12mindfulness it is becoming a reoccurring21:15theme and all of my conversations about21:17mental health yes which makes me think21:19if there’s one thing we all could do to21:21make our lives better it would be to be21:23conscious of what we’re doing mindful of21:26what we’re doing and then the second21:28thing is that difference between21:29reacting and responding yeah that’s huge21:33everywhere we live in a very reactive21:34world and especially when you think21:36about tweeting and texting and and21:39responding to those times but that’s21:41reacting to right seats in text yeah21:43responding means you stop you think21:46what’s meaningful what would hurt what21:49would make sure well how do I write this21:51oh I don’t hurt people you know that21:53it’s actually beneficial to either the21:55receiver or other people who will be21:57seeing this message you go through a21:59series of cognitive steps but22:01unfortunately technology doesn’t I mean22:03I wish all technology made you like I22:06sure are sure are sure like you know22:08yeah yeah and honestly they made you22:10like in 60 seconds and then another22:13and then another 60 seconds and then are22:16you sure because by then22:17a lot of reacting would have come down22:19and you’re like I forget about it it’s22:20not that important you think about those22:22emails that you write in a rage and22:24hopefully you don’t send them and you22:26save it in the next morn you read and go22:27thank goodness I can say no never ever22:29put a name in a subject line of an email22:31until you’re ready to send it that’s22:32sort of a bit of advice but it’s that22:34react respond and mindfulness are linked22:36and because everything these days is so22:38quick quick quick and we’re judged on22:41speed and everything’s designed not only22:42for speed but not to catch ourselves22:45before we go off the edge yes that we22:48can send things without you know back in22:49the day you’d have to like write the22:51letter fold the letter put the letter in22:53the envelope find the stamp write the22:55addressed go to the mailbox that was22:56nine times you could have said maybe I22:58shouldn’t send this you know and so we23:00that’s where that mindful sits23:03mindfulness is a stop it’s a feel it’s a23:06think but that does mean awareness of23:09other people and if you don’t have23:10empathy all the mindfulness in the world23:12may not necessarily pay out let’s get23:14into it23:14what is antisocial personality disorder23:16so antisocial personality disorder is a23:19long-standing pattern of inability to23:24comply with moral legal ethical or23:27social codes or really an unwillingness23:29to do so these are people that are23:31characterized by lying deceit malice23:34lack of empathy they exploit other23:37people they break the law they are lack23:41responsibilities they don’t follow23:43through on things they have very23:45checkered work histories that kind of23:47thing they’ll use aliases23:49they’ll put other people at risk and23:51they lack remorse or guilt or shame for23:55the bad things that they do so that’s23:56what antisocial personality disorder is23:58now there’s a little interesting wrinkle24:00in this diagnosis in order for a person24:03to be diagnosed with antisocial24:04personality disorder we also have to24:07establish they had a diagnosis of24:09something called conduct disorder prior24:12to the age of 15 conduct disorder24:15probably best sort of ascribes to what24:17we might call juvenile delinquency these24:19are kids who were who’ve either engaged24:22in illegal activities like theft or24:25assault but also things like torturing24:27setting fires bullying peers abusing24:33taking advantage of taking advantage of24:35peers and that could even include like24:36sexually exploiting younger peers they24:40are there’s sort of almost a willful24:43cruelty even though they’re children24:45and they often won’t to show remorse or24:47even recognition of what the24:49ramifications of these actions are so24:51these are kids who may end up in24:52juvenile detention who will have trouble24:55with educational systems may drop out of24:57school so you have to establish this25:00track record that they were a kid who25:02would have these kinds of problematic25:04behaviors prior to the age of 15 and25:06then after the age of 18 we diagnosed25:09antisocial personality disorder so they25:11don’t have to get the diagnosis that25:14before the age of 15 because someone25:17could skip it someone could skip it25:18in fact they often do right but you’ll25:19go back and tell me about when your25:21teenage years it yeah then go you25:22probably had yeah and they’ll say yeah I25:24skipped school all the time and I got25:26expelled or I salted a kid or assaulted25:28a teacher I stole my dad’s money that25:31kind of thing you know doesn’t have to25:32all be big-ticket stuff it could be the25:35the if you will the the kind of bad25:38childhood behavior like bullying or25:41stealing candy a lot or stealing other25:44kids lunch money that sort of thing25:45those kinds of patterns yeah the play25:49devil’s advocate though couldn’t that25:51just be a symptom of bad parents sure it25:53could absolutely but you’d absolutely25:55get a disorder diagnosed you could yeah25:57because even still that bad bad26:00parenting has is the predictor of lots26:02of psychiatric disorders you know what26:04I’m saying so at the end of the day26:05parenting has a lot to do with what what26:08gets shape is it is it a guarantee so if26:11a person has a traumatic neglectful or26:14invalidating childhood is that a26:16guarantee that things will go wrong for26:17them and dealt with it absolutely not26:19but is it a vulnerability absolutely26:22what does it mean to be a psychopath ah26:25so here’s where things start getting26:26until we get into sort of interesting26:28sort of semantics territory here to be a26:31psychopath it’s a term that probably26:34ascribes best to this thing we’re26:36calling antisocial personality disorder26:38so psychopathy is not a diagnostic26:41it’s a descriptive term it’s a26:43sociological term but it’s definitely26:45not a diagnostic term okay but26:48researchers will use it and that sort of26:49thing so what’s psychopathy is somebody26:52who tends to be very calculating26:55manipulative cunning smart malevolent27:00dangerous exploitative they have very27:04little empathy they don’t really think27:07through the consequences of their27:08actions they really don’t care about the27:10consequences of their actions27:12they break rules ethics laws they27:15violate moral codes they’re deceitful a27:18real picnic yeah love to meet one of27:20those but there it’s not actually you27:24can’t be diagnosed as a psychic yeah you27:25so if a person met those criteria and27:28they had this is a long-standing pattern27:29for them since childhood we call it27:31antisocial personality disorder yeah I27:32understood what about a sociopath so27:35sociopath this is where people get very27:37confused27:37okay so psychopathy and sociopathy are27:40very like you know they’re leagues of27:41Venn diagrams there’s a lot of overlap27:43but there’s definitely they’re distinct27:44entities the sociopath in many ways is27:48not as glib socially skilled successful27:52and manifest is well put together in the27:55way the psychopath does the psychopath27:57in some ways is more chilling because27:59they have an absolute lack of empathy28:02and if they have a relationship with28:04someone it is solely exploitative it’s28:07to get something from them sex money28:09power connections you name it the28:12sociopath in they’re very unskilled way28:15might get into a human relationship but28:18they still don’t have any empathy and in28:20that relationship they still remain very28:22cold and and stand still somewhat28:25calculating but really more cold and28:27rejecting the psychopath makes a better28:29criminal the sociopath tends to be a28:31messy sloppy and reactive your sociopath28:34is your bar fighter the psychopath is a28:37person who will kill that person three28:39days later methodically you see what I’m28:41saying so it’s like the sociopath tends28:42to be more reactive they tend to be more28:44sloppy28:45they tend don’t tend to be as planful28:47they’re not as sophisticated as the28:49psychopath who tends to be coolly28:51efficient and in that way almost more28:53dangerous28:54because there was a book that was that28:58was written called the mask of sanity29:00and that’s where they were described he29:02was describing Psychopaths in that book29:04and it was this idea that the psychopath29:07can look sane because they actually29:09there was some research that estimates29:11that corporate heads like heads of major29:13corporations of all kinds the rates of29:16psychopathy and those folks is five to29:18twenty one percent to twenty one so29:21depending on how you measure psychopathy29:22that would be one out of five major CEOs29:25as hell yeah yeah yeah because those are29:28there’s all the stuff that the the power29:30drive the the willingness has that sort29:33of taking a prisoner’s attitude to power29:36in this absolutely almost scarily29:38surgically precise focused way that’s29:41very profitable in preparing for this29:43interview I was researching the term29:45psychopathy and it was almost I would29:48say 80% of the time correlated with29:50serial killers almost like it was an29:53interchangeable term like almost all29:55serial killers are psychopaths probably29:57almost all of them are because there’s29:59there’s a precision to being a serial30:02killer right because in order to be a30:03serial killer you have to have killed30:05two or more people so you got away with30:07one right so you got away with one and30:10there’s some there tends to be some very30:12stereotypical killing the keeping of30:17trophies the taunting of law enforcement30:19almost getting some pride out of getting30:23everyone in the world rattled and paying30:24attention to what you’re doing if you30:26even think of folks like the Son of Sam30:27as OD a killer they were actually30:29writing letters to the newspapers and to30:32journalists and even to the police – you30:34know even Jack the Ripper did that yeah30:36and so it’s this sense that there’s30:38something again very methodical and30:40there’s almost a sadistic pleasure that30:42they’re deriving from committing these30:45crimes that’s very much the Psychopaths30:47game because it’s very planful they30:49think about it I just I just can’t30:51believe that those people who are likely30:54a psychopath and perhaps one out of30:57every five see also a psychopath are the31:00same cat well look about where the31:01overlaps are the utter lack of empathy31:03the precision the singular focus yeah31:07very31:08those oh and could you have no because31:12you have to have let her lack of empathy31:13I was thinking could you have a31:14psychopath who uses his makeup for good31:17but it’s not that way31:19no because ultimately it’s self-serving31:21so I guess maybe the only way you might31:22see that is let’s say you have a31:23psychopath out there who is running this31:26incredibly successful corporation but in31:28order to sort of launder money or to31:30distract people raises tens and tens of31:33millions of dollars for charitable31:34causes and that money really does go to31:38protecting people feeding people giving31:41them health care or something like that31:43so it’s dirty money yeah but people get31:45helped and let’s face it that does31:46happen it’s a philanthropic psychopathy31:49so you know it’s money laundering to31:51them people benefit I mean I guess31:54viewers out there could think about is31:56it worth it if somebody gets help that31:58they wouldn’t gotten helped otherwise31:59but the money came from a really32:01manipulative place out of curiosity if32:04you’re watching this do you feel like32:07your boss is one of those who are 5% or32:1021% likely to be a psychopath I’ve never32:13worked for a psychopath I can say that32:15you know I don’t think I have worked for32:17a second but they work for people are32:18deeply deeply deeply narcissistic yes a32:21full-on psychopath you tend to see them32:23in more competitive industries media32:26business law maybe even sometimes32:29medicine like high-stake athletics that32:32kind of military yeah high stakes high32:36visibility kinds of spaces where the32:39profit lines are high and the stakes are32:41high I mean let’s face it when you hire32:43people to do a job you’re not doing a32:45personality test you’re looking at what32:47they can do and if they’re making money32:48and you’re hiring for a company then32:51you’re gonna look at the person who32:52hires money and you may not ask32:53questions about what how they’re making32:56how they’re getting that done until32:57after the fact32:58window someone going back to entice or33:00antisocial personality disorder when33:03does someone cross the line between or33:05from suave confidence to antisocial33:09personalities well I mean obviously33:10someone being suave and confident is not33:12a is not a diagnosis or an indictment it33:15is to me actually when I made soft33:16people I actually get I get really put33:19off like to me now charming people are33:20terrifying33:21that is wrong money yeah it’s a Romany33:23tats like personal life charming people33:25I tend to excuse myself to the restroom33:27and I will often join another table or33:29something it terrifies okay so if we33:31didn’t know each other and we’re at a33:32party and I go oh doctor rowdy I’ve seen33:34her videos on red circle let me get you33:36a drink you look fantastic tonight I33:38love your shoes wow you’re so smart33:40intelligent you would go oh my gosh33:41thank you you have lost me I love your33:43shoes I noticed probably start watching33:48how after these mental health33:50professionals I tend to be very33:52complimentary yeah but complimentary33:54that but then there’s a point to which33:55like I don’t watch your angle yeah no33:57that’s the so that that’s that it that33:59that’s the the struggle there so this34:01idea then where’s the line right suave34:04and charming and sophisticated in all of34:06that what you’re looking though to is to34:08see is our empathy is there a meaningful34:11give-and-take in the conversation are34:13they looking through you or are they34:15looking at you is are they actually34:18interested in what you’re saying and if34:19you continue to spend time with them are34:21they present are they are they34:24reciprocal are they warm how do they34:27treat other people so obviously if34:29they’re not mistreating other people if34:31they don’t have a track record of having34:33done bad things that kind of thing then34:35then they’re not that then they’re suave34:36and charming yeah and they’re not a34:38psychopath no obviously not almost34:40charming people are not psychopaths yeah34:43but it’s again when you do what I do34:46charm gets scary well let’s dive deeper34:48into that what does the average person34:51who has antisocial personality disorder34:53look like where do they what do that34:56physically look like how do they dress34:58how do they carry themselves that’s a34:59tricky question because there is no35:01average person with antisocial35:02personality disorder you can find people35:04with antisocial personality disorder35:06everywhere from death row to the best35:09table at the best restaurant in Los35:10Angeles so it’s one bit is how they got35:13there you know in both instances yeah35:16absolutely that their and their35:17personality sort of is likely what got35:19them there so they look very different35:20they can be in a $5,000 suit or a ten35:24dollar prison jumpsuit they can be in a35:26they can be in any number of professions35:29they could be any race definitely35:32proportionately more men35:34more men how many more do you think I35:36would say it’s a gosh if I were to spit35:38box I don’t know the numbers off from35:39top of my head I would hazard a guess35:41that’s probably five to one eight to one35:43men versus what I’m doing eight to one35:44yeah something like that yeah it’s a35:45quite a few many more men are there’s35:49are there women with antisocial35:50personalities we’re out there of course35:51there are from the course but for sure35:54you’d see it the only thing I could say35:56in common is this would be a man that’s35:59the best I got for you you know but36:01beyond that like I said they could be36:02successful they may not be successful36:04they could be living in the streets they36:06could be living in a mansion that’s36:08where it’s interesting whereas with36:10other mental illnesses we might actually36:12see sort of a truncation but even there36:14we look at substance abusers they can be36:16fabulously wealthy or they can be living36:17in the streets you know there can be any36:18race or ethnicity they could be you know36:20I you know any gender it doesn’t it36:23doesn’t matter you are the country’s36:25leading expert on narcissism perhaps the36:27world’s leading expert on our system I36:29think that would be very narcissistic36:31that’s why you’re the expert you already36:33cut it out how is this different though36:35than narcissism it’s a very good36:37question what I view them I’ve used them36:39as on a continuum and here’s a good rule36:40of thumb all people with psychopathy are36:44narcissistic not all narcissistic people36:47are psychopathic okay and in that way I36:50would say nearly all people with36:52antisocial personality disorder are36:54narcissistic but not the other way not36:57all people in our statistic personality36:58sort of have antisocial personality sir37:00I would never diagnose both if you have37:02antisocial personality disorder it’s a37:04built-in that you have many many traits37:06of narcissistic personality so it’s it’s37:09a continuum of sorts it really is and so37:12narcissism sort of there’s a form of37:14narcissism we sort of term malignant or37:17toxic narcissism these are people who37:19have all the stuff associate with37:21narcissism like the lack of empathy37:22entitlement etc etc but there’s also a37:25really hard manipulative exploitative37:28edge to them and they tend to be the37:31more deceitful interpersonally brutal37:34narcissists and then when you look at37:37what a psychopath or a person with37:38antisocial personality disorder now you37:40jump the rails into a space where a37:43person does not feel remorse for the bad37:45things they do people with narcissism37:48actually do feel guilty or shameful when37:51they do a bad thing they don’t they are37:54they well more shame than Gayle Koosh37:56aims a very public emotion but they will37:58definitely they’ll definitely feel bad38:01about it whereas a person with38:03antisocial personality sort of a38:04psychopathy in general won’t as a38:06technical matter and this is a it’s a38:09fine point but I want to make it the way38:11DSM allows us to diagnose antisocial38:15personality disorder symptom number38:19seven is the one that’s called lack of38:21remorse okay that there’s a specific38:23symptom called lack of remorse you can38:25get the diagnosis though even if you do38:29feel remorse and I struggle with that38:30because I have interviewed and in my38:34research we’ve interviewed many people38:36who will say I did a bunch of really bad38:38stuff and I did this bad stuff because I38:41was living in a very dangerous38:42neighborhood in Los Angeles I came up38:44with the wrong kids I get that I had an38:46abusive family I was gang involved we38:49stole we assaulted I did time and I feel38:53awful about the lives I’ve ruined and38:54they’re very in they’re genuine they’ve38:56done their time and they’re actually now38:57devoting their lives to better work38:59they’re participating in research like39:01they feel bad yeah and there’s the39:02remorse rang true so they didn’t get in39:04our research they didn’t get that but39:06they still got the diagnosis I guess do39:08you see what I’m saying where39:09psychopathy requires that lack of39:11remorse that’s right39:12well dr. Romani and I sat down for an39:15entire series on narcissism and if you’d39:17like to watch that here is a little39:19preview39:20[Music]39:20[Applause]39:23so when we talk about narcissistic39:25personality disorder there’s a long list39:28of patterns and they have to have five39:30of the nine on that list it has to be39:32something we call pervasive meaning it39:35cuts across situations with a variety of39:36people in at work at home it’s not just39:40like their narcissistic to only you and39:42they’re nice and nice to everyone in the39:43world tends to be pervasive but here’s39:45the rub it has to involve what we call39:48social and occupational impairment and39:52subjective distress that’s a fancy way39:54of saying it is messing up that person’s39:57life they’re aware it’s messing up their39:59life and they’re uncomfortable with it40:01and that’s where you don’t see as many40:04people with narcissistic personality40:05disorder40:06dr. Romany kin sociopathic or can40:11someone have sociopathic and40:13psychopathic traits without having40:15antisocial personality disorder yes they40:17can actually you can see that now here’s40:19a rub it’s like began antisocial40:21personality disorder has such a sort of40:23specific diagnostic set of criteria you40:25know terms of this the early life40:28experience and all of that that you know40:30you may have that person who is coolly40:33efficient and manipulative and40:36singularly focused on success and lacks40:39empathy and exploits other people maybe40:42they’ll come in right under the40:43threshold at this point we’re sort of40:45really where we’re splitting hairs mmm40:49does that make sense who cares what the40:51word is thank you you know I mean it is40:54it’s dangerous it’s problematic you know40:56my work in this area is very much40:58focused on how people how these how41:01people with these patterns affect people41:03in relationships I can tell you this now41:05people with psychopathy and sociopathy41:08100% are not built for close intimate41:10relationships they just don’t they41:12cannot put the roots down deep and I41:14think what ends up happening is cuz41:16they’re so smooth and charm and glib and41:19successful they absolutely draw partners41:22in many times for the psychopathy it’s41:24like a it’s like big-game hunting they41:27just want the trophy they want the prize41:28of it all or they value that partner41:31they’re very attractive41:32they’re very wealthy41:34successful they may be a bridge to41:35something they want or they just want41:36sex yeah I mean it can literally be that41:38that’s simple and in fact you do see41:40that in when we look at the hare41:43psychopathy checklist which is a very41:45famous frequently used checklist41:48research the hair like hair hair like41:51but hair like a bunny the hare41:53psychopathy checklist in that checklist41:56one of the things actually one of the41:57items gets at their inability to be in42:00long-term relationships like they have42:01very short term marriages kind of thing42:04because often times they’re exploitative42:05they want something and they get out or42:07they just have very brief sexual unions42:09are very sexually exploitative they’ll42:11you know they’ll use people for sex and42:13you know and then just sort of spit them42:15up and chew them out and leave them you42:16know leave them out and so people are42:18very hurt by that42:19and they’ll say gosh she was so charming42:21you seem so into me and but that’s42:23because they’re so charming and when42:24that’s why you avoid that’s why that’s42:26why I avoid charming people because42:27really their damage comes from the fact42:29that if you don’t know what you’re42:30dealing with it’s so easy to get drawn42:32in because it feels like a fairy tale42:34it really no little do we know that like42:37many fairy tale princes probably are42:39psychopaths okay it’s a it’s a nudist42:43fairytale princes are most likely a42:46psychopath they’re just a little too42:47charming I mean I think you know we42:49don’t do their name Prince Charming yeah42:50Prince Charming yeah Prince Charming42:52it’s more Prince psychopathy today yeah42:55by the way when people meet you now42:58they’re not gonna be very nice to you I43:00feel like beyond that circle not a lot43:03just an appropriate amount like there’s43:06the narcissism woman I’m like no no not43:08really if I actually successful dick but43:12instead actually stop and make sure43:14everyone’s okay very funny uh this does43:18come with a lot of co-occurring43:19disorders yes43:20what are the most common an antisocial43:22personality disorder the co-occurring43:24disorders we most often see are43:26substance use disorders interestingly43:29you might actually see depression but43:32it’s probably wonder diagnosed because43:34they won’t we would probably present43:35more as irritability yeah what we call43:39impulse control disorders but that the43:41impulse control might be like they lash43:43out of people road rage intermittent43:45explosive disorder but we may not43:46diagnose43:47both because it’s likely that their rage43:49and stuff is subsumed under the43:50antisocial personality disorder but43:52really the most common comorbid43:54diagnosis is going to be substance use43:56are there different forms of antisocial43:58personality disorder you know in the in44:00the diagnostic manual there’s not44:01there’s antisocial personality disorder44:03and it doesn’t have different kinds of44:05it doesn’t have different kinds of44:07descriptors if you will in my research44:10we’ve actually sometimes split them out44:11by people who report having remorse44:13versus those who don’t so it’s not44:16really differentiated in that way in44:18fact the research on psychopathy44:19actually makes it takes the time to44:21distinguish between psychopathy and44:23sociopathy or between primary and44:26secondary side copy there’s different44:27ways you can slice and dice that pie and44:29a lot of it has to do with the the44:31forward-facing characteristics how44:33intelligent well-put-together articulate44:35smart charming glib all that stuff we44:38associated with success and that44:41precision that’s sort of different than44:43what I call kind of like the sloppy bar44:45fight psychopathy or sociopathy yes why44:48or rather what would not be considered44:53antisocial person a personality disorder44:55but often is what type of behavior um I44:58would say that I mean again many people45:02that mistakenly have called narcissists45:04mmm as having antisocial personality45:06disorder but if indeed that narcissists45:08is like I can’t believe I did this I’m45:10so sorry and they’re they’re apologizing45:11and they go do it again that’s probably45:13more of the narcissism piece um bipolar45:16disorder bipolar disorder could be45:19mistakenly diagnosis antisocial45:21personality disorder because it’s very45:23possible that during a manic phase a45:25person’s behavior may drift into the45:28illegal they may use a lot of drugs they45:32may solicit the services of prostitutes45:33and you know behave very badly with them45:36they may gamble a lot of money and45:38engage in illegal activity to get more45:40money to gamble so they may actually45:42behave in a way that is risky and in45:46violation of the law so we’d have to be45:48very very careful to ensure that when45:52there were these sorts of upticks of45:54illegal behavior that it occurred only45:56during a manic up45:57so you got to remember an antisocial45:59personality the behavior is consistent46:01it’s not like six days a week they’re a46:03nice guy and only on day seven do they46:05go out and put their serial-killer mask46:06on they tend to not work well in society46:10even when they’re charming and glib they46:12don’t tend to have high quality deep46:13personal relationships or people46:15diagnosed with border or antisocial46:19personality disorder when in fact46:20they’re bipolar they could be but it’s46:24good it’s gonna be somebody should catch46:26that pretty quick okay you know what I’m46:27saying because then they should46:28recognize that that person is in an46:30episode of mania and this has not been46:31their typical pattern of behavior but46:34since one of the biggest errors we can46:35make is make a diagnosis on the basis of46:37a snapshot if all you did was focus on46:40one day of one person’s manic episode46:42yeah you could easily then completely46:44call it something it’s not so that’s why46:46we have to look at psychiatric patterns46:48over time and so also in some substance46:51abuse disorders I could see how somebody46:53who has a diagnosis of certain forms of46:55substance abuse particularly activating46:58drugs like cocaine or methamphetamine47:00people use those drugs are more likely47:02to engage in risky behavior they may47:04engage in illegal activities procure the47:06drug they may sell the drug they may47:08engage in high-risk sexual activities47:10while they use the drug and if they’re47:12an addict and they’re using regularly47:13that may contribute to the likelihood47:16that they’re engaging in these high-risk47:17illegal behaviors which over time could47:20look like antisocial personality47:22disorder what would have to happen is47:24get that person off the drugs get them47:25clean see if the behavior changes or not47:27I make a point to say this in almost47:30every series because for me it is it is47:33the difference between mental health47:35therapy working or not and that is47:37people must must must get the right47:40diagnosis absolutely and do not take47:43that as a new label or a new terrible47:46thing that’s wrong with you only take it47:48as that that’s the next step to get the47:50right treatment well any in fact we47:52don’t have to call it a diagnosis we can47:53call it a pattern this is the pattern I47:55think I’m very I’ve been really we’re47:58talking about depression per se I’m sad47:59I’m more irritable than usual da da da48:01da da da you know so it’s we’re looking48:03at patterns and these are patterns that48:05make a person uncomfortable and make it48:08so that they’re not achieving at their48:10fullest potential48:11because really my goal as a therapist is48:14to get a person to achieve at their48:17fullest potential48:18to be the best version of themselves dr.48:21sue Varma in New York we did a series48:22with her on depression she goes my job48:25is to give people what you just said an48:27optimal life that’s what I do people go48:31yeah but I can deal with it48:32I don’t you could you could why why48:35don’t we work hard to make it even48:36better right I love that yes that’s good48:38I want people to understand what we’re48:40doing here is providing the education48:42right so that they can get into the48:45right people get the right diagnosis and48:47get the right thing and you Kylie I want48:48to say something to that because I know48:49many people who watch Med Circle have48:52lived with an experience or may even48:53currently be experiencing mental health48:56or mental illness issues I always say to48:58people this is part of your story49:01and if you’ve come through this and you49:04will come through this that that’s part49:06of your strength and resilience and it’s49:08not a piece of you to be forgotten49:10because I work with clients for example49:11who are health care practitioners who49:13are teachers and we can use this as a49:16way say you have an empathy that someone49:19else may not and you may be gentler with49:21a patient or you may be kinder to a49:24student and to me I think that many49:26times that people who’ve walked through49:28the fires that can be harnessed in a way49:31that actually can not only bring you to49:33a fuller potential but benefit the49:35people around you it’s really like49:36spinning straw into gold49:38so I think that that’s what’s absolutely49:39critical as people don’t view this as49:41there’s something wrong with you there’s49:43absolutely nothing wrong with you49:43everything’s right we just want to get49:45you to a better place but that you can49:48use part of this this part of your story49:50to enhance the lives of others mmm49:53that’s so beautiful I would love to49:55leave it right there but I have more49:56questions I can’t leave it on that49:59perfect note that you just gave me when50:02it comes to antisocial personality50:04disorder what am I not asking you that I50:07need to be asking you you know50:09antisocial personality disorder the big50:12question is what if I you know the big50:16question around antisocial personality50:18sort of really is kind of be treated you50:20know to which I’m typically going to say50:21the answer’s no in most cases no50:25we do know that over time people with50:27antisocial personalities sort of kind of50:28get tired out they kind of it’s it gets50:31exhausting to be a person who keeps50:34breaking the rules at ninety or50:36seventy-five like you’ll get tired it’s50:37exhausting right but these are patterns50:42that are very very very very resistant50:44to change these are folks that many50:47therapists don’t have the training to50:49work with nor do all therapists even50:51want to work with this population they50:52feel threatened or intimidated and50:54nobody should work with a patient50:55population they don’t feel comfortable50:57with but there’s typically no motivation51:01for change because these folks don’t51:03think anything’s wrong you know they51:04really and and and it’s also the51:06question is how does the person becoming51:08this way let’s dive into that explain51:10first of the born part yes so there is51:13you know particularly in the area of51:14psychopathy an antisocial personality51:16disorder there’s actually been a lot of51:18research done on sort of brain function51:21in people with with antisocial51:23personality disorder and there are51:25various brain areas that have been51:27implicated the ventromedial prefrontal51:29cortex the anterior cingulate cortex the51:33amygdala all these fancy names are51:36really simply boiled down to somethings51:38wrong upstairs you know their brains51:40aren’t the same as everybody else’s51:43however what these researchers have51:46found is that that those brain51:48differences in structure and chemistry51:51colliding with childhoods that may be51:55characterized by abuse neglect violence52:00being the victim or witnessing violence52:03frankly invalidation emotional abuse52:07those things might potentiate any of52:10those sorts of structural issues in the52:13brain we also know that there are areas52:14in the brain that subserve empathy and52:17that one reason yeah empathy so the52:19research has been done actually with52:21people who qualify sort of psychopaths52:23or as antisocial personality disorder I52:25think they had they had been in prison52:27what they found was when they were able52:31to tell these the subjects in this52:33research to think about something and52:36forced them into empathy like they’re52:38told them a story52:39and say can you really stop and think52:40how that person in that story felt and52:43the person concentrated and how that52:45person felt that area of the brain lit52:46up but it wouldn’t have happened52:47naturally for them so they don’t52:49naturally find themselves to empathy so52:51they’re capable of what we might call52:52cognitive empathy they’re like yeah I52:54can get that and that area of the brain52:55will light up but it doesn’t happen52:56spontaneously so a relationship isn’t52:59really possible with them but it’s not53:00entirely broken you can turn the system53:02on Wow53:04now if I just take my glasses off when I53:08get excited if a child is born with53:11something not functioning correctly53:13upstairs and it is a psychopathic or53:16sociopathic tendency and they don’t have53:19an environment that is violent they53:21actually live in a very supportive53:23environment can it can you raise53:26somebody not to be that way I have read53:27case literature of exactly what you’re53:29describing a kid who is actually from53:31the loving home parents who love them53:34you know a nurturing environment plenty53:36of resources they weren’t it wasn’t an53:38impoverished or dangerous community or53:40anything and that child started53:42displaying antisocial tendencies and it53:45kept unraveling and they became you know53:47violent or predatory or53:48poorly behaved adults if you will and it53:52you know those are case reports that’s53:54not normative that’s definitely a very53:56low probability event if you will but54:00it’s interesting when you read some of54:02the work being done by some of the54:03really great researchers in this area54:06Adrian rein for example as a guy at the54:07University of Pennsylvania and he’s done54:09some really great research on54:11psychopathy and you know I was reading54:13something or an interview done with him54:15and he had said like listen we’re gonna54:16get to the point where we may be able to54:18identify some of these patterns and54:19children and if that’s the case we54:22really should work with parents to help54:24them identify some of these patterns54:26early on do you see if we can do some54:29intervention with them we’re not quite54:31there yet but I must say that when we54:32see kids who are engaging in patterns of54:34behavior like bullying or acting out we54:37have to spend the time to do the54:39necessary assessments to determine why54:41what might be going on for that child54:43both at home and in school and what54:46behaviors are manifesting because it is54:49possible in some of these cases if we54:50could get ahead of some of this54:52then sure we might be able to engage in54:54some prevention work but it’s that’s54:57difficult to do you know you can only54:59mandate so much that I understand when55:01you we have the behavior we try to fix55:04it you’re saying just on the basis of55:05the brain yeah because that’s the the55:07mental health landscape mm-hmm is so55:11great yeah and what’s so frustrating to55:14a lot of people is that it’s just a55:17experts opinion whether or not their kid55:20has ADHD or their kid has bipolar55:22disorder or that their cousin is55:24depressed it’s just somebody’s opinion55:26right so when we can have something more55:29definitive that can be test that’s so55:31exciting to that’s what the hope has55:32been in and of all the personality55:34disorders really antisocial personality55:37disorder is the area where a lot of this55:38work on the central nervous system and55:40the activity of the central nervous55:42system is being conducted and you know55:45the challenge is what do you do you give55:47everyone in America a brain scan no you55:50see what I’m saying so it’s sort of like55:52where do we go with this and the55:54findings right now are very subtle a lot55:56of them happen after the fact so a55:58person goes and does bad things and then56:01we do the scan56:02what other things happen in their life56:03that’s right you know and some of the56:05research hasn’t been as good at sort of56:06describing how much abuse or deprivation56:11or all those other kinds of conditions56:12are present how much of that shaped56:15their brains and that’s the thing the56:16brain is shaped by its environment so56:19you have a bit we’re kind of doing56:20playing a chicken egg chase game here56:22and but definitely both things are at56:25play there are vulnerable brains out56:27there and when that vulnerable brain56:29meets an invalidating environment that’s56:32where that’s sadly where the issues56:34arise do you think we would ever get to56:38a point where we would do a scan on kids56:43for scan their brain and we could say56:47yes they are likely to be a sociopath or56:51psychopath not in our lifetimes I don’t56:53think so I think that I wouldn’t be56:55surprised if slowly we get to remember56:56the brain is a very complicated it’s a56:59very complicated system it’s not so57:01simple it’s like there’s like a little57:02it’s other organs are much more57:05right other organ systems are a lot more57:07straightforward but the brain the brain57:09hides four secrets and you know you57:12could have four scans that look similar57:13and yet the behavioral manifestations57:15could be quite different because it’s an57:17intersection of so many things the57:20person’s everything from the person’s57:22gender to their ethnicity to where they57:24live to what their parents did to what57:26kinds of early environment they have you57:28know there’s it’s not that simple it57:30would that it were would that it were57:32but we’re not there that this this57:34extraordinary thing called the brain is57:36you know that allows us to do everything57:38from you know write poetry to fall in57:40love to drive a car it’s it’s not that57:43simple and I don’t think we’re gonna get57:45it we want it to be that simple we want57:47to be able to predict these patterns I57:50think it’s a pretty high order as is it57:52so it feels like a science fiction film57:54to me but who knows maybe maybe57:56neuroscience will prove me wrong do you57:59think or is there any proof that any of58:03this is hereditary there is some58:06evidence showing that it runs in58:08families now it’s particularly58:10father-to-son and as we talked about58:12these rates are higher in men when we58:14talk about antisocial personality58:16disorder from a more biological model58:19one of the things we talk about is58:21something called the autonomic nervous58:23system the autonomic nervous system has58:26an arm of it called the sympathetic58:27nervous system that we’ve popularly58:29referred to as the fight-or-flight58:30system but the autonomic nervous system58:33is associated with arousal so when we58:36get worked up about anything when we’re58:37frightened when we’re anxious you know58:39anything that is threatening up to us we58:42get aroused our heart rate increases we58:45sweat our eyes become wide we become58:49short of breath those are sort of we get58:52our skin you know we put a hair stand up58:54on edge kind of thing all those our58:56autonomic signs the belief is that58:58people with antisocial personality58:59disorder have a lower autonomic arousal59:02meaning that under conditions of fear or59:05threat they don’t get as aroused which59:07is why they’re willing to take risks and59:08they don’t have the same anxiety we59:11avoid things that make us anxious right59:12they don’t get anxious so they don’t59:13avoid those same things that are really59:15high59:15risk and in fact there’s research that59:17shows that people with psychopathy have59:19a lower resting heart rates they just59:21are more under aroused so sometimes that59:24manifests in them getting into really59:25dangerous thrill-seeking types of sports59:27because they almost want to feel the59:30arousal the rest of us feel on a regular59:32basis day after day and that low it’s59:34believed that that that autonomic59:36nervous system under arousal could be59:38inherited in our first video you and I59:42ever made I think it was our first one59:43you told a story saying that they could59:47be in a car with a dead body in the59:50trunk and get pulled over by the police59:52and be they won’t probably call totally59:55cool59:56absolutely the place are those the thats59:59a sociopath that’s a psychopath or a60:01psychopath and they are born Psychopaths60:05tend to be more born sociopaths are60:07probably a little bit more made you know60:09and I mean that’s a rule of thumb that’s60:11not perfect science but definitely use60:13that you see that that that sociopathy60:15tends to be a bit more a byproduct of60:17the chaotic or negligent early60:21environment whereas psychopathy you60:25could have that you can definitely have60:27the negligent early environment it’s60:28probably likely but either’s likely also60:30that biological sort of piece again the60:32sociopaths tend to be a bit more sloppy60:34messy reactive what age in your personal60:41experience do you find Psychopaths or60:43sociopaths being diagnosed you can’t60:44diagnose them until they’re over 18 I60:46don’t think it’s a reliable diagnosis60:48none of the personality disorders are60:50diagnosed in adolescence except for the60:54conduct disorder conduct disorder is not60:57a personality disorder it’s a childhood60:59disorder oh so you could diagnose a kid61:01with conduct disorder okay because they61:03keep breaking the rules right it’s61:05possible that kid will not go on to61:06develop antisocial personality sort of61:08if you’re really really really really61:09lucky they’d be put into some perhaps a61:11juvenile center where they really get61:13good rehabilitative care and they don’t61:15commit crime again61:16I mean the odds are not in your favor61:18but it can happen that way so conduct61:20disorder is a disorder of childhood61:22personality disorders are only diagnosed61:24in adulthood we’re making we’re making61:27room for the fact that the personality61:28can61:29used to evolve shape and grow during the61:32adolescent years into emerging adulthood61:34I actually really wouldn’t feel61:36comfortable giving a definitive61:37diagnosis of a personality disorder and61:39anyone who’s much younger than 20 or 2161:41that’s so fascinating that was my next61:44question to where you would feel61:45comfortable yeah I mean I would talk61:47about patterns I say you definitely have61:49the traits here but you also have a61:50teenager and I can tell you as the61:52parent of teenagers I think I’ve61:54probably seen what it feels like every61:55personality disorders symptoms and them61:58you know like wow they’re being really61:59she still love them but I was like oh my62:03gosh you know and that’s where I really62:05learned that teenagers are up down and62:07all around and they are again that’s62:08just that’s a developmental issue and62:10that’s why we want to be very careful62:11the last thing you want to do is toss a62:14label on it adolescent who’s coming into62:17their own and make them pathologize this62:20process of them trying to find62:21themselves and if we look at any of62:23ourselves when we are teenagers like we62:25were anything but graceful oh goodness62:27that is the truth mm-hmm in regards to62:30antisocial personality disorders what62:33demographic besides men do you find more62:37effective this is where it gets a little62:38tricky socio-politically unfortunately62:41what we see in this is something that as62:42I’ve reviewed the literature from my62:44research that these patterns tend to be62:46over diagnosed and people from62:49lower-income groups and ethnic minority62:52groups and the belief is it’s that’s62:54because those groups are also62:56disproportionately incarcerated and the62:58target of law enforcement so the belief63:02is that it’s almost like the sense of63:03pathologizing people who are different63:05than the norm and that’s why those63:08statistics I think we have to be very63:09very very careful with so again these63:13disorders don’t know to discriminate per63:15se but since they’re based on moral63:18social ethical and legal codes and those63:21codes are enforced by other entities63:24there’s now you’re bringing politics in63:27you see that’s where it gets tricky and63:28that which those things don’t belong in63:30mental health but we have to be mindful63:31of them so we and in fact what we do63:34sometimes see is that sometimes women63:36who probably have antisocial personality63:39disorder will get misdiagnosed with63:41another syndromes63:42borderline personality disorder because63:44we don’t think of women as having63:46antisocial personality disorder and so63:48and there are men out there who might63:50very well have borderline personality63:51sort of who get diagnosed with63:52antisocial personality disorder63:54so things like gender race social class63:57is those other things for matter when a63:59therapist or psychiatrist brings their64:02own personal you know prejudices and64:05yeah their practice bias bias by just64:08the normal ice bias and that’s why that64:10you know ideally you have multiple pairs64:12of eyes on case data which you don’t64:14always have you know because I’ve been64:16surprised when I do every so often get64:19to see you know past you know diagnostic64:22you know systems late on a client I’m64:24like really you know I got to say I’m64:26not seeing it this way so it’s not it’s64:28not a precise science that’s why these64:30these labels don’t tell us much I think64:31we’re better off focusing on patterns64:33yeah I’ve had patterns in our lifetime64:37what do you hope or think that we could64:41develop when it comes to the causes of64:43antisocial personality disorder you know64:45this is actually I mean a lot of what is64:47being done in you know in personality64:49just sort of research very much focuses64:51on antisocial personality because we do64:53know but it’s it’s dangerous to society64:55so what do I think we’ll learn I do64:57think that newer new newer and newer65:00tools neuroimaging tools that look at65:03namely functional neuroimaging tools65:06that really look in real-time at brain65:09function those are going to shed some65:11really important light on how these65:13brains work differently and then once65:17therapies or treatments are applied to65:19folks to see if you actually see any65:21franc shift in functioning and whether65:24that’s also associated with a behavioral65:27change you know again these are not65:29patterns that are that amenable to65:31change I think that we might be able to65:33isolate what the snapshot of what this65:35looks like in the brain whether we can65:37then acts on it you know there the jury65:40is out like and it would it then become65:42something that’s more medical is there65:44medication that could be even is it65:45surgical right you know and then you but65:47you face bigger bigger ticket issues65:49like consent to treatment we are very we65:52in the United States of America65:54an adult has to consent to treatment65:56can’t just crack open a person’s skull65:58and start fiddling around in it you just66:00know how it works and so I think that as66:02much as we think well there could be all66:03these magical solutions people have to66:06agree to uptake therapy and you know66:08there’s reasons for that obviously but66:11if a person doesn’t think something’s66:12wrong whether it’s psychotherapy whether66:15it’s medication whether it’s newer66:17therapies you know newer sorts of brain66:20stimulation techniques whether it’s66:22psychosurgery you a person has to66:25consent to that and it has to be really66:26medically indicated so we have to be66:29careful and how we think about those66:30things66:31dr. Emily someone comes to you a patient66:33and they say my husband is a sociopath I66:36am convinced what’s your first reaction66:38I first of all hear this regularly and I66:41get heartbroken for them mmm because66:44what it means that they’ve been enduring66:46is somebody who is likely verbally66:48abusive or ignoring them neglectful66:51lacks empathy is cruel as cold is66:57distant is manipulative like they use66:59that one word and it gives me some real67:02insight into what they’ve been enduring67:03and by the time they pick up the phone67:05and call me67:06it often means they’ve been enduring it67:07for a while how severe do the symptoms67:13of a sociopath become I mean I mean I67:17like all disorders it’s on a range right67:19you know I mean it’s not like there’s67:21one version obviously in the milder67:23levels you’re often talking about67:24someone who’s cold angry brooding67:27resentful mean-spirited you know at the67:29more extreme levels it you’ll you seem67:31violence manifested so obviously at the67:34more extreme levels you you’re often67:35talking about victims of more physical67:37domestic violence but I think even at67:38the mild levels it can look like67:40emotional abuse what if somebody comes67:42to you and they say I heard this word67:45sociopath and I don’t I’m not really67:49sure what it is but I think my husband67:50might be one what how can I tell I break67:54it down for them because I think a lot67:55of people use the word sociopath67:57interchangeably with narcissistic yeah67:59and like I said these are labels I’m68:01interested in the pad or matter I’ll say68:04don’t use the word tell me what it’s68:06like don’t don’t show me a bucket dump68:08tell me show me what’s in it yes okay68:09metaphor and so I I say tell me what the68:12patterns are and then once they start68:14laying it out I say okay here’s what the68:16pattern is if it makes you feel better68:17to have a word you explain no sometimes68:20they want to keep doing digging and68:21doing research but then we break down68:23that pattern so when somebody is68:24experiencing that like I said they’re68:26experiencing all those things coldness68:27distance manipulation lying all those68:30things and it almost doesn’t matter68:32whether it’s a sociopath or narcissist68:34neither pattern is that amenable to68:36change and neither pattern feels good so68:39they dump out the bucket and they’re68:41pulling out verbal abuse coldness all of68:46those things that you mentioned yeah who68:48cares what we call it right this type of68:50person is unlikely to change no they’re68:53not gonna change they’re not going No68:55so that leaves that person with two68:57options yeah stay with it69:00yeah and deal with it or get out and69:01when I say they’re not gonna change I69:03say that very as you can see reflexively69:06let’s say let’s say you get that person69:09is like okay I never thought it would69:12get to this point you’re leaving let me69:14give this a shot and they want to make a69:17good-faith attempt in therapy and69:19they’re really owning it and they get in69:21there and they maybe make some minor69:23changes in some small small small small69:26small small small percentage of cases69:29you might see that since most people out69:31there and most people watching are not69:33going to be the exception to the rule69:34I’m going with the idea that if their69:36partner is not endorsing any issues on69:39their end that they’re responsible for69:42any of this then they likelihood of69:43change is zero you know you have to add69:45that acknowledgement of change so69:47assuming that that’s what this person is69:49like they won’t change and when I bring69:50it to their attention they look at me69:53like you know I that’s great I’m not you69:56know there’s nothing wrong with me this69:57is you and Laughton blame the person so69:59they’ll say you’re an idiot you’re a70:02fool maybe you’re the one with a problem70:04they’ll then they’ll undergo a whole new70:06litany of emotional abuse so you’re70:08right the two options are to either get70:10out or stay and if they stay to70:12understand they’re staying under70:13conditions that really aren’t going to70:14shift that much but how able are we to70:18unbias Lee70:20tell a therapist how our significant70:23other no I get it every day 10 times a70:25day so then people are by the time70:27listen you go into a therapist office70:29and you’re paying good money why would70:30you lie I know I’m not saying that70:32they’re lying I’m saying if I say all70:34right like I my name is Jennifer and I70:37have a husband named Paul and I’m saying70:39Paul is manipulative and cold how70:42accurate is that because maybe I’m just70:44angry okay then in which case you’re70:46gonna get your guidance from that70:47perspective and that’s why it’s great to70:49work with couples right because if you70:51get to work with a couple then you get70:52to see both sides unfortunately if Paul70:54in fact is a sociopath he’s gonna be70:56manipulative you know so you have to be70:58a really skilled therapist to sort of70:59suss that out and smell that out you’d71:02be amazed how many clients pull out71:04their phone and show me the text71:05messages and that’s when I get a real71:07sense of it I see the emails this is so71:10good yeah I bet you people don’t realize71:13that they can even do that with the71:14therapist they can’t always some71:16therapist listen I’m I when my clients71:20come in they might bring in old photo71:21albums I welcome all that they show me71:23the text messages it helps your71:25therapist though any of your viewers71:27your therapist may say no and I don’t71:29ever want to impugn how another71:31therapist works so I’m not saying all of71:34us will do that71:34I certainly will because I am there71:37because of the sheer number of clients I71:39work with who have been in narcissistic71:42or sociopathic or psychopathic71:44relationships it’s really important to71:46me to never Gaslight my patients yeah71:48you know maybe you’re not telling me the71:50truth that’s what the world has been71:51telling this person for a while like71:53well maybe it’s not that bad71:54and they went gasps elated by the world71:56and I refuse to be someone who does71:58there’s a reason this person picked up72:01the phone came to my office once spent72:04the money to see me and if it’s to come72:06in and say I’m gonna give you this sort72:08of mythological version and do I think72:10sometimes clients do that absolutely72:11absolutely and so then what’s happening72:14is probably nothing is changing at home72:16because I’m working in good faith so at72:19some point they’re either gonna stop72:19coming cuz saying nothing you’re doing72:20is helping me but but I have to say that72:24it is important for me to honor their72:26truth is I’m a humanistic therapist and72:28I really miss my orientation be72:30humanistic existential and a big part of72:32that is that your72:33is what matters to me and for some72:35reason you’re coming in here and saying72:36this is your experience of this person72:38and it’s not my place to doubt that I72:40just want to understand it that is so72:44good I love a the permission to bring72:49evidence as well call it to a therapist72:51who’s open for that you know why they do72:54that though Kyle sometimes people bring72:55that in because they’ve been doubted by72:57everyone and there they feel like72:59they’re losing their grip on reality73:00that’s what gaslighting does to people73:02it’s a doubt it’s a test your reality73:04and it could be going on for 20 years73:05and sometimes to them they’ve stopped73:08trusting their own reality so much that73:11they hand over the text messages because73:13they don’t think anyone will believe73:14them it’s actually a rather73:15heartbreaking gesture I am not kidding73:17you I’ve had clients come into boxes of73:20stuff and you know and I mean it’s73:21heartbreaking because I think god no one73:23has been listening to this person and73:25they literally feel like they’re losing73:27their grip on reality and not to me is73:29devastating73:30so I Jennifer comes in and she’s73:33irritated with her husband Paul because73:35he’s a sociopath and you tell her look73:38the evidence would suggest that he’s a73:39sociopath but I would assume Jennifer73:42didn’t marry him when he was doing all73:44those things yeah here’s the thing with73:47these patterns narcissism sociopathy73:49psychopathy these are long-standing73:52patterns now because of the charm73:56particularly we see in psychopathy and73:58narcissism they can often keep a lid on74:00it long enough to get a ring on it okay74:04sociopathy tends to be a bit more sloppy74:06I’m not quite sure why people fall for74:08that but they do some people just74:10desperately want to get married and74:11they’re just sort of taking whatever74:14person is in front of them they’re like74:16okay I guess I can work with this and74:17sometimes is that sociopaths don’t tend74:20to be as successful as Psychopaths but74:22if that person maybe brings enough74:25practical characteristics they can live74:27with they may be willing initially to74:29overlook the rest so know this person74:30these red flags were here from the jump74:33going back to a conversation we had74:35previously in this series about being74:38mindful and being aware and conscious74:41because when you’re mindful aware and74:43conscious you can hopefully see that74:46Paul is74:47characteristics that are maybe won’t be74:49good in a marriage yeah and but people74:51are so easily go into denial and then74:55get married thinking I’ll get better74:56well that’s the biggest mistake a person74:58can make any nothing’s gonna get better74:59once you’re married if anything I put my75:01good bet on things are probably gonna75:02get a little worse yeah you know I’ll75:04quote my father who’s not a therapist he75:06said look it better be so good by the75:09time you get married because it’s only75:10gonna I mean it’s possible some things75:14could get better with time you know but75:16we I have to say that it is you’re75:18absolutely right and every single client75:21I have ever worked with man or woman gay75:26or straight you name it Amy culture they75:30have said they owned it these signs were75:32there all along and if anything they75:34feel angry at themselves they feel75:35ashamed and embarrassed humiliated why75:38didn’t I see this sooner and they’ll own75:41it family tradition they wanted to get75:43married they wanted to be a parent75:47they thought this person could take care75:49of them they felt bad for them because75:50that they had a bad childhood those are75:53those the reasons they get all the way75:55in and like we’ll fix this it’s almost75:57like we’ll get the house and it’s like a75:58fixer-upper75:59what could the house and then we’ll fix76:00it yeah not a good idea I’ll share a76:02personal story I had a six-year76:05relationship broke up in therapy about76:09it we didn’t break up in therapy but I’m76:10in my therapists office reviewing the76:13relationship and I brought something up76:15that happened in our first few weeks of76:18dating and that event occurred76:21throughout our relationship and I told76:24my therapist yeah but I didn’t know it76:26was happening you were in denial I76:28wasn’t in denial76:30I saw it happen in the beginning he said76:32that wasn’t that’s not gonna happen76:34anymore and I just didn’t know what was76:36happening he wasn’t I’ll you know you76:37just chose not to see him and I left his76:39office angry because I go who are you to76:42tell me that I’m gonna now you know but76:43then after a few weeks I came back76:44though you were right I was in denial I76:47saw it all along I just chose to pretend76:51like it wasn’t or make rationalizations76:53I mean the other pattern I see folks76:54make is like he’s having a bad day at76:56work the kids are really noisy his76:59father’s been really sick77:00I’m wait until we move by the new house77:03I mean it never ends right any anyone77:05can write those rationalizations and77:07while those things may be true their77:09causes of stress that kind of bad77:11behavior is unacceptable emotional abuse77:13is unacceptable any day of the week mmm77:17perfect I want to stop it right there77:20that was there was so many great77:21takeaways and my big one was going to77:24the therapist with evidence yeah I’ve77:28never done that and I probably should77:30have yeah I mean if I said but I warn77:32folks that you know like before they77:34show up to the therapists office77:36bringing a bottle cap with five boxes of77:39Records and they end up and they open77:44their phone their therapist may say we77:46you know I only want to hear about your77:47reality they don’t want the therapy to77:49be punctured by outside realities like I77:52said I respect how other therapists work77:54given the nature of the populations I77:57work with that I must say it sometimes77:59elucidate something and it allows them78:02to almost feel heard and it normalizes78:05things for them because they’ll78:06sometimes say I have to show you this78:07because otherwise I am I feel like no78:11one could believe something this78:12outlandish I say I believe you78:14if this helps you by all means you know78:17I’m just trying to give them a sense78:18that I’m trying to help them feel sane78:20and whole again yes by whatever path78:22possible yes water what’s the first sign78:25someone needs to look at as if they78:27think somebody they know is a psychopath78:28I mean if you come to find out that78:31they’re breaking major rules moral codes78:35ethical codes or laws now obviously on a78:39first date a person doesn’t I mean78:41unless that they’ve got their like their78:43I just broke the law bracelet around78:45their ankle you know they’re not going78:50to I don’t think that most people are78:53gonna like put their rap sheet in front78:55of you on a first date so you know but78:58pay attention even to look at how they78:59might handle rule-breaking79:02in a relationship I don’t know they79:06might take something that doesn’t belong79:07to them if you’re you know from a like I79:10don’t a place of business or a hotel or79:11something it may feel like a small79:13transgression79:14but it’ll be enough to make you uneasy79:15they may share something that they did79:17at work that feels like it’s on the79:19wrong side of shady you know there’s79:21enough of those little things start to79:23accumulate and you know the danger is it79:25like wow they’re they’re really slick79:27like they’re a hustle their player you79:29know like you think you’re in some sort79:30of cool movie with them but it’s not79:33cool it’s actually they’re breaking79:36rules and they’re doing it over and over79:38again and that might be a sign or a79:40signal you know they just are it’s and79:43then may end up culminating in more and79:45more stuff and you may find it out I79:46think one of the most devastating things79:48that people have said to me when they’ve79:50been in relationships with Psychopaths79:51is what they learned down the road they79:54come to find out that this person had a79:56history of incarceration that they may79:58actually be married to someone else at80:00the same time that they lied about their80:02occupational history that they lied80:05about a bills that went unpaid and which80:08are now are ruining their credit you80:09might go try to buy a house and find out80:11oh they had two bankruptcies in their80:13past or something so it’s a it may be80:15something you don’t learn early on80:17nowadays with Google you might be able80:20to look into people Psychopaths have a80:22tendency to use aliases they may not be80:24who you think they are Wow80:26does it look do a psychopath look80:28different depending on the role they80:30take in your life for example a80:32significant other versa coworker verse80:35absolutely you gotta remember a80:38Psychopaths front game is the best game80:41in town80:41smooth glib charming intelligent80:46articulate perfectly put together I mean80:50you’re you really need to know what80:53you’re looking at to be able to catch80:54them in what they’re doing so they’re80:58gonna be if they’re trying to attract80:59you as a new partner they’re gonna bring81:01their a-game if they’re trying to81:03impress somebody in the workplace81:04they’re gonna bring their a-game however81:06if you’re someone who’s disposable or81:09dispensable to them or someone they81:11views you’re in their service god help81:14you is all I have to say if you find81:16yourself in a relationship with a81:18psychopath or you believe that your81:20husband or boyfriend let’s say is a81:22psychopath are there any questions you81:25could ask them to81:26maybe find out if you’re right I would81:28say that what you wanted use look for81:30inconsistencies in their story and find81:33out talk to people who know them now I’m81:34not saying you need to go CSI on this81:36and start this interrogation of everyone81:38who’s ever known them but try to see if81:41there’s continuity if the dates line up81:42if their life story lines up if you know81:45he might have said he went to college in81:47one place and another person’s like yeah81:49when they graduated they were working at81:51this job and you’re like something’s not81:53adding up81:54psychopaths often go out of their way to81:57isolate their partner from other people81:59who know their histories look for that82:02pattern – why aren’t you being82:04introduced to anyone in the past they’ll82:05often say I was done wrong and I’ll make82:07up some dramatic story about how82:09everyone did this to them so they have82:11nothing to do with anyone from their82:13past that’s pretty rare that somebody82:15would cut off everyone all friends all82:17family all extended family it may be82:19that they’re on a fresh start path and82:22they’re sort of reinventing themselves82:23and that you’re in the in the you’re in82:25the eyeline of a grifter kind of person82:27at this point so look for82:29inconsistencies psych psychopathy is not82:32a diagnosis of all time no but can82:35someone have psychopathic tendencies but82:39not be a psychopath you know I mean82:41they’re you then again you’re splitting82:42hairs you’re splitting hairs because82:44like because there’s no diagonally if82:46you have five psychopathic tendencies82:47then you’re a psychopath right you know82:49the people who have like really are82:53breaking rules in this consistent way82:54and they’re cold and they’re and they82:58fail to take responsibility and they’re83:00deceitful and they’re manipulative and83:03they’re exploitative I mean these things83:04tend to hang together it’s very rare83:07that a person exploits other people but83:09then they’re really sweet and they do83:10bake sales and they run a Girl Scout83:12troop like you’re not going to tend to83:14see those things kind of hanging out83:15together these things cluster together83:17so the more of them you have the more83:19likely you are to dealing with somebody83:21who is truly a psychopath I like the83:24takeaway of looking for inconsistencies83:26and this person and if you’re in a83:31relationship with them you do have the83:32option to leave but if you have a83:34co-worker for example you can’t83:37necessarily leave them so how do you83:39adapt for working with a psychopath83:41if you suspect you’re working with a83:43psychopath that you what you want to do83:45is you really really really want to83:47cover your bases83:49remember HR is not going to help you83:51unless you have documentation you can’t83:53walk into a try and say hey the person83:55in the next cubicle is a psychopath83:56they’ll be like okay that’s I watch the83:58red circle of it you know so if you I84:02mean I always tell people anytime you84:04start on a new job you almost have to be84:06kind of paranoid you start you save84:08every email you make folders you get84:10that stuff off the server you print it84:12off like you knows all these steps that84:14you really should engage in if you think84:15you’re working with a psychopath but you84:18want to make sure you document things84:20you want to avoid having meetings with84:22them one-on-one you want to ensure that84:23there’s a third party present you want84:25to ensure minutes are being taken of84:27meetings you want to you know most times84:28people scan minutes and don’t really pay84:30attention pay attention to those minutes84:33because that might be the only84:33documentation you have and then you want84:38to make sure you have alliances at work84:40people that you can trust but what you84:41don’t want to do is gossip about the84:43psychopath because they’re better than84:44at that than you are they’re already84:46stabbing you in the back and numerous84:48other places you can’t see you know a84:50way ahead of you they’re gonna play this84:52game better than you so you’re best off84:55playing a clean game yeah yeah then84:57trying to beat them at their own game84:58yeah really good advice what about for85:02family members how do you tell how do85:05you know if your mom yeah I mean that’s85:09incredibly painful cuz I got to tell you85:10one thing I’ve seen in more than a few85:12family systems is some people who won’t85:14refuse to believe it like I refuse to85:16believe that we’re just being dramatic85:17and they’ll say they’re not a psychopath85:19and so you’ll have these families that85:20also be schism didn’t split like people85:23will say I think you’re exaggerating I85:24think that you know they’ll actually85:25Gaslight the person who’s making the85:27accusation so it can be very painful if85:30you come into the realization that one85:33or god forbid both of your parents is a85:35psychopath that’s a very painful85:38revelation but I gotta tell you you85:39probably figured that out as a child85:41psychopathic parents tend to be abusive85:43neglectful manipulative one of the more85:48famous Psychopaths out there85:50is Bernie Madoff mm-hmm okay he’s used85:52as a classical example of a psychopath85:55when you look and he was very wealthy85:58and he raised his children up with86:00tremendous comfort he certainly wasn’t86:02beating them with a stick or you know86:04locking them in the basement or86:05depriving them but there was a cruel86:08edge to him and his kids would86:10acknowledge that if you watch any86:11retelling of that story there’s well86:13it’s definitely not a comfortable86:14relationship86:15some people have high-functioning86:16psychopathic parents a dad who’s a CEO86:19or a mom who’s really really you know86:21successful at whatever it is she’s done86:24and they’ll report like having two86:27parents the public person and this86:29really cruel invalidating malevolent86:32horrible person that would come home and86:34they’d note the dichotomy how seamlessly86:37their parent would go between those two86:39worlds and so on and put through and put86:42their child through unrealistic kinds of86:44expectations so um people it’s not like86:47a person wakes up at 30 and says oh dad86:49was a psychopath you know you know is86:52there such thing as a self-aware86:55psychopath you know the funny thing86:58about Psychopaths is I don’t even think86:59they’d get mad if you call them87:00Psychopaths because they don’t care what87:02anybody thinks of them so if you go up87:04they’ll laugh it off you wouldn’t be87:06like even a narcissist to get super87:08defensive the Psychopaths like you want87:10to call me a psychopath call me a psycho87:12so that’s how they respond but do they87:13think hmm yeah I am a psychopath yeah I87:16know they’re not affected about by the87:18evaluations or labels placed on them by87:20other people what they don’t like87:22I know they’re not affected by it but do87:24they recognize that they are a87:26psychopath87:28maybe yeah maybe yeah they might in some87:31cases they might and if anything it’s87:33like there’s a there’s a sadistic glee87:36mmm-hmm you see what I’m saying like87:38it’s they may recognize it like how cool87:41that I got like how cool like I’m a87:42psychopath and I’m getting away with it87:44or I’m a psychopath and look how much87:46money I’m making or you know it’s almost87:47like if you I don’t know it’s like87:49finding a bag of money on the street87:50dropped by a armored truck and you’re87:53like no one’s around and I’m picking87:54this up and I’m walking down the street87:55and I’m getting away with this like87:57their whole life is about getting away87:58with stuff so if anything that bath88:01might even be like a badge of honor88:03but I don’t again I think they’re88:05impervious to the criticisms of other88:09people that’s where they’re different88:11than the narcissus the narcissus hates88:13being criticized right the Psychopaths88:15don’t mind yes88:17what are we talk what are we not talking88:20about when it comes to identifying a88:22psychopath that people need to know I88:24think that with a psychopath it is it is88:25really about looking for inconsistencies88:28inconsistency in mood inconsistency in88:31life history88:32inconsistency in their stories the88:34problem is we so want to believe when we88:36meet someone new that their stories are88:38real I’ve just met a supercool person88:41that we we make the puzzle pieces fit88:44even when they don’t I tell people be a88:47cynic when the dates don’t line up88:49recreate it listen Google’s making some88:51of this stuff possible – no I’m not I88:53mean it’s not like I want everyone to I88:54said go out there and play like junior88:57detective but if you’re being isolated88:59from anybody who knows anything about89:01this person pay attention to that you89:04know before you entirely by their their89:07recreation of the events look for things89:09that don’t add up they have this huge89:11job like they’re so successful but they89:13don’t have enough money to get through89:14the month but can you help me out this89:16month like next month the big payouts89:18gonna come come out I mean so I’ve got89:20everything covered from then on in you89:22know anything that feels like a hustle89:24is probably a hustle we are seeing that89:27there are certain there programs like89:28for example prison transition programs89:31and you know other programs working with89:34more like incarcerated antisocial89:38personality disordered groups that have89:41found some utility in some forms of89:43social skills training group therapies89:46some some luck with cognitive behavioral89:49therapies there has been some good work89:50there you know listen at the end of the89:52day it’s like you know the old joke of89:54how many psychologists does it take to89:56change a lightbulb one but needs to want89:58to change it’s the same thing with89:59antisocial personality disorder you know90:02the person has to need to want to change90:04and you know you may or may not have it90:06I have to be honest with you it’s more90:08of those slick glib charming almost if90:12you want to call them white-collar90:13Psychopaths that are you’re gonna get90:16absolutely90:17we’re there I mean I think there’s90:18absolutely no chance of change there I90:20think actually in the in the criminal90:22populations you may be able to do some90:25level of job training social skills90:28training meaning and purpose focus work90:30and I actually would put my bet on the90:32incarcerated population more than I90:33would on the sort of the slick you know90:36the slick sophisticated successful group90:39of psychopaths quite frankly because90:40there’s almost no motivation for change90:41they’re getting rewarded for their90:43behavior that’s right90:44they’re there in their world they’re90:46killing they’re killing it they’re90:47killing it and the world is telling them90:48they’re killing it90:49too right yeah so maybe cured is the90:52wrong word yeah could a and a person who90:57is psychopathic could they at least get90:59to a point where they’re not breaking91:02the rules I mean that’s obviously the91:04goal and that’s that’s the goal of you91:06know rehabilitation after prison and you91:08know that kind of thing is that there is91:10no recidivism and we try to avoid91:12recidivism is where we’re trying to91:14prevent a person from committing crimes91:16again but you know criminal behavior or91:19illegal behaviors just only one part of91:22what we see an antisocial personality91:23disorder we’re also seeing violation of91:25ethics or morality or social norms so91:29for example somebody who is antisocial91:31personality or psychopathy is very91:33likely to cheat on a romantic partner if91:35they have one they’re going to probably91:36keep doing that because it really are91:39they’re really almost immune to it any91:41sense of morality and so that’s not91:45going to change which can make it very91:46difficult to maintain any kind of91:48trusting relationship with somebody like91:51that so I think that some of the91:52treatment targets may be in terms of91:54illegal behavior they may be willing to91:56bring some of that hustle if you will to91:58a more legal behavior but even then92:00you’ll sort of see that their tendency92:02is going to want to take moral and92:04ethical shortcuts what does the92:06treatment actually look like for these92:08people you know a lot of it is again92:09it’s cognitive behavioral it’s it’s it’s92:11challenging their beliefs and changing92:14them their beliefs and thoughts and a92:16hope of changing their behavior that’s92:18really what you’re trying to do right92:19and so it’s that’s where you’re sort of92:23pushing back on their cognitions pushing92:24back on their schemas on their sense of92:27how the world works trying to enhance92:29their sense of empathy92:31you know to really help them focus on92:32this is how people are being hurt92:34especially if it’s a kind of it’s not92:36like person on person crime like violent92:38crime something that feels more remote92:40that to help them sort of see that this92:43is hurting somebody else and the people92:46around them now in a person who’s really92:49a cold stone-cold psychopath they don’t92:53care so I don’t care if I’m hurting92:55someone it doesn’t matter to me and so92:57if that’s the case what how are you93:00gonna make change there if I don’t think93:02something I’m doing is wrong like if93:03some if I’m somebody tells me tomorrow93:06like it’s wrong to turn off my bedroom93:08light when I sleep oh my gut yeah why is93:10that a problem93:11that is that’s a really good way to put93:13that that’s how far it is yeah what do93:17you mean I gotta make a hundred million93:18dollars yeah do it you know I’m gonna do93:20it and no one’s gonna stop me or it’s a93:23game again I’m gonna bring up the Bernie93:24Madoff case because he’s sort of like a93:26real textbook kind of a psychopathic93:29antisocial personality sort of person in93:31some ways it’s almost like it was93:33gamesmanship to him at some point how93:34much money does one person well it isn’t93:36that the price it’s got to the truth93:38yeah yeah that’s all it was and it felt93:40like that’s what it was despite93:42literally so many people’s lives being93:46destroyed by his decisions absolutely93:49didn’t even seem to it was the game was93:52more important than the other people and93:53that’s what it is like they are players93:55who really only care about the game so93:58someone’s watching this I doubt they’re94:00psychopathic no probably are in a94:02relationship with somebody is nobody who94:04are family members a family member or94:08work with them or work with them yeah94:10they are likely going to be advised to94:14go seek therapy for themselves in that94:16therapy session what do they ask the94:19therapist because what I want what I94:22want to have happen for them is that94:23they don’t have to go to five therapy94:26sessions to figure out what is a94:28psychopath and what all these things94:30that you’re educating them on and giving94:33them the tools to ask the therapist so94:35that maybe in the first session they can94:37make a ton94:38of a game it depends on the relationship94:41of the psychopath is this your child is94:43this your coworker94:45is this your husband you know because94:47obviously the nature of the relationship94:49it’s gonna have a lot of bearing on what94:52you need to know for example if it’s94:54your child the question a lot of parents94:56are gonna have is am I responsible for94:58this will we’ll go into the whole child95:01thing in our next video right so let’s95:03assume that this is for a loved one so95:06you mean like a part of romantic95:08romantic partner is it possible he can95:12change because he keeps telling me he95:14will we have kids together can I expect95:18that he’s going to be a decent co-parent95:21if we have kids should I be scared95:26you know I keep giving him second95:29chances but it never works out why not95:33you know is it possible he’ll change95:36those are the kinds of questions you’re95:37gonna you know that somebody should95:39probably ask and you know by and large95:41if that person has any expertise95:43whatsoever in psychopathy or antisocial95:44personality they’re going to be able to95:46give you some straight answers on that95:48like I said these people are not made95:50for long-term intimate relationships95:51they’re not and what if somebody’s a95:53what what if somebody’s in the position95:55where their partner makes all the money95:57they have nothing in common scenario and96:00they have five kids what and they come96:02to a therapist and they say you’re96:04telling me he’s not gonna change and96:06you’re telling me to leave be for all96:07these reasons there just won’t tell her96:09to leave I wouldn’t tell her okay then96:10but they’re saying this is gonna be96:12really tough and that person says I want96:16to stay in the relationship now what’s96:19your response to that then I’ll say look96:22at the history of what it’s been like so96:24far that’s how it’s going to keep being96:26okay he has not been listening to you96:29he’s not going to start he has been96:31cheating on you he’s going to continue96:33he’s been disrespecting you that’s gonna96:36keep going like everything you’re seeing96:37I said at least you already have the96:38roadmap expect nothing you expect96:42nothing do you help them with coping96:44strategies things like continuing if96:47they can continue96:48stay in therapy group therapy96:52I do ensure that people women in96:54particular who are relationships with96:55men who have antisocial personality96:57disorder or psychopathy have access to97:00domestic violence resources because97:02that’s not an uncommon pattern in these97:03relationships encourage them to97:06cultivate some of their own interests97:09encourage them to cultivate friendships97:11and their partner will probably try to97:14isolate them from those friendships but97:15create you know even if it’s online97:17communities you know and I do want to97:20tell med circle listeners the guidance97:23we’re giving right now is not meant to97:26be to serve a person who is in a violent97:31relationship if you are in a97:33relationship where you or other children97:37or other dependent adults in your97:39environment are in danger you must seek97:42help immediately you must seek domestic97:46violence services law enforcement and97:49keep in mind if you’re researching those97:51resources online on a computer make sure97:53you clear out your cache every time97:55because it’s not unusual in those97:57relationships for a partner to go97:59through and search everything you’ve98:01searched it’s that level of control so I98:03mean I do want listeners to understand98:06that what we’re talking about it’s98:08situations where it has not escalated to98:10violence financial abuse things that are98:13putting you at abject risk that this98:15this is not a substitute for the98:17guidance somebody needs in that kind of98:19a situation and it can go there and in98:21with Psychopaths not uncommon is98:23creating an exit strategy for the98:25relationship every part of it is a part98:27of it now unfortunately this is where98:29you start exactly getting sometimes into98:31the world of restraining orders and98:32really painful custody hearings if the98:35antisocial personality pattern has more98:37financial resources in you they may try