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Sertraline withdrawal can occur when someone abruptly stops taking their antidepressant medication. It can lead to flu-like symptoms, irritability, nausea, imbalance, strange skin sensations, headache, and insomnia. Such symptoms are common and affect more than half of people who take antidepressants, so talk to your doctor before changing or stopping your medication.

What to Know About Sertraline Withdrawal

Sertraline withdrawal symptoms may persist for anywhere from a few days to a few weeks after your last dose. For most people, sertraline withdrawal begins within three to four days of their last dose. The duration of SSRI withdrawal can vary, but you can expect it to last anywhere from a few days to a few weeks; however, sometimes it can last much longer.

Sertraline (Zoloft) is a commonly prescribed antidepressant. It is part of a class of drugs known as selective serotonin-reuptake inhibitors (SSRIs). It is used to treat:

It is also used to treat severe premenstrual symptoms caused by premenstrual dysphoric disorder (PMDD) and obsessive-compulsive disorder (OCD).

More than half (56%) of people quitting antidepressants experience withdrawal symptoms. The experience is different for everyone. Some people experience mild symptoms, while others have symptoms severe enough to interfere with daily life.

Why Sertraline Withdrawal Happens

Sertraline works by preventing the reabsorption (reuptake) of serotonin, thereby increasing the serotonin available in the brain. Serotonin is a neurotransmitter that plays an essential role in mood and emotions.

When you stop or reduce your dose of sertraline, these serotonin levels will drop, eventually reaching pretreatment levels. Withdrawal symptoms happen as your mind and body adapt to this change.

Sertraline has a relatively short half-life compared to other SSRIs—about one day. This means that within a few days, you will have very little sertraline in your bloodstream.

It’s important to know that discontinuing your antidepressants may lead to a relapse of your original symptoms and even to the emergence of suicidal thoughts.

What It Feels Like

The most common symptoms that develop during sertraline withdrawal include:

• Flu-like symptoms
• Insomnia
• Nausea
• Imbalance
• Sensory disturbances
• Anxiety or agitation

While these may be the most common symptoms, SSRI withdrawal affects many of the body’s systems. The full range of potential withdrawal symptoms includes:

• Digestive: Nausea, vomiting, cramps, diarrhea, or appetite loss
• Balance: Dizziness or lightheadedness, sometimes making it difficult to walk
• Sleep problems: Nightmares, unusual dreams, excessive/vivid dreams, or insomnia
• Overall: Flu-like symptoms, including headache, muscle pain, weakness, and tiredness.
• Mood: Anxiety, agitation, panic, suicidal ideation, depression, irritability, anger, mania, or mood swings
• Bizarre sensations: Brain zaps (like an electrical shock or shiver in your brain), pins and needles, ringing in the ears, strange tastes, or hypersensitivity to sound
• Heat intolerance: Excessive sweating, flushing, or an intolerance to high temperatures
• Motor control: Tremors, muscle tension, restless legs, unsteady gait, or difficulty controlling speech and chewing movements 

Withdrawal symptoms vary from person to person. Some people have no symptoms at all, whereas others have symptoms severe enough to interfere with their responsibilities at home, work, or school.

If you do have severe withdrawal symptoms, it does not mean that you are addicted to sertraline. Addiction is characterized by the pattern of the use of substances in the face of adverse consequences. Withdrawal can happen to anyone taking sertraline for a few months or longer.

To get a better idea of the range of symptoms and symptom severity, you may want to check out the Discontinuation-Emergent Signs and Symptoms Scale (DESS), which is sometimes used by clinicians to measure the severity of SSRI withdrawal symptoms.

Tapering Off Sertraline

One method that people use to quit SSRIs is a medication taper. This means gradually reducing your dose over the course of several weeks or months.

Your doctor may:

• Switch you to a different antidepressant: Some doctors prefer to switch their patients to a longer-acting SSRI before beginning a taper. Because sertraline has such a short half-life, the amount of drug in your system can drop off quickly. Switching to a longer-acting SSRI, like Prozac, may help you avoid these peaks and valleys.
• Taper your dose over a long period: In the past, doctors weren’t sure whether tapering SSRIs was an effective treatment for withdrawal. However, new research suggests that a slow taper over several months may be more effective than traditional tapering schedules.
• Taper until your dose is below therapeutic levels: The researchers recommend continuing the taper until your dose is nearly zero, well past therapeutic levels. This means that by the end of the taper, you may be breaking pills into tiny pieces or switching to a liquid dose.

How to Feel Better If You Experience Withdrawal

If you are still experiencing withdrawal symptoms, these remedies may help.

• Psychotherapy: Psychotherapy can improve mood, reduce anxiety, and help you better cope with your symptoms.
• OTC medications: You can treat aches and flu-like symptoms with over-the-counter pain relievers and anti-nausea medications.
• Natural remedies: Vitamins, minerals, and herbal supplements may be helpful. However, you should always review all of these with your doctor before taking any natural supplements or home remedies.

Lifestyle Changes

There are also steps you can take that might decrease your withdrawal symptoms, or at least make them easier to manage. These include:

• Exercise. Getting at least 45 minutes of moderate activity three times a week can improve mood and reduce stress.
• Sleep. Make sure that you are getting adequate rest each night. Focus on going to bed and waking up at the same time each day.
• Eat well. Eat nutritious meals on a regular schedule, and stay hydrated. Try to avoid foods that may increase your anxiety, such as caffeinated beverages.

Social Support

One of the most important factors in SSRI withdrawal management is the presence of a social support system. Having people around who can help and support you through a difficult time can reduce stress and anxiety, both of which can make withdrawal symptoms even worse.

When your friends and family understand that you are in withdrawal, they will be more forgiving of irritability and mood swings. By preventing interpersonal conflict at home, you will avoid some of the negative social effects of withdrawal.

Important Warnings and Safety Notes

Sertraline, like other SSRIs, comes with a warning from the FDA about the potential for an increase in suicidal ideation and behaviors in children and young adults, particularly when medication is initiated or dosages are changed.

Recognizing the signs of suicidal ideation in yourself or someone else can help save your life or the life of a loved one. Call for help right away if you or a loved one shows any of the following symptoms:

• Planning how you would commit suicide if you were going to do it
• Talking or thinking about suicide more than normal, for example, “I wish I were dead”
• Gathering the means to commit suicide, such as bullets or pills
• Feeling hopeless or trapped
• Having intense mood swings
• Engaging in risky or self-destructive activities, such as driving drunk
• Becoming preoccupied with death, dying, or violence
• Getting affairs in order or giving away belongings
• Saying goodbye to people as if it were the last time

If you are pregnant or planning to become pregnant, talk to your obstetrician/gynecologist or psychiatrist about the risks and benefits of continuing and discontinuing sertraline. There is a small risk of giving birth too early if you take antidepressants during your second and third trimesters. On the other hand, if you do discontinue sertraline while you’re pregnant, you are more likely to relapse.

Managing Mental Health in the Long Term

You may require additional treatment after the withdrawal period has ended. If you are still experiencing mental illness such as depression or anxiety, you may require continued care.

Some people stay on antidepressants indefinitely to prevent such an outcome, whereas others choose different modalities of treatment, such as psychotherapy. Researchers have found that psychotherapy reduces the risk of relapse in people discontinuing antidepressants.

Where to Get More Support

• Call a hotline: The National Suicide Prevention Lifeline will connect you with staff or volunteers at a crisis center near you. The people on the other end of the line can help you calm down and figure out what to do next. It is available 24/7, 365 days per year.
• Try a chatline: If you are hesitant to call, you may prefer to chat with a counselor. The chat services are also open 24/7.
• Contact a local provider: If you have health insurance, you can also search the company’s list of local providers who accept your insurance. Most insurance companies have at least some mental health coverage, including state and federal plans.

Sertraline withdrawal symptoms are real, and discontinuing this medicine is a real challenge for lots of people. Don’t hesitate to talk to your doctor or other members of your support system about the way it’s affecting your life. And remember: Withdrawal symptoms are only temporary.

Phrases to express gratitude can range from a simple “thank you” to something more profound that explains just how much you appreciate someone. Kindness is important for relationships and mental health. Telling someone you are grateful for them is a way to show your love and feel closer to others.

Why Expressing Gratitude Is So Important

Acts of kindness are needed now more than ever. And they’re good for you, too: Studies show that expressing kindness releases powerful hormones, such as endorphins and oxytocin.

Whether they are random moments of courtesy that pay respect to the ways we are all interconnected or well-thought-out acts of love to those dearest to us, sometimes a simple “thank you” just isn’t enough.

As a therapist, I am in the business of connection. In the therapy room, we work tirelessly to get past the layers of symptoms and accumulated wounds. What we eventually arrive at is the core part of us that needs to give and receive love, that longs to belong and be part of something greater than ourselves.

Ways to Say ‘Thank You’

The 40 following phrases aren’t just sweet sign-offs to use in the body of emails or at the end of birthday cards. They’re words you can say aloud as needed or spontaneously send in a text to convey the depths of your gratitude for those who mean the most to you.

1. This means a lot.

Though simple, it is precise. Letting someone know their actions hold weight for you can be moving in of itself. 

2. I can’t express my gratitude enough.

I can think of dozens of times when there haven’t been words to explain how deeply someone’s actions have moved me. When words fail to do us justice, simply stating that can speak volumes.

3. This makes me feel…

You fill in the rest! ‘Thank you’ is a courtesy, telling someone how you feel is a gift.

4. This reminds me of …

Similar to the previous phrase, you’ll fill in the rest with what the act of kindness reminds you of. It could be a childhood memory, a movie you once saw, or a dream. Whatever it is, letting someone know that their actions have pleasantly jogged your memory can be moving.

5. Your support means more than you know.

Support is often the buoy that keeps us afloat. Unfortunately, the people offering support may not even know how important their actions are to you. So don’t be afraid to let them know.

6. I feel honored.

Receiving care is an honor. Express that to them.

7. I can’t wait to return the favor.

I like to consider gratitude as part of the dance of relationships. You receive, you give, you continue the tango of connection. 

8. I’m not sure how to say thank you enough.

It can be hard to find the words to say thank you. Saying that alone can speak volumes.

9. I’m grateful for you.

Let them know how grateful you are for them – it conveys the meaning they hold in your life.

10. I will always remember this.

Some things people can live in our minds as core memories. Nothing is a higher compliment than to be told that your act of kindness will resonate with someone forever.

11. I am not sure I’ll ever be able to repay you.

There are some things we can never repay someone for. The greatest gift we can offer in return is letting them know that. 

12. I’ll never forget this.

Similar to “I’ll always remember this,” this phrase can stick with others the same way their actions did for you.

13. Sending warmth your way.

Admittedly, this is how I sign off my emails. But it is also the truth. In expressing my gratitude for someone reaching out, I do send warm, good, connective feelings their way.

14. I receive this with warmth and care.

How we receive an act of kindness can show our gratitude. Let them know you receive it with warm feelings and care for them.

15. I appreciate your help.

Appreciation is an important thing to convey. Let them know that you appreciate their actions.

16. You always have my back.

For those you feel truly have your best interests in mind, make sure they know it doesn’t go unnoticed.

17. I haven’t experienced something like this before. 

There can be things people do that are so gracious, it is unlike anything we’ve ever experienced. Don’t be afraid to say that.

18. You are the best.

If someone has done something that you feel is otherworldly, letting them know they are the best conveys the place they hold in your life.

19. This moment will stick out to me forever.

Letting someone know they have given you the gift of a moment that will stick with you forever holds far more value than a thank you gift. 

20. All my gratitude.

Easy, brief, and honest. What more could you need to say?

21. How can I ever repay you?

If someone has gone above and beyond, it is thoughtful to ask them if there’s anything you can do in return. After all, acts of service may be a love language for them.

22. Please let me know what I can do for you.

Similar to the previous phrase, this one is direct. It isn’t a question, it is a statement, a declaration that you will offer the same care they gifted you.

23. You are very generous.

While many give selflessly, it is safe to say most of us hope to hear an acknowledgment in return.

24. Your generosity doesn’t go unnoticed.

Hearing your generosity is noticed and appreciated can feel good, even if you didn’t think what you were doing was generous.

25. I’m so moved by this gesture.

Sometimes, people do things without realizing it is a kind gesture. Acknowledge that—it lets them see how their actions are being viewed.

26. I’m wishing you all good things.

Dedicating a hope and a dream to someone is a sweet and understated way to express your gratitude.

27. I appreciate you.

You might want to tell someone you appreciate their help, like I suggested above, or you appreciate a certain thing they did for you. However, simply saying you appreciate them is a generous offering of care.

28. You mean a lot to me.

How often do we hear someone tell us we mean a lot to them? Probably not enough.

29. You’ve changed my life.

There is no higher expression of gratitude and no greater honor than hearing you’ve changed someone’s life. Use this one sparingly, when you truly mean it.

30. You truly understand me.

A core human desire is to understand and be understood. When you feel that someone gets you, tell them that.

31. Let’s spend quality time together.

Consider this one a thank-you gift. Quality time together trumps physical gifts any day.

32. I admire how you care for me. 

Sometimes, we are lucky enough to have someone care for us in a way that we find admirable. Don’t hesitate to let them know that.

33. I feel seen by you.

Feeling truly seen by someone isn’t something everyone can offer. Let them know how connected you feel to them.

34. How can I support you?

Offering someone support in exchange for something kind they did for you is an incredible gift to give.

35. I’ve been thinking about what you did for me.

Sometimes we are quick to thank someone and don’t voice how their actions have stayed with us. This phrase lets someone know they’re still on your mind.

36. Your actions have changed me for the best.

What a compliment it is to hear someone feels you’ve helped shape them as a human being. 

37. You have given me such a gift.

This phrase is excellent for experiences of love, kindness, and care that don’t necessarily feel pointed. It allows someone to see how much they do for you.

38. This is such an example of how caring you are. 

Let someone know that you see how caring they are and their actions are yet another example of it.

39. You are so attentive.

Undivided attention can feel rare these days, so acknowledging when someone is attentive can be moving.

40. I see you. 

At the end of it all, we want to know someone notices, understands, and sees us. The simplest way to say it may be the best.

Signs of narcissism are often hard to spot in the beginning stages of a relationship, but over time, these signs can be seen more clearly. A narcissistic marriage is where one partner constantly prioritizes their own needs, lacks empathy, and uses manipulation and control to get what they want. Understanding these patterns can help you recognize when the relationship has become harmful.

How Narcissism Affects Marriage

The “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5) defines narcissism as a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy. At least five of these criteria must be present:

• A grandiose sense of self-importance
• A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
• A need for excessive admiration; craving narcissistic supply
• A sense of entitlement
• Interpersonally exploitive behavior
• A lack of empathy
• Envy of others or a belief that others are envious of him or her
• A demonstration of arrogant and haughty behaviors or attitudes

These traits can have a profound impact on marriages and relationships. They often lead to one-sided, unbalanced relationships where one person is always giving and the other is always taking. The narcissistic partner may have problems with empathy, compromise, and accountability. That makes it hard to trust them and leaves the other person feeling neglected, confused, and emotionally exhausted.

How to Tell If You’re in a Narcissistic Marriage

Let’s take a look at some behaviors that someone with narcissistic personality disorder (NPD) may present. While many of the following behaviors can be indicative of narcissistic personality disorder, only a mental health professional can provide an accurate diagnosis.

1. You Don’t Feel Connected

• Your partner talks with you when it is convenient for them. However, they have never actually asked what your plans are for the future or how you can work together to build the life you want.
• They constantly brag about themselves and their accomplishments and rarely show interest or ask questions about anything going on in your life.
• Their happiness comes from external sources such as prestige at work and money. You wonder if they are even capable of feeling romantic love or emotional connection.

2. You Feel Manipulated

• Your partner will make subtle threats throughout the relationship. They may not be direct with their words, but you’ll get a sense that if you don’t do something for them or give in to what they want, bad things will happen.
• Sometimes, it’s easier just to go along with what they want, even if you don’t really agree with it. This is a way of controlling and manipulating their partners to get what they want.
• Often, people in this kind of relationship forget what life was like before the manipulation started.

3. You Don’t Feel Good Enough

• You feel inadequate despite what you’ve accomplished in your life.
• Your partner tends to put you down or make negative comments about what you do.
• You’ve lost touch with the things that you used to enjoy doing because you don’t have time for them anymore.
• Maybe you’re always tired, and it isn’t easy to get out of bed in the morning.
• You’ve begun hiding things from family or friends or feel ashamed about what goes on in your life.
• You lie to cover up the things that your partner does or does not do.

4. You’re Constantly Being Gaslighted

When someone constantly denies things that you know to be true, they are gaslighting you. This is often seen in abusive or controlling relationships and is a common tactic among narcissists.

For example:

• They deny what happened: Your spouse may comment, “You just don’t remember right,” about something that you know happened. They will gaslight you into believing that certain things never happened or that they did things because of something you did or said first.
• They lie to make themselves look better: Your partner may tell lies about your behavior and twist reality to fit their version of events rather than what really happened. You might begin second-guessing yourself and feel like you’re going crazy.

If they do this in front of family members and friends, those people may start to think the problem lies with you rather than with your partner. It can be difficult for others to realize what happens behind closed doors because your partner appears so charming on the surface.

5. You Avoid Conversations

• It may seem as though every conversation with your partner ends in an argument, no matter how hard you try to stay calm and not get upset by what they say or do.
• The narcissist constantly tries to push your buttons to get you to react; controlling others’ emotions gives them a sense of satisfaction.
• Often, it’s easier to avoid having a conversation entirely than to deal with the constant mind games.

6. You Feel Responsible for Everything

Narcissists think that everything is always someone else’s fault, including the things that they do wrong.

• You won’t get an apology from a narcissistic person. Narcissists don’t see other people as being on equal footing with them, so it makes sense why apologizing would be out of the question.
• Your narcissistic partner likely never takes responsibility for their actions and always blames you.
• If something goes wrong, it is your fault, even if they’re to blame.

7. You’re Walking on Eggshells

Do you feel as though you’re walking on eggshells because you never know when your partner is going to explode or be in one of their moods?

Typically, it goes like this:

• Everything seems fine, but then something minor happens and they go into a rage.
• Even a small thing like someone at work being recognized for an accomplishment while your partner feels overlooked can cause a narcissist to throw a fit. This is known as narcissistic rage.

You probably feel like you’ve lost yourself because now all of your decisions are based on what will keep your narcissistic partner happy.

8. You See Through the Charm

On the surface, your partner is charming, confident, and accomplished. However, they seem this way only because they are so skillful at hiding their true colors when in public.

They say all the right things, and people love them, but the second that you’re alone with your partner, everything changes. The switch flips, and suddenly you’re dealing with a completely different person than the one everyone else sees on the outside.

9. You Feel Criticized Constantly

• Your partner is excessively critical of your appearance. They might make comments about your weight, clothes, or choice of hairstyle.
• They make fun of you or put you down; this might happen behind your back and/or to your face.
• They make fun of others, especially people they perceive as lesser than them (i.e., someone they deem as less attractive or wealthy).
• In general, they are highly critical of everyone.

10. Your Needs Are Ignored

Your partner thinks only about their own needs and how things affect them, not you or anyone else—including the kids if you have a family. They will do only things that benefit themselves, not you or your relationship together.

For example, your partner might:

• Want to have sex when they want it, but not so much when you want it
• Expect you to pick up after them
• Take credit for your hard work
• Get upset when others treat their family better than yours
• Favor certain children over others in the family if they feel one child makes them look better

11. Your Family Is Warning You (or Is Oblivious)

Your family has told you that they don’t like how your partner treats you. Or, your family is oblivious that anything is wrong because your partner has been feeding them lies about you. Either way, your partner is a point of contention when it comes to family relations.

12. You’ve Been Cheated On

A narcissist is often a master flirt and might be cheating on you.

• They are very charming and know how to sweep people off their feet.
• You may find yourself constantly questioning if your partner is being faithful because of their flirting.
• They might have cheated multiple times, so nothing will stop them from doing it again.

13. You Feel Unloved

When you first got together, you felt like the most amazing person in the world. However, as time went on and problems arose, your partner began to devalue and ignore you. This is a red flag that they’re not who they made themselves out to be in the first place.

You likely were receiving love bombs in the beginning to get you hooked, but once you were married, those love bombs went away.

14. You Get the Silent Treatment

• Your partner uses the silent treatment as a power play to control you.
• They’ll withhold affection and ignore your existence until they feel like being nice again.
• They are only affectionate or attentive when it will benefit them in some way (like getting what they want).

You might think that this behavior is normal or even “expected” of people who are married. However, the truth is that the silent treatment isn’t part of a healthy, loving, and respectful relationship.

15. You’re Stuck Financially

If there’s one thing that narcissists know how to do well, it’s to take advantage of their spouses financially. You might be paying for everything while your partner can’t hold down a job, or their job might be bringing in a lot of income but they’re not letting you see any of it.

If this is the case, chances are that your partner has been spending every last cent on themselves and isn’t planning to share with you now or in the future.

16. You Can’t Rely on Your Partner

When they make promises, you never know if they’re going to keep them. Narcissists are notorious for making promises and then breaking them when it’s convenient. You don’t feel as though you have a partner you can rely on, and you find yourself having to do everything yourself.

17. You’ve Asked, They Won’t Change

Narcissists aren’t willing to change because this would mean admitting something is wrong within themselves—and narcissists never admit such things. On the other hand, some will proudly admit that they are narcissists, but claim that everyone else is the problem.

What to Do If You’re in a Relationship With a Narcissist

Being in a relationship with a narcissist can have significant, long-lasting effects on your mental health. If your partner is emotionally abusive and unwilling to change their behavior, it’s time for you to reconsider the relationship. And if you decide to leave it, have a support system in place beforehand—people you trust enough to confide in. This might be your friends, family, or therapist, for example.

If you continue your relationship with the narcissist:

• Seek therapy or outside support.
• Create and maintain boundaries.
• Keep records of conversations, events, etc., to ward off gaslighting.
• Try to remain calm and assertive.
• At work, resist gossip, even though you might need to vent.
• Learn all you can about narcissism so you can recognize their tactics and manipulation.

The biggest difference between a sociopath vs. a psychopath is that sociopaths tend to be impulsive and reactive, while psychopaths are cold and calculating. For example, a psychopath might be a careful planner and charming manipulator, while a sociopath tends to act more aggressively and erratically in the heat of the moment. Psychopathy is linked to genetic causes and results in a lack of empathy, while sociopathy is more influenced by environmental causes, including traumatic experiences.

Key Differences Between a Sociopath and a Psychopath

Sociopaths have a limited, albeit weak, ability to feel empathy and remorse. They’re also more likely to fly off the handle and react violently when confronted by the consequences of their actions. Psychopaths are classified as people with little or no conscience, but can follow social conventions when it suits their needs.

While psychopaths have problems processing emotional experiences, research has shown that they are affected by social exclusion and loneliness. Being rejected socially is perceived as stressful, sometimes resulting in selfish and aggressive behavior. Most have led hurt-filled lives and have an inability to trust people, but like every human being on the planet, they, too, want to be loved and accepted.

However, their own behavior makes this extremely difficult, if not impossible, and most are aware of this. Some feel saddened by the actions they are unable to control because they know it isolates them from others even more.

What the Terms Mean

Although sociopath and psychopath are often used interchangeably and may overlap, each has its own clear lines of distinction. For example, sociopathy is the unofficial term for antisocial personality disorder (ASPD), while psychopathy is not an official diagnosis and is not considered an ASPD.

“Sociopaths are generally more clearly aligned with symptoms of ASPD, but psychopathy can cross over to these characteristics as well,” says Hannah Owens, LMSW. “Labeling someone as a sociopath or a psychopath is a big deal – but not distinguishing between the two, and using them interchangeably, doesn’t do either of you much good.”

Sociopath is a term people use, often arbitrarily, to describe someone who is apparently without conscience and is hateful or hate-worthy. The term psychopath is used to convey a sociopath who is simply more dangerous, like a mass murderer.

Approach to Violence

While it’s common to think of sociopaths and psychopaths as being inherently dangerous, this is more a construct of a TV drama than a true reflection of the disorder. Violence, while certainly possible, is not an inherent characteristic of either sociopathy or psychopathy.

With that being said, people with ASPD will often go to extraordinary lengths to manipulate others, whether it be to charm, disarm, or frighten them, in order to get what they want. When psychopaths do become violent, as in the case of someone like Jeffrey Dahmer, they’re just as likely to hurt themselves as others.

Where These Traits Come From

Some say that “sociopaths are made, and psychopaths are born,” but this characterization may be too broad. Although psychopathy is indeed believed to have genetic components (perhaps caused by the underdevelopment of the parts of the brain that regulate emotion and impulsiveness), there are clearly other factors that contribute to the behavioral disorder.

Research suggests that psychopaths often experience:

• Childhood maltreatment, including neglect and physical abuse
• Exposure to violence in their home and community during childhood
• A history of trauma

While genetics plays a clear role in psychopathy, research also shows that social and environmental factors can disrupt a child’s emotional development and increase the likelihood of psychopathic traits.

Sociopathy also tends to be associated with harmful childhood experiences, including:

This differentiation may suggest that nature plays more of a role in the creation of a psychopath than a sociopath. This is supported by research showing that traits associated with sociopathy tend to decline as a person ages. These traits tend to peak in young adulthood (3.91%) and drop significantly by age 65 (0.78%).

Signs of Sociopathy and Psychopathy

As a reminder, sociopath and psychopath are not clinical diagnoses in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR). The DSM does, however, classify ASPD by a range of personality and behavioral traits that describe how a person functions, how they relate to others, and how those beliefs express themselves through actions.

Self-Functioning Characteristics

Self-functioning characteristics are those that reflect a person’s nature and how they view their actions or goals. To be diagnosed with ASPD, you must exhibit all of the following characteristics:

• Attaining self-esteem from power, personal gain, or pleasure
• Egocentricity or self-centeredness
• Setting goals based on personal gratification with little regard to law or ethics

Interpersonal Characteristics

Interpersonal characteristics are those that describe how a person interacts with others in general. You must also exhibit these traits to be diagnosed with ASPD:

• A lack of empathy for other people’s suffering or hurt or when confronted with the hurt or anger of people they have manipulated
• The inability to have a truly mutually emotionally intimate relationship because of the instinct to control (by dominance or intimidation), coerce, or deceive

Behavioral Characteristics

Behavioral characteristics complete the clinical diagnosis by describing the route a person will take to either control, coerce, or deceive, such as:

• A strong tendency to disregard commitments, promises, and agreements, including financial ones
• Difficulty in making plans, preferring to believe you’re able to nimbly navigate problems as they appear
• It is not uncommon for someone with ASPD to be in repeated fights or assaults.
• Lying as a means to gain social entry or advantage, such as proclaiming yourself a decorated war hero when you have never served
• Making decisions on the spur of the moment with little regard to consequence if an immediate goal is to be achieved
• Persistent anger or irritability, even over small things, as well as mean, spiteful behavior
• Reacting with callousness, aggression, remorselessness, or even sadism when confronted by the fallout of your actions
• Risk-taking, becoming easily bored, and an ability to ignore personal boundaries and justify even the most outrageous of actions
• The emotional manipulation of others—for example, pretending to be interested in someone simply to achieve a goal

Can Sociopaths and Psychopaths Be Treated?

ASPD has no cure or first-line recommended treatment. Instead, therapeutic strategies often focus on problematic behavior, coping skills, and comorbidities such as substance use disorders. Typical approaches include:

• Talk therapy (individual and group): Helps people recognize harmful behavior patterns, explore emotions, and learn healthier relationship and coping skills
• Cognitive behavioral therapy (CBT): Helps people identify distorted thoughts and replace them with healthier responses
• Mentalization-based therapy (MBT): Helps people improve their emotional understanding to reduce the risk of impulsive or aggressive reactions
• Democratic therapeutic community (DTC): A type of group treatment that can foster greater accountability, social learning, and behavior change
• Impulsive lifestyle counseling: Helps people learn to recognize triggers and teach safe, prosocial choices to help reduce risky, impulsive behaviors
• Medications: Antidepressants, antipsychotics, and mood stabilizers can help reduce symptoms such as aggression, mood instability, irritability, and other symptoms of co-occurring mental disorders

How They Differ From Narcissists

Despite common usage and some overlap of features, not all people with narcissism are sociopaths/psychopaths, and not all sociopaths/psychopaths are narcissists.

Sociopathy falls under the classification of antisocial personality disorders, which are marked by “a pervasive pattern of disregard for, and violation of, the rights of others.” In contrast, narcissism is a distinct personality disorder.

However, DSM-5 classifies both antisocial and narcissistic personality disorders as cluster B personality disorders, a category that also comprises borderline and histrionic personality disorders.

In practical application to daily life, the main differences lie in the person’s intent. People with narcissistic personality disorder (NPD) are:

• Self-serving
• They exaggerate their self-importance
• Crave constant praise
• Go to great lengths to feed their ego
• Are exceedingly concerned with image

For these reasons, narcissists often appear to be successful and high-functioning. Unlike sociopaths, some narcissists are capable of empathy and remorse. People whom the narcissist hurts are merely unintended casualties on the way to a desired result.

On the other hand, sociopaths intend to harm others and often derive pleasure in the act. They aren’t concerned with what others think of them; they lack the narcissist’s preoccupation with image, which frequently translates to an inability to hold a job and maintain relationships.

If Someone You Know Has ASPD

If a friend or loved one shows signs of antisocial personality disorder, it can be challenging for them to get the help they may need. In many cases, they may not accept or acknowledge that there is even an issue with their behavior. At a certain point, you may have to decide if the relationship is worth preserving. Some tips that can help:

• Set clear boundaries and communicate them clearly.
• Stick to your limits when the person tries to test them.
• Protect your personal time, energy, and resources.
• Encourage them to get personal help, but understand they may refuse or drop out of treatment.
• Get support from friends, family, or a mental health professional.
• Watch for signs of physical, emotional, or financial abuse and seek help immediately if your safety becomes an issue.
• Prioritize your own well-being.

Letting someone go may be one of the hardest things you’ll ever have to do, but ultimately it may be for the best. As always, it’s most important to take care of yourself and your needs, and surround yourself with people who enrich your life, support you, and appreciate your support of them.