Since Prichard, in 1835, first described this condition under the term immoral insanity, there have been many attempts to give it a more precise definition and to avoid using it as a psychiatric wastebasket. At the turn of the century, Koch introduced the term psychopathic inferiority, implying that it was a constitutionally determined deviation in personality. Later the term psychopathic personality came into common use. In the past, many authors used this last term indiscriminately to embrace all forms of deviant personality. Subsequently, the term came to be used in a more restricted sense to define a subgroup of antisocial or aggressive psychopaths (antisocial personality disorder in DSM-IV). Aubrey Lewis has given a lucid account of the history of the concept of sociopathy. By far the best modern study of sociopathy is that of L.N. Robins, based on a 30-year followup study of 524 cases from a child guidance clinic and 100 controls. Other investigations of note are those of Cleckley, of McCord and McCord, and of Guze and coworkers, who studied psychiatric illness in large numbers of felons and their first-degree relatives. More recently, the descriptor, “callous youth” has become part of the syndrome. The following material and the preceding quotation are taken largely from these writings and from those of Reid.
This condition, unlike the majority of psychiatric disorders, is manifest by the age of 12 to 15 years, and frequently earlier. The manifestations of sociopathic behavior in children and adults are 5 to 10 times more frequent in males than they are in females. It consists essentially of deviant behavior in which individuals seem driven to cause difficulty in everything they do or behave in a way that most societies identify as grossly criminal. Codes imposed by family, school, religion, and society are broken. Seemingly, the sociopath acts on impulse, but after committing the unsocial act, he shows no remorse. The most frequent antisocial activities are theft, truancy, running away, associating with undesirable characters, indiscriminate sexual relations, repeated fighting, recklessness and impulsivity, lying without cause, vandalism, abuse of drugs and alcohol, and, later, inability to work steadily or keep a job. Criminality is intimately associated. Fire setting and cruelty to animals are particularly associated with future sociopathy according to several authors (the “callous youth” alluded to above). In the study by Robins et al, of children or adolescents who exhibited 10 or more antisocial symptoms, 43 percent were categorized as sociopaths in adulthood. If only 8 or 9 of these traits were present, 29 percent were so grouped; if 6 or 7, 25 percent; and 3 to 5, 15 percent. Conversely, not a single adult sociopath was observed who did not manifest antisocial symptoms in earlier life. Interestingly, a number of other problems of childhood and adolescence—such as enuresis, dirty appearance, sleepwalking, irritability, nail biting, oversensitivity, poor eating habits, nervousness, being withdrawn or seclusive, unhappiness, tics, and fears—were not predictive of adult sociopathy. None of Robins’ patients was mentally retarded.
At the same time, it should be noted that more than half the disturbed children in Robins’ study (even those with 10 or more antisocial manifestations) had lost most of their sociopathic traits by adulthood. This does not mean that they remained psychiatrically normal. Of those who did not become adult sociopaths, the large majority developed other adult psychiatric illnesses, particularly addiction to alcohol. Only in the group of children with fewer than 3 antisocial symptoms did a reasonable number (one-third) remain entirely well from a psychiatric point of view in adult life. Because sociopathic behavior in children may terminate spontaneously or evolve into other disorders, it is advised that the diagnosis of antisocial personality disorder be reserved for adults; the same behavior pattern in children is designated as conduct disorder.