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Did 'Dexter' Get Sociopaths, Psychopaths And Antisocial Personality Disorder Wrong?

The new season of "Dexter," and its titular sociopath, is back. But psychiatry's understanding of that term has changed.

Dexter Still Showtime

When viewers last saw television's most beloved sociopathic serial killer, Dexter Morgan, back in 2013, it was after he faked his own death on a boat during a hurricane.

And while a lot has changed since then, Dexter is still struggling with his "Dark Passenger" – his name for his sociopathic tendencies – in the new limited series streaming now on Showtime, "Dexter: New Blood."

Since the beginning of show's final season in 2013, however, the American Psychiatric Association (APA) updated its "Diagnostic and Statistical Manual of Mental Disorders" in a fifth edition (DSM-V). And, if you tried to read it, you wouldn't find either sociopathy — or, for that matter, psychopathy — defined as a disorder. The field of psychiatry, which is ever-evolving, doesn't recognize either as a distinct psychiatric disorder, despite the diagnoses' persistent, ongoing use by laypeople. Instead, they recognize a larger category called antisocial personality disorder (ASPD).

And, in fact, the DSM-IV, released in 1994, didn't recognize either sociopathy or psychopathy, either, referring to people with the traits we might recognize as "sociopathy" or "psychopathy" as ASPD as well.

In order to diagnose someone with ASPD, the subject must be 18 years or older, the onset of their symptoms must begin at age 15 or older and persist for years, and their anti-social behavior cannot be limited to schizophrenic or bipolar disorders. (Prior to age 18, similar symptoms would be diagnosed as a conduct disorder.)

A psychiatric diagnosis of ASPD would be made on the basis of "A pervasive pattern of disregard for and violation of the rights of others ... as indicated by three (or more) of the following: failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest; deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit; impulsivity or failure to plan; irritability and aggressiveness, often with physical fights or assaults; reckless disregard for the safety of self or others; consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations; lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person."

The term ASPD came out of the psychiatric community's understanding of sociopathy, which was included in earlier DSMs; the term psychopathy comes, instead, from criminology and the narrow field of criminal psychology. (This could, at least in terms of the internal logic of the show "Dexter," explain why the protagonist's father, a cop, "diagnosed" him as a sociopath at a young age.)

The exclusion of sociopathy and psychopathy as distinct diagnoses in the DSM-V is not without controversy, though at least one study comparing the non-DSM diagnostic criteria for measuring psychopathy to the DMS-V criteria for ASPD suggests the latter pretty well captures the former.

Still — possibly in part because laypeople are so familiar with the terms psychopath and sociopath — there are still researchers and clinicians that lean on the concepts.

And even within the conceptions of sociopaths and psychopaths, it's clear that Dexter is a psychopath, not a sociopath.

Sociopaths, after all, are characterized by violent, often uncontrollable outbursts, which Dexter is not; any violence they commit is impulsive, which Dexter is not. Though, like Dexter, clinicians believe people develop sociopathic traits as a result of childhood trauma (witnessing his mother's brutal murder is said to be the cause of his sociopathy), they are not generally incapable of forming strong bonds with others — they just do so more rarely than non-sociopaths.

Psychopaths, on the other hand, are considered manipulative planners who are unable to feel empathy with others but who are very good at faking that they do — which, of course, describes Dexter perfectly. Their behavior is considered more of a result of genetics or brain injury than trauma — and, of course, Dexter's brother was also a serial killer, while his biological father's origins prior to the age of 30 are sketchy and not revealed in the original series.

Interesting, research into ASPD suggests that, while the condition never goes away, it does tend to moderate itself in people around age 35. When the series — which is set contemporaneously — began in 2006, Dexter would have been 35 and he would have been 42 at its conclusion. In that time, he repeatedly struggled with his reduced interest in acting on his violent urges and his growing realization that he did have empathy and feelings for other people, including his adoptive sister, Debra Morgan, his wife, Rita, and her two kids from a prior relationship and, ultimately, his girlfriend at the end of the series, Hannah McKay. 

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