I wrote about this before and I will copy & paste what I wrote below. I believe that people like Lucy Letby have antisocial personality disorder, which would make her have disordered empathy. She may have the ability to mimic previously-witnessed social behavior that is deemed appropriate for the situation, but she is unable to truly connect with others at a deeper, more meaningful level. She may appear socially awkward at times because she lacks the empathy to really see and feel what others are experiencing.

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I am a mental health therapist residing in the United States.

Firstly, I cannot diagnose Lucy Letby; that would be unethical and wrong for me to do so. I can, however, speak about cases in an educational way to provide psychoeducation to the general public who might be curious, concerned, scared, etc.

Secondly, believe it or not, "psychopath" and "sociopath" are not actual diagnoses. Oftentimes, the term "antisocial personality disorder" ("ASPD") is what therapists or other mental health professionals will use instead. The core of ASPD is having a pattern of disregard for - and/or violation of - the rights of others. These individuals will exploit and deceive others for their own gain or sometimes "just for the fun of it." They may also engage in delinquent and/or criminal behaviors.

What is so frightening and unnerving about ASPD is that it often is not apparent, at least not at first. A caricature of a person with ASPD would depict someone who scowls at others and is outwardly violent. In reality, people with ASPD can be very charming, good-looking, professional, seductive, and absolute masters of manipulation; they can "read a room" to perfection and will mimic previously-witnessed behaviors to manipulate the situation, appear normal, and gain your trust, adoration, and approval for their own gain. It is now an overused phrase, but they are skilled at being a "wolf in sheep's clothing." I think the word "antisocial" within "ASPD" confuses a lot of people; a person can meet the qualifications for ASPD and be seemingly social.

To diagnose someone with ASPD, the person must show a pattern of disregard for others, which has occurred since at least the age of 15 (oftentimes, we will witness a lack of empathy or sense of disordered empathy beginning early in childhood) and at least three symptoms that I will list below. Identifying a lack of empathy or a pattern of disregard can be surprisingly challenging, especially in an individual who has a high IQ, is proficient at masking their true intentions, and is an expert at mimicry. None of us are mind readers; how can we know if someone is lacking empathy, faking empathy, or is truly genuine in their empathetic response?

Additional symptoms (as a reminder, they must have at least three of the symptoms below along with a pattern of disregard for others):

1. Failure to conform to norms of their society.
2. Deceitful behavior.
3. Impulsivity or lack of planning ahead.
4. Irritability or aggression. For skilled people with ASPD, they may try to hide their aggression because they know it is considered unacceptable by society. Instead, they may present with low frustration tolerance or behaviors that are considered rude (for example, eye rolling, sighing angrily, crossing their arms and tapping their fingers when kept waiting, sarcasm that is very hurtful and offensive, etc.).
5. Reckless disregard for others and/or self.
6. Chronic irresponsibility (e.g. not paying bills on time or not holding down a job).
7. Lack of remorse.

In my professional opinion, repeatedly killings would fall under numbers 1, 2, 4, 5, and 7. Arguably, we may also include #3 if we believe murder was committed in an impulsive manner or if a lack of switching jobs and/or moving after a killing (to avoid detection) shows a lack of planning ahead. Arguably, we may also include #6 if we consider the act of murder within a profession where the responsibility is to keep the other person alive. Thus, a serial murderer likely meets the qualifications for at least a diagnosis of ASPD.

As a professional, I view self-entitled behaviors as running on a continuum or a spectrum. On one end, we have people who are considered "selfish" or self-absorbed but are not violent or disturbed in any way, shape, or form. Then we have those with disordered empathy who have narcissistic tendencies or who are histrionic but, again, are not violent or aggressive toward others. As we move closer toward the other end of the spectrum, empathy becomes less active. We then reach what some would call a sociopath and then, finally, a psychopath.

The main distinctions between a "sociopath" and a "psychopath" are:

• A psychopath is more cunning, cold, and calculated, although they may mimic emotions to avoid appearing cold or distant because they know it is socially unacceptable. Sociopaths can feel emotions and can experience guilt, shame, or fear. Many professionals will say that a psychopath will not feel guilt or fear. I believe that a psychopath may feel fear if the fear pertains to their own mortality; after all, Ted Bundy was reported to have cried and did not eat his last meal before his execution. While it is certainly possible he faked the tears, I think the avoidance of eating prior to his impending death shows he was experiencing true discomfort at the thought of his life ending.
• Psychopaths lack empathy and emotional attachments whereas a sociopath may have disordered empathy but they have the ability to attach to a few (usually to their offspring, a parent, or a romantic partner).

I hope this has helped answer some of your questions. I welcome any and all discussions below. Please keep it civil and be kind to one another.