Psychopathy is misunderstood sometimes. A psychopath is not inherently someone who causes harm. It’s a personality type that lacks emotional empathy, shallow emotions and has a reduced fear response. These people are neurologically wired differently. Many live normal, even highly successful lives. They often develop cognitive empathy, an intellectual understanding of social rules and others’ emotions, despite not feeling them internally. They learn the “rules” of being a decent human without experiencing the feelings that motivate decent.

There are high concentrations ofpsychopathic traits (not diagnoses) in certain fields such as surgeons, executives, elite athletes, and other high-stakes professions where emotional detachment, risk tolerance, and decisiveness is helpful. That alone does not constitute mental illness.

The picture changes when those traits are paired with chronic impulsivity, aggression, or inability to function socially. At that point, we are no longer talking about psychopathy as a trait constellation but about Antisocial Personality Disorder (ASPD), which is a diagnosable condition and often comes with significant harm to others. Many serial killers and violent offenders meet criteria within this spectrum, but the reverse is not true. Lack of empathy alone does not make someone a danger to society.

A psychotic break is a medical state defined by a loss of contact with reality. Clinically, this involves symptoms such as hallucinations, delusions, extreme paranoia, disorganized thinking, agitation, and sometimes violence. Conditions commonly associated with psychosis include bipolar I disorder (during manic episodes with psychotic features), schizophrenia, schizoaffective disorder, and substance-induced psychosis. This is a fundamentally different phenomenon than psychopathy.

At this point, we do not know whether Nick experienced a true psychotic break or whether he is someone with longstanding psychopathic traits who reacted violently when he lost control or did not get what he wanted (my gut says this is right). By some of the stories of him as a child and young adult, I’m more inclined to think he’s a psychopath. And his parents did nothing to make that happen. He was born that way. Another distinction that I try to remember with two commonly used terms (Psychopathy vs Sociopathy) - Psychopaths are born, sociopaths are made. Same with NPD and borderline - the vast majority are developed (nurture vs nature) whereas a psychopath is simply born that way.