Can a Sociopath Change? What Research Actually Says (And What to Do With the Answer)

PERSONALITY DISORDERS • June 8, 2026

Last reviewed: June 2026 by Annie Wright, LMFT

In short: Research on antisocial personality disorder shows limited treatment response, especially in primary presentations, and the more important clinical question for partners is whether their life should wait for an answer that may not come.

Leila Already Knew What the Research Said Before She Opened the Search Bar

It’s 10:02 on a Wednesday night. Leila, 45, a nonprofit director in Boston, is sitting up in bed with her laptop. The room is quiet except for the hum of the heating unit. Her cat, Simone, is a warm weight against her left leg, breathing steadily, indifferent to the blue-white glow of the screen.

Leila has typed “ASPD treatment outcomes” into PubMed before. The browser history above the search bar confirms it: same query, three different dates, each about three weeks apart. She hasn’t forgotten what she found those times. She can practically quote the abstracts. She knows that the literature on antisocial personality disorder treatment is not optimistic, that structured interventions show modest effects at best, that there’s a subset of secondary presentations that show more responsiveness. She knows all of this. She has cited it to friends.

She presses enter anyway.

The results load. Nothing has changed. She knew it wouldn’t. And in the moment before she closes the laptop, Simone doesn’t move, doesn’t register the soft click of the lid. She has the thought, clear and a little brutal: I’m not looking for information. I’m looking for a different answer.

If you’ve ever found yourself in a version of this moment, researching something you already understand because understanding it still hasn’t changed what you feel or what you’re willing to leave. This article is for you. Not because I have a different answer than the research does. I don’t. But because the question “can a sociopath change?” is almost never the question that actually needs answering, and the one underneath it deserves just as much honesty.

What the Research Actually Shows: ASPD Treatment Outcomes in 2025

Let’s start with the clinical literature, because it matters, and because you deserve an honest reading of it rather than one shaped by what’s comforting or what drives clicks.

Robert Hare, PhD, criminal psychologist and emeritus professor at the University of British Columbia, spent decades developing the Psychopathy Checklist-Revised and studying long-term outcomes in men with high psychopathic traits. His research is consistent and not comfortable: standard psychiatric interventions have limited effectiveness for primary psychopathy. Including many well-regarded therapy modalities. More troubling, Hare’s data suggest that some poorly structured group treatment programs may actually produce worse outcomes, because individuals with high psychopathic traits can use the social learning environment of group therapy to become better at mimicking prosocial behavior rather than developing it.

This is worth sitting with. Treatment designed for people whose suffering motivates change can, in some ASPD cases, function as a skills acquisition opportunity for manipulation. That’s not a reason to assume the worst about anyone. It’s a reason to understand that the usual treatment mechanisms don’t necessarily apply.

The overall research picture on ASPD treatment is mixed, with modest effect sizes, high dropout rates, and serious questions about durability. Pharmacological interventions can address comorbid symptoms (depression, impulsivity) but don’t alter the core personality structure. Cognitive-behavioral approaches show some effects in structured settings, particularly with justice-involved populations. But “some effects in structured settings with extrinsic motivation” is a long way from “the person in your life will change because he loves you.”

That’s the honest clinical picture. And it’s not the whole picture, which is where the distinction between primary psychopathy and secondary sociopathy becomes clinically important.

Primary Psychopathy vs. Secondary Sociopathy: Why the Change Prognosis Is Different

Not everyone who meets ASPD criteria presents the same way, and the distinction matters for prognosis. Jennifer Skeem, PhD, Professor of Public Policy at UC Berkeley and one of the most rigorous empirical voices on differential ASPD treatment response, has published extensively on the heterogeneity within ASPD presentations. Her work makes clear that treating ASPD as a monolithic diagnosis with a single treatment prognosis is clinically imprecise.

Skeem’s research on conditional treatment responsiveness is the most current empirical basis for cautious optimism about secondary presentations. The key word is conditional. In her work, the secondary ASPD subgroup showed measurably better treatment response under specific conditions: intrinsic motivation (not coercion), treatment targeting underlying emotional dysregulation and trauma rather than only behavioral compliance, and a therapeutic relationship that avoided the coercive dynamic that tends to activate rather than reduce antisocial behavior.

What this means clinically: secondary sociopathy, when the person is seeking treatment because they genuinely want to change (not because a court ordered it, not because a relationship is contingent on it) in a setting that takes their trauma history seriously, can respond to trauma-informed treatment. That’s real. And it’s not nothing.

What it doesn’t mean: that a motivated person with secondary features can change while staying in an environment where the consequences of not changing are continuously managed by a partner. More on that below.

The practical challenge for most people asking “can he change?” is that the primary/secondary distinction is not visible from inside a relationship. You can’t diagnose someone from proximity. What looks like secondary sociopathy (the moments of vulnerability, the plausible backstory of early injury, the occasional apparent remorse) can also be present in primary presentations. This is part of why the diagnostic question “what kind of ASPD is this?” is less clinically actionable than it sounds, and why the question I want to put alongside it is different.

The Three Conditions Under Which Change Is Most Likely (And Why Those Conditions Rarely Coexist)

Setting aside the primary/secondary distinction for a moment: across the literature, three factors consistently appear as associated with better outcomes in ASPD presentations. The important caveat is that “better outcomes” in research often means reduced criminal recidivism or fewer impulsive episodes. Not transformation of empathic capacity.

The first condition is intrinsic motivation, meaning the person with ASPD is seeking change because they have internalized a reason to change that isn’t dependent on external enforcement. Not because a judge required it, not because a partner will leave otherwise, not because they’re trying to preserve access to something they want. Research by Skeem and others consistently finds that extrinsic motivation produces compliance behavior in structured settings that doesn’t generalize. When the external pressure is removed, the behavioral pattern tends to return. Intrinsic motivation (“I want to live differently because I’m experiencing the cost of how I live”) is rarer, harder to assess, and more often claimed than actually present. Especially in active intimate relationships.

The second condition is the absence of the current relationship as a buffer. This is the uncomfortable one. When a person with ASPD is in an active relationship with someone who is managing the relational consequences of their behavior (interpreting, excusing, adjusting, absorbing) there’s no experiential feedback loop that might generate intrinsic motivation. The consequences aren’t landing. And this doesn’t mean you’re enabling in the moralistic sense. It means that neurologically and behaviorally, the design conditions for change can’t exist when someone else is softening every impact.

The third condition is intensive, specialized treatment that addresses underlying emotional and neurobiological processes rather than surface behavior. This is not standard weekly outpatient therapy. It’s not a therapist who sees ASPD occasionally and addresses it with CBT worksheets. The literature on ASPD treatment that shows meaningful results involves intensive structured programs, often residential, often with specific ASPD training. That level of intervention is hard to access, expensive, and requires the person to actively seek and sustain it.

What I see consistently in my work with clients who are or have been in relationships with ASPD partners: when they map these three conditions against the actual situation (is he in intrinsically motivated treatment? is he experiencing the full consequences of his behavior? is the treatment intensive and specialized?). The answer to all three is almost never yes, simultaneously, for a sustained period.

This isn’t pessimism. It’s clinical honesty about what the research requires for the prognosis to shift.

Nadia, a 38-year-old physician in San Francisco, had watched her partner enter and exit therapy three times in four years. Each time, there was a genuine-seeming recommitment. Each time, the behavioral changes lasted approximately as long as the external pressure that prompted treatment. “He was different in therapy,” she told me. “I could see it. And then he’d stop going, and within six weeks, we were back.” What she was describing isn’t imaginary change. It’s the compliance pattern that research on extrinsically motivated ASPD treatment documents reliably. The change was real, but the durability required conditions that weren’t present.

What “Waiting for Him to Change” Costs You While You Wait

Here’s where I want to shift from the research on him to the research on you, because it’s the part that usually gets left out of the “can a sociopath change?” conversation.

Sandra Brown, MA, researcher and author who has studied women in relationships with partners with psychopathic and ASPD traits, documented something important in her research for Women Who Love Psychopaths: the women in her sample were not naive. They had, in many cases, done the research. They understood the diagnostic picture. They stayed (or returned) not because they lacked information but because information is not the same as the capacity to act on information. When your attachment system is engaged, those are very different things.

This is clinically important: the experience Leila is having at 10pm on a Wednesday, searching for information she already has, is not a cognitive failure. It’s a description of how attachment functions under conditions of prolonged uncertainty and intermittent reinforcement. The intermittent reinforcement that characterizes many relationships with ASPD partners (the warmth that appears unpredictably, the moments of apparent connection, the version of him you love that shows up just often enough) produces a neurobiological bonding process that doesn’t yield to reading. Knowing the statistics doesn’t unwind an attachment that formed under those conditions.

What waiting costs, while the attachment is active: the years themselves. The other relationships that don’t get built because your relational energy is organized around this one. The professional and creative projects that don’t get full attention. I’ve sat across from women in individual therapy who couldn’t remember, after five or six years, who they’d been before the relationship. That earlier self had been so thoroughly overwritten by the adaptive person who learned to function alongside ASPD.

It also costs you the clinical clarity that comes from full information. When you’re still in the relationship, you’re seeing the behavior through the attachment lens. Which means you’re seeing the version of his behavior that your nervous system can tolerate. The capacity to assess clearly comes back, gradually, when you’re not inside the thing you’re trying to assess.

Knowing what a sociopath is and knowing what it costs you to stay in a relationship with one are two different kinds of knowledge. The second one takes longer, and it usually requires some distance.

Both/And: The Hope That He Could Change Is Not Foolish AND Acting on That Hope as a Life Strategy Is Something Different

I want to be precise here, because this distinction matters and it’s easy to flatten it.

The hope that someone you love can change is one of the most human things you can feel. It’s not evidence of stupidity, poor boundaries, or pathological attachment, even when the person you’re hoping for has a diagnosis that substantially limits the probability of change. That hope is part of what love means. It’s present in people with full information, good judgment, and years of clinical context. Leila has it. Most of the women I work with who’ve been in relationships with ASPD partners have had it. Hoping for change in the person you love is not the problem. The question is what you do with that hope structurally.

The distinction, and this is where I want to be clinically direct, is between holding that hope and building a life around waiting for it to be answered. Those are different acts. And they cost different things.

Building a life around waiting for change in a person whose disorder specifically impairs the motivation required for change means making decisions about where you live, whether you have children, how you spend your relational energy, how much of yourself you keep available versus give away. All of it organized around a hypothetical future version of someone who may never arrive. That’s a choice your nervous system deserves to make with full information. Not a moral failing, not stupidity, but a choice with real costs, made with or without awareness of what it’s costing.

The clinical question isn’t “should I stop loving him?” It’s “what does my life look like if this is the level of change he’s capable of?” And more pointedly: if you knew with certainty that he would never change, if the research gave you a definitive answer rather than a probability. What would you do? That question tends to surface what the hope is actually protecting you from having to face.

In my work with clients navigating ASPD dynamics, the most important therapeutic movement is usually not arriving at an answer about the partner. It’s the person in my office becoming clearer about their own life. What they want it to contain, what it’s already missing, what the cost of further waiting has been.

The Systemic Lens: The Belief That Love Is Sufficient to Heal Anyone Is One of the Most Damaging Cultural Stories We Tell Women

The question “can he change?” doesn’t exist in a vacuum. It’s being asked inside a cultural framework that has spent centuries telling women that love, patience, and self-sacrifice are the mechanism by which difficult men become good ones.

The belief that love plus patience will heal anyone is not a neutral cultural story. It is a story disproportionately told to women about their capacity for relational transformation. And it becomes a prison when the person they are committed to changing has a disorder characterized by indifference to others’ wellbeing. In popular culture, in romantic narratives, in a thousand variations on “he just needs someone who really sees him,” the implicit promise is that the right quality of loving (patient enough, consistent enough, present enough) will eventually crack open the person who hasn’t been capable of change with anyone else.

This story is not benign. It locates the problem of ASPD in the insufficiency of the partners who’ve come before rather than in the disorder itself. It makes the failure of change a function of the woman’s inadequate loving rather than the person’s actual clinical presentation. And it places women in the position of being the solution to a problem they didn’t create, using relational warmth as the instrument. Which research does not support as the active ingredient in ASPD treatment.

Driven women (physicians, executives, nonprofit directors, entrepreneurs) are particularly susceptible to this story in a specific way. These are women who’ve spent their professional lives being the person who figures it out, who applies sufficient intelligence and effort and makes things work. That identity transfers. If she just understands him better, advocates for his treatment more effectively, creates the right conditions, stays when others have left: maybe she’s the one who solves it. The problem is that ASPD is not a management problem. And the skills that make someone exceptional in organizational life don’t transfer to healing someone whose capacity for relational change is neurobiologically constrained. The executive coaching skills that work brilliantly in professional contexts simply don’t apply here.

There’s also a subtler story operating: the cultural script that leaving, rather than staying and working, represents failure. Women are often more harshly evaluated for leaving a relationship (giving up, not trying hard enough) than for staying in one that is harming them (loyal, committed, giving). That asymmetry doesn’t just live in external judgment. It’s internalized. The drive to stay and prove it can work is partly about love, and partly about not wanting to be the woman who couldn’t make it work.

Understanding this systemic context doesn’t make the feelings less real. It does make the choice clearer. The question “should I keep trying?” is being asked inside a cultural narrative that has a predetermined answer. Yes, try harder, love better, be more patient. Seeing that narrative as narrative rather than truth is itself a form of clinical progress.

For more on how these dynamics play out, the full guide on how to spot and stop a sociopath walks through the relational patterns that often accompany ASPD presentations in intimate relationships.

What to Do With the Answer

The research says: primary psychopathy shows minimal treatment response; secondary sociopathy shows more, under specific conditions that rarely coexist in an active intimate relationship. The honest clinical answer to “can a sociopath change?” is: some presentations, somewhat, sometimes, under conditions that you cannot create and that require his absence from the relationship you’re currently in.

What do you do with that?

First: notice whether you’ve been asking the research question as a substitute for a different question. The research question feels answerable. There are studies, there is data, there are meta-analyses. The actual question (what do I do with my life given what I now know) is harder and doesn’t have a PubMed entry. But it’s the question that matters.

Second: give yourself permission to stop trying to solve the diagnostic puzzle. You are not in a position to determine whether he’s primary or secondary, whether his apparent moments of remorse are genuine or performed, whether the version of him you fell in love with is still in there and just needs the right conditions. You’re too close, too attached, and too implicated in the outcome of your own assessment. This is a job for a clinician with distance.

Third: get your own support that isn’t organized around him. Not couples therapy, where the dynamic tends to advantage the partner with greater comfort with deception, but individual therapy focused on you: your history, what drew you to this relationship, what it’s cost you, and what you actually want your life to contain. The attachment that makes leaving feel impossible doesn’t dissolve through willpower. It changes through a different relational experience, with a therapist, with other people who are safe, with yourself.

Fourth: if you’re staying, be honest with yourself about what you’re staying for and what timeline you’re working with. “I’m giving this six more months to see if the treatment he’s starting produces lasting change, and I’m tracking specific behavioral markers, and if those markers aren’t present by October, I’m making a different decision” is a different thing than “I’m staying because I love him and I believe he can change.” Both are choices. Only one includes the information your nervous system needs to make the choice with its whole self.

Fifth: consider what the answer to the research question actually changes for you. If the research definitively said “no, he cannot change,” what would you do tomorrow? If the answer is “leave,” you already have the answer you need. If the answer is “I still couldn’t leave,” then the issue isn’t the research. It’s the attachment, and that requires a different kind of help than more information.

What I’ve watched happen, in my work with clients, is that the moment of clarity usually doesn’t come from the research. It comes from a quiet, ordinary moment not unlike a Wednesday at 10pm with a laptop and a sleeping cat. When a woman realizes that she’s been asking the same question for a long time and the answer has never been what she needed it to be, and that might be telling her something about the question itself.

If that moment is where you are, reaching out for a consultation is a reasonable next step. Not because you need someone to tell you what to do. But because working through this inside a relationship is different from working through it with someone outside it. Someone who can see you clearly and isn’t implicated in the outcome.

The research hasn’t changed. It probably won’t. And the part of you that already knows this, the part that closed the laptop before Simone even shifted. Deserves to be taken seriously.

Related Reading

Brown, Sandra L. Women Who Love Psychopaths: Inside the Relationships of Inevitable Harm. Mask Publishing, 2009.

Hare, Robert D. Without Conscience: The Disturbing World of the Psychopaths Among Us. Guilford Press, 1993.

Skeem, Jennifer L., Devon L. L. Polaschek, Christopher J. Patrick, and Scott O. Lilienfeld. “Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy.” Psychological Science in the Public Interest 12, no. 3 (2011): 95, 162.

Lykken, David T. The Antisocial Personalities. Lawrence Erlbaum Associates, 1995.

Ogloff, James R. P. “Psychopathy/Antisocial Personality Disorder Conundrum.” Australian and New Zealand Journal of Psychiatry 40, no. 6, 7 (2006): 519, 528.

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