Are People-pleasing and Sociopathy Opposite Ends of the Same Spectrum?

Most of us know people with sociopathic traits: think about that neighbor who gets a rise out of taunting and bullying, or that colleague that always seems to get all the credit at work and wiggles their way to the top while covertly shooting you down. The same is true for people-pleasers: bring to mind that family member or friend who constantly seeks approval and always goes over the top to please others, often at the expense of his or her own needs or desires. Could it be that these two personality profiles actually live on opposite ends of the same behavioral and biological continuum?

Some Definitions

First, let's start with some definitions to clear up some confusing and overlapping terms. "Sociopathy" is another word used for antisocial personality disorder (ASPD) found in psychiatry's Diagnostic and Statistical Manual (DSM), but more commonly used in the forensic arena and by the general public than "ASPD". "Psychopathy" is a related term, but is most often used to describe people in criminal populations, and is assessed for with the Hare Psychopathy Checklist-Revised (PCL-R), rather than the DSM. Many people with sociopathy also have psychopathy.

"High-functioning sociopathy" is a useful colloquial term that refers to people who have sociopathic/psychopathic traits but who function well in society, and sometimes excel. These people may be especially successful in business, politics, or media. They tend to have superior intelligence and better impulse control than a typical person with ASPD, which helps them succeed in work and social settings.

The term “people-pleaser”, also colloquial, is commonly used in the psychotherapy and self-help realms to describe people who seek approval and put the needs of others above their own. A tendency towards people-pleasing often goes hand in hand with anxiety, depression, eating, and substance use disorders, and can make recovery from these disorders harder. Teaching people how to be assertive and set boundaries are often key components of established treatments.

Sociopathy/Psychopathy vs. People Pleasing

Pooling characteristics from the DSM-V diagnostic manual for ASPD and the PCL-R, here are some qualities commonly seen in people with sociopathy and psychopathy:

• Failure to conform to social norms
• Lying and manipulativeness for profit or pleasure
• Irresponsible in work and finances
• Lack of remorse or guilt
• Overblown sense of self-esteem
• Charming
• Callous and lack of empathy
• Tendency towards risk-taking
• Aggressiveness
• Impulsivity
• Easily angered

And here are some qualities attributed to people-pleasers:

• Wants everyone to like them
• Frequently apologizes
• Craves validation
• Feels guilty when they set boundaries
• Fearful of and avoids conflict
• Rule-follower
• Perfectionistic
• Puts their own feelings, needs, and opinions behind others’
• Has difficulty saying no
• Feels excessively responsible for how others feel

These two lists couldn’t be more contrasting. A sociopath puts their own happiness first, lives guilt-free, uses any means necessary to get what they want, eschews responsibility, breaks rules if they can get away with it, and feels little empathy. A people-pleaser puts others' needs above their own, is often guilt-ridden, goes overboard to help others, avoids conflict, is excessively responsible, follows protocol, and worries about others' opinions and approval constantly.

Social Hierarchies and Dopamine

In many animal species (mice, primates) there exist hierarchies of social dominance. The dominant animals more frequently engage in aggressive and impulsive behaviors and tend to get more food, access to preferred mates, and space when resources are scarce. Animals with a lower social ranking are more likely to be recipients of the dominant animals’ aggressions, and to engage in submissive behaviors like turning on their back, and conflict avoidance through hiding. Could high-functioning sociopaths be the human counterpart of these dominant animals? Maybe so. If you buy that possibility (like I do), then the ensuing facts should pique your interest.

Studies show that the levels of a sub-type of dopamine receptor in the brain, the type-2 dopamine receptor (DRD2), are higher in the brains of dominant animals. Furthermore, experimental blockade of this receptor in dominant animals reduces social dominance behaviors, and causes the animals to behave more submissively. Not only that, but animals with low DRD2 levels will develop addictive behaviors more readily than those with normal levels. Therefore, high activity at this receptor may confer a higher social ranking, whereas lower activity leads to lower ranking, and a greater vulnerability to addiction

Imaging studies in humans show a similar pattern. Although, to my knowledge, the levels of DRD2 in sociopaths and people-pleasers have not been directly measured, there are other studies we can draw from. For example, one research group found that psychopaths have higher dopamine release than normal individuals, indicating a more robust dopamine system. By contrast, people with substance use disorders, obesity, and anxiety disorders (disorders commonly seen with people-pleasing) all have lower levels of DRD2 in the brain.

Pooled together, these studies would indicate that higher DRD2 function or dopamine release leads to aggression and dominant behavior (sociopath-like), whereas low levels confer an increased risk of vulnerability to aggression and mental health struggles (people-pleasing-like).

Brain Activation During Decision Making and Mental Stress

Functional MRI (fMRI) studies allow scientists to image brain activation patterns while people perform cognitive and emotional tasks specifically designed to elicit responses in key brain circuits and regions.

Numerous fMRI studies have been performed in people diagnosed with ASPD or with psychopathy and indicate abnormal functioning in brain regions involved in emotional and stress processing, moral decision-making, empathy generation, and conflict monitoring. During tasks designed to elicit activation in these circuits, sociopaths/psychopaths show reduced engagement of key brain regions such as the amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex.

By contrast, people on the people-pleasing end of the spectrum have heightened activation in many of these same brain areas. For example, greater activation in the insula and medial prefrontal cortex is observed in people with a higher tendency to conform when confronted with beliefs that they disagree with. For them, disagreeing may have evoked more mental stress. This same pattern of elevated activation during stress-eliciting tasks or during decision-making in the insula, amygdala, anterior cingulate cortex, and medial prefrontal cortex is also seen in people with anxiety and substance use disorders.

In summary, whereas people with psychopathy or sociopathy have blunted activation in key brain regions involved in emotional processing and moral decision-making, the brains of people with people-pleasing tendencies and associated mental health challenges have heightened activation.

Conclusion

Is there a causal link here between the dopamine system or brain activity in these key circuits and both psychopathy/sociopathy and people-pleasing? Could these data point to a biological and behavioral continuum, where psychopathy/sociopathy and people-pleasing lie on opposite ends? It's too soon to tell, but more studies can and should be done to establish whether these two clusters of traits might just be mirror images of one another, and whether "normal" lies somewhere in the middle.