As reported by The Hartford Courant, March 10, 2005.

The Killers (and Liars) in Our Midst

How Does a Serial Murderer Live Undetected Among 'Normal People'? By Being a Sociopath - A Person Without a Conscience, Without the Ability to Love

By Kathleen Megan

If Dennis L. Rader is the BTK killer, the most nightmarish fact for his Kansas neighbors probably will be that he lived among them without anyone's ever suspecting.

He managed to fool them into believing that he was as he appeared: a pillar in the church, a Scout leader, a perhaps overly zealous city compliance officer.

How could Rader have been capable of leading such a double life? And how could he have fooled so many?

Martha Stout, a psychologist and Harvard Medical School clinical instructor and author of the newly released "The Sociopath Next Door: The Ruthless vs. the Rest of Us" (Broadway Books, $24.95), said it's not so unusual to find that people who appear to be "unassailable" are actually sociopaths - people with no conscience, incapable of remorse.

"They play all kinds of roles. I am a parent; I am a spouse; I am a doctor, Boy Scout leader, a member of the administration," said Stout.

In her new book, Stout writes about sociopaths who know how to appear normal but actually have no empathy, no ability to love, no connection to other people. Underneath it all, they are ruthless.

Stout concentrates in her book on sociopaths who are not violent but have ruined lives around them. Once people start to think about it, Stout said, they realize, "Well, maybe that's what happened with my ex-husband, or that's why my business partner ridiculed me when there was no reason. We've all known more than one, whether we realize it or not."

Whether a sociopath is a killer or the domineering CEO who treats people mercilessly on his way up the ladder, Stout said, the operating principle is the same: They all lack a conscience and any sense of remorse. It is simply their behavior that is different, with some more prone to violence than others.

While the percentage of true sociopaths is debated - Stout contends it is 4 percent of the population, or one person in 25, while others believe it is one in 100 or fewer - experts do agree on what characterizes them.

Dr. Robert Trestman, a professor of psychiatry and vice chairman at the University of Connecticut Health Center who has done 20 years of research on severe mood and personality disorders, said sociopaths are people who "really do not demonstrate a sense that you're a human. From their perspective, it's them, and everybody else is just as useful to them as a chair, just as meaningless as a chair. So if you hurt or kill, it's no worse than hurting a chair. It's just the utility of the chair as it relates to them."

Sociopaths are often very skilled interpersonally and can be charming and manipulative. "Think of Ted Bundy," said Trestman. "He was very socially gifted and used that to attack others. And in his discussion afterwards [with authorities], it wasn't like he was hurting his peers. He saw them as prey in the same way that a tiger sees a calf as prey."

Often, Trestman said, sociopaths may "say the right words, but you see no emotional connectivity - no emotional reaction to horrific situations."

Or, as Michael Stevens, a neuropsychologist at the Olin Neuropsychiatry Research Center at Hartford's Institute of Living, recalls another expert saying, "They know the words but not the music."

Trestman said that in psychiatry's diagnostic manual, there actually is no diagnosis for sociopathy. The traits associated with the condition are found under "antisocial personality disorder." Typically, people with antisocial personality disorder might show behaviors like lying, cheating or stealing, but a sociopath goes further in that he or she has no conscience, Trestman said. A lie detector test doesn't work with sociopaths because they feel no guilt.

For the most part, the terms sociopath and psychopath are synonymous, although Stout said that the general public often associates a psychopath with more violent behaviors.

Stevens cautioned that in the case of a serial killer like the BTK murderer, there may be psycho-sexual or other factors at play beyond sociopathy or psychopathy.

Stout, who has worked with trauma survivors for 25 years, said she became interested in sociopaths because she wondered, "Who are these people doing these terrible things. ... Who are these people, and what are they like?"

In her book, Stout draws sketches of sociopaths based on actual cases. There is "Skip," the successful businessman who tortured frogs as a child - blowing them up with firecrackers - and later used his brilliance and charm to work his way to the top of a corporation. He married - not for love but because his wife was the daughter of a billionaire. He continued to have random sexual encounters and once was sued by a secretary who said he broke her arm while trying to force her to sit on his lap. Skip, predictably, blamed the secretary. "Why the hell did she put up such a fight?" he wanted to know. The company paid an out-of-court settlement in the case.

"What is the worst part of this picture - the central flaw in Skip's life that makes him into a tragedy despite his success and into the maker of tragedies for so many others?" Stout writes. "It is this: Skip has no emotional attachment."

So why do people become sociopathic? Is it nature or nurture? Trestman said it's almost certainly a combination. There may be some "genetic predisposition" combined with environmental factors.

The astounding statistic, Stout believes, may actually be that so many people - 96 percent, by her count, but perhaps more - do have a conscience and are inclined to be nice. "Most human beings are very conscience-burdened," she said. "Most wouldn't eat the last piece of chocolate cake."

As the former chief psychiatrist for Connecticut's jails and prisons, Trestman said he has interviewed hundreds of people with antisocial personality disorders, but of those, he said, only four or five were what he would consider true sociopaths.

Stevens - who prefers the term psychopath, partly based on research on the topic - and colleague Kent Kiehl, a psychologist, are using magnetic resonance imaging and other brain imaging technology to look at how a psychopath's brain functions. The tests have revealed abnormalities during particular cognitive operations, including the processing of emotions, self examination of behavior for errors, and rethinking or changing a course of action.

Can an adult sociopath or psychopath change his or ways? Usually not, doctors and researcher say, though attempts have been made. Dr. Nick DeMartinis, an assistant professor of psychiatry at the University of Connecticut Health Center, said, "It seems that if you don't develop a conscience early, it's hard to get one."

So how do you recognize a sociopath if you happen to meet one in your daily life? Stout urges readers to practice what she calls "the rule of threes."

One lie or broken promise or neglected responsibility may simply be a misunderstanding. Two may involve a serious mistake, but "three lies says you're dealing with a liar, and deceit is the linchpin of conscienceless behavior," Stout writes.

"Do not give your money, your work, your secrets or your affection to a three-timer."

Stout also says to pay attention to your instincts, even if the person advising you is supposed to be an authority; to be suspicious of extreme flattery; and to watch out if someone insists you "owe" him or her something. "`You owe me' has been the standard line of sociopaths for thousands of years," Stout writes.

If you do recognize a sociopath, Stout says, the best way to protect yourself is to avoid him or her. "Psychologists do not usually like to recommend avoidance," writes Stout, "but in this case, I make a very deliberate exception."

Martha Stout will speak tonight at 7 at the West Hartford Public Library, where she will read from her book and talk about "The Thirteen Rules for Dealing With Sociopaths in Everyday Life."