Tony Soprano is not a sociopath.

The term "sociopath" is constantly used to explain Tony's behavior throughout this sub, but we cannot forget that a sociopath is not just someone who does horrible things and can live with it; a sociopath fundamentally does not feel remorse for others, cannot empathize with others, and has no true loyalty to others. A sociopath, unlike Tony, has absolutely no need to justify bad behaviors to themselves and to others.

I truly do not believe he is one, and his panic attacks are the first peek into this fact.

Tony has feelings for quite a few people and is bothered when they are bothered. So how can he murder or put those people in harm's way? The same reason he gets the panic attacks: because for years he stuffs down his life with the following justification that he shared with Melfi:

Tony believes he is a soldier. He sees the Mafia as an army. He's said that anyone who agrees to be part of this army knows what they're getting into, and casualties are part of the territory. He believes loyalty is above all because that was the oath he made to his army and as a leader of a troop, he is doing the right thing by protecting the troop at any cost. He sees himself as better/ more virtuous than "those sick fucks who murder for pleasure, or kill little kids" and clearly looks down on animal killers. His need to tell himself that he isn't an evil person betrays sociopathy, because sociopaths do not care about good or evil. Sociopaths aren't just someone who does horrendous things, they have to do it with zero remorse and gain pleasure from it. I don't think Tony gets any pleasure from killing people or fucking people he cares about over, but he justifies it to his core because that's how he can survive.

He continually says that the reason he does all of this is for his family. To provide for his wife and children. We the viewers know that this is simply what Tony tells himself to avoid the truth because he DOES care. Tony has been indoctrinated to view this life and all that comes with it as his mission, his purpose, his way to feel powerful and be successful. His dreams reveal that he gives a fuck about the people closest to him because it's always the same people who appear, and his reactions to them reveal his nature.

Now let's talk about animals. I've read in this sub that people have said Tony is a sociopath because he doesn't truly care about animals, he just sees them as something to control. I totally disagree because the show does not indicate this whatsoever. The ducks brought him joy, feeding them, building them a ramp, enjoying watching their natural behaviors. When they grew up and flew away, he was "abandoned" by things that he cared for from a truly pure perspective, which led to his panic attack, this feeling of abandonment. Tony's need to be part of the Mafia is because built into its premise is that you can't be abandoned if you follow the rules, you will always be protected as long as you never leave.

Then there's little Cosette, whose accidental smothering upset Tony more than the fact that Chris was a raging addict. Chris accepted the life and all the came with it; Cosette didn't, so she deserves more sympathy. It's also why he is so soft on Meadow and AJ, because they did not make the deal he did and therefore they are innocent. Animals represent innocence to Tony. His bond with Pie-oh-My was also because she was innocent, and so when Ralphie led to her death, Ralphie was the one who deserved to die. Because he went off the books and harmed something innocent that never made the same deal they made, something that Tony cared for. Ralphie "knew what he was getting into" which is another justification to "cut out the cancer" for the greater good in Tony's mind.

Ralph, on the other hand, is a true sociopath. There is no one and nothing he seems to genuinely care about, and the "kindness" he's shown is always, without exception, to further his own self-interest, not the interest of the Family or his family. He murders innocent people (Tracee, Pie-O-My...) and is a sadist (making Tracee give oral to the cop as she's crying) who takes pleasure in hurting others. He's someone who is drawn to the Mob not because it guarantees you won't be abandoned, but because it is an acceptable outlet for violence and crime.

Tony's mental illness is directly caused by his refusal to accept that he has become The Bad Guy. His mind is so warped that if he hears "Do unto others as you'd want done to you" he would believe that he follows this universal creed for morality because he is loyal and the ends justify the means for the Family, not just himself. A sociopath would never care about the weight of this creed nor would they justify it to themselves.

TLDR; Tony has become a bad guy not because he was born one like sociopaths are, but because he has allowed the delusion of being a soldier to turn him into a liar, thief, and killer.