Are most ghouls born sociopathic?

The more I read the story, the more I realized how nuanced the relationship between ghouls and humans are. But are most of them insane?

I might sound weird, but a lot of ghouls have relationships with humans - empathy even. Yet they still go out at night and kill. Are ghouls also sociopathic from birth, because I can't imagine any sane individual maintaining this sort of life.