Theory of mind and mentalizing ability in antisocial personality disorders with and without psychopathy

Psychopathy and the ability to read the "language of the eyes": divergence in the psychopathy construct

The capacity to interpret others people's behavior and mental states is a vital part of human social communication. This ability, also called mentalizing or Theory of Mind (ToM), may also serve as a protective factor against aggression and antisocial behavior. This study investigates the relationship between two measures of psychopathy (clinical assessment and self-report) and the ability to identify mental states from photographs of the eye region. The participants in the study were 92 male inmates at Bergen prison, Norway. The results showed some discrepancy in connection to assessment methodology. For the self-report (SRP-III), we found an overall negative association between mental state discrimination and psychopathy, while for the clinical instrument (PCL-R) the results were more mixed. For Factor 1 psychopathic traits (interpersonal and affective), we found positive associations with discrimination of neutral mental states, but not with the positive or negative mental states. Factor 2 traits (antisocial lifestyle) were found to be negatively associated with discrimination of mental states. The results from this study demonstrate a heterogeneity in the psychopathic construct where psychopathic traits related to an antisocial and impulsive lifestyle are associated with lower ability to recognize others' mental states, while interpersonal and affective psychopathic traits are associated with a somewhat enhanced ability to recognize others' emotional states.

Impaired Theory of Mind and psychosocial functioning among pediatric patients with Type I versus Type II bipolar disorder

Deficits in Theory of Mind (ToM) have been documented among pediatric patients with Bipolar Disorder (BD). However, fewer studies have directly examined differences between type I and type II patients and whether or not ToM deficits are related to psychosocial difficulties. Therefore, the aim of this study was to compare type I versus type II pediatric bipolar patients and matched Healthy Controls (HC) on ToM and interpersonal functioning tasks. All participants completed the Revised Mind in the Eyes Task (MET), the Cognitive and Emotional Perspective Taking Task (CEPTT), and the Index of Peer Relations (IPR). Type I BD patients reported greater peer difficulties on the IPR compared to HC, and also performed more poorly on the MET and the cognitive condition of the CEPTT, but did not differ significantly on the emotional condition. There were no significant group differences between type II BD patients and HC. More impaired ToM performance was associated with poorer interpersonal functioning. Type I BD patients show deficits in the ability to understand another's mental state, irrespective of emotional valence. Deficits in understanding others' mental states could be an important treatment target for type I pediatric patients with BD.

Neural bases of Theory of Mind in children with autism spectrum disorders and children with conduct problems and callous-unemotional traits

Individuals with autism spectrum disorders (ASD) have difficulty understanding other minds (Theory of Mind; ToM), with atypical processing evident at both behavioural and neural levels. Individuals with conduct problems and high levels of callous-unemotional (CU) traits (CP/HCU) exhibit reduced responsiveness to others' emotions and difficulties interacting with others, but nonetheless perform normally in experimental tests of ToM. The present study aimed to examine the neural underpinnings of ToM in children (aged 10–16) with ASD (N = 16), CP/HCU (N = 16) and typically developing (TD) controls (N = 16) using a non-verbal cartoon vignette task. Whilst individuals with ASD were predicted to show reduced fMRI responses across regions involved in ToM processing, CP/HCU individuals were predicted to show no differences compared with TD controls. The analyses indicated that neural responses did not differ between TD and CP/HCU groups during ToM. TD and CP/HCU children exhibited significantly greater medial prefrontal cortex responses during ToM than did the ASD group. Within the ASD group, responses in medial prefrontal cortex and right temporoparietal junction (TPJ) correlated with symptom severity as measured by the Autism Diagnostic Observation Schedule (ADOS). Findings suggest that although both ASD and CP/HCU are characterized by social difficulties, only children with ASD display atypical neural processing associated with ToM.

Mentalizing mediates the relationship between psychopathy and type of aggression in schizophrenia

Convincing evidence demonstrates that psychopathy is associated with premeditated aggression. However, studies have failed to explain why this association exists and whether socio-cognitive functions, such as mentalizing, could explain the relation. This cross-sectional study investigates, in 108 patients with schizophrenia, the association of psychopathy and mentalizing abilities with premeditated and impulsive aggression and probes the nature of their influence on these specific aggression patterns. Patients' engagement in premeditated aggression was associated with diminishing mentalizing and increasing psychopathic tendencies. Moreover, mediation analyses reveal that the ability to attribute mental states to others mediates the relation between psychopathy and type of aggression. This mediation is facilitated by a specific mentalizing profile characterized by the presence of intact cognitive and deficient emotional mentalizing capacities. This study is the first to report a mediating effect of mentalizing on the relationship between psychopathy and type of aggression in schizophrenia. Implications of these results are discussed.

Empathic competencies in violent offenders

Violent offending has often been associated with a lack of empathy, but experimental investigations are rare. The present study aimed at clarifying whether violent offenders show a general empathy deficit or specific deficits regarding the separate subcomponents. To this end, we assessed three core components of empathy (emotion recognition, perspective taking, affective responsiveness) as well as skin conductance response (SCR) in a sample of 30 male violent offenders and 30 healthy male controls. Data analysis revealed reduced accuracy in violent offenders compared to healthy controls only in emotion recognition, and that a high number of violent assaults was associated with decreased accuracy in perspective taking for angry scenes. SCR data showed reduced physiological responses in the offender group specifically for fear and disgust stimuli during emotion recognition and perspective taking. In addition, higher psychopathy scores in the violent offender group were associated with reduced accuracy in affective responsiveness. This is the first study to show that mainly emotion recognition is deficient in violent offenders whereas the other components of empathy are rather unaffected. This divergent impact of violent offending on the subcomponents of empathy suggests that all three empathy components can be targeted by therapeutic interventions separately.

Knowing right from wrong, but just not always feeling it: relations among callous-unemotional traits, psychopathological symptoms, and cognitive and affective morality judgments in 8- to 12-year-old boys

The present research expands our understanding of cognitive and affective morality by exploring associations with callous-unemotional (CU) traits and externalizing symptoms. Participants were 46 8- to 12-year-old boys from the community who completed the Affective Morality Index, the Youth Self-Report, and the Inventory of Callous-Unemotional Traits. A pattern of results was found indicating that in particular the combination of high CU traits and high externalizing symptoms was associated with lack of affective morality, and an increased perceived likelihood of recommitting antisocial acts (recidivism). The implications of these findings and suggestions for future research are discussed.

Dissecting empathy: high levels of psychopathic and autistic traits are characterized by difficulties in different social information processing domains

Individuals with psychopathy or autism spectrum disorder (ASD) can behave in ways that suggest lack of empathy towards others. However, many different cognitive and affective processes may lead to unempathic behavior and the social processing profiles of individuals with high psychopathic vs. ASD traits are likely different. Whilst psychopathy appears characterized by problems with resonating with others’ emotions, ASD appears characterized by problems with cognitive perspective-taking. In addition, alexithymia has previously been associated with both disorders, but the contribution of alexithymia needs further exploration. In a community sample (N = 110) we show for the first time that although affective resonance and cognitive perspective-taking are related, high psychopathic traits relate to problems with resonating with others’ emotions, but not cognitive perspective taking. Conversely, high ASD traits relate to problems with cognitive perspective-taking but not resonating with others’ emotions. Alexithymia was associated with problems with affective resonance independently of psychopathic traits, suggesting that different component processes (reduced tendency to feel what others feel and reduced ability to identify and describe feelings) comprise affective resonance. Alexithymia was not associated with the reduced cognitive perspective-taking in high ASD traits. Our data suggest that (1) elevated psychopathic and ASD traits are characterized by difficulties in different social information processing domains and (2) reduced affective resonance in individuals with elevated psychopathic traits and the reduced cognitive perspective taking in individuals with elevated ASD traits are not explained by co-occurring alexithymia. (3) Alexithymia is independently associated with reduced affective resonance. Consequently, our data point to different component processes within the construct of empathy that are suggestive of partially separable cognitive and neural systems.

Dissecting empathy: high levels of psychopathic and autistic traits are characterized by difficulties in different social information processing domains

Individuals with psychopathy or autism spectrum disorder (ASD) can behave in ways that suggest lack of empathy towards others. However, many different cognitive and affective processes may lead to unempathic behavior and the social processing profiles of individuals with high psychopathic vs. ASD traits are likely different. Whilst psychopathy appears characterized by problems with resonating with others' emotions, ASD appears characterized by problems with cognitive perspective-taking. In addition, alexithymia has previously been associated with both disorders, but the contribution of alexithymia needs further exploration. In a community sample (N = 110) we show for the first time that although affective resonance and cognitive perspective-taking are related, high psychopathic traits relate to problems with resonating with others' emotions, but not cognitive perspective taking. Conversely, high ASD traits relate to problems with cognitive perspective-taking but not resonating with others' emotions. Alexithymia was associated with problems with affective resonance independently of psychopathic traits, suggesting that different component processes (reduced tendency to feel what others feel and reduced ability to identify and describe feelings) comprise affective resonance. Alexithymia was not associated with the reduced cognitive perspective-taking in high ASD traits. Our data suggest that (1) elevated psychopathic and ASD traits are characterized by difficulties in different social information processing domains and (2) reduced affective resonance in individuals with elevated psychopathic traits and the reduced cognitive perspective taking in individuals with elevated ASD traits are not explained by co-occurring alexithymia. (3) Alexithymia is independently associated with reduced affective resonance. Consequently, our data point to different component processes within the construct of empathy that are suggestive of partially separable cognitive and neural systems.

Reduced spontaneous but relatively normal deliberate vicarious representations in psychopathy

Psychopathy is a personality disorder associated with a profound lack of empathy. Neuroscientists have associated empathy and its interindividual variation with how strongly participants activate brain regions involved in their own actions, emotions and sensations while viewing those of others. Here we compared brain activity of 18 psychopathic offenders with 26 control subjects while viewing video clips of emotional hand interactions and while experiencing similar interactions. Brain regions involved in experiencing these interactions were not spontaneously activated as strongly in the patient group while viewing the video clips. However, this group difference was markedly reduced when we specifically instructed participants to feel with the actors in the videos. Our results suggest that psychopathy is not a simple incapacity for vicarious activations but rather reduced spontaneous vicarious activations co-existing with relatively normal deliberate counterparts.

The neurobiology of psychopathic traits in youths

Conduct disorder is a childhood behaviour disorder that is characterized by persistent aggressive or antisocial behaviour that disrupts the child's environment and impairs his or her functioning. A proportion of children with conduct disorder have psychopathic traits. Psychopathic traits consist of a callous-unemotional component and an impulsive-antisocial component, which are associated with two core impairments. The first is a reduced empathic response to the distress of other individuals, which primarily reflects reduced amygdala responsiveness to distress cues; the second is deficits in decision making and in reinforcement learning, which reflects dysfunction in the ventromedial prefrontal cortex and striatum. Genetic and prenatal factors contribute to the abnormal development of these neural systems, and social-environmental variables that affect motivation influence the probability that antisocial behaviour will be subsequently displayed.

An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy

While it is well established that individuals with psychopathy have a marked deficit in affective arousal, emotional empathy, and caring for the well-being of others, the extent to which perspective taking can elicit an emotional response has not yet been studied despite its potential application in rehabilitation. In healthy individuals, affective perspective taking has proven to be an effective means to elicit empathy and concern for others. To examine neural responses in individuals who vary in psychopathy during affective perspective taking, 121 incarcerated males, classified as high (n = 37; Hare psychopathy checklist-revised, PCL-R ≥ 30), intermediate (n = 44; PCL-R between 21 and 29), and low (n = 40; PCL-R ≤ 20) psychopaths, were scanned while viewing stimuli depicting bodily injuries and adopting an imagine-self and an imagine-other perspective. During the imagine-self perspective, participants with high psychopathy showed a typical response within the network involved in empathy for pain, including the anterior insula (aINS), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), inferior frontal gyrus (IFG), somatosensory cortex, and right amygdala. Conversely, during the imagine-other perspective, psychopaths exhibited an atypical pattern of brain activation and effective connectivity seeded in the anterior insula and amygdala with the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC). The response in the amygdala and insula was inversely correlated with PCL-R Factor 1 (interpersonal/affective) during the imagine-other perspective. In high psychopaths, scores on PCL-R Factor 1 predicted the neural response in ventral striatum when imagining others in pain. These patterns of brain activation and effective connectivity associated with differential perspective-taking provide a better understanding of empathy dysfunction in psychopathy, and have the potential to inform intervention programs for this complex clinical problem.

An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy

While it is well established that individuals with psychopathy have a marked deficit in affective arousal, emotional empathy, and caring for the well-being of others, the extent to which perspective taking can elicit an emotional response has not yet been studied despite its potential application in rehabilitation. In healthy individuals, affective perspective taking has proven to be an effective means to elicit empathy and concern for others. To examine neural responses in individuals who vary in psychopathy during affective perspective taking, 121 incarcerated males, classified as high (n = 37; Hare psychopathy checklist-revised, PCL-R ≥ 30), intermediate (n = 44; PCL-R between 21 and 29), and low (n = 40; PCL-R ≤ 20) psychopaths, were scanned while viewing stimuli depicting bodily injuries and adopting an imagine-self and an imagine-other perspective. During the imagine-self perspective, participants with high psychopathy showed a typical response within the network involved in empathy for pain, including the anterior insula (aINS), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), inferior frontal gyrus (IFG), somatosensory cortex, and right amygdala. Conversely, during the imagine-other perspective, psychopaths exhibited an atypical pattern of brain activation and effective connectivity seeded in the anterior insula and amygdala with the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC). The response in the amygdala and insula was inversely correlated with PCL-R Factor 1 (interpersonal/affective) during the imagine-other perspective. In high psychopaths, scores on PCL-R Factor 1 predicted the neural response in ventral striatum when imagining others in pain. These patterns of brain activation and effective connectivity associated with differential perspective-taking provide a better understanding of empathy dysfunction in psychopathy, and have the potential to inform intervention programs for this complex clinical problem.

Emotion processing in Psychopathy Checklist-assessed psychopathy: a review of the literature

Deficient emotional experience is recognized as one of the central features of psychopathy and an impressive body of empirical findings regarding emotion processing in psychopathy has amassed over the past several decades, resulting in two broad theoretical perspectives. The general emotional deficit perspective postulates a globally reduced capacity for emotional experience and processing across the emotional spectrum. In contrast, according to the specific emotional deficit perspective, psychopathy is associated with abnormal experience of only specific types of emotion; several distinct hypotheses have been proposed under this latter perspective. We systematically and critically review findings from peer-reviewed research of emotion processing in psychopathy in relation to the two theoretical perspectives. In general, findings suggest that, compared to controls, psychopaths exhibit behavioral, psychophysiologic, and regional brain activation anomalies when processing emotion, but their ratings of self-arousal and stimulus valence/intensity do not differ from controls. However, when behavioral findings are examined separately by emotion type, the overall pattern of findings is not clearly consistent with any of the dominant theoretical perspectives of emotion processing in psychopathy. We summarize the current state of the field, including consistencies and inconsistencies in the literature, offer alternative explanations for the findings, and outline directions for future research.

Social cognition deficits and psychopathic traits in young people seeking mental health treatment

Antisocial behaviours and psychopathic traits place an individual at risk for criminality, mental illness, substance dependence, and psychosocial dysfunction. Social cognition deficits appear to be associated with psychopathic traits and are believed to contribute to interpersonal dysfunction. Most research investigating the relationship of these traits with social cognition has been conducted either in children or adult forensic settings. We investigated whether psychopathic traits were associated with social cognition in 91 young people presenting for mental healthcare (aged between 15 and 25 years). Participants completed symptom severity measures, neuropsychological tests, the Reading the Mind in the Eyes Test of social cognition (RMET), and the Antisocial Process Screening Device (APSD) to assess psychopathic personality traits. Correlation analyses showed poorer social cognition was associated with greater psychopathic traits (r = −.36, p = .01). Interestingly, social cognition performance predicted unique variance in concurrent psychopathic personality traits above gender, IQ sustained attention, and working memory performance. These findings suggest that social cognitive impairments are associated with psychopathic tendencies in young people presenting for community mental healthcare. Research is needed to establish the directionality of this relationship and to determine whether social cognition training is an effective treatment amongst young people with psychopathic tendencies.

The modulation of somatosensory resonance by psychopathic traits and empathy

A large number of neuroimaging studies have shown neural overlaps between first-hand experiences of pain and the perception of pain in others. This shared neural representation of vicarious pain is thought to involve both affective and sensorimotor systems. A number of individual factors are thought to modulate the cerebral response to other's pain. The goal of this study was to investigate the impact of psychopathic traits on the relation between sensorimotor resonance to other's pain and self-reported empathy. Our group has previously shown that a steady-state response to non-painful stimulation is modulated by the observation of other people's bodily pain. This change in somatosensory response was interpreted as a form of somatosensory gating (SG). Here, using the same technique, SG was compared between two groups of 15 young adult males: one scoring very high on a self-reported measure of psychopathic traits [60.8 ± 4.98; Levenson's Self-Report Psychopathy Scale (LSRP)] and one scoring very low (42.7 ± 2.94). The results showed a significantly greater reduction of SG to pain observation for the high psychopathic traits group compared to the low psychopathic traits group. SG to pain observation was positively correlated with affective and interpersonal facet of psychopathy in the whole sample. The high psychopathic traits group also reported lower empathic concern (EC) scores than the low psychopathic traits group. Importantly, primary psychopathy, as assessed by the LSRP, mediated the relation between EC and SG to pain observation. Together, these results suggest that increase somatosensory resonance to other's pain is not exclusively explained by trait empathy and may be linked to other personality dimensions, such as psychopathic traits.

Towards a neuroscience of empathy: ontogeny, phylogeny, brain mechanisms, context and psychopathology

Empathy allows individuals to share the affective states of others, predict others' actions, and stimulate prosocial behavior. Whilst the proximate mechanisms of empathy, modulated in part by neuropeptides such as oxytocin, control the ways we interact with our social environment, the ultimate causes seem to have arisen along with the mechanisms involved in mammalian parental care. The conceptual boundaries of empathy, however, have been blurred by definitional inaccuracies of mechanisms that can be regarded as phylogenetic precursors or physiological prerequisites for empathy, including mimicry and emotion contagion. Contextual factors such as early experiences with primary care-givers (attachment), current mood states and other environmental contingencies are capable of modulating empathy. Moreover, evidence suggests that there is also a "dark side" of empathy, namely envy and schadenfreude (gloating) that are elicited by social comparison, competition and ingroup-outgroup distinction. This review aims at clarifying some of the open definitional questions related to empathy, and emphasizing the need for considering contextual factors in the study of empathy in both normal and abnormal psychology.

Emotional empathy and psychopathy in offenders: an experimental study

Previous studies associated psychopathy in adults with deficits in empathy but these studies did not directly compare cognitive and emotional facets of empathy. The present study sought to establish whether psychopathy is associated with impairments in emotional empathy among adult offenders. Participants were 90 male offenders scoring low (n = 29), medium (n = 33) or high (n = 28) on the Psychopathy Checklist-Revised (PCL-R) and n = 28 male noncriminal controls. Empathy functioning was assessed through self-report and computerized decision tasks, differentiating between perspective-taking (cognitive empathy) and compassion (emotional empathy). Against expectations, level of psychopathy among the offenders was not associated with either emotional or cognitive empathy. Offenders however had lower scores for both cognitive and emotional components of empathy functioning than controls. Both facets of empathy showed small but significant positive correlations with education level and social desirability. The methods employed to assess differences in empathy functioning may not be sensitive enough to assess differences in forensic samples.

Machiavellianism and Spontaneous Mentalization: One Step Ahead of Others

In spite of the Machiavellians’ successful strategies in exploitation of others, they show cognitive deficiencies, especially reduced mind–reading skill. Theory of mind is usually regarded as an ability to make inferences about the mental states of others and thus to predict their behaviour. In our study, we have instead emphasized a motivation–based approach, using the concept of spontaneous mentalization. This concept is construed solely in a motivational context and not in relation to the automaticity of mind–reading ability. It entails that people in their social relations make efforts to explore the thoughts and intentions of others and are motivated to make hypotheses about the mental state of the other person. We assumed that what is peculiar to Machiavellianism is spontaneous mentalization as a kind of motivation rather than mind–reading as an ability. To measure spontaneous mentalization, we created a set of image stimuli and asked our participants to describe their impressions of the pictures. The results show that individual differences in spontaneous mentalization correlate positively with the scores of Machiavellianism. These results suggest that those who have a stronger motivation for putting themselves into the mind of others can be more successful in misleading and exploiting them. Further research should be carried out to clarify how spontaneous mentalization and mind–reading ability relate to each other. Copyright © 2011 John Wiley & Sons, Ltd.

Dissociation between affective sharing and emotion understanding in juvenile psychopaths

Empathy dysfunction is one of the core characteristics of youth with callous-unemotional (CU) traits. How such a dysfunction is associated with abnormal neural processing, however, remains to be determined. This study combined assessment of Hare Psychopathy Checklist Youth Version, pressure pain threshold, and event-related brain potentials elicited by the perception of people in pain in 15 young offenders with low CU traits (LCU), 13 with high CU traits (HCU), and 15 typically developing controls. Compared to the controls, LCU and HCU had higher pain thresholds. Although only the central late positive potential (LPP) was reduced in LCU, both the frontal N120 and central LPP were diminished in HCU. When exposed to situations in which someone was harmed by another, HCU retained the LPP, and this response was significantly correlated with their psychopathic traits and pain thresholds. Both groups had no deficit in sensorimotor resonance as assessed by mu suppression. These results demonstrate that youth with HCU exhibit atypical neural dynamics of pain empathy processing in the early stage of affective arousal, which is coupled with their relative insensitivity to actual pain. Their capacity to understand intentionality, however, was not affected. Such uncoupling between affective arousal and emotion understanding may contribute to instigating aggressive behaviors in juvenile psychopaths.

Cortical thickness and folding deficits in conduct-disordered adolescents

BACKGROUND

Studies of pediatric conduct disorder (CD) have described frontal and temporal lobe structural abnormalities that parallel findings in antisocial adults. The purpose of this study was to examine previously unexplored cortical thickness and folding as markers for brain abnormalities in "pure CD"-diagnosed adolescents. On the basis of current frontotemporal theories, we hypothesized that CD youth would have thinner cortex or less cortical folding in temporal and frontal lobes than control subjects.

METHODS

We obtained T1-weighted brain structure images from 24 control and 19 CD participants aged 12 to 18 years, matched by gender and age. We measured group differences in cortical thickness and local gyrification index (regional cortical folding measure) using surface-based morphometry with clusterwise correction for multiple comparisons.

RESULTS

The CD participants, compared with control subjects, showed both reduced cortical thickness and folding. Thinner cortex was located primarily in posterior brain regions, including left superior temporal and parietal lobes, temporoparietal junction and paracentral lobule, right superior temporal and parietal lobes, temporoparietal junction, and precuneus. Folding deficits were located mainly in anterior brain regions and included left insula, ventro- and dorsomedial prefrontal, anterior cingulate and orbitofrontal cortices, temporal lobe, right superior frontal and parietal lobes, and paracentral lobule.

CONCLUSIONS

Our findings generally agree with previous CD volumetric studies but here show the unique contributions of cortical thickness and folding to gray matter reductions in pure CD in different brain regions.

[Impaired resonance in offenders with psychopathic traits]

BACKGROUND

Resonance is the phenomenon of unconsciously mirroring the motor actions of another person. Beside autism and schizophrenia psychopathic personality traits are associated with empathy dysfunction.

METHODS

We explore empathic resonance in terms of contagion by laughing and yawning in a group of offenders with psychopathic traits. Offenders with psychopathic traits (n = 12) and matched controls (n = 10) were video-taped while watching short video sequences of yawning, laughing or neutral faces. They were rated regarding contagion. Further, we assessed a self-report on psychopathy and on empathic tendencies.

RESULTS

Compared to the control group, the offenders showed significantly less contagion and less self-reported empathic tendencies. Individuals who rated themselves as more empathic showed more contagion.

CONCLUSIONS

The observed reduced resonance in terms of contagion may illuminate the cold-heartedness, with which some psychopathic offenders treat their victims: When embodied experiencing of other's physical and emotional situation is missing, a natural inhibition of violence may be overcome. The small sample size limits the generalisability of these findings.

A review on the relationship between testosterone and the interpersonal/affective facet of psychopathy

Testosterone (T) has received increasing interest in the recent years as a probable biological determinant in the etiology of male-biased clinical conditions such as psychopathy (i.e. psychopathy is more prevalent in men and leads to an earlier onset and more severe expression of antisocial and aggressive behavior in men compared to women). In this review, the authors evaluated the potential relationship between T and different constructs closely related to the core characteristics of psychopathy (affective empathy, fear-reactivity, and instrumental aggression). After a thorough examination of the literature, it is concluded that high T exposure in utero and high circulating T levels throughout important life phases (most notably adolescence) or in response to social challenges (e.g. social stress, competition) could be an important etiological risk factor in the emergence of psychopathic behavior. Nevertheless, studies consistently indicate that high T is not related to a significantly reduced fear-reactivity and is only indirectly associated with the increased levels of instrumental aggression observed in psychopathic individuals. Therefore, psychopathy is likely to arise from an interaction between high T levels and other biological and socio-psychological risk factors, such as a constitutionally based dampened fear-reactivity, insecure/disordered attachment processes in childhood, and social discrimination/rejection in adolescence and/or adulthood.

["Theory of mind" and its neuronal correlates in forensically relevant disorders]

Theory of mind (ToM), the ability to recognize mental states of others, and empathy are crucial cognitive-emotional processes for appropriate social interactions. Deficits in these processes can lead to maladjusted social behavior or even to aggressive or criminal behavior. ToM and empathy deficits have been found in different forensically relevant disorders, such as schizophrenia, pedophilia but especially in autism and psychopathy according to Hare. Most notably, autistic and psychopathic patients differ in their type of deficits and in their neuronal correlates. While autistic individuals lack the ability to take the perspective of others, psychopaths lack empathy. The aim of this article is to provide a better understanding of the pathophysiology of ToM and empathy deficits in forensically relevant disorders by reviewing and discussing the findings of neuroimaging and lesion studies and to highlight crucial implications for neuropsychotherapy according to Grawe.

Psychopathy increases perceived moral permissibility of accidents

Psychopaths are notorious for their antisocial and immoral behavior, yet experimental studies have typically failed to identify deficits in their capacities for explicit moral judgment. We tested 20 criminal psychopaths and 25 criminal nonpsychopaths on a moral judgment task featuring hypothetical scenarios that systematically varied an actor's intention and the action's outcome. Participants were instructed to evaluate four classes of actions: accidental harms, attempted harms, intentional harms, and neutral acts. Psychopaths showed a selective difference, compared with nonpsychopaths, in judging accidents, where one person harmed another unintentionally. Specifically, psychopaths judged these actions to be more morally permissible. We suggest that this pattern reflects psychopaths' failure to appreciate the emotional aspect of the victim's experience of harm. These findings provide direct evidence of abnormal moral judgment in psychopathy.

Perceptions of aggressive conflicts and others' distress in children with callous-unemotional traits: 'I'll show you who's boss, even if you suffer and I get in trouble'

BACKGROUND

Children with callous-unemotional (CU) traits may have a particularly malevolent view of social conflicts and a pervasive insensitivity to others' distress. The current study examined whether children with CU traits have unique expectations and values regarding the consequences of aggressive conflicts and a ubiquitous lack of concern for others' feelings independent of co-occurring aggression.

METHODS

Participants were 96 (46 males, 50 females) children recruited from elementary schools within an urban city. Associations between CU traits and child reports of outcome expectancies/values following aggressive conflicts and facets of empathy were examined after controlling for aggression, academic abilities, and demographic covariates.

RESULTS

Children with higher CU traits were less likely to expect that aggression would result in victim suffering and feelings of remorse. After controlling for co-occurring aggression, children with higher CU traits were more likely to expect that aggression would result in peer dominance, while children with higher levels of aggression were more likely to expect that attacking others would reduce their aversive behavior. Children with higher CU traits were less concerned that aggressive behavior would result in punishment, victim suffering, and feelings of remorse. Moreover, children with higher CU traits reported lower levels of empathetic concern and sadness in response to others' distress outside of aggressive conflicts.

CONCLUSIONS

Children with CU traits tend to minimize the extent to which aggression causes victim suffering and openly acknowledge caring less about distress and suffering in others. They are less intimidated by the possibility of being punished for aggressive behavior and tend to view aggression as an effective means for dominating others. In sum, children with CU traits have a particularly malicious social schema that may be difficult to change using conventional treatment methods.

Lack of empathy in patients with narcissistic personality disorder

The study's objective was to empirically assess cognitive and emotional empathy in patients with narcissistic personality disorder (NPD). To date, "lack of empathy" is a core feature of NPD solely based on clinical observation. The study's method was that forty-seven patients with NPD, 53 healthy controls, and 27 clinical controls with borderline personality disorder (BPD) were included in the study. Emotional and cognitive empathy were assessed with traditional questionnaire measures, the newly developed Multifaceted Empathy Test (MET), and the Movie for the Assessment of Social Cognition (MASC). The study's results were that individuals with NPD displayed significant impairments in emotional empathy on the MET. Furthermore, relative to BPD patients and healthy controls, NPD patients did not show deficits in cognitive empathy on the MET or MASC. Crucially, this empathic profile of NPD is not captured by the Structured Clinical Interview for DSM-IV for Axis II Disorders (SCID-II). The study's conclusions were that while NPD involves deficits in emotional empathy, cognitive empathy seems grossly unaffected.

Theory of mind and neurodevelopmental disorders of childhood

To a large extent, the human infant is socialized through the acquisition of a specific cognitive mechanism known as theory of mind (ToM), a term which is currently used to explain a related set of intellectual abilities that enable us to understand that others have beliefs, desires, plans, hopes, information, and intentions that may differ from our own. Various neurodevelopmental disorders, such as autism spectrum disorders, attention deficit hyperactivity disorder, developmental language disorders, and schizophrenia, as well as acquired disorders of the right brain (and traumatic brain injury) impair ToM. ToM is a composite function, which involves memory, joint attention, complex perceptual recognition (such as face and gaze processing), language, executive functions (such as tracking of intentions and goals and moral reasoning), emotion processing-recognition, empathy, and imitation. Hence, ToM development is dependent on the maturation of several brain systems and is shaped by parenting, social relations, training, and education; thus, it is an example of the dense interaction that occurs between brain development and (social) environment.

Narcissistic personality disorder in DSM-V--in support of retaining a significant diagnosis

Narcissistic personality disorder, NPD, has been excluded as a diagnostic category and independent personality disorder type in the Personality and Personality Disorder Work Group's recent proposal for DSM-5 Personality and Personality Disorders. The aim of this paper is to present supporting evidence in favor of keeping NPD as a personality type with a set of separate diagnostic criteria in DSM-5. These include: the prevalence rate, extensive clinical and empirical reports and facts, its psychiatric, social and societal significance especially when associated to functional vocational and interpersonal impairment, social and moral adaptation, and acute suicidality. Proposals for a clinically relevant and empirically based definition of narcissism, a description of the narcissistic personality disorder type, and a set of diagnostic criteria for NPD are outlined.

Perceptions of social conflicts among incarcerated adolescents with callous-unemotional traits: 'you're going to pay. It's going to hurt, but I don't care.'

BACKGROUND

Delinquent youth with callous-unemotional (CU) traits may have a unique social-cognitive processing pattern that perpetuates their violent behavior. The current study examined the association between CU traits and the endorsement of deviant social goals during peer conflicts as well as expectancies and values regarding victim suffering following aggression.

METHODS

Participants included 156 (84 males, 72 females) adjudicated juveniles residing at two gender-specific residential facilities in an urban city within the southeastern United States. The association between CU traits and participants' ratings of their social goals in hypothetic conflict situations and outcome expectancies/values regarding victim suffering were examined after controlling for prior violence, intelligence, and demographic covariates.

RESULTS

 CU traits were associated with an increased endorsement of social goals associated with revenge, dominance, and forced respect in social conflict situations. Adjudicated youth with CU traits were also less likely to endorse conflict avoidance and friendship building as important social goals when provoked by peers. There was no association between CU traits and expectations for victim suffering following aggression, but CU traits were significantly associated with lower levels of concern about victim suffering. These findings were significant after controlling for participants' prior history of violence, intelligence, and demographic covariates.

CONCLUSIONS

Adjudicated youth with CU traits tend to emphasize power-oriented goals when provoked by peers and have little interest in rectifying social conflicts to build potential friendships with others. Juveniles with CU traits seem to be aware that their aggressive behavior will cause others to suffer, but they do not care when it does.

Clinically Relevant Measures of Children's Theory of Mind and Knowledge about Thinking: Non-Standard and Advanced Measures

Measures of Theory of Mind (ToM) in clinical disorders and conditions are reviewed, focusing on non-standard and advanced measures. Relevant studies linking these measures to social problems and cognitive symptoms are reviewed. The multifaceted nature of ToM is stressed and clinically relevant aspects of ToM are suggested. Strategies to select relevant measures for clinical research and practice are presented and examples are discussed in more detail. It is recommended to consider specific aspects of ToM in relation to specific clinical conditions and symptoms. Relationships between ToM and other cognitive deficits, and implications for clinical practice and intervention are also discussed.

Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder

BACKGROUND

  Empathy dysfunction is one of the hallmarks of psychopathy, but it is also sometimes thought to characterise autism spectrum disorders (ASD). Individuals with either condition can appear uncaring towards others. This study set out to compare and contrast directly boys with psychopathic tendencies and boys with ASD on tasks assessing aspects of affective empathy and cognitive perspective taking. The main aim of the study was to assess whether a distinct profile of empathy deficits would emerge for boys with psychopathic tendencies and ASD, and whether empathy deficits would be associated with conduct problems in general, rather than psychopathic tendencies or ASD specifically.

METHODS

  Four groups of boys aged between 9 and 16 years (N = 96) were compared: 1) psychopathic tendencies, 2) ASD, 3) conduct problems and 4) comparison. Tasks were included to probe attribution of emotions to self, empathy for victims of aggression and cognitive perspective-taking ability.

RESULTS

  Boys with psychopathic tendencies had a profile consistent with dysfunctional affective empathy. They reported experiencing less fear and less empathy for victims of aggression than comparison boys. Their cognitive perspective-taking abilities were not statistically significantly different from those of comparison boys. In contrast, boys with ASD had difficulties with tasks requiring cognitive perspective taking, but reported emotional experiences and victim empathy that were in line with comparison boys. Boys with conduct problems did not differ from comparison boys, suggesting that the affective empathy deficit seen in boys with psychopathic tendencies was specific to that group, rather than common to all boys with conduct problems.

CONCLUSIONS

  Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people's distress, whereas ASD is characterised by difficulties in knowing what other people think.

What imaging tells us about violence in anti-social men

This paper provides an overview of imaging studies in samples of men with personality disorder (PD) who have been violent. Mention is also made of the work of two groups that have looked at the neural correlates of violence across diagnostic categories, including schizophrenia and anti-social PD given their relevance in the field. The paper focuses on the notion that aggressive behaviour can be conceptualised in terms of at least two types, reactive and pro-active, and that few studies separate them. The neuro-anatomical basis of aggression and associated neurobehavioural theories are discussed in relation to clinical disorders (mainly anti-social personality pathology) associated with these different types of aggressive behaviour. Structural (computed tomography, magnetic resonance imaging) and functional (positron emission tomography, fMRI, single-photon emission tomography) studies with violent people variously characterised as anti-social or having psychopathy will be critically reviewed.

In psychopathic patients emotion attribution modulates activity in outcome-related brain areas

The understanding that other people's emotional states depend on the fulfilment of their intention is fundamentally important for responding adequately to others. Psychopathic patients show severe deficits in responding adequately to other people's emotion. The present study explored whether these impairments are associated with deficits in the ability to infer others' emotional states. Using functional magnetic resonance imaging (fMRI), identical cartoon stories, depicting a subject whose intention was fulfilled or not fulfilled, were presented to 14 psychopathic patients and 14 non-psychopathic patients. The participants should indicate the protagonist's emotional state. Additionally, a non-mentalizing control condition was presented. The two groups showed no behavioural differences. But in non-psychopathic patients emotion attribution was associated with increased activity of the mirror neuron system, the bilateral supramarginal gyrus and the superior frontal gyrus. In contrast psychopathic patients showed increased activation of regions associated with outcome monitoring and attention, such as the orbitofrontal cortex, the medial frontal cortex and temporo-parietal areas. The results emphasize that although psychopathic patients show no deficits in reasoning about other people's emotion if an explicit evaluation is demanded, they use divergent neural processing strategies that are related to more rational, outcome-oriented processes.

[Neurobiological aspects of reactive and proactive violence in antisocial personality disorder and "psychopathy"]

Impulsive-reactive violent offenders show increased autonomic activity in response to negative emotional and threatening stimuli. A volume reduction and/or activity decrease of frontal brain structures associated with impulse control and the regulation of fear and anger are likewise found in combination with a fear-related hyperactivity of the amygdala. In addition, impulsive aggression is facilitated by variants of gene polymorphisms influencing the serotonergic system. Conversely, proactive-instrumental violent offender with psychopathy, who are characterized by a lack of empathy and remorse, demonstrate an autonomic hypo-responsivity as well as dysfunctions of the amygdala and of cortical regions related to empathic and social behavior. Developmentally, aggressive children exhibit temperamental differences from early childhood on that are characteristic of a developmental pathway towards either reactive or proactive violence later in life. Exposure to negative environmental factors like ineffective parenting or childhood maltreatment has been related to a heightened risk for developing reactive violence. A developmental trajectory of proactive violence, however, has been related to a mostly genetically determined callous unemotional temperament of the child that disrupts the parental socialization efforts during childhood.

Impaired decentration in personality disorder: a series of single cases analysed with the Metacognition Assessment Scale

BACKGROUND

There is growing support for the idea that an impaired understanding of others' mental states is an underlying feature of personality disorder (PD). Only recently has there begun to be evidence of impairments to subjects' ability to infer and reason about others' intentions and emotions, and detach from their own perspective when doing so.

METHOD

We analysed the transcripts from the first 16 psychotherapy sessions of 14 PD patients. Scales for understanding others' minds from the Metacognition Assessment Scale were used.

RESULTS

Patients were generally able to describe others' mental states, although, at times, they had problems. There was, on the other hand, an inability to decentre while reasoning about others, and this was common to all the patients.

CONCLUSIONS

PDs indeed feature a poor decentration, which is not easily identified with the usual lab tasks. Implications for further research and treatment are discussed.

KEY PRACTITIONER MESSAGE

*Patients with personality disorders have substantial difficulties in adopting others' point of view and standing back from their own, and grasping that they are not the center of other peoples' thoughts.

Theory of mind and psychiatry: an introduction

OBJECTIVE

'Theory of mind' (ToM) arose from the study of primates and their social organization, and scholars in many fields - philosophy, anthropology, psychology, psychiatry and neuroscience - have contributed to this expanding topic. In this paper, we provide an overview of aspects of ToM of relevance to psychiatry. We briefly describe the origins of ToM in primates and humans and some relevant neurobiology, and then touch on possible contributions to psychopathology.

METHOD

We searched for articles on PubMed and Medline, using the terms 'theory of mind', 'mirror neuron system' and 'psychiatry'.

CONCLUSION

There is evidence that ToM deficits are important in certain psychiatric disorders. While more research is required, an appreciation of ToM will have an impact on our further understanding and management of at least some mental disorders, including autism and schizophrenia.

The purpose and neurobiology of theory of mind functions

Theory of Mind (ToM) refers to a cognitive process which allows an individual to "place him/herself" in the other person's "mind," so as to comprehend the latter's cognitive and emotional status, so as to predict his/her behavior and emotional response to a particular situation. ToM is necessary for everyday interaction among individuals and accounts for such human traits as empathy, compassion, and deceit. It is also particularly important in the relationship between a healer and his or her client, as well as in the God-human relationship. Recent research in the area of neurosciences has identified a specific brain "system" responsible for ToM, as well as described how these functions may be affected in certain neuropsychiatric conditions. In this article, we discuss the definition and neurobiological substrate of ToM. In addition, we discuss the cognitive steps important to achieve an "accurate" theory of mind, its relevance to "self-knowledge," and its limitations. We also review some of the data concerning abnormalities and "distortion" of ToM in neuropsychiatric disorders and aberrant human behavior.

Psychopathy and the mirror neuron system: preliminary findings from a non-psychiatric sample

Recent advances in social neuroscience suggest a link between empathy and the mirror neuron system (MNS). Impaired empathy is one of the core diagnostic features of psychopathic personality disorder. In the present study, we investigated whether psychopathic personality traits in a non-psychiatric sample were related to MNS function. Healthy participants viewed short videos known to activate the sensorimotor MNS for pain (a needle penetrating a human hand) while transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) were recorded as a measure of motor cortex excitability. Individual psychopathic personality traits were assessed using the Psychopathic Personality Inventory (PPI) and correlated with the MEP findings. Consistent with previous data, observation of the painful stimulus was associated with a significant reduction in the amplitude of the TMS-induced MEP. Interestingly, the level of corticospinal excitability modulation was positively correlated with individual scores on the coldheartedness subscale of the PPI, such that individuals with the greatest MEP reduction were the ones scoring highest on the coldheartedness measure. These data suggest the existence of a functional link between 'motor empathy' and psychopathy.