Emotion regulation in psychopathy

Understanding empathy deficits and emotion dysregulation in psychopathy: The mediating role of alexithymia

Psychopathy is a severe personality disorder marked by a wide range of emotional deficits, including a lack of empathy, emotion dysregulation, and alexithymia. Previous research has largely examined these emotional impairments in isolation, ignoring their influence on each other. Thus, we examined the concurrent interrelationship between emotional impairments in psychopathy, with a particular focus on the mediating role of alexithymia. Using path analyses with cross-sectional data from a community sample (N = 315) and a forensic sample (N = 50), our results yielded a statistically significant mediating effect of alexithymia on the relationship between psychopathy and empathy (community and forensic) and between psychopathy and emotion dysregulation (community). Moreover, replacing psychopathy with its three dimensions (i.e., meanness, disinhibition, and boldness) in the community sample revealed that boldness may function as an adaptive trait, with lower levels of alexithymia counteracting deficits in empathy and emotion dysregulation. Overall, our findings indicate that psychopathic individuals' limited understanding of their own emotions contributes to their lack of empathy and emotion dysregulation. This underscores the potential benefits of improving emotional awareness in the treatment of individuals with psychopathy.

Social exclusion evokes different psychophysiological responses in individuals high on the psychopathy facets fearless dominance and self-centered impulsivity

Individuals with psychopathic personality traits are generally thought to have difficulties in processing and experiencing emotions. These difficulties could also translate to emotionally charged social situations such as social exclusion. Being socially excluded is often experienced as stressful and unpleasant, potentially even leading to selfish or aggressive behavior-both of which are linked to certain aspects of psychopathy. The current study investigated self-report and physiological responses to social exclusion in the cyberball paradigm in a carefully selected community sample of individuals either scoring high on primary (N = 24) or secondary psychopathy traits (N = 17). Across the sample, the cyberball paradigm decreased experiences of joy and approach motivation, increased subjective anger reports, and induced changes in heart rate. In contrast, individuals scoring high on secondary psychopathy traits (Self-Centered Impulsivity group) displayed stronger physiological reactivity during a habituation phase of prolonged social exclusion than individuals scoring high on primary psychopathy traits (Fearless Dominance group), indexed by changes in skin conductance level. Moreover, a potential mismatch between self-reported and physiological arousal seemed to be only observable in individuals with high secondary psychopathy traits. Overall, the current results suggest diverging patterns of emotional processing and regulation in a social exclusion situation when comparing well-functioning individuals with varying psychopathy traits. It seemed as if individuals high on primary psychopathy traits were insensitive to contextual social cues, while individuals high on secondary psychopathy traits were more affected by the potentially threatening social situation. Cautiously transferring the current findings to forensic samples, they support the idea of moving from a behavioral understanding of the psychopathy construct to a more clinical picture with distinct cognitive and emotional processing patterns in individuals high on either primary or secondary psychopathy traits.

Low defensive cardiac reactivity as a physiological correlate of psychopathic fearlessness: Gender differences

Affective/interpersonal features of psychopathy have been consistently associated with diverse psychophysiological indicators of low threat sensitivity, suggesting an underlying deficit in the reactivity of the brain's defensive motivational system. This study examined the Cardiac Defense Response (CDR) -a complex pattern of heart rate changes in response to an aversive, intense, and unexpected stimulus- and its second accelerative component (A2), as a new physiological indicator of the fearlessness trait component of psychopathy. The differential contribution of dispositional fearlessness, externalizing proneness, and coldheartedness to the CDR pattern elicited during a defense psychophysiological test was examined in a mixed-gender sample of 156 undergraduates (62% women) assessed by the Psychopathic Personality Inventory-Revised (PPI-R). Higher PPI-R Fearless Dominance scores were related to lower heart rate changes throughout the CDR in women, but not in men. Further analyses on scales conforming the fearless dominance factor revealed that the hypothesized reduced A2 was specifically related to higher PPI-R Fearlessness scores only in women. Our findings provide initial evidence for the utility of the A2 to better understand the physiological aspects of fearlessness tendencies and its potential distinct manifestations across genders.

Psychopathic personality traits stress immunity and social potency moderate the relationship between emotional competence and cognitive functions in depression

Background

Psychopathic personality traits (PPT) and depression have both been shown to worsen emotional and cognitive functions. Moreover, PPT and depression share similar underlying neuronal circuits tapping into the emotional and cognitive domains. However, little is known about the influence of PPT on emotion and cognition in individuals with depression.

Objectives

This study aimed to examine the correlative relationships and moderating role of PPT in the association between emotional competence and cognitive functions in individuals with depression.

Methods

Data from 373 individuals diagnosed with depression (158 males, 215 females) were examined within a cohort study. Subjects filled out validated questionnaires surveying PPT and emotional competences. Furthermore, a comprehensive neuropsychological test battery was administered.

Results

Correlation analyses revealed a significant positive association between emotional competence and cognitive functions. Further, negative associations between emotional competence and the PPT "Blame Externalisation" and "Careless Nonplanfulness," as well as positive associations with psychopathic "Social Potency" and "Stress Immunity" were found. Moderation analyses indicated a significant positive influence of psychopathic "Stress Immunity" and "Social Influence" on the relationship between emotional competence and cognitive functions.

Conclusion

The findings highlight the importance of integrating PPT in depression research. Considering PPT in depression treatment could also facilitate the therapeutic process by identifying individual traits as resilience-strengthening or potentially harmful factors for depressive symptomatology. This study represents a stepping stone for further research regarding the role of personality traits in psychiatric disorders and their treatment.

Effects of childhood trauma in psychopathy and response inhibition

Childhood trauma is linked to impairments in executive function and working memory, thought to underly psychological disorders including depression and posttraumatic stress disorder. Research demonstrates that childhood trauma can partially mediate posttraumatic stress disorder in those with executive function deficits. Despite a link with executive function deficit, psychopathy as a consequence of trauma is yet to be studied in this context. The present study investigates the possibility of a relationship between childhood trauma, psychopathic traits, and response inhibition. Eighty participants were tasked to completed the Childhood Traumatic Events Scale (Pennebaker & Susman, 2013), Levenson’s Self-Report Psychopathy Scale (Levenson et al., 1995), and Flanker task of response inhibition (Eriksen & Eriksen, 1974). Scores of trauma exposure, psychopathic traits, and reaction times in the Flanker task were measured. Regression analysis revealed no significance for trauma exposure in predicting psychopathic traits (p = .201) and response inhibition (p = .183), indicating that childhood trauma does not strongly predict susceptibility to psychopathic traits or response inhibition deficits. These findings form an important basis on which to build a further understanding of the consequences of childhood trauma exposure, specifically in terms of understanding how specific cognitive functions may be influenced and providing a clearer understanding of how psychopathic traits develop.

Heart Rate and Skin Conductance Associations with Physical Aggression, Psychopathy, Antisocial Personality Disorder and Conduct Disorder: An Updated Meta-Analysis

The associations between physiological measures (i.e., heart rate and skin conductance) of autonomic nervous system (ANS) activity and severe antisocial spectrum behavior (AB) were meta-analyzed. We used an exhaustive partitioning of variables relevant to the ANS-AB association and investigated four highly relevant questions (on declining effect sizes, psychopathy subscales, moderators, and ANS measures) that are thought to be transformative for future research on AB. We investigated a broad spectrum of physiological measures (e.g., heart rate (variability), pre-ejection period) in relation to AB. The search date for the current meta-analysis was on January 1^st, 2020, includes 101 studies and 769 effect sizes. Results indicate that effect sizes are heterogeneous and bidirectional. The careful partitioning of variables sheds light on the complex associations that were obscured in previous meta-analyses. Effects are largest for the most violent offenders and for psychopathy and are dependent on the experimental tasks used, parameters calculated, and analyses run. Understanding the specificity of physiological reactions may be expedient for differentiating between (and within) types of AB.

The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.

Fifty Shades of Darkness: A Socio-Cognitive Information-Processing Framework Applied to Narcissism and Psychopathy

Existing trait-based and cognitive models of psychopathy and narcissism fail to provide a comprehensive framework that explains the continuum between sub-clinical and clinical presentations of those personalities and to predict associated maladaptive behavior in different social and cultural contexts. In this article, a socio-cognitive information-processing framework for narcissism and psychopathy (SCIPNP) is proposed to explain how psychopathic and narcissistic schemata influence the activation of psychological processes that interact with social and cultural contexts to display those personalities at a sub-clinical level. The proposed framework enables us to predict maladaptive behavior and to explain how sub-clinical narcissists and psychopaths develop personality disorders. The SCIPNP emphasizes the role of culture in shaping motives, appraisals, behavior and affect. Recommendations for future research are provided.

Biased interpretation in paranoia and its modification

BACKGROUND AND OBJECTIVES

Cognitive models of psychosis implicate interpretation biases as one of the mechanisms involved in the formation and maintenance of symptoms. First we measured the strength of association between interpretation biases and psychosis-relevant traits. Next we manipulated these biases and quantified the effects of doing so on psychosis-relevant outcomes.

METHODS

Experiment 1 used two measures of interpretation bias in a healthy sample (n = 70). Experiment 2 used a novel cognitive bias modification procedure (CMB-pa) in individuals with moderate trait paranoia (n = 60).

RESULTS

Experiment 1 revealed that over a third of the variance in interpretation bias could be explained by the combined effect of trait measures of paranoia/psychosis. In Experiment 2, CBM-pa produced training-congruent changes in the interpretation of new ambiguous information and influenced the interpretation, attribution and distress associated with a real-life social event.

LIMITATIONS

The potentially confounding effects of elevated anxiety and depression on interpretation bias and the restricted range of outcome measures to assess the wider effects of CBM-pa.

CONCLUSIONS

These studies are consistent with interpretation biases contributing to the maintenance of paranoia. CBM-pa could next be adapted and evaluated to test its efficacy as a therapeutic intervention.

I Can But I Shall Not Always Be Empathic

Empathy, a core process for social interactions, is the capacity to understand and share others' mental states and emotions. Each individual is thought to have a maximum level of empathy (empathic ability) and a spontaneous tendency to express it (empathic propensity), which can be affected by multiple factors. Two within-subject studies were conducted to assess the malleability of empathy by modulating contextual factors and measuring their interaction with psychological characteristics. In Study 1, 59 healthy adults evaluated their empathy for people showing facial expressions of pain following different instructions: Passive Observation and Instruction to Actively Empathize. In Study 2, 56 healthy adults performed a similar task under two conditions: Passive Observation and Observation under a Cognitive Load. The results revealed that empathy was significantly increased in the actively empathizing condition (Study 1) and under a cognitive load, but more importantly for men (Study 2). The level of change between the two conditions was associated with self-reported empathy, autistic, alexithymia and psychopathic traits (Study 1), as well as with working memory capacities and the level of empathy reported in the passive observation condition (Study 2). These findings suggest that an instruction to actively empathize and, surprisingly, a cognitive load can both increase empathy, but not for the same individuals. An instruction to actively empathize seems to increase empathy for individuals with good empathic dispositions, while a cognitive load enhances empathy in people for which empathic propensity is sub-optimal.

Psychopathy and emotion dysregulation: More than meets the eye

Emotional dysfunctions have long been associated with psychopathy. Yet, the extent to which these dysfunctions include problems in emotion regulation (ER) has only recently become clearer. In this study, we first reviewed theoretical and empirical literature on psychopathy and ER, and then examined associations between ER and psychopathy in four diverse samples from two countries (MTurk, college, community, and offender samples from the United States and Italy; total N = 1940). We employed Structural Equation Modeling (SEM) to examine latent associations between ER and measures of psychopathy and the dark triad, respectively. Results revealed a consistent pattern of moderate associations between psychopathy and poorer ER. These patterns were replicated across samples and psychopathy assessment, and held when including Machiavellianism and narcissism in the models. Replicating and extending recent studies, these findings provide incremental evidence that the emotional dysfunctions associated with psychopathy include problems in ER. Thus, we contend that prevention efforts in the general community, as well as clinical risk assessment and treatment planning in clinical (forensic) populations should include an emphasis on ER, as it may represent an important factor explaining some of the maladaptive correlates of psychopathic personality.

Coregulation of therapist and client emotion during psychotherapy

OBJECTIVE

Close interpersonal relationships are fundamental to emotion regulation. Clinical theory suggests that one role of therapists in psychotherapy is to help clients regulate emotions, however, if and how clients and therapists serve to regulate each other's emotions has not been empirically tested. Emotion coregulation - the bidirectional emotional linkage of two people that promotes emotional stability - is a specific, temporal process that provides a framework for testing the way in which therapists' and clients' emotions may be related on a moment to moment basis in clinically relevant ways.

METHOD

Utilizing 227 audio recordings from a relationally oriented treatment (Motivational Interviewing), we estimated continuous values of vocally encoded emotional arousal via mean fundamental frequency. We used dynamic systems models to examine emotional coregulation, and tested the hypothesis that each individual's emotional arousal would be significantly associated with fluctuations in the other's emotional state over the course of a psychotherapy session.

RESULTS

Results indicated that when clients became more emotionally labile over the course of the session, therapists became less so. When changes in therapist arousal increased, the client's tendency to become more aroused during session slowed. Alternatively, when changes in client arousal increased, the therapist's tendency to become less aroused slowed.

Evaluating the risk assessment tools used by Australian police officers responding to domestic violence incidents: a narrative review

Family and domestic violence (FDV) remains a topical issue in Australia. With state incidences of FDV reaching up to 1668 victims per 100,000 persons, the need for tools assessing the likelihood of future offending and recidivism is paramount. The present study reviewed the quality and efficacy of FDV risk assessment tools currently in use by police in each Australian state/territory. The review revealed a large gap in the development and quality assessment of tools employed by Australian police officers. Additionally, when compared to international 'gold standard' risk assessment tools, it was evident that the tools currently in use are assessing for too many variables, and that key high-risk factors are absent. It is argued that Australian FDV risk assessment tools need revising, with the development of a nationwide risk assessment tool being the goal of future research in this area.

Impaired processing of threat in psychopathy: A systematic review and meta-analysis of factorial data in male offender populations

Background

Psychopathy is a personality disorder characterised by two underlying factors. Factor 1 (affective and interpersonal deficits) captures affective deficits, whilst Factor 2 (antisocial and impulsive/disorganised behaviours) captures life course persistent antisocial behaviours. Impaired processing of threat has been proposed as an aetiologically salient factor in the development of psychopathy, but the relationship of this impairment to the factorial structure of the disorder in adult male offenders is unclear.

Objectives

To investigate whether threat processing deficits are characteristic of psychopathy as a unitary construct or whether such deficits are specifically linked to higher scores on individual factors.

Data sources

A systematic review of the literature was conducted by searching PubMed, Web of Science and PsycINFO.

Methods

Studies were included if they (1) reported physiological measures of threat response as the primary outcome measure (2) indexed psychopathy using a well-validated clinician rated instrument such as the PCL-R (3) investigated male offenders between 18 and 60 years of age (4) reported threat processing analyses using both Factor 1 and Factor 2 scores (5) provided sufficient data to calculate effect sizes and (6) were published in English-language peer-reviewed journals. We identified twelve studies with data on 1112 participants for the meta-analysis of the relationship with Factor 1 scores, and nine studies with data on 801 participants for the meta-analysis of the relationship with Factor 2 scores. We conducted the meta-analyses to calculate correlations using random-effects models.

Results

PCL-R/SV Factor 1 scores were significantly and negatively related to threat processing indices (r = -0.22, (95%CI [-0.28, -.017]). Neither PCL-R/SV Factor 2 scores (r = -0.005, 95%CI [-0.10, 0.09]), nor PCL-R total score (r = -0.05, (95%CI [-0.15, -0.04]) were related to threat processing indices. No significant heterogeneity was detected for the Factor score results.

Conclusions

The meta-analyses of the distinct psychopathy factors suggest that the threat processing deficits observed in male offenders with psychopathy are significantly associated with higher scores on Factor 1. A similar relationship does not exist with Factor 2 scores. Our findings highlight the importance of investigating the potentially discrete relationships between aetiological variables and the two factor constructs in the disorder.

Capacity for upregulation of emotional processing in psychopathy: all you have to do is ask

Historically, psychopathic individuals have been described as suffering a chronic hyporesponsivity to negatively valent stimuli. However, while a wide body of empirical work indicates that the psychopath does not manifest normal reactivity to emotional stimuli, it does not similarly indicate that they cannot do so. To attempt to differentiate these alternatives, the current functional magnetic resonance imaging (fMRI) study evaluated the extent to which offenders with varying PCL-R scores could up- (or down-) regulate their neural response to negatively valent stimuli. Participants were asked to either watch negatively- and neutrally-valent images naturally (passive-processing), or to try to increase or decrease their emotional response to the images (instructed-processing). During passive processing, high-psychopathy offenders showed reduced activity compared to both low- and mid-psychopathic offenders through a majority of emotion-relevant regions. However, when participants were instructed to try to increase their emotional response all groups showing increased activity throughout relevant regions, including left insula, orbitofrontal cortex and anterior cingulate/medial frontal cortex (ACC/mFC). Comparison of participants' subjective emotion ratings indicated that all groups showed symmetry between their neural/subjective emotion metrics, and the high-psychopathy group may have showed the greatest such symmetry. These findings suggest that psychopathic individuals may be capable of manifesting emotional reactivity to negatively valent stimuli, at least under certain conditions. Relevance for traditional and developing models of psychopathy is discussed in turn.

Hostile Attribution Bias as a Mediator of the Relationships of Psychopathy and Narcissism With Aggression

Hostile attribution bias (HAB), the tendency to perceive hostility in ambiguous situations, has been linked to aggressive outcomes, such as reactive aggression. HAB has been connected to personality types involving hostile beliefs and reactive aggression, including narcissism and psychopathy. Specifically, secondary psychopathy is associated with HAB and reactive aggression. Despite research and theory connecting these constructs, few studies have examined if HAB mediates the relationships among psychopathy, narcissism, and aggression. The current study explores this possible mediation in an urban college sample. Narcissism was associated with aggression but not hostile aggression or HAB. Reactive aggression and HAB were both associated with psychopathy, but there were no mediation relationships. The associations with aggression may be, therefore, due to underlying traits of secondary psychopathy rather than the hostile attributions to which the traits contribute; consequently, treatments focused on reducing aggressive responses by correcting interpretations of social situations may not be successful.

Psychopathy and its relation to personality psychopathology in a South African female forensic context

There is a paucity of research about personality pathology among female offenders. This study aims to address this gap in the forensic psychology empirical base by examining the relationship between female psychopathy, as measured by the Psychopathy Checklist–Revised, and personality disorders, as measured by the Millon Clinical Multiaxial Inventory-III in a South African forensic context. Participants included 108 purposively sampled female offenders incarcerated in South Africa. The Kruskal–Wallis H test and Mann–Whitney U test revealed a number of significant differences in levels of personality pathology between groups. Importantly, the results support international findings that significantly higher rates of Cluster B personality pathology are found among psychopathic offenders compared to non-psychopathic offenders.

Differentiating Community Dwellers at Risk for Pathological Narcissism From Community Dwellers at Risk for Psychopathy Using Measures of Emotion Recognition and Subjective Emotional Activation

The Italian translations of the Pathological Narcissism Inventory (PNI) and Triarchic Psychopathy Measure (TriPM) were administered to 609 community dwelling adults. Participants who scored in the upper 10% of the distribution of the PNI total score were assigned to the group of participants at risk for pathological narcissism, whereas participants who scored in the upper 10% of the distribution of the TriPM total score were assigned to the group of participants at risk for psychopathy. The final sample included 126 participants who were administered the Reading the Mind in the Eyes Test (RMET) and emotion-eliciting movie clips. Participants at risk for pathological narcissism scored significantly lower on the RMET total score than participants who were not at risk for pathological narcissism. Participants at risk for psychopathy showed a significant reduction in the subjective experience of disgust, fear, sadness, and tenderness compared to participants who were not at risk for psychopathy.

The Mask of Sanity: Facial Expressive, Self-Reported, and Physiological Consequences of Emotion Regulation in Psychopathic Offenders

This study investigated the physiological, self-reported, and facial correlates of emotion regulation in psychopathy. Specifically, we compared psychopathic offenders (n = 42), nonpsychopathic offenders (n = 42), and nonoffender controls (n = 26) in their ability to inhibit and express emotion while watching affective films (fear, happy, and sad). Results showed that all participants were capable of drastically diminishing facial emotions under inhibition instructions. Contrary to expectation, psychopaths were not superior in adopting such a "poker face." Further, the inhibition of emotion was associated with cardiovascular changes, an effect that was also not dependent on psychopathy (or its factors), suggesting emotion inhibition to be an effortful process in psychopaths as well. Interestingly, psychopathic offenders did not differ from nonpsychopaths in the capacity to show content-appropriate facial emotions during the expression condition. Taken together, these data challenge the view that psychopathy is associated with either superior emotional inhibitory capacities or a generalized impairment in showing facial affect.

Take the Money and Run: Psychopathic Behavior in the Trust Game

We study the association among different sources of individual differences such as personality, cognitive ability and risk attitudes with trust and reciprocate behavior in an incentivized experimental binary trust game in a sample of 220 (138 females) undergraduate students. The game involves two players, player 1 (P1) and player 2 (P2). In the first stage, P1 decides whether to trust and let P2 decide, or to secure an egalitarian payoff for both players. If P1 trusts P2, the latter can choose between a symmetric payoff that is double than the secure alternative discarded by P1, and an asymmetric payoff in which P2 earns more than in any other case but makes P1 worse off. Before the main experiment, we obtained participants' scores for Abstract Reasoning (AR), risk attitudes, basic personality characteristics, and specific traits such as psychopathy and impulsivity. During the main experiment, we measured Heart Rate (HR) and ElectroDermal Activity (EDA) variation to account for emotional arousal caused by the decision and feedback processes. Our main findings indicate that, on one hand, P1 trust behavior associates to positive emotionality and, specifically, to the extraversion's warmth facet. In addition, the impulsivity facet of positive urgency also favors trust behavior. No relation to trusting behavior was found for either other major personality aspects or risk attitudes. The physiological results show that participants scoring high in psychopathy exhibit increased EDA and reduced evoked HR deceleration at the moment in which they are asked to decide whether or not to trust. Regarding P2, we find that AR ability and mainly low disagreeable disinhibition favor reciprocal behavior. Specifically, lack of reciprocity significantly relates with a psychopathic, highly disinhibited and impulsive personality. Thus, the present study suggests that personality characteristics would play a significant role in different behaviors underlying cooperation, with extraversion/positive emotionality being more relevant for initiating cooperation, and low disagreeable disinhibition for maintaining it.

Motor Empathy in Individuals With Psychopathic Traits: A Preliminary Study

The present laboratory study examined motor empathy in male and female individuals, who were either high or low on psychopathic traits, drawn from a nonclinical university population. Past findings suggest that psychopathic individuals are impaired in affective empathy, but findings on impairments in cognitive empathy are mixed. Research on motor empathy in psychopathy is scarce. The authors hypothesized that individuals high on psychopathic traits would have deficient motor empathy (similar to affective empathy) related to valenced emotion stimuli because of the automatic nature of motor empathy. Potential participants completed the Psychopathic Personality Inventory-Revised (PPI-R). Participants were chosen for the study on the basis of their PPI-R scores. All participants viewed photographic images drawn from a well-established set of stimuli (the International Affective Picture System) and were video recorded while doing so. Intensity for eight emotions (anger, contempt, disgust, fear, sad, joy, surprise, and neutral) in participants' facial expressions was measured objectively using an automated program, the Computer Expression Recognition Toolbox. Individuals high on psychopathic traits as compared with low PPI-R scorers displayed significantly less emotional congruence when viewing negative images. The study results suggest that deficits in motor empathy related to psychopathic trait levels are relatively restricted to negative emotions.

Dialectical behavior therapy skills use and emotion dysregulation in personality disorders and psychopathy: a community self-report study

BACKGROUND

Emotion dysregulation is a critical transdiagnostic mental health problem that needs to be further examined in personality disorders (PDs). The current study examined dialectical behavior therapy (DBT) skills use, emotion dysregulation, and dysfunctional coping among adults who endorsed symptoms of cluster B PDs and psychopathy. We hypothesized that skills taught in DBT and emotion dysregulation are useful for adults with PDs other than borderline personality disorder (BPD).

METHODS

Using a self-report questionnaire, we examined these constructs in three groups of community adults: those who reported symptoms consistent with borderline personality disorder (BPD; N = 29), those who reported symptoms consistent with any other cluster B PD (N = 22), and those with no reported cluster B PD symptoms (N = 77) as measured by the Personality Diagnostic Questionnaire-4 + .

RESULTS

Both PD groups reported higher emotion dysregulation and dysfunctional coping when compared to the no PD group. Only the BPD group had significantly lower DBT skills use. DBT skills use was found to be a significant predictor of cluster B psychopathology but only before accounting for emotion dysregulation. When added to the regression model, emotion dysregulation was found to be a significant predictor of cluster B psychopathology but DBT skills use no longer had a significant effect. Across all groups, DBT skills use deficits and maladaptive coping, but not emotion dysregulation, predicted different facets of psychopathy.

CONCLUSION

Emotion dysregulation and use of maladaptive coping are problems in cluster B PDs, outside of BPD, but not in psychopathy. Inability to use DBT skills may be unique to BPD. Because this study relied exclusively on self-report, this data is preliminary and warrants further investigation.

A New Understanding of Psychopathy: The Contribution of Phenomenological Psychopathology

The objective of this study is to present a theoretical paper about a clinical issue. Our aim is to propose some clinical and semiological considerations for a psychopathological conception of psychopathy. We will discuss several major theoretical works dedicated to this nosographic entity (mainly those of Schneider [Psychopathic Personalities (1923). London, Cassell, 1950], Cleckley [The Mask of Sanity. St. Louis, Mosby, 1941] and Hare [The Hare Psychopathy Checklist - Revised Manual, ed 2. Toronto, Multi-Health Systems, 2003]). We will also examine a significant issue raised by Cooke et al. [Psychol Assess 2001;13:171-188; J Person Disord 2004;18:337-357; Br J Psychiatry Suppl 2007;49:s39-s50; Int J Forensic Ment Health 2012;11:242-252], namely whether psychopathic functioning is consistently related to antisocial behavior. This theoretical essay is informed by clinical situations (involving psychopaths who were interviewed in prison or in forensic centers). The method applied a phenomenological psychopathology analysis to the clinical material. We first compare Binswanger's conception of mania with psychopathic functioning. Patient behavior is similar, but there is a difference related to the dialectic between the ego and the alter ego. A patient with mania has a fundamental crisis of the ego, which a psychopath does not have. A second finding of our investigations concerns emotions and the adaptive dimension of the psychopathic disorder. An epistemological discussion of the concept of emotions reveals that psychopaths are competent in the management of emotional stimuli, which confers a psychological advantage upon them.

Interpretation biases in paranoia

Information in the environment is frequently ambiguous in meaning. Emotional ambiguity, such as the stare of a stranger, or the scream of a child, encompasses possible good or bad emotional consequences. Those with elevated vulnerability to affective disorders tend to interpret such material more negatively than those without, a phenomenon known as "negative interpretation bias." In this study we examined the relationship between vulnerability to psychosis, measured by trait paranoia, and interpretation bias. One set of material permitted broadly positive/negative (valenced) interpretations, while another allowed more or less paranoid interpretations, allowing us to also investigate the content specificity of interpretation biases associated with paranoia. Regression analyses (n=70) revealed that trait paranoia, trait anxiety, and cognitive inflexibility predicted paranoid interpretation bias, whereas trait anxiety and cognitive inflexibility predicted negative interpretation bias. In a group comparison those with high levels of trait paranoia were negatively biased in their interpretations of ambiguous information relative to those with low trait paranoia, and this effect was most pronounced for material directly related to paranoid concerns. Together these data suggest that a negative interpretation bias occurs in those with elevated vulnerability to paranoia, and that this bias may be strongest for material matching paranoid beliefs. We conclude that content-specific biases may be important in the cause and maintenance of paranoid symptoms.

Psychopathy, intelligence and emotional responding in a non-forensic sample: an experimental investigation

This study examined the relationships between psychopathy (primary and secondary), intelligence and emotional responding in a sample of 50 university students, using a task measuring autonomic responses to 40 pictorial stimuli (20 neutral and 20 emotionally provoking). Results indicated no significant direct relationship between primary or secondary psychopathy and emotional response, or primary or secondary psychopathy and intelligence. However, a significant moderating effect of intelligence on the association between both psychopathy factors and emotional response was observed, indicating those scoring higher on psychopathy but with lower intelligence portray the expected emotional responses to the affective stimuli (primary: β = -.56, p < .05; secondary: β = .80, p < .001). These findings indicate abnormal reactivity to emotional stimuli in lower intelligence, higher psychopathic individuals, and suggest differing roles for the two facets of psychopathy in affective responsiveness deviations.