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

Psychopathy and Impairments in Emotion Regulation: A systematic review and Meta-analysis

Considering the sparse but rapidly growing literature concerning the relationship between psychopathy and emotion regulation, taking stock of accumulating knowledge in a systematic review and meta-analysis of the existing results is needed. We performed a systematic search (up to May 30, 2024) following PRISMA guidelines of five scientific databases (PsycINFO, PsycARTICLES, MEDLINE, PubMed, Scopus and Web of Science). Also, gray literature was searched. After removing the duplicates, a total of 8.786 records were screened, and 73 articles were selected based on the inclusion criteria used for systematic review. The meta-analytic procedure was performed on 55 identified studies consistent with the criteria adopted, which overall comprised 29.856 individuals. The current systematic and meta-analysis review has clarified the association between impairments of emotional regulation abilities and facets of psychopathy. More specifically, analyses indicated that emotional dysregulation is associated with overall levels of psychopathic traits, as well as with both the lifestyle and affective components of psychopathy, which suggests the utility of assessing these features when designing interventions focused on modulating negative emotional states and enhancing regulation of impulsive behaviors.

Unfeeling or Uncontrolled? PCL-R Subfactor-Specific Anomalies in Psychological Processing During Criminal Behavior

Psychopathy has been linked to insensitivity to negative affect as well as to a self-regulatory deficit. However, studies on these associations rarely involve real-life behavioral data. Using a theory-based content analysis of offense descriptions in criminal verdicts, the affective and regulatory processes that male German prison inmates (N = 109) displayed during criminal norm-violations were coded. Their PCL-R scores were split up into the interpersonal-affective (F1) and the lifestyle-antisocial (F2) factors. As expected, F1 was associated with positive (as opposed to negative) activation affect during criminal behavior (τ = .32, p < .001), while F2 was not. In contrast, F2 was associated with impulsive reactivity (τ = .14, p = .03), while F1 was not. No differential association was found with angry emotionality. Overall, the bifactorial nature of the PCL-R psychopathy construct seems to be reflected in psychological processing during real-life criminal behavior. This might indicate differential criminogenic processes.

Perception of emotional facial expressions in aggression and psychopathy

BACKGROUND

Altered affective state recognition is assumed to be a root cause of aggressive behavior, a hallmark of psychopathologies such as psychopathy and antisocial personality disorder. However, the two most influential models make markedly different predictions regarding the underlying mechanism. According to the integrated emotion system theory (IES), aggression reflects impaired processing of social distress cues such as fearful faces. In contrast, the hostile attribution bias (HAB) model explains aggression with a bias to interpret ambiguous expressions as angry.

METHODS

In a set of four experiments, we measured processing of fearful and angry facial expressions (compared to neutral and other expressions) in a sample of 65 male imprisoned violent offenders rated using the Hare Psychopathy Checklist-Revised (PCL-R, Hare, R. D. (1991). The psychopathy checklist-revised. Toronto, ON: Multi-Health Systems) and in 60 age-matched control participants.

RESULTS

There was no evidence for a fear deficit in violent offenders or for an association of psychopathy or aggression with impaired processing of fearful faces. Similarly, there was no evidence for a perceptual bias for angry faces linked to psychopathy or aggression. However, using highly ambiguous stimuli and requiring explicit labeling of emotions, violent offenders showed a categorization bias for anger and this anger bias correlated with self-reported trait aggression (but not with psychopathy).

CONCLUSIONS

These results add to a growing literature casting doubt on the notion that fear processing is impaired in aggressive individuals and in psychopathy and provide support for the idea that aggression is related to a hostile attribution bias that emerges from later cognitive, post-perceptual processing stages.

In the I of the beholder: an attempt to capture the implicit self-concept regarding psychopathy

This article explores the implicit self-concept pertaining to psychopathy. Two online studies showed inconsistent results, with Study 1 (n = 243) suggesting that psychopathy is linked to an implicit self-concept marked by low empathy and Study 2 (n = 230) implying no such relationship. In a sample of offenders and community controls (Study 3a, n = 166), higher scores on the Psychopathy Checklist-Revised (PCL-R) were related to an implicit self-concept of being less rather than more antisocial, and the implicit self-concept showed incremental validity compared to the explicit self-concept. The retesting of an offender subsample (Study 3b, n = 47) yielded no evidence for temporal stability or convergent validity. The implicit self-concept of highly psychopathic individuals thus appears to vary, depending on the social context. Future studies should replicate these results in different samples, using additional external correlates.

Psychopathy and gaze cueing

BACKGROUND AND OBJECTIVES

Psychopathic traits - and especially callous affective features - have been linked to altered processing of others' emotional expressions, and to reduced attention to the eyes. Despite the importance of gaze cueing (i.e., the tendency to orient attention toward where someone else is looking) for social functioning, few studies have investigated relationships between psychopathic traits and gaze cueing, and whether facial emotional expression influence these relationships, obtaining mixed results. To address this gap, the present study aimed to evaluate associations between psychopathic traits and gaze cueing for emotional and neutral expressions.

METHODS

65 non-clinical male participants (Mage = 27.3 years) completed two self-report measures of psychopathy and performed laboratory tasks to assess gaze-cueing for emotional vs. neutral faces and an arrow-cueing task as a comparison.

RESULTS

Linear mixed models showed no significant associations of emotional (versus neutral) expressions, or psychopathy trait dimensions, with either gaze cueing or arrow cueing.

LIMITATIONS

Reliance on a convenience sample of non-clinical men, assessed with self-reports measures of psychopathy, and using static emotional stimuli limit the generalizability of our findings.

CONCLUSIONS

Findings suggest that psychopathic traits are not associated with individual differences in following others' gaze to direct attention, and that there was no advantage for affective relative to neutral expressions.

Violent Offending in Males With or Without Schizophrenia: A Role for Social Cognition?

BACKGROUND AND HYPOTHESIS

Reduced social cognition has been reported in individuals who have committed interpersonal violence. It is unclear if individuals with schizophrenia and a history of violence have larger impairments than violent individuals without psychosis and non-violent individuals with schizophrenia. We examined social cognition in two groups with violent offenses, comparing their performance to non-violent individuals with schizophrenia and healthy controls.

STUDY DESIGN

Two social cognitive domains were assessed in four groups: men with a schizophrenia spectrum disorder with (SSD-V, n = 27) or without (SSD-NV, n = 42) a history of violence, incarcerated men serving preventive detention sentences (V, n = 22), and healthy male controls (HC, n = 76). Theory of mind (ToM) was measured with the Movie for the Assessment of Social Cognition (MASC), body emotion perception with Emotion in Biological Motion (EmoBio) test.

STUDY RESULTS

Kruskal-Wallis H-tests revealed overall group differences for social cognition. SSD-V had a global and clinically significant social cognitive impairment. V had a specific impairment, for ToM. Binary logistic regressions predicting violence category membership from social cognition and psychosis (SSD status) were conducted. The model with best fit, explaining 18%-25% of the variance, had ToM as the only predictor.

CONCLUSIONS

Social cognitive impairment was present in individuals with a history of violence, with larger and more widespread impairment seen in schizophrenia. ToM predicted violence category membership, psychosis did not. The results suggest a role for social cognition in understanding interpersonal violence.

Morality, self-control, age, type of offence and sentence length as predictors of psychopathy amongst female incarcerated offenders in South Africa

There has been an increase in female incarcerated offenders nationally and internationally. Despite this trend, literature and research on female offenders remain limited compared to their male counterparts. Evidence of the relationship between certain personality disorders and offending behaviour has led numerous countries to prioritise identifying and assessing personality disorders among the offender population. Psychopathic personality traits may contribute to women's risk factors for expressing antisocial behaviours, resulting in their potential future incarceration. Thus, a need exists to understand possible factors that may predict the expression of psychopathic traits in females, which may have notable utility among female offenders. This study aimed to investigate possible predictor variables of psychopathy amongst incarcerated female offenders in South Africa. A quantitative research approach, non-experimental research type, and correlational research design were employed. A convenience sampling technique was used. The sample consisted of 139 (N = 139) female offenders housed in two correctional centres in South Africa who voluntarily participated in this study. Correlation analyses and hierarchical regression analysis procedures were conducted to analyse the results. Results indicated (i) a certain combination of predictor variables that statistically and practically significantly explained both primary and secondary psychopathy and (ii) individual predictor variables (e.g., Impulsivity, Simple Tasks, Risk-Seeking, and Self-Centredness) that explained both primary and secondary psychopathy statistically and practically significantly. This study provides valuable information about the possible predictor variables of psychopathy amongst female offenders within the context of South Africa. However, further research must be conducted to validate these findings and advance our knowledge on this topic.

The "zipper model of empathy" applied to violence in schizophrenia: A search for social cognitive underpinnings of lack of empathic behavior

BACKGROUND

The "zipper model of empathy" has been proposed for psychopathy. It postulates that empathic behavior may fail to arise due to impaired facial emotion recognition. In this study, we examined if the model may be of relevance for schizophrenia.

METHODS

In a sample of participants with schizophrenia and a history of severe interpersonal violence, associations between measures of social cognition (emotion recognition, theory of mind) and aspects of psychopathy (lack of empathy, lack of remorse) were investigated. A non-violent sample experiencing schizophrenia served as a control group.

RESULTS

Correlation analyses revealed a specific and statistically significant association between facial emotion recognition and lack of empathy in the violent sample. Follow-up analyses identified that neutral emotions were of particular importance. Logistic regression analyses confirmed that impairments in facial emotion recognition predicted levels of empathy in the violent sample experiencing schizophrenia.

CONCLUSIONS

Our results suggest that the "zipper model of empathy" may be relevant for schizophrenia. The findings further point to the potential benefit of including social cognitive training in the treatment of persons with schizophrenia and a history of interpersonal aggression.

Attention-affect interactions and triarchic psychopathy: New electrophysiological insights from the late positive potential

One of the most prominent characteristics of psychopathy is a reduced processing of emotionally relevant information. However, it is still unclear how attentional mechanisms may modulate this deficit. The current study aimed to examine the impact of attentional focus on emotion processing in relation to the triarchic constructs of boldness, meanness, and disinhibition. Participants performed two tasks in which pleasant, neutral, and unpleasant framed pictures were presented. In the first task, participants were required to indicate the color of the frame (alternative-focus task), whereas in the second task they were instructed to indicate the emotional category of the image (affect-focus task). The Late Positive Potential (LPP) was used as an index of sustained engagement of attention to affective material. Confirming a successful task manipulation, we observed reduced LPP amplitudes, particularly for affective relevant material, in the alternative-focus task compared to the affect-focus task. Most interestingly, our results evidenced that trait meanness scores were associated with blunted elaborative processing of affective material (both appetitive and aversive) when this information was task-relevant (affect-focus task), but not when it was task-irrelevant (alternative-focus task). These findings indicate that high mean individuals are characterized by blunted elaborative processing of affective stimuli when their motivational relevance is determined in a top-down manner (i.e., when it is task-relevant). Our results highlight the need for further studying of the bottom-up and top-down dynamics of emotional attention in psychopathy.

Social-affective functioning and learning in psychopathy

Psychopathy is a personality construct for which impairments in multiple aspects of social and affective functioning are considered to be central. Individuals with elevated levels of psychopathic traits tend to exhibit maladaptive behaviors that are harmful to themselves and others, and seem to be limited in how they perceive and experience affective states. This chapter provides a brief overview of biopsychological theories and studies of psychopathy targeting impairments in affective processing and behavioral adaptation through learning. Also, current gaps in the literature will be discussed in addition to findings highlighting the need to routinely reexamine the validity and robustness of decades-old views on psychopathy in the light of recent multidisciplinary empirical research. The chapter ends with a short reflection on how alternative views may offer novel insights that may bring significant advances in the study of the biopsychological factors underlying psychopathy.

Difficulties in facial emotion recognition: taking psychopathic and alexithymic traits into account

BACKGROUND

Alexithymic and psychopathic traits are closely associated, but distinct constructs. Both have been associated with facial emotion processing deficits reflecting empathy deficits, however the underlying mechanism contributing to these deficits is not well-understood.

METHODS

This study investigated facial emotion recognition performance in a non-clinical sample (N = 110) including both male and female participants, with varying levels of psychopathic and alexithymic traits. Facial emotion recognition was assessed using a computerized task, that presented different expressions depicting five emotional states (pain, fear, sadness, anger, happiness) and neutral expressions.

RESULTS

Results suggest that the high psychopathic traits group reported lower accuracy compared to the low psychopathic traits group, indicating a more generalized deficit in facial affect recognition, across all emotions. The alexithymic groups (high vs. low) on the other hand did not differ in their performance on the task for any of the emotions presented.

CONCLUSION

These findings add to the current body of research regarding face processing categorization deficits in relation to psychopathic and alexithymic traits and can inform prevention and intervention efforts that aim to facilitate facial emotion recognition in individuals with these personality traits.

Psychopathic tendency in violent offenders is associated with reduced aversive Pavlovian inhibition of behavior and associated striatal BOLD signal

Background

Violent offenders with psychopathic tendencies are characterized by instrumental, i.e., planned, callous, and unemotional (aggressive) behavior and have been shown to exhibit abnormal aversive processing. However, the consequences of abnormal aversive processing for instrumental action and associated neural mechanisms are unclear.

Materials and methods

Here we address this issue by using event-related functional magnetic resonance imaging (fMRI) in 15 violent offenders with high psychopathic tendencies and 18 matched controls during the performance of an aversive Pavlovian-to-instrumental transfer paradigm. This paradigm allowed us to assess the degree to which aversive Pavlovian cues affect instrumental action and associated neural signaling.

Results

Psychopathic tendency scores were associated with an attenuation of aversive Pavlovian inhibition of instrumental action. Moreover, exploratory analyses revealed an anomalous positive association between aversive inhibition of action and aversive inhibition of BOLD signal in the caudate nucleus of violent offenders with psychopathic tendencies. In addition, psychopathic tendency also correlated positively with amygdala reactivity during aversive versus neutral cues in Pavlovian training.

Conclusion

These findings strengthen the hypothesis that psychopathic tendencies in violent offenders are related to abnormal impact of aversive processing on instrumental behavior. The neural effects raise the possibility that this reflects deficient transfer of aversive Pavlovian inhibitory biases onto neural systems that implement instrumental action, including the caudate nucleus.

An examination of autonomic and facial responses to prototypical facial emotion expressions in psychopathy

Meta-analyses have found that people high in psychopathy categorize (or “recognize”) others’ prototypical facial emotion expressions with reduced accuracy. However, these have been contested with remaining questions regarding the strength, specificity, and mechanisms of this ability in psychopathy. In addition, few studies have tested holistically whether psychopathy is related to reduced facial mimicry or autonomic arousal in response to others’ dynamic facial expressions. Therefore, the current study presented 6 s videos of a target person making prototypical emotion expressions (anger, fear, disgust, sadness, joy, and neutral) to N = 88 incarcerated adult males while recording facial electromyography, skin conductance response (SCR), and heart rate. Participants identified the emotion category and rated the valence and intensity of the target person’s emotion. Psychopathy was assessed via the Psychopathy Checklist-Revised (PCL-R). We predicted that overall PCL-R scores and scores for the interpersonal/affective traits, in particular, would be related to reduced emotion categorization accuracy, valence ratings, intensity ratings, facial mimicry, SCR amplitude, and cardiac deceleration in response to the prototypical facial emotion expressions. In contrast to our hypotheses, PCL-R scores were unrelated to emotion categorization accuracy, valence ratings, and intensity ratings. Stimuli failed to elicit facial mimicry from the full sample, which does not allow drawing conclusions about the relationship between psychopathy and facial mimicry. However, participants displayed general autonomic arousal responses, but not to prototypical emotion expressions per se. PCL-R scores were also unrelated to SCR and cardiac deceleration. These findings failed to identify aberrant behavioral and physiological responses to prototypical facial emotion expressions in relation to psychopathy.

Automatic processing of emotional images and psychopathic personality traits

Psychopathy is associated with a deficit in affective processes and might be reflected in the inability to extract the emotional content of a stimulus. Across two experiments, we measured the interference effect from emotional images that were irrelevant to the processing of simultaneous target stimuli and examined if this interference was moderated by psychometrically defined traits of psychopathy. In Experiment 1, we showed this emotional distraction effect was reduced as a function of psychopathic traits related to cold-heartedness and occurred for both positively- and negatively-valenced images. Experiment 2 attempted to test the automaticity of the effects by presenting the emotional stimuli briefly so that the emotion was difficult to report. Again, high visibility images produced strong effects that were moderated by the cold-heatedness/meanness traits of psychopathy, but the low-visibility images did not evoke the emotional distractor effect. Our results strongly support the notion that psychopathic traits related to cold-heartedness/meanness are associated with an inability to automatically process the emotional content of images.

Unzipping empathy in psychopathy: Empathy and facial affect processing in psychopaths

Psychopathy is a neurodevelopmental disorder that has a highly deleterious effect upon both individuals and society at large. Psychopaths grossly neglect and disrespect the interests of others. Their antisocial behavior is thought to originate from a lack of empathy. However, empathy is multidimensional in nature, as evidenced by the considerable heterogeneity in extant theorizing on the subject. Here, we present the "Zipper model of empathy" that reconsiders how both its affective and cognitive components converge in mature empathic behavior. Furthermore, the Zipper model of empathy is expedient for explaining the empathy deficits in psychopathy, insofar as it brings together current theories on the dysfunctional affective components of empathy, violence inhibition, and automatic versus goal-directed attention. According to the literature, the neurobiological underpinnings of these theories are amygdala-centered; however, this article traces this specifically to the basolateral and central amygdala subregions. When viewed together, the cognitive and affective components of empathy are zipped together in a natural fashion in healthy empathic behavior, whereas psychopaths leave the zipper substantially unzipped in pursuit of their purely self-centered goals.

Reflexive Gaze Shifts and Fear Recognition Deficits in Children with Callous-Unemotional Traits and Impulsivity/Conduct Problems

The ability to efficiently recognize the emotions on others' faces is something that most of us take for granted. Children with callous-unemotional (CU) traits and impulsivity/conduct problems (ICP), such as attention-deficit hyperactivity disorder, have been previously described as being "fear blind". This is also associated with looking less at the eye regions of fearful faces, which are highly diagnostic. Previous attempts to intervene into emotion recognition strategies have not had lasting effects on participants' fear recognition abilities. Here we present both (a) additional evidence that there is a two-part causal chain, from personality traits to face recognition strategies using the eyes, then from strategies to rates of recognizing fear in others; and (b) a pilot intervention that had persistent effects for weeks after the end of instruction. Further, the intervention led to more change in those with the highest CU traits. This both clarifies the specific mechanisms linking personality to emotion recognition and shows that the process is fundamentally malleable. It is possible that such training could promote empathy and reduce the rates of antisocial behavior in specific populations in the future.

Neural responses to morally laden interactions in female inmates with psychopathy

Much of social cognition requires making inferences about the mental and emotional states of others. Moreover, understanding the emotions of others is an important foundation for moral decision-making. Psychopathy is associated with both aberrant emotional understanding and atypical hemodynamic responses when viewing and evaluating morally laden social interactions. In the present functional MRI study, female inmates (N = 107) were asked to evaluate the likely emotional state of either the recipient or the initiator of harmful or helpful interactions. Psychopathy was assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R scores were not associated with differences in confidence or accuracy ratings. However, psychopathy scores were significantly related to increased hemodynamic response in right dorsolateral prefrontal cortex when viewing harmful interactions and decreased functional connectivity from right amygdala to inferior parietal cortex and insula, and from temporal parietal junction to dorsomedial prefrontal cortex. Overall, this work indicates that in females, psychopathy is associated with normal behavioral accuracy and confidence but alterations in neural network activity during moral decision-making.

Frontal alpha asymmetry and emotional processing in youth with psychopathic traits

Emotional processing deficits are often considered central to psychopathy. There is evidence that those high in psychopathy pay less attention to emotional stimuli, and it is possible that these individuals experience diminished withdrawal motivation or heightened approach motivation in response to emotional stimuli. Studying emotional processing abnormalities, especially among youth, may be essential for better understanding psychopathy's development and for informing interventions. However, few studies on psychopathy have experimentally manipulated emotional processing, and despite the growing literature on neuroscience and psychopathy, there are aspects of neural activity that have yet to be investigated. The current study used a sample of 52 justice-involved youth to examine how psychopathy, as measured by the Proposed Specifiers for Conduct Disorder scale, relates to frontal alpha asymmetry (FAA), a neural correlate of approach and withdrawal motivation. Alpha asymmetry was first measured at rest and then while youth were asked to process emotional stimuli spontaneously as well as to increase and decrease their responses to emotional stimuli. Results indicated that total psychopathy was not related to FAA at rest or during task performance. However, youth higher in callous-unemotional traits demonstrated similar patterns of neural activity to youth lower in callous-unemotional traits when instructed to increase their response to emotional stimuli. These findings were not evident for grandiose-manipulative or daring-impulsive traits. These findings may indicate that youth high in callous-unemotional traits are capable of modulating their emotional responding, which could in turn have treatment implications for youth high in psychopathic traits.

Emotional modulation of the pupil in psychopathy: A test of the Response Modulation Hypothesis

Some aspects of psychopathy may be underpinned by a deficit in processing emotional information, although there is evidence that this impairment only emerges when the affective cues are not central to ongoing goal-directed behaviour. However, this hypothesis has not been explored previously in relation to autonomic reactivity to emotional stimuli. The current study investigated this in a large (N = 174) community sample by examining changes in pupil diameter, a measure of autonomic nervous system activity, while participants viewed images that were either neutral in content or contained highly arousing/emotional content. Participants' attentional focus was manipulated across two tasks, such that participants either focused on whether the image contained emotional content (emotion-focus) or whether there were people present in the image (alternate-focus). Psychopathy was conceptualised via the Triarchic model of boldness, meanness and disinhibition. As expected, the arousing images caused greater pupil dilation compared to neutral images. However, the magnitude of this dilation was not moderated by any aspect of psychopathy regardless of the participant's attentional focus. It may be that reduced pupil reactivity to emotional stimuli is only expressed at high levels of psychopathy not normally found in community samples, or that participants with high traits of psychopathy in the community were still able to sufficiently attend to the emotional components of the images to overcome any autonomic deficits regardless of their attentional focus. Further research is needed to explore these possibilities.

The Empathic Brain of Psychopaths: From Social Science to Neuroscience in Empathy

Empathy is a crucial human ability, because of its importance to prosocial behavior, and for moral development. A deficit in empathic abilities, especially affective empathy, is thought to play an important role in psychopathic personality. Empathic abilities have traditionally been studied within the social and behavioral sciences using behavioral methods, but recent work in neuroscience has begun to elucidate the neural underpinnings of empathic processing in relation to psychopathy. In this review, current knowledge in the social neuroscience of empathy is discussed and a comprehensive view of the neuronal mechanisms that underlie empathy in psychopathic personality is provided. Furthermore, it will be argued that using classification based on overt behavior, we risk failing to identify important mechanisms involved in the psychopathology of psychopathy. In the last decade, there is a growing attention in combining knowledge from (neuro)biological research areas with psychology and psychiatry, to form a new basis for categorizing individuals. Recently, a converging framework has been put forward that applies such approach to antisocial individuals, including psychopathy. In this bio-cognitive approach, it is suggested to use information from different levels, to form latent categories on which individuals are grouped, that may better reflect underlying (neurobiological) dysfunctions. Subsequently, these newly defined latent categories may be more effective in guiding interventions and treatment. In conclusion, in my view, the future understanding of the social brain of psychopaths lies in studying the complex networks in the brain in combination with the use of other levels of information (e.g., genetics and cognition). Based on that, profiles of individuals can be formed that can be used to guide neurophysiological informed personalized treatment interventions that ultimately reduce violent transgressions in individuals with psychopathic traits.

Feedforward Neural Network-Based Architecture for Predicting Emotions from Speech

We propose a novel feedforward neural network (FFNN)-based speech emotion recognition system built on three layers: A base layer where a set of speech features are evaluated and classified; a middle layer where a speech matrix is built based on the classification scores computed in the base layer; a top layer where an FFNN- and a rule-based classifier are used to analyze the speech matrix and output the predicted emotion. The system offers 80.75% accuracy for predicting the six basic emotions and surpasses other state-of-the-art methods when tested on emotion-stimulated utterances. The method is robust and the fastest in the literature, computing a stable prediction in less than 78 s and proving attractive for replacing questionnaire-based methods and for real-time use. A set of correlations between several speech features (intensity contour, speech rate, pause rate, and short-time energy) and the evaluated emotions is determined, which enhances previous similar studies that have not analyzed these speech features. Using these correlations to improve the system leads to a 6% increase in accuracy. The proposed system can be used to improve human–computer interfaces, in computer-mediated education systems, for accident prevention, and for predicting mental disorders and physical diseases.

Emotional Intelligence in Incarcerated Female Offenders With Psychopathic Traits

Emotional impairment is a core feature of psychopathy, and the disorder has been linked to an inability to recognize and regulate emotion, leading to deficiencies in empathy and difficulties in social functioning. This study investigated associations among psychopathic traits and ability-based emotional intelligence (EI) in female offenders and integrated data with previously published male offender data (Ermer, Kahn, Salovey, & Kiehl, 2012) to examine gender differences in relationships. Results showed that female offenders were impaired in the understanding and management of emotion relative to the general population, and that female offenders scored higher than male offenders in EI. Affective psychopathic traits (e.g., callousness) yielded a small relationship with difficulties in managing emotion in female offenders, and few gender differences in relationships between psychopathy and EI were found. Findings contribute to literature on emotional functioning in females with psychopathic traits and further understanding of gender differences in emotional abilities among offenders.

Affective startle modulation and psychopathology: Implications for appetitive and defensive brain systems

Startle reflex potentiation versus startle attenuation to unpleasant versus pleasant stimuli likely reflect priming of the defensive versus appetitive motivational systems, respectively. This review summarizes and systemizes the literature on affective startle modulation related to psychopathologies with the aim to reveal underlying mechanisms across psychopathologies. We found evidence for psychopathologies characterized by increased startle potentiation to unpleasant stimuli (anxiety disorders), decreased startle potentiation to unpleasant stimuli (psychopathy), decreased startle attenuation to pleasant stimuli (ADHD), as well as a general hyporeactivity to affective stimuli (depression). Increased versus decreased startle responses to disorder-specific stimuli characterize specific phobia and drug dependence. No psychopathology is characterized by increased startle attenuation to standard pleasant stimuli or a general hyperreactivity to affective stimuli. This review indicates that the defensive and the appetitive systems operate independently mostly in accordance with the motivational priming hypothesis and that affective startle modulation is a highly valuable paradigm to unraveling dysfunctions of the defensive and appetitive systems in psychopathologies as requested by the Research Domain Criteria initiative.

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.

Do psychopathic traits impair autobiographical memory for emotional life experiences?

We examined the relationship between psychopathic traits and autobiographical memory (AM) for emotional life experiences in both a community (Study 1) and forensic sample (Study 2). Considering that psychopathy is traditionally linked to an impairment in the processing of emotion, we hypothesised an emotional deficit of AM in individuals with high levels of psychopathic traits. Participants in both samples were asked to recall an emotionally charged event, and were then administered the Psychopathic Personality Inventory-Revised, the Flashbulb Memory Checklist, and the Autobiographical Memory Characteristics Questionnaire. A linguistic content analysis was applied to inmates' memory transcriptions (Study 2). Only in the forensic sample, was self-centered impulsivity found to be positively related to the linguistic use of mood terms, and negatively related to the linguistic use of cognitive labels. Furthermore, high levels of fearless dominance were associated to a low emotional attribution to the event and its implications, and highly confident and coherent memory. Lastly, coldheartedness was the psychopathic trait most associated to a deficit in emotional AM, in terms of a lack of hedonic labels and contextual details, a poor emotional evaluation of the event and its implications. The current results encourage further investigation concerning AM in psychopathic traits.

Emotional modulation of the pupil response in psychopathy

Psychopathy is a form of personality disorder associated with a deficit in emotional processing. However, there is debate whether this deficit applies to all emotions or exists only for negative emotions. The pupil dilates rapidly in response to emotional stimuli, allowing a time-sensitive index of emotional processing. Across 3 experiments using (a) visual images of real-world scenes, (b) auditory sound clips, and (c) videos of dynamic facial expressions, we measured emotional modulation of the pupil response to both negative and positive stimuli. Participants were 82 male mentally disordered offenders. Psychopathy was measured using the Psychopathy Checklist—Revised to produce factor scores of interpersonal–affective traits (Factor 1) and lifestyle–antisocial traits (Factor 2). Participants with high Factor 1 scores showed reduced emotional modulation of the pupil response to negative images and angry faces but not to any of the positive stimuli. These effects only occurred shortly after the emotion was presented (<2,000 ms), suggesting delayed processing of negative affective stimuli in Factor 1 psychopathy. Factor 2 scores were not associated with any changes in pupil response. There were no effects of psychopathy on the pupil response to the affective sound clips. The results support a specific psychopathic deficit in the processing of negative stimuli related to the interpersonal–affective dimension of psychopathy. We argue that pupillometry is a powerful and noninvasive tool to investigate emotional processing in clinical populations.

Facial responsiveness of psychopaths to the emotional expressions of others

Psychopathic individuals show selfish, manipulative, and antisocial behavior in addition to emotional detachment and reduced empathy. Their empathic deficits are thought to be associated with a reduced responsiveness to emotional stimuli. Immediate facial muscle responses to the emotional expressions of others reflect the expressive part of emotional responsiveness and are positively related to trait empathy. Empirical evidence for reduced facial muscle responses in adult psychopathic individuals to the emotional expressions of others is rare. In the present study, 261 male criminal offenders and non-offenders categorized dynamically presented facial emotion expressions (angry, happy, sad, and neutral) during facial electromyography recording of their corrugator muscle activity. We replicated a measurement model of facial muscle activity, which controls for general facial responsiveness to face stimuli, and modeled three correlated emotion-specific factors (i.e., anger, happiness, and sadness) representing emotion specific activity. In a multi-group confirmatory factor analysis, we compared the means of the anger, happiness, and sadness latent factors between three groups: 1) non-offenders, 2) low, and 3) high psychopathic offenders. There were no significant mean differences between groups. Our results challenge current theories that focus on deficits in emotional responsiveness as leading to the development of psychopathy and encourage further theoretical development on deviant emotional processes in psychopathic individuals.

As Far as the Eye Can See: Relationship between Psychopathic Traits and Pupil Response to Affective Stimuli

Psychopathic individuals show a range of affective processing deficits, typically associated with the interpersonal/affective component of psychopathy. However, previous research has been inconsistent as to whether psychopathy, within both offender and community populations, is associated with deficient autonomic responses to the simple presentation of affective stimuli. Changes in pupil diameter occur in response to emotionally arousing stimuli and can be used as an objective indicator of physiological reactivity to emotion. This study used pupillometry to explore whether psychopathic traits within a community sample were associated with hypo-responsivity to the affective content of stimuli. Pupil activity was recorded for 102 adult (52 female) community participants in response to affective (both negative and positive affect) and affectively neutral stimuli, that included images of scenes, static facial expressions, dynamic facial expressions and sound-clips. Psychopathic traits were measured using the Triarchic Psychopathy Measure. Pupil diameter was larger in response to negative stimuli, but comparable pupil size was demonstrated across pleasant and neutral stimuli. A linear relationship between subjective arousal and pupil diameter was found in response to sound-clips, but was not evident in response to scenes. Contrary to predictions, psychopathy was unrelated to emotional modulation of pupil diameter across all stimuli. The findings were the same when participant gender was considered. This suggests that psychopathy within a community sample is not associated with autonomic hypo-responsivity to affective stimuli, and this effect is discussed in relation to later defensive/appetitive mobilisation deficits.

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.

From shared to distinct self-other representations in empathy: evidence from neurotypical function and socio-cognitive disorders

Neuroscientific research has identified two fundamental components of empathy: shared emotional representations between self and other, and self-other distinction. The concept of shared representations suggests that during empathy, we co-represent another person's affect by engaging brain and bodily functions underpinning the first-hand experience of the emotion we are empathizing with. This possible grounding of empathy in our own emotional experiences explains the necessity for self-other distinction, which is the capacity to correctly distinguish between our own affective representations and those related to the other. In spite of the importance of these two components in empathy, several aspects still remain controversial. This paper addresses some of them and focuses on (i) the distinction between shared activations versus representations, raising the question what shared representations entail in terms of the underlying neural mechanisms, (ii) the possible mechanisms behind self-other distinction in the cognitive and the affective domains, and whether they have distinct neural underpinnings and (iii) the consequences associated with a selective impairment of one of the two components, thereby addressing their importance in mental disorders such as autism spectrum disorders, psychopathy and alexithymia.

The anatomy of empathy: Vicarious experience and disorders of social cognition

Empathy, the ability to vicariously experience and to understand the affect of other people, is fundamental for successful social-cognitive ability and behaviour. Empathy is thought to be a critical facilitator of prosocial behaviour and is disrupted in a number of psychiatric and neurological disorders. Research has begun to uncover the neural basis of such 'vicarious experience', which has been studied as a proxy measure of empathy. Together, these studies have identified portions of the insula and anterior cingulate cortex as critically involved. A key debate is whether overlapping or non-overlapping brain areas respond to personal and vicarious experience. This review will highlight emerging evidence for both types of brain response. Importantly, animal models have suggested that there are central divisions between the anterior cingulate gyrus and anterior cingulate sulcus that may be crucial for understanding social behaviour. Attention to this specific anatomy of vicarious processing could therefore help shed light on the functional profile of empathy. Studies in individuals with psychopathy and autism spectrum disorders have found that vicarious experience is atypical. However, the precise nature of these atypicalities is mixed. Understanding the mechanisms of vicarious experience can enhance our knowledge of the neural basis of empathy and, ultimately, help those with disorders of social cognition and behaviour.

Attentional Bias in Psychopathy: An Examination of the Emotional Dot-Probe Task in Male Jail Inmates

Numerous studies have identified differences in the identification of emotional displays between psychopaths and non-psychopaths; however, results have been equivocal regarding the nature of these differences. The present study investigated an alternative approach to examining the association between psychopathy and emotion processing by examining attentional bias to emotional faces; we used a modified dot-probe task to measure attentional bias toward emotional faces in comparison with neutral faces, among a sample of male jail inmates assessed using the Psychopathy Checklist-Revised (PCL-R). Results indicated a positive association between psychopathy and attention toward happy versus neutral faces, and that this association was attributable to Factor 1 of the psychopathy construct.

Brain Structural Correlates of Emotion Recognition in Psychopaths

Individuals with psychopathy present deficits in the recognition of facial emotional expressions. However, the nature and extent of these alterations are not fully understood. Furthermore, available data on the functional neural correlates of emotional face recognition deficits in adult psychopaths have provided mixed results. In this context, emotional face morphing tasks may be suitable for clarifying mild and emotion-specific impairments in psychopaths. Likewise, studies exploring corresponding anatomical correlates may be useful for disentangling available neurofunctional evidence based on the alleged neurodevelopmental roots of psychopathic traits. We used Voxel-Based Morphometry and a morphed emotional face expression recognition task to evaluate the relationship between regional gray matter (GM) volumes and facial emotion recognition deficits in male psychopaths. In comparison to male healthy controls, psychopaths showed deficits in the recognition of sad, happy and fear emotional expressions. In subsequent brain imaging analyses psychopaths with better recognition of facial emotional expressions showed higher volume in the prefrontal cortex (orbitofrontal, inferior frontal and dorsomedial prefrontal cortices), somatosensory cortex, anterior insula, cingulate cortex and the posterior lobe of the cerebellum. Amygdala and temporal lobe volumes contributed to better emotional face recognition in controls only. These findings provide evidence suggesting that variability in brain morphometry plays a role in accounting for psychopaths’ impaired ability to recognize emotional face expressions, and may have implications for comprehensively characterizing the empathy and social cognition dysfunctions typically observed in this population of subjects.

A test of core psychopathic traits as a moderator of the efficacy of a brief motivational intervention for substance-using offenders

OBJECTIVE

In a randomized controlled trial we studied a brief motivational intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy.

METHOD

Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% Black and other minorities and 48% White. Outcome variables at a 6-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug version), and self-reported participation in nonstudy mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R).

RESULTS

BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or nonstudy treatment participation at follow-up, and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use.

DISCUSSION

Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use.

Possible role of a dysregulation of the endogenous opioid system in antisocial personality disorder

Around half the inmates in prison institutions have antisocial personality disorder (ASPD). A recent theory has proposed that a dysfunction of the endogenous opioid system (EOS) underlies the neurobiology of borderline personality disorder (BPD). In the present theoretical paper, based on a comprehensive database and hand search of the relevant literature, this hypothesis is extended to ASPD, which may be the predominant expression of EOS dysfunction in men, while the same pathology underlies BPD in women. According to evidence from human and animal studies, the problematic behaviours of persons with antisocial, callous, or psychopathic traits may be seen as desperate, unconscious attempts to stimulate their deficient EOS, which plays a key role in brain reward circuits. If the needs of this system are not being met, the affected persons experience dysphoric mood, discomfort, or irritability, and strive to increase binding of endogenous opioids to receptors by using the rewarding effects of aggression by exertion of physical or manipulative power on others, by abusing alcohol or substances that have the reward system as target, by creating an "endorphin rush" by self-harm, by increasing the frequency of their sexual contacts, or by impulsive actions and sensation seeking. Symptoms associated with ASPD can be treated with opioid antagonists like naltrexone, naloxone, or nalmefene.

Abnormal frontostriatal activity in recently abstinent cocaine users during implicit moral processing

Investigations into the neurobiology of moral cognition are often done by examining clinical populations characterized by diminished moral emotions and a proclivity toward immoral behavior. Psychopathy is the most common disorder studied for this purpose. Although cocaine abuse is highly co-morbid with psychopathy and cocaine-dependent individuals exhibit many of the same abnormalities in socio-affective processing as psychopaths, this population has received relatively little attention in moral psychology. To address this issue, the authors used functional magnetic resonance imaging (fMRI) to record hemodynamic activity in 306 incarcerated male adults, stratified into regular cocaine users (n = 87) and a matched sample of non-cocaine users (n = 87), while viewing pictures that did or did not depict immoral actions and determining whether each depicted scenario occurred indoors or outdoors. Consistent with expectations, cocaine users showed abnormal neural activity in several frontostriatial regions during implicit moral picture processing compared to their non-cocaine using peers. This included reduced moral/non-moral picture discrimination in the vACC, vmPFC, lOFC, and left vSTR. Additionally, psychopathy was negatively correlated with activity in an overlapping region of the ACC and right lateralized vSTR. These results suggest that regular cocaine abuse may be associated with affective deficits which can impact relatively high-level processes like moral cognition.

Neural networks underlying implicit and explicit moral evaluations in psychopathy

Psychopathy, characterized by symptoms of emotional detachment, reduced guilt and empathy and a callous disregard for the rights and welfare of others, is a strong risk factor for immoral behavior. Psychopathy is also marked by abnormal attention with downstream consequences on emotional processing. To examine the influence of task demands on moral evaluation in psychopathy, functional magnetic resonance imaging was used to measure neural response and functional connectivity in 88 incarcerated male subjects (28 with Psychopathy Checklist Revised (PCL-R) scores ⩾ 30) while they viewed dynamic visual stimuli depicting interpersonal harm and interpersonal assistance in two contexts, implicit and explicit. During the implicit task, high psychopathy was associated with reduced activity in the dorsolateral prefrontal cortex and caudate when viewing harmful compared with helpful social interactions. Functional connectivity seeded in the right amygdala and right temporoparietal junction revealed decreased coupling with the anterior cingulate cortex (ACC), anterior insula, striatum and ventromedial prefrontal cortex. In the explicit task, higher trait psychopathy predicted reduced signal change in ACC and amygdala, accompanied by decreased functional connectivity to temporal pole, insula and striatum, but increased connectivity with dorsal ACC. Psychopathy did not influence behavioral performance in either task, despite differences in neural activity and functional connectivity. These findings provide the first direct evidence that hemodynamic activity and neural coupling within the salience network are disrupted in psychopathy, and that the effects of psychopathy on moral evaluation are influenced by attentional demands.

Socioemotional processing of morally-laden behavior and their consequences on others in forensic psychopaths

A large body of evidence supports the view that psychopathy is associated with anomalous emotional processing, reduced guilt and empathy, which are important risk factors for criminal behaviors. However, the precise nature and specificity of this atypical emotional processing is not well understood, including its relation to moral judgment. To further our understanding of the pattern of neural response to perceiving and evaluating morally-laden behavior, this study included 155 criminal male offenders with various level of psychopathy, as assessed with the Psychopathy Check List-Revised. Participants were scanned while viewing short clips depicting interactions between two individuals resulting in either interpersonal harm or interpersonal assistance. After viewing each clip, they were asked to identify the emotions of the protagonists. Inmates with high levels of psychopathy were more accurate than controls in successfully identifying the emotion of the recipient of both helpful and harmful actions. Significant hemodynamic differences were detected in the posterior superior temporal sulcus, amygdala, insula, ventral striatum, and prefrontal cortex when individuals with high psychopathy viewed negative versus positive scenarios moral scenarios and when they evaluated the emotional responses of the protagonists. These findings suggest that socioemotional processing abnormalities in psychopathy may be somewhat more complicated than merely a general or specific emotional deficit. Rather, situation-specific evaluations of the mental states of others, in conjunction with sensitivity to the nature of the other (victim vs. perpetrator), modulate attention to emotion-related cues. Such atypical processing likely impacts moral decision-making and behavior in psychopaths.

Affective empathy differs in male violent offenders with high- and low-trait psychopathy

This study investigated affective and cognitive empathic processes in incarcerated violent offenders with lower and higher psychopathic traits and healthy controls. Participants witnessed painful expressions of others displayed on video clips. Skin conductance responses (SCR) were recorded to assess autonomic emotional arousal, and various empathy ratings were used as measures of self-reported vicarious responses. Reduced SCRs occurred during the observation of pain in others in lower and higher psychopathic-trait participants alike, compared to controls. Despite these diminished autonomic responses indicating reduced vicarious responses, only inmates with higher psychopathic traits provided empathy ratings comparable to those of the controls. These findings indicate that violent offenders display reduced autonomic arousal in response to distress cues of others, irrespective of psychopathy. However, only higher psychopathic-trait offenders were able to provide self-report in a way that let them appear to be as empathic as controls-enabling them to know, yet not to feel, what others feel.

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.

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.