No feelings for me, no feelings for you: A meta-analysis on alexithymia and empathy in psychopathy

Psychopathy, criminogenic cognitions and emotional responses to affective stimuli among male adult offenders

BACKGROUND

Previous research has consistently shown value in studying emotion processing with psychopathy, but the relative effect of aural and visual stimulation has hardly been considered.

AIMS

Our aims were to (1) compare reaction time and self-rated valence ((un)pleasantness), arousal and sense of being dominated by affective sounds or visual images among offenders with and without psychopathy (=/>26) on the psychopathy check-list revised; (2) investigate any associations, controlling for social desirability and depression; (3) explore the possible mediating effect of criminogenic cognitions on any relationships between psychopathy and emotional responses to affective stimuli.

METHODS

Professional educators invited all male offenders serving semi-open custody sentences in one prison to participate. After a semi structured interview to assess psychopathy, they self-reported on criminogenic cognition, depression and social desirability scales, before a computer task using standardised human and animal sounds and images. Using the self-assessment manikin, participants rated the emotional valence, arousal and dominance levels when pleasant, unpleasant and neutral sounds or images were presented.

RESULTS

About one in three prisoners completed all the ratings-120 men, of mean age 38.8 years (SD = 11.06). All had shorter reaction times to sounds than images. Offenders with high affective-interpersonal factor scores rated all types of sounds as less pleasant. Men with high psychopathy scores took longer to respond to unpleasant images than those with lower scores. There was a positive relationship between psychopathy factors and criminogenic cognitions and the external locus of criminogenic cognitions mediated the relationship between psychopathy facets and emotional responses of valence to pleasant sounds.

CONCLUSION

Our findings confirm the potential importance of emotional reactions to sounds as well as images among men with psychopathy. Given the shorter reaction times to sounds, in real life sounds could prove more provocative than images. While only small differences emerged between men above and below the PCL-R threshold, indications from facet analyses suggest that further study of sound stimuli could enhance the understanding of emotional response differences to inform interventions. Future research in this area should focus on human-related stimuli and add alexithymia measures.

Executive functions in psychopathy: a meta-analysis of inhibition, planning, shifting, and working memory performance

Much research has focused on executive function (EF) impairments in psychopathy, a severe personality disorder characterized by a lack of empathy, antisocial behavior, and a disregard for social norms and moral values. However, it is still unclear to what extent EF deficits are present across psychopathy factors and, more importantly, which EF domains are impaired. The current meta-analysis answers these questions by synthesizing the results of 50 studies involving 5,694 participants from 12 different countries. Using multilevel random-effects models, we pooled effect sizes (Cohen's d) for five different EF domains: overall EF, inhibition, planning, shifting, and working memory. Moreover, differences between psychopathy factors were evaluated. Our analyses revealed small deficits in overall EF, inhibition, and planning performance. However, a closer inspection of psychopathy factors indicated that EF deficits were specific to lifestyle/antisocial traits, such as disinhibition. Conversely, interpersonal/affective traits, such as boldness, showed no deficits and in some cases even improved EF performance. These findings suggest that EF deficits are not a key feature of psychopathy per se, but rather are related to antisociality and disinhibitory traits. Potential brain correlates of these findings as well as implications for future research and treatment are discussed.

Psychopathy, pain, and pain empathy: A psychophysiological study

The present study examined whether people higher in psychopathy experienced less self-reported and psychophysiological nociceptive pressure than people lower in psychopathy. We also examined whether psychopathy affects empathy for others' pain via self-reported and psychophysiological measures. Three hundred and sixty-nine students (18-78 years; M = 26, SD = 9.34) were screened for psychopathic traits using the Youth Psychopathy Inventory (YPI). Stratified sampling was used to recruit 49 adults residing in the highest (n = 23) and lowest (n = 26) 20% of the psychopathy spectrum. Using skin conductance response (SCR) and self-report responses, participants responded to individually adjusted intensities of pneumatic pressure and others' pain images and completed self-reported psychopathy and empathy measures (Triarchic Psychopathy Measure, TriPm; Interpersonal Reactivity Index, IRI). People higher in psychopathy self-reported feeling less nociceptive pressure compared to people lower in psychopathy, yet we did not find any differences in SCR to nociceptive pressure. However, when viewing other people in pain, the high psychopathy group displayed lower SCR and lower self-reported empathy compared to those lower in psychopathy. Our results suggest psychopathic traits relate to problems empathising with others' pain, as well as the perception of nociceptive pressure. We also show support for the theory of dual harm which has been receiving increasing attention. Consequently, psychopathy interventions should focus both on recognising and empathising with the pain of others.

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.

Mediating effects of impulsivity and alexithymia in the association between traumatic brain injury and aggression in incarcerated males

Studies suggest both alexithymia and impulsivity (partially) explain aggressive behavior in traumatic brain injury (TBI) patients, but none of these studies use both questionnaire and performance-based measures as recommended, nor simultaneously investigate both impulsivity and alexithymia. The available studies therefore likely miss part of the constructs of alexithymia and impulsivity, and do not comprehensively assess the mediating effects of both constructs in the relationship between TBI and aggression. A sample of N = 281 incarcerated individuals were recruited from Dutch penitentiary institutions, and completed the Buss Perry Aggression Questionnaire (aggression), BIS-11 (impulsivity) and Toronto Alexithymia Scale-20 (alexithymia) questionnaires, as well as a stop-signal task and an emotion recognition paradigm. Several multiple mediation analyses were conducted using structural equation modelling, to assess the viability of a causal theoretical model of aggression. The final planned models were the original models with a good fit with the data (comparative fit index > 0.95, root mean square error of approximation and Standardized root mean square residual < 0.05), and results indicate that only questionnaire-based impulsivity mediated the relationship between TBI and aggression. TBI was unrelated to alexithymia, stop-signal or emotion recognition performance. Aggression was predicted by both alexithymia and impulsivity, but not by the performance measures. Post hoc analyses shows that alexithymia moderates the relationship between impulsivity and aggression. These results imply that aggressive incarcerated individuals showing impulsive behavior should be screened for TBI, since TBI is often overlooked or misdiagnosed, and indicate that both impulsivity and alexithymia are potential focus points for aggression reduction treatment in TBI patients.

Empathy deficits, callous-unemotional traits and structural underpinnings in autism spectrum disorder and conduct disorder youth

Distinct empathy deficits are often described in patients with conduct disorder (CD) and autism spectrum disorder (ASD) yet their neural underpinnings and the influence of comorbid Callous-Unemotional (CU) traits are unclear. This study compares the cognitive (CE) and affective empathy (AE) abilities of youth with CD and ASD, their potential neuroanatomical correlates, and the influence of CU traits on empathy. Adolescents and parents/caregivers completed empathy questionnaires (N = 148 adolescents, mean age = 15.16 years) and T1 weighted images were obtained from a subsample (N = 130). Group differences in empathy and the influence of CU traits were investigated using Bayesian analyses and Voxel-Based Morphometry with Threshold-Free Cluster Enhancement focusing on regions involved in AE (insula, amygdala, inferior frontal gyrus and cingulate cortex) and CE processes (ventromedial prefrontal cortex, temporoparietal junction, superior temporal gyrus, and precuneus). The ASD group showed lower parent-reported AE and CE scores and lower self-reported CE scores while the CD group showed lower parent-reported CE scores than controls. When accounting for the influence of CU traits no AE deficits in ASD and CE deficits in CD were found, but CE deficits in ASD remained. Across all participants, CU traits were negatively associated with gray matter volumes in anterior cingulate which extends into the mid cingulate, ventromedial prefrontal cortex, and precuneus. Thus, although co-occurring CU traits have been linked to global empathy deficits in reports and underlying brain structures, its influence on empathy aspects might be disorder-specific. Investigating the subdimensions of empathy may therefore help to identify disorder-specific empathy deficits.

The role of empathy in trolley problems and variants: A systematic review and meta-analysis

The role of empathy in morality is a subject of ongoing scientific debate due to the lack of systematic reviews and meta-analyses on this topic. To address this gap, we conducted a PRISMA-based systematic quantitative review to investigate the role of empathy in moral judgements, decision-making, and inclinations using trolley problems and variants, which are popular types of moral dilemmas that explore utilitarianism and deontology. We searched for articles in four databases (PsycINFO, Pubmed, WorldWideScience, and Scopus) and performed citation searches. Out of 661 records, we selected 34 that studied the associations between empathy and moral judgements, moral decision-making, and/or moral inclinations. Six meta-analyses and systematic reviews of these records consistently showed small to moderate associations between affective empathy and these moral parameters, particularly in personal moral dilemmas involving intentional harm (although some approaches highlighted more complex associations between these parameters). Regarding other empathy domains, most studies found limited or insignificant links between cognitive empathy domains and moral judgements, decision-making, and inclinations. We discuss the nuances and implications of these results.

Dissociating cognitive and affective empathy across psychopathy dimensions: The role of interoception and alexithymia

This study examined the associations between psychopathy dimensions (triarchic phenotypes and classical factors), empathy domains (cognitive and affective), and interoception (interoceptive attention and accuracy) while accounting for the putative role of alexithymia. A community sample (n = 515) completed an online survey encompassing: Triarchic Psychopathy Measure (boldness, meanness, disinhibition); Levenson Self-Report Psychopathy Scale (primary and secondary psychopathy); Body Perception Questionnaire (interoceptive attention); Interoceptive Accuracy Scale; Toronto Alexithymia Scale. Hierarchical linear regression models were implemented for hypothesis-driven analyses examining the associations between psychopathy, empathy, and interoception while controlling for sex, age, and alexithymia. Exploratory path models were employed to investigate alexithymia and/or cognitive empathy as mediators between interoception and psychopathy. Our results largely confirmed the postulated empathy profiles across psychopathy dimensions, as meanness and primary psychopathy displayed a broad empathy impairment, while disinhibition and secondary psychopathy were only associated with diminished cognitive empathy. Importantly, boldness displayed a unique pattern (enhanced cognitive empathy and reduced affective empathy), further reinforcing its importance within the constellation of psychopathy traits. Contrary to our hypotheses, self-perceived interoceptive attention and accuracy were not associated with either psychopathy dimension after controlling for alexithymia. However, interoceptive accuracy and alexithymia were associated with cognitive empathy, while alexithymia was also positively related to all psychopathy dimensions (as expected), despite the unexpected strong and negative association with boldness. Exploratory analyses suggested significant indirect effects (mediation) between interoceptive accuracy and psychopathy via alexithymia and/or cognitive empathy. These mediating effects must be interpreted with caution and future studies should be designed to formally test this model.

Effects of Alexithymia on Moral Decision-Making in Sacrificial Dilemmas: High Alexithymia is Associated with Weaker Sensitivity to Moral Norms

Purpose

Although several studies have investigated the association between alexithymia and moral decision-making in sacrificial dilemmas, the evidence remains mixed. The current work investigated this association and how alexithymia affects moral choice in such dilemmas.

Methods

The current research used a multinomial model (ie, CNI model) to disentangle (a) sensitivity to consequences, (b) sensitivity to moral norms, and (c) general preference for inaction versus action irrespective of consequences and norms in responses to moral dilemmas.

Results

Higher levels of alexithymia were associated with a greater preference for utilitarian judgments in sacrificial dilemmas (Study 1). Furthermore, individuals with high alexithymia showed significantly weaker sensitivity to moral norms than did those with low alexithymia, whereas there were no significant differences in sensitivity to consequences or a general preference for inaction versus action (Study 2).

Conclusion

The findings suggest that alexithymia affects moral choice in sacrificial dilemmas by blunting emotional reactions to causing harm, rather than through increased deliberative cost-benefit reasoning or general preference for inaction.

Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy

Ho, M.H., Kemp, B.T., Eisenbarth, H. & Rijnders, R.J.P. Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy. NEUROSCI BIOBEHAV REV YY(Y) XXX-XXX, 2023. The heterogeneity of the literature on empathy highlights its multidimensional and dynamic nature and affects unclear descriptions of empathy in the context of psychopathology. The Zipper Model of Empathy integrates current theories of empathy and proposes that empathy maturity is dependent on whether contextual and personal factors push affective and cognitive processes together or apart. This concept paper therefore proposes a comprehensive battery of physiological and behavioral measures to empirically assess empathy processing according to this model with an application for psychopathic personality. We propose using the following measures to assess each component of this model: (1) facial electromyography; (2) the Emotion Recognition Task; (3) the Empathy Accuracy task and physiological measures (e.g., heart rate); (4) a selection of Theory of Mind tasks and an adapted Dot Perspective Task, and; (5) an adjusted Charity Task. Ultimately, we hope this paper serves as a starting point for discussion and debate on defining and assessing empathy processing, to encourage research to falsify and update this model to improve our understanding of empathy.

Moral Decision-Making in Trolley Problems and Variants: How Do Participants' Perspectives, Borderline Personality Traits, and Empathy Predict Choices?

The aim of the present study was to demonstrate and extend the causal effect of participants' perspectives on moral decision-making using trolley problems and variants. Additionally, we investigated whether empathy and borderline (BDL) personality traits predicted participants' choices in these scenarios. We used both a classical trolley problem (a causing harm scenario) and an everyday trolley-like problem (a causing inconvenience scenario). Participants (N = 427, women: 54%) completed BDL traits and empathy questionnaires and, randomly, the two types of trolley problems, presenting both three different perspectives. Our study provided strong evidence that the perspective from which participants were enrolled in the trolley problem caused significant changes in their moral decision-making. Furthermore, we found that affective empathy and BDL traits significantly predicted participants' decisions in the causing inconvenience scenario, while only BDL traits predicted choices in the causing harm scenario. This study was original in providing new experimental materials, causal results, and highlighting the significant influence of BDL traits and affective empathy on moral decision-making. These findings raised fundamental questions, which are further developed in the discussion section.

Psychopathic Traits and Theory of Mind Task Performance: A Systematic Review and Meta-analysis

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes, from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy.

Empathy, impulsiveness, and sensation seeking as mediators between primary psychopathic traits and driving behaviors in French driving offenders

OBJECTIVE

The aim of this study was to examine the links between primary psychopathic traits and driving behavior on the one hand, and driving anger expression on the other hand, through the specific contribution of empathy, impulsiveness, and sensation seeking, in a sample of French driving offenders.

METHODS

One thousand six hundred and eighty-six driving offenders completed a paper-and-pencil questionnaire during 110 drivers' rehabilitation programs.

RESULTS

Primary psychopathic traits were positively associated with violations and aggressive driving anger expression, and negatively associated with prosocial driving behaviors. These associations were partially mediated by empathy, impulsiveness, and sensation seeking. In addition, the negative relation between primary psychopathic traits and adaptive anger expression was fully mediated by these three personal dispositions.

CONCLUSION

Low empathy, high impulsiveness and sensation seeking are important characteristics of driving offenders with high psychopathic traits. Our results provide a better understanding of French driving offenders' risky behaviors and the role of primary psychopathic traits.

A stenography of empathy: Toward a consensual model of the empathic process

Empathy has gained popularity in the general population and the scientific world during the past decade. Recently, several researchers found a significant decrease in empathy scores of healthcare students (notably medical students) and recommend promoting empathy skills in several fields of education. The current paper presents a new model of the empathic process: a stenography of empathy compelling scientific data and contemporary conceptions. Indeed, we combined all pioneer researchers' conceptions of empathy (Davis, Decety, Batson, Preston & de Waal) into an integrative model. This model is centered on the empathizer (i.e., a person observing a target experiencing emotions) and displays how all empathy components are articulated, explaining the individuals' general functioning and how the process might become dysfunctional. We illustrated applications of the model with three clinical examples (i.e., burnout, psychopathy, and borderline personality disorders) to display how empathy is related to psychopathological symptoms. We believe this new dynamic and sequential model would be helpful in explaining how empathy works, which is of great interest to healthcare students, clinicians, researchers, and academics.

Mirror neurons and empathy-related regions in psychopathy: systematic review, meta-analysis, and a working model

Mirror neurons have been associated with empathy. People with psychopathic traits present low levels of empathy. To analyze this, a systematic review of fMRI studies of people with psychopathic traits during an emotional facial expression processing task was performed. The regions of interest were structures associated with the mirror neuron system: ventromedial prefrontal cortex (vmPFC), inferior parietal lobe (IPL), inferior frontal gyrus and superior temporal sulcus. The analysis was also extended to structures related to affective empathy (insula, amygdala and anterior cingulate cortex) and to two more emotional processing areas (orbitofrontal cortex and fusiform gyrus). Hypoactivation was more frequently observed in regions of the mirror neuron system from people with high psychopathic traits, as well as in the emotional processing structures, and those associated with affective empathy, except for the insula, where it presented higher activity. Differences were observed for all types of emotions. The results suggest that the mirror neuron system is altered in psychopathy and their relationship with affective empathy deficits is discussed.

Effects of Primary and Secondary Psychopathy on Deontological and Utilitarian Response Tendencies: The Mediator Role of Alexithymia

(1) Background: The purpose of this study is to provide more nuanced insights into the effects of sub-dimensional levels of psychopathy on moral dilemma judgments. To this end, this study examined the effects of primary and secondary psychopathy on utilitarian and deontological response tendencies. Moreover, this study also explored the mediating role of alexithymia as well as the moderating role of gender in these effects. (2) Methods: A total of 1227 participants were recruited through the online questionnaire service wjx.cn. After deleting unfinished questionnaires, the remaining 1170 participants were included in the final data analysis. Each participant completed a demographic information questionnaire, the Levenson Self-Report Psychopathy Scale, the Toronto Alexithymia Scale-20, and six pairs of moral dilemmas. Descriptive and correlational analyses of study variables were conducted in SPSS 22.0. Mediation and gender difference analyses were conducted in AMOS 23.0. (3) Results: Primary psychopathy was negatively correlated with deontological response tendencies and uncorrelated with utilitarian response tendencies. By contrast, secondary psychopathy also correlated negatively with deontological response tendencies, but it correlated positively with utilitarian response tendencies. Mediation analysis revealed that alexithymia only mediated the relationship between secondary psychopathy and deontological response tendencies. Multi-group analysis revealed that there was no difference between females and males in the indirect effect model. (4) Conclusions: People with high primary psychopathy are less likely to reject harm in moral dilemmas. By contrast, people with high secondary psychopathy have high alexithymia, which causes them to be less concerned about avoiding harm, and they are more likely to maximize outcomes in moral dilemmas. These findings shed new light on the moral dilemma judgments of individuals with primary and secondary psychopathy.