Psychopathy in instrumental and reactive violent offenders

Reduced vagal tone in intimate partner violence perpetrators is partly explained by anger rumination

Polyvagal theory proposed that an autonomous nervous system imbalance might be characteristic of violent individuals, especially reduced parasympathetic or vagal tone. Accordingly, some studies concluded that when intimate partner violence (IPV) perpetrators deal with acute stress, they tend to present a sympathetic predominance over the parasympathetic nervous system once the stress has ended. However, less is known about cognitive mechanisms that explain this phenomenon. In fact, this functioning might be explained by inner speech and/or angry thoughts (anger rumination) in reactive aggressors. Nonetheless, there is a gap in the scientific literature assessing whether this psychophysiological functioning in IPV perpetrators is explained by anger rumination. For this reason, the first aim of this study was to assess the cardiorespiratory (heart rate (HR), pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA)) and electrodermal (skin conductance level (SCL)) changes, as well as the anger state, when coping with an acute laboratory stressor, comparing a group of reactive IPV perpetrators (n = 47) and a group of non-violent men (n = 36). The second aim was two-fold. After checking whether the groups differed on their anger rumination and manifestation of aggression (reactive and/or proactive) scores, we studied whether these variables explained psychophysiological and psychological responses to a laboratory task (changes and levels during the recovery period) in each group. Our results demonstrated that, compared to the control group, IPV perpetrators presented lower RSA levels (vagal tone). Even though the groups did not differ on their anger rumination or manifestation of aggression scores (except for proactive aggression), only in the IPV perpetrators, high anger rumination and reactive aggression partly explained the lower vagal tone (RSA levels) and high levels of anger state at post-task. Consequently, this study contributes to understanding the psychobiological basis for violence proneness in IPV perpetrators, making it possible to explore new therapeutic strategies.

Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis

Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there are differences in the level of symptoms between forensic and non-forensic patients. According to PRISMA guidelines, a systematic search was performed in PubMed, Web of Science, and ProQuest, using the following key words: "forensic" AND "Positive and Negative Syndrome Scale" OR "PANSS". A total of 27 studies were included in the systematic review, while only 23 studies in the meta-analysis. The overall sample included a total of 1702 participants, most commonly male and inpatients in forensic settings. We found that studies with an entirely male sample had significantly lower Positive PANSS ratings than studies with mixed samples. Although both forensic and non-forensic patients were affected by mild psychopathological symptoms, forensic patients presented higher ratings in all four PANSS scales. This meta-analysis shows that forensic patients reported a mild level of symptomatology, as assessed with the PANSS, and therefore might be considered as patients in partial remission. Among patients with schizophrenia, the association between symptoms and violence is very complex: many factors might be considered as key mediators and thus should be taken into account to explain this association. Further studies are needed.Trial registration all materials and data can be found on the OSF framework: https://osf.io/5ceja (date of registration: 8 September 2021).

Virtual Reality for Aggression Assessment: The Development and Preliminary Results of Two Virtual Reality Tasks to Assess Reactive and Proactive Aggression in Males

Validly measuring aggression is challenging because self-reports are plagued with biased answer tendencies and behavioral measures with ethical concerns and low ecological validity. The current study, therefore, introduces a novel virtual reality (VR) aggression assessment tool, differentially assessing reactive and proactive aggression. Two VR tasks were developed, one in an alley environment (N = 24, all male, Mage = 23.88, 83.3% students) and an improved second one in a bar (N = 50, all male, Mage = 22.54, 90% students). In this bar VR task, participants were randomly assigned to either the reactive condition where they were triggered by a cheating and insulting dart-player or to the proactive condition where they could earn extra money by aggressing. Participants' level of self-reported aggression and psychopathy was assessed, after which they engaged in either the reactive or proactive VR task. Changes in affect and blood pressure were also measured. Aggression in the reactive VR task was evidenced to mostly display convergent validity because it positively correlated with self-reported aggression and total and fearless dominance factor scores of psychopathy, and there was a trend relationship with increased systolic blood pressure. The validity of the proactive aggression variant of our VR bar paradigm received less support, and needs more refinement. It can be concluded that VR is a potentially promising tool to experimentally induce and assess (reactive) aggression, which has the potential to provide aggression researchers and clinicians with a realistic and modifiable aggression assessment environment.

Impulsive and premeditated aggression in male offenders with antisocial personality disorder

INTRODUCTION

Aggression is a clinical symptom of various psychiatric disorders that can be conceptualised as a physical act towards another person with the intent to cause harm. In antisocial personality disorder (ASPD), aggression is a frequent manifestation that differently compromise therapeutic and prognostic goals according to its impulsive or premeditated categorisation. ASPD is characterised by high levels of impulsivity, psychopathic traits, and a high prevalence of co-morbid substance use disorders (SUDs). Aggression in ASPD patients may determine long and recurrent imprisonment thus representing a challenge clinicians and legal experts face.

OBJECTIVES

Our aims were to characterise impulsive and premeditated aggression in male ASPD offenders as well as to determine the potential role of SUDs, impulsivity, and psychopathic traits as predictors.

MATERIALS AND METHODS

In this cross-sectional study we evaluated a sample of ASPD offenders with a battery of clinical and psychometric, standardised instruments: the Psychopathy Checklist-Revised (PCL-R), the European Version of the Addiction Severity Index (EuropASI), the Barratt Impulsivity Scale Version 11 (BIS-11), and the Impulsive/Premeditated Aggression Scale (IPAS).

RESULTS

We used a total sample of 134 offenders, all of whom were male. ASPD patients (n = 96) had a 71.9% prevalence of impulsive aggression and a 28.1% prevalence of premeditated aggression. ASPD patients with impulsive aggression had significantly lower scores of total PCL-R (p<0.01) factor 1 and interpersonal facet 1 (p<0.05), compared with ASPD patients with premeditated aggression. ASPD patients with impulsive aggression and ASPD patients with premeditated aggression had comparable BIS-11 mean scores, and exhibited an equal prevalence of SUDs. The interpersonal facet 1of the PCL-R predicted the aggression type (p<0.05) in ASPD patients, and the exponential beta value for facet 1 was 1.42 (CI = 1.03; 1.95).

CONCLUSIONS

The aggression type that is associated with ASPD is mainly impulsive in nature. ASPD patients who have higher scores of psychopathic traits have a lower probability of exhibiting impulsive aggression and a higher probability of exhibiting premeditated aggression. Although ASPD patients have high levels of impulsivity and a high frequency of SUDs, these two variables were not predictors of the aggression type.

Facets of Psychopathy, Intelligence, and Aggressive Antisocial Behaviors in Young Violent Offenders

Psychopathy continues to be a challenge in forensic contexts, and evidence of its association with destructive behaviors, such as aggressive antisocial behaviors, is extensive. However, the potential role of intelligence as moderator of the well-established association between psychopathy and aggressive antisocial behaviors has largely been neglected, despite intelligence having been independently related to both concepts. Increased knowledge of whether intelligence is relevant to this association is needed because of its possible implications on the assessment and treatment of individuals with psychopathic traits and aggressive antisocial behaviors. This study aimed to investigate the association between psychopathic traits, aggressive antisocial behaviors, and intelligence in young violent offenders and to test whether intelligence moderates the relationship between psychopathic traits and aggressive antisocial behaviors. Participants were 269 male violent offenders aged 18–25 years, assessed on the Psychopathy Checklist-Revised (PCL-R), the Life History of Aggression (LHA), and the General Ability Index from the Wechsler Adult Intelligence Scale, 3rd edition. Associations were tested with Spearman’s rho, and moderation analysis was performed through ordinary least squares regressions. The PCL-R four-facet structure was used for the analyses. We found a positive association between psychopathic traits and aggressive antisocial behaviors, and a small negative association between the Affective PCL-R facet and intelligence. In the moderation analyses, a small yet statistically significant moderation effect of intelligence on the association between the Interpersonal facet and LHA total scores was demonstrated. However, the amount of variance in the LHA total score explained by the model was very small: 2.9%. We suggest that intelligence, however, important for rehabilitation strategies and everyday functioning, is not necessarily pertinent to understanding aggressive antisocial behaviors in young offenders with psychopathic traits.

Specific Contributions of Age of Onset, Callous-Unemotional Traits and Impulsivity to Reactive and Proactive Aggression in Youths with Conduct Disorders

Youths with conduct disorders (CD) are particularly studied for their violent and aggressive behaviors. Many researchers considered aggressive behaviors as being either reactive or proactive. Moreover, factors such as age of CD onset, impulsivity, and callous-unemotional traits, separately, have been related to these different types of aggressive behaviors. However, very few studies addressed the combined contribution of these three factors on proactive and reactive aggression. This question was tested in a sample composed of 43 male adolescents with CD. A single regression analysis including all predictors and outcomes, using Bayesian statistics, was computed. Results indicated that impulsivity was related to reactive aggression, while CU traits were related to proactive aggression. These results suggest first, an important heterogeneity among youth with CD, probably leading to different trajectories and, second, that youths with callous-unemotional traits should receive special attention and care as they are more at risk for proactive aggression.

Validation of the Portuguese Version of Impulsive-Premeditated Aggression Scale in an Inmate Population

Aggression is one of the core symptoms of antisocial personality disorder (ASPD) with therapeutic and prognostic relevance. ASPD is highly prevalent among inmates, being responsible for adverse events and elevated direct and indirect economic costs for the criminal justice system. The Impulsive/Premeditated Aggression Scale (IPAS) is a self-report instrument that characterizes aggression as either predominately impulsive or premeditated. This study aims to determine the validity and reliability of the IPAS in a sample of Portuguese inmates. A total of 240 inmates were included in the study. A principal component factor analysis was performed so as to obtain the construct validity of the IPAS impulsive aggression (IA) and premeditated aggression (PM) subscales; internal consistency was determined by Cronbach's alpha coefficient; convergent and divergent validity of the subscales were determined analyzing correlations with the Barratt Impulsiveness scale, 11th version (BIS-11), and the Psychopathic Checklist Revised (PCL-R). The rotated matrix with two factors accounted for 49.9% of total variance. IA subscale had 11 items and PM subscale had 10 items. The IA and PM subscales had a good Cronbach's alpha values of 0.89 and 0.88, respectively. The IA subscale is correlated with BIS-11 attentional, motor, and non-planning impulsiveness dimensions (p < 0.05). The PM subscale is correlated with BIS-11 attentional, motor impulsiveness dimensions (p < 0.05). The PM subscale is correlated with PCL-R interpersonal, lifestyle, and antisocial dimensions (p < 0.05). The IA subscale is not correlated with PCL-R. The Portuguese translated version of IPAS has adequate psychometric properties, allowing the measurement of impulsive and premeditated dimensions of aggression.

Further Evidence for Reliability and Validity of the Triarchic Psychopathy Measure in a Forensic Sample and a Community Sample

Psychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory -Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument.

Relations of Distinct Psychopathic Personality Traits with Anxiety and Fear: Findings from Offenders and Non-Offenders

Early descriptions of psychopathy emphasise fearlessness and a lack of nervousness or anxiety as key characteristics of the disorder. However, conflicting evidence suggests that anxiety may be positively correlated with some aspects of the psychopathy construct. This position may seem somewhat paradoxical when considered alongside impaired processing of fear related stimuli in psychopathic personality. The aim of the current paper was to examine the distinct relations of callous, egocentric, and antisocial psychopathic traits with measures of anxiety and social anxiety in samples of non-offenders (Study 1) and violent offenders (Study 2). In Study 2 we also used an emotion recognition task to examine fearful face recognition. In Studies 1 and 2 we showed distinct and opposite significant relationships of egocentric and antisocial psychopathic traits with trait anxiety. Thus, while trait anxiety was negatively predicted by egocentric traits, it was predicted in a positive direction by antisocial traits in both samples. In Study 2 we found that callous traits were predictive of greater impairments in fearful face recognition. These findings suggest that anxiety and fear are distinguishable constructs in relation to psychopathic personality traits, and are discussed in terms of potentially separable mechanisms for these two constructs.

Impulsive versus premeditated aggression in the prediction of violent criminal recidivism

Past aggression is a potent predictor of future aggression and informs the prediction of violent criminal recidivism. However, aggression is a heterogeneous construct and different types of aggression may confer different levels of risk for future violence. In this prospective study of 91 adults in a pretrial diversion program, we examined (a) premeditated versus impulsive aggression in the prediction of violent recidivism during a one-year follow-up period, and (b) whether either type of aggression would have incremental validity in the prediction of violent recidivism after taking into account frequency of past general aggression. Findings indicate that premeditated, but not impulsive, aggression predicts violent recidivism. Moreover, premeditated aggression remained a predictor of recidivism even with general aggression frequency in the model. Results provide preliminary evidence that the assessment of premeditated aggression provides relevant information for the management of violent offenders.

Response monitoring and adjustment: differential relations with psychopathic traits

Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a 2-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., posterror slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the 2 main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy.

Understanding Youth Antisocial Behavior Using Neuroscience through a Developmental Psychopathology Lens: Review, Integration, and Directions for Research

Youth antisocial behavior (AB) is an important public health concern impacting perpetrators, victims, and society. Functional neuroimaging is becoming a more common and useful modality for understanding neural correlates of youth AB. Although there has been a recent increase in neuroimaging studies of youth AB and corresponding theoretical articles on the neurobiology of AB, there has been little work critically examining the strengths and weaknesses of individual studies and using this knowledge to inform the design of future studies. Additionally, research on neuroimaging and youth AB has not been integrated within the broader framework of developmental psychopathology. Thus, this paper provides an in-depth review of the youth AB functional neuroimaging literature with the following goals: 1. to evaluate how this literature has informed our understanding of youth AB, 2. to evaluate current neuroimaging studies of youth AB from a developmental psychopathology perspective with a focus on integrating research from neuroscience and developmental psychopathology, as well as placing this research in the context of other related areas (e.g., psychopathy, molecular genetics), and 3. to examine strengths and weaknesses of neuroimaging and behavioral studies of youth AB to suggest how future studies can develop a more informed and integrated understanding of youth AB.

The Assessment of Dangerous Behaviour: Research and Clinical Issues

Mental health professionals in forensic settings are increasingly called upon to assess the probability of dangerous behaviour, or level of risk, that certain individuals pose to the community. These assessments may inform decisions concerning the containment and management of violent offenders within forensic settings, sentencing options, and whether or not to grant bail or parole. In this paper we provide an overview of the key issues associated with the assessment of dangerous behaviour. Specifically, we briefly consider the debate on clinical versus actuarial assessments of dangerous behaviour and risk, and provide a synopsis of the current research on dangerous behaviour, focusing on the key areas of mental disorder, psychopathy, and substance use. Finally, we outline guidelines for addressing specific content areas in the clinical risk-assessment process and discuss areas for future research.

Personality influences the neural responses to viewing facial expressions of emotion

Cognitive research has long been aware of the relationship between individual differences in personality and performance on behavioural tasks. However, within the field of cognitive neuroscience, the way in which such differences manifest at a neural level has received relatively little attention. We review recent research addressing the relationship between personality traits and the neural response to viewing facial signals of emotion. In one section, we discuss work demonstrating the relationship between anxiety and the amygdala response to facial signals of threat. A second section considers research showing that individual differences in reward drive (behavioural activation system), a trait linked to aggression, influence the neural responsivity and connectivity between brain regions implicated in aggression when viewing facial signals of anger. Finally, we address recent criticisms of the correlational approach to fMRI analyses and conclude that when used appropriately, analyses examining the relationship between personality and brain activity provide a useful tool for understanding the neural basis of facial expression processing and emotion processing in general.

Psychopathy and instrumental violence: facet level relationships

The relationship between psychopathy and violence is well established. However, the extent to which psychopathy is related to different types of violent behavior warrants further study. We examined the relationship between instrumental violence, psychopathy, and psychopathic traits among 248 European American and African American adult male county jail inmates. We assessed instrumentality based on subjective motivations for respondent-identified acts of violence. Psychopathy was assessed using the PCL-R based on interview and file review. We controlled for potentially important covariates, namely IQ and prior violence. Results were in part consistent with findings from studies with adolescents, in that we identified a positive relationship between instrumentality of violence and manipulative interpersonal style. Results differed from youth studies with regard to relationships between instrumentality and other facets of psychopathy. The implications of our study are discussed with regard to treatment and the developmental stability of the relationship between psychopathic traits and instrumental violence.

Connectivity from the ventral anterior cingulate to the amygdala is modulated by appetitive motivation in response to facial signals of aggression

For some people facial expressions of aggression are intimidating, for others they are perceived as provocative, evoking an aggressive response. Identifying the key neurobiological factors that underlie this variation is fundamental to our understanding of aggressive behaviour. The amygdala and the ventral anterior cingulate cortex (ACC) have been implicated in aggression. Using functional magnetic resonance imaging (fMRI), we studied how the interaction between these regions is influenced by the drive to obtain reward (reward–drive or appetitive motivation), a personality trait consistently associated with aggression. Two distinct techniques showed that the connectivity between the ventral ACC and the amygdala was strongly correlated with personality, with high reward–drive participants displaying reduced negative connectivity. Furthermore, the direction of this effect was restricted from ventral ACC to the amygdala but not vice versa. The personality-mediated variation in the pathway from the ventral anterior cingulate cortex to the amygdala provides an account of why signals of aggression are interpreted as provocative by some individuals more than others.

Appetitive motivation predicts the neural response to facial signals of aggression

The "behavioral approach system" (BAS) (Gray, 1990) has been primarily associated with reward processing and positive affect. However, additional research has demonstrated that the BAS plays a role in aggressive behavior, heightened experience of anger, and increased attention to facial signals of aggression. Using functional magnetic resonance imaging, we show that variation in the BAS trait in healthy participants predicts activation in neural regions implicated in aggression when participants view facial signals of aggression in others. Increased BAS drive (appetitive motivation) was associated with increased amygdala activation and decreased ventral anterior cingulate and ventral striatal activation to facial signals of aggression, relative to sad and neutral expressions. In contrast, increased behavioral inhibition was associated with increased activation in the dorsal anterior cingulate, a region involved in the perception of fear and threat. Our results provide the first demonstration that appetitive motivation constitutes a significant factor governing the function of neural regions implicated in aggression, and have implications for understanding clinical disorders of aggression.

Psychopathy and violence: increasing specificity

A large body of literature has established that the construct of psychopathy is broadly related to violence, and the clinical application of the psychopathy construct as a predictor of violence appears to be increasing. This increased application warrants further specification of this relationship. That is, it may be important to identify factors that moderate relationships between psychopathy and violence, and to determine the extent to which subcomponents of the syndrome account for the relationships between psychopathy and specific types of violence. The present review summarises initial attempts to address these goals. We begin by summarising recent trends in the forensic application of the psychopathy construct. We then examine evidence bearing on the extent to which the predictive power of psychopathy for violence is moderated by other factors. Finally, we examine relationships between subcomponents of the psychopathy construct and specific types of violent and aggressive behaviour to examine whether relationships between psychopathy and violence are accounted for by specific components of psychopathy.

Types of aggression, responsiveness to provocation, and callous-unemotional traits in detained adolescents

The present study investigated differences in the behavioral and psychophysiological responses to provocation and in the level of callous-unemotional traits in boys exhibiting different patterns of aggression. Eighty-five boys (ages 13-18) in a juvenile detention center played a competitive computer task against a hypothetical peer who provided low and high levels of provocation. Youth high on both self-reported reactive and proactive aggression showed different behavioral responses to provocation than youth high on only reactive aggression. Specifically, the combined group showed high levels of aggressive responses without any provocation, whereas the group high on reactive aggression showed an increase in aggressive responding to low provocation. Further, results revealed a trend for the combined group to show lower levels of skin conductance reactivity to low provocation if they were also high on callous-unemotional traits.

Testing Factor Models of the Psychopathy Checklist: Youth Version and Their Association With Instrumental Aggression

Although there is a documented link between psychopathy and instrumental violence in adult offenders, the association between these constructs has not garnered significant attention in adolescent offenders. In this study, we evaluated the relationship between psychopathy and instrumental aggression in a sample of 122 male adolescents incarcerated in a state facility for serious and chronic offenders. We evaluated the primary (2-, 3-, and 4-factor) models of the Psychopathy Checklist: Youth Version (PCL:YV; Forth, Kosson, & Hare, 2003) and assessed their relationship to a separate 5-item measure of instrumental violence. CFA revealed good model fit for the 3- and 4-factor latent variable models of adolescent psychopathy and a single-factor model reflecting a 5-item measure of instrumental violence. Structural equation modeling results indicate that the 4-factor model accounted for 20% of the variance for instrumental violence. In contrast, the 3-factor model of the PCL:YV accounted for 8%, and the 2-factor model accounted for 5% of the variance associated with instrumental violence.

Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account

This paper reviews the role of orbitofrontal cortex (OFC) lesions in antisocial behaviors and the adequacy of a strict OFC account of antisocial disorders where there is no evidence of lesion. Neurocognitive accounts of antisocial behaviors are extended beyond the OFC. Several methodological shortcomings specific to this neuroscience approach to antisocial behavior are identified. A developmental approach is advocated to chart the developmental sequences of impaired brain development and of the various comorbid states typically seen in antisocial disorders.