Emotion-modulated startle in psychopathy: clarifying familiar effects

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

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

Parsing patterns of reward responsiveness: Initial evidence from latent profile analysis

Variation in reward responsiveness has been linked to psychopathology. Reward responsiveness is a complex phenomenon that encompasses different temporal dimensions (i.e., reward anticipation or consumption) that can be measured using multiple appetitive stimuli. Furthermore, distinct measures, such as neural and self-report measures, reflect related but distinct aspects of reward responsiveness. To understand reward responsiveness more comprehensively and better identify deficits in reward responsiveness implicated in psychopathology, we examined ways multiple measures of reward responsiveness jointly contribute to distinct psychological problems by using latent profile analysis. Specifically, we identified three profiles of reward responsiveness among 139 female participants based on their neural responses to money, food, social acceptance, and erotic images and self-reported responsiveness to reward anticipation and consumption. Profile 1 (n = 30) exhibited blunted neural responses to social rewards and erotic images, low self-reported reward responsiveness, but average neural responses to monetary and food rewards. Profile 2 (n = 71) showed elevated neural response to monetary rewards, average neural responses to other stimuli, and average self-reported reward responsiveness. Profile 3 (n = 38) showed more variable neural responses to reward (e.g., hypersensitivity to erotic images, hyposensitivity to monetary rewards), and high self-reported reward responsiveness. These profiles were differentially associated with variables generally linked to aberrations in reward responsiveness. For example, Profile 1 was most strongly associated with anhedonic depression and social dysfunction, whereas Profile 3 was associated with risk-taking behaviors. These preliminary findings may help to elucidate ways different measures of reward responsiveness manifest within and across individuals and identify specific vulnerabilities for distinct psychological problems.

Impaired salience network switching in psychopathy

Growing evidence suggests that psychopathy is related to altered connectivity within and between three large-scale brain networks that support core cognitive functions, including allocation of attention. In healthy individuals, default mode network (DMN) is involved in internally-focused attention and cognition such as self-reference. Frontoparietal network (FPN) is anticorrelated with DMN and is involved in externally-focused attention to cognitively demanding tasks. A third network, salience network (SN), is involved in detecting salient cues and, crucially, appears to play a role in switching between the two anticorrelated networks, DMN and FPN, to efficiently allocate attentional resources. Psychopathy has been related to reduced anticorrelation between DMN and FPN, suggesting SN's role in switching between these two networks may be diminished in the disorder. To test this hypothesis, we used independent component analysis to derive DMN, FPN, and SN activity in resting-state fMRI data in a sample of incarcerated men (N = 148). We entered the activity of the three networks into dynamic causal modeling to test SN's switching role. The previously established switching effect of SN among young, healthy adults was replicated in a group of low psychopathy participants (posterior model probability = 0.38). As predicted, SN's switching role was significantly diminished in high psychopathy participants (t(145) = 26.39, p < .001). These findings corroborate a novel theory of brain function in psychopathy. Future studies may use this model to test whether disrupted SN switching is related to high psychopathy individuals' abnormal allocation of attention.

Affective theory of mind impairments underlying callous-unemotional traits and the role of cognitive control

Affective theory of mind (aToM) impairments associated with the youth antisocial phenotype callous-unemotional (CU) traits predict antisocial behaviour above CU traits alone. Importantly, CU traits associate with decrements in complex but not basic aToM. aToM is modulated by cognitive control and CU traits associate with cognitive control impairments; thus, cognitive control is a plausible mechanism underlying aToM impairments in CU traits. Because cognitive control is dependent on the availability of cognitive resources, youth with CU traits may have difficulty with allocating cognitive resources under greater demands that impact complex aToM. To test this, 81 participants (ages 12-14, Female = 51.8%, Male = 48.2%) were recruited to complete a behavioural paradigm that involved an initial aToM task with complex and basic emotions followed by placing additional demands on cognitive control and a final repeat of the same aToM task. Results indicate adolescents higher in CU traits had intact basic aToM but less accuracy in complex aToM that worsened after taxing cognitive control; and this load only required a short duration to account for ToM decrements (200 ms [range 150-1600 ms]). These results demonstrate CU traits association with cognitive control limitations that impact complex aToM. This may partially explain antisocial behaviour associated with CU traits.

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.

New insights on the correspondence between subjective affective experience and physiological responses from representational similarity analysis

Classical views suggest that experienced affect is related to a specific bodily response, whereas recent perspectives challenge this view postulating that similar affective experiences rather evoke different physiological responses. To further advance this debate in the field, we used representational similarity analysis to investigate the correspondence between subjective affect (arousal and valence ratings) and physiological reactions (skin conductance response [SCR], startle blink response, heart rate, and corrugator activity) across various emotion induction contexts (picture viewing task, sound listening task, and imagery task). Significant similarities were exclusively observed between SCR and arousal in the picture viewing task. However, none of the other physiological measures showed a significant relation with valence and arousal ratings in any of the tasks. These findings are discussed within the framework of the Populations hypothesis, suggesting that physiological responses do not depend on the experienced affect but are directly associated with the context in which they are evoked.

Does Eye Gaze Uniquely Trigger Spatial Orienting to Socially Relevant Information? A Behavioral and ERP Study

Using behavioral and event-related potential (ERP) measures, the present study examined whether eye gaze triggers a unique form of attentional orienting toward threat-relevant targets. A threatening or neutral target was presented after a non-predictive gaze or an arrow cue. In Experiment 1, reaction times indicated that eye gaze and arrow cues triggered different attention orienting towards threatening targets, which was confirmed by target-elicited P3b latency in Experiment 2. Specifically, for targets preceded by arrow and gaze cues, P3b peak latency was shorter for neutral targets than threatening targets. However, the latency differences were significantly smaller for gaze cues than for arrow cues. Moreover, target-elicited N2 amplitude indicated a significantly stronger cue validity effect of eye gaze than that of arrows. These findings suggest that eye gaze uniquely triggers spatial attention orienting to socially threatening information.

The importance of an exaggerated attention bottleneck for understanding psychopathy

The psychopath has long captured the imagination. A name such as Ted Bundy evokes a morbid curiosity. The crimes committed by Bundy are so cruel that it is hard to imagine how someone could do such things. In this review we discuss evidence that exaggeration in an attention bottleneck is one mechanism that makes it possible for psychopathic individuals to be adept at focusing on a single stimulus feature or goal but struggle to process multiple streams of information simultaneously. This exaggeration may partly explain the behavioral, affective, and social deficits that are apparent among psychopathic individuals. Further research on this attentional mechanism may promote a science that adequately captures the complexity of psychopathic behavior and offers new avenues for intervention.

A Multidimensional Examination of Psychopathy Traits and Gray Matter Volume in Adults

Uncovering the neurobiological abnormalities that may contribute to the manifestation of psychopathic traits is an important step toward understanding the etiology of this disorder. Although many studies have examined gray matter volume (GMV) in relation to psychopathy, few have examined how dimensions of psychopathic traits interactively relate to GMV, an approach that holds promise for parsing heterogeneity in neurobiological risk factors for this disorder. The aim of this study was to investigate the affective-interpersonal (Factor 1) and impulsive-antisocial (Factor 2) dimensions of psychopathy in relation to cortical surface and subcortical GMV in a mixed-gender, high-risk community sample with significant justice-system involvement (N = 156, 50.0% men). Cortex-wide analysis indicated that (i) the Factor 1 traits correlated negatively with GMV in two cortical clusters, one in the right rostral middle frontal region and one in the occipital lobe, and (ii) the interaction of the affective-interpersonal and impulsive-antisocial traits was negatively associated with GMV bilaterally in the parietal lobe, such that individuals high on both trait dimensions evidenced reduced GMV relative to individuals high on only one psychopathy factor. An interactive effect also emerged for bilateral amygdalar and hippocampal GMV, such that Factor 1 psychopathic traits were significantly negatively associated with GMV only at high (but not low) levels of Factor 2 traits. Results extend prior research by demonstrating the neurobiological correlates of psychopathy differ based on the presentation of Factor 1 and 2 traits.

Some Methodological Issues in Neuroethics: The Case of Responsibility and Psychopathy

There are some distinct methodological challenges, and possible pitfalls, for neuroethics when it evaluates neuroscientific results and links them to issues such as moral or legal responsibility. Some problems emerge in determining the requirements for responsibility. We will show how philosophical proposals in this area need to interact with legal doctrine and practice. Problems can occur when inferring normative implications from neuroscientific results. Other problems arise when it is not recognized that data about brain anatomy or physiology are relevant to the ascription of responsibility only when they are significantly correlated with the psychological capacities contemplated by the legal formulations of responsibility. We will demonstrate this by considering two significant cases concerning psychopathy. Some paradigms that aim at measuring higher-order capacities, such as moral understanding, have limited validity. More robust paradigms for the study of learning in restricted controlled conditions, on the other hand, have limited ecological validity across individuals and context to be of any use for the law.

Rational, emotional, or both? Subcomponents of psychopathy predict opposing moral decisions

Recent research has documented a small but significant correlation between psychopathic capacities and utilitarian moral judgment, although the findings are generally inconsistent and unclear. We propose that one way to make sense of mixed findings is to consider variation in perspective-taking capacities of psychopathic individuals. With this in mind, we had criminal offenders (n = 60), who varied in their psychopathy levels according to the Psychopathy Checklist-Revised (PCL-R), respond to common sacrificial moral dilemmas (e.g., trolley dilemmas) under different conditions. In a baseline condition, participants simply responded to the sacrificial moral dilemmas as is typically done in previous research. In an "emotion-salient" condition, participants had to reason about the emotions of another person after solving moral dilemmas (deliberative processing). In the "emotion-ambiguous" condition, participants saw images of people in distress, after solving moral dilemmas, but did not have to explicitly reason about such emotions (spontaneous processing). The four PCL-R facets predicted distinct interference effects depending on spontaneous versus deliberative processing of hypothetical victim's emotions. The findings suggest that the use of a multi-faceted approach to account for cognitive and moral correlates of psychopathy may help address previously mixed results. Implications and future directions for theory and research are discussed.

The startle reflex as an indicator of psychopathic personality from childhood to adulthood: A systematic review

The startle reflex has been suggested to operate as a psychophysiological marker of psychopathic personality, based on findings from studies using a range of different methodologies and participant samples. The present review aims at synthesizing existing evidence of the relationship between psychopathy and the startle reflex across task paradigms, psychopathic personality subtypes and subdimensions, participant samples (i.e., incarcerated/ clinical or non-offenders), and age groups using the triarchic model of psychopathy as a frame of reference. Systematic literature searches were conducted up until the 24th of March 2020 in PubMed, PsycINFO, and Web of Science. A total of 2311 potential studies were identified, out of which 40 met relevancy and quality criteria. Results indicate that reduced aversive startle potentiation is associated with psychopathic personality in general, but clusters of traits relating to the triarchic model constructs of boldness and meanness in particular. Available evidence suggest that startle paradigms could be meaningful for differentiating individuals with and without psychopathic personality. Findings support suggestions of psychopathic personality as a multifaceted, rather than a unitary construct. Reduced aversive startle potentiation has also been found in relation to psychopathic features in child-aged samples but work of this kind is limited and more research is needed. Future studies should focus on greater consistency in task paradigms and analytic strategies to enhance the capacity to compare and integrate findings across studies.

Does attentional focus modulate affective information processing in male violent offenders with psychopathic traits?

Antisocial and psychopathic individuals are characterized by a reduced responsivity to affective information. Yet, the role of attentional processes as possible modulator of these deficits is poorly understood. The current study investigated early and late processing of emotional stimuli in a sample of incarcerated offenders while manipulating the attentional focus. Twenty-seven male violent offenders with psychopathic traits and 27 healthy controls completed two experimental tasks while electroencephalography (EEG) data were collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task, while Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. EEG data indicated no differences in early stage processing (early posterior negativity) between the experimental groups. However, we found significant group differences with regard to the late processing stage (late positive potential, LPP). Controls showed increased LPP amplitudes in Task 2 as compared to Task 1, indicating that task demands (i.e., attentional focus) had an effect on the processing of the emotional stimuli. In contrast, LPP amplitudes in the violent offender group were largely unaffected by task demands, suggesting specific late alterations in the neural processing of emotional stimuli. In sum, this study provides new evidence for a modulatory impact of attention on affective information processing in male violent offenders with psychopathic traits.

Impaired global efficiency in boys with conduct disorder and high callous unemotional traits

Callous unemotional (CU) traits differentiate subtypes of conduct disorder (CD). It has been suggested that CU traits may be related to topographical irregularities that hinder information integration. To date, there is limited evidence of whether CU traits may be associated with abnormal brain topology. In this study, 43 CD boys with high and low CU trait (CD-HCU, CD-LCU), and 46 healthy controls (HCs) were subjected to resting-state functional magnetic resonance imaging to investigate how CU trait level and conduct problems may be reflected in topological organization. Brain functional networks were constructed and network/nodal properties, including small-world properties and network/nodal efficiency, were calculated. Topological analysis revealed that, compared with HCs, CD-HCU group were characterized by decreased small-worldness (σ), decreased global efficiency, and increased path length (λ). These variables were similar between the CD-LCU and HC groups. Self-reported CU traits in CD patients correlated negatively with global efficiency and positively with λ. Regional analysis revealed diminished nodal efficiency in the right amygdala in the CD-HCU group compared with HCs. The present results suggest that disrupted global efficiency, together with a regional abnormality affecting the amygdala, may contribute to abnormal information processing and integration in adolescents with CD and high CU traits.

Psychopathy is associated with an exaggerated attention bottleneck: EEG and behavioral evidence from a dual-task paradigm

Psychopathy is a personality disorder associated with a chronic disregard for the welfare of others. The attention bottleneck model of psychopathy asserts that the behavior of individuals higher on psychopathy is due to an exaggerated attention bottleneck that constrains all information processing, regardless of the information's potential goal-relevance. To date, the majority of research on the attention bottleneck model of psychopathy conceptually applied the tenets of the model but did not implement methods that directly test an exaggeration of the bottleneck in psychopathy. Accordingly, the presence of an exaggerated bottleneck, the exact expression of that bottleneck, and its potential mechanistic relevance for behavior in individuals higher on psychopathy remains untested. To address these gaps, a sample of 78 male community members, evaluated for psychopathic traits using the Self-Report Psychopathy-III scale, completed an EEG-based dual-task paradigm examining short stimulus onset asynchrony (SOA; 300 ms), long SOA (1,100 ms), and single-task baseline conditions. Additionally, participants were asked about their frequency of real-world risky, impulsive, and antisocial behaviors. Psychopathy was associated with slower reaction times to second targets (T2s) presented during the dual-task conditions, relative to the baseline condition. Psychopathy also was associated with blunted P300 responses, a neural index of stimulus evaluation, across all types of T2 events. Finally, bottleneck-related interference during the short SOA events mediated the relationship between psychopathy and real-world behavior. These findings suggested that individuals higher on psychopathy exhibit an exaggerated bottleneck which produces intense and long-lasting interference, impacting all information processing and partially contributing to their maladaptive behavior.

A Plea for Preregistration in Personality Disorders Research: The Case of Psychopathy

In response to a crisis of confidence, several methodological initiatives have been launched to improve the robustness of psychological science. Given its real-world implications, personality disorders research is all too important to not follow suit. The authors offer a plea for preregistration in personality disorders research, using psychopathic personality (psychopathy) as a prominent case example. To suit action to word, the authors report on a preregistered study and use it to help refute common misconceptions about preregistration as well as to illustrate that the key strength of preregistration: transparency outweighs its (perceived) disadvantages. Although preregistration will not conclusively settle the many debates roiling the field of psychopathy and other personality disorders, it can help to verify the robustness of empirical observations that inform such debates.

Abnormalities of the late positive potential during emotional processing in individuals with psychopathic traits: a meta-analysis

BACKGROUND

Individuals with psychopathic traits display deficits in emotional processing. A key event-related potential component involved in emotional processing is the late positive potential (LPP). In healthy controls, LPP amplitude is greater in response to negative stimuli than to positive or neutral stimuli. In the current study, we aimed to compare LPP amplitudes between individuals with psychopathic traits and control subjects when presented with negative, positive or neutral stimuli. We hypothesized that LPP amplitude evoked by emotional stimuli would be reduced in individuals with psychopathic traits compared to healthy controls.

METHODS

After a systematic review of the literature, we conducted a meta-analysis to compare LPP amplitude elicited by emotional stimuli in individuals with psychopathic traits and healthy controls.

RESULTS

Individuals with psychopathic traits showed significantly reduced LPP amplitude evoked by negative stimuli (mean effect size = -0.47; 95% CI -0.60 to -0.33; p < 0.005) compared to healthy controls. No significant differences between groups were observed for the processing of positive (mean effect size = -0.15; 95% CI -0.42 to 0.12; p = 0.28) and neutral stimuli (mean effect size = -0.12; 95% CI 0.31 to 0.07; p = 0.21).

CONCLUSIONS

Measured by LPP amplitude, individuals with psychopathic traits displayed abnormalities in the processing of emotional stimuli with negative valence whereas processing of stimuli with positive and neutral valence was unchanged as compared with healthy controls.

Psychopathy is associated with shifts in the organization of neural networks in a large incarcerated male sample

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Psychopathy is linked to disruptions in neural information processing.

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Graph analysis revealed that psychopathy impacts neural network organization.

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Psychopathy is linked to a hyper-efficiently organized dorsal attention network.

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Subcortical structures are less central to neural communication in psychopathy.

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No psychopathy differences were found in default or salience network graph metrics.

Psychopathy is a personality disorder defined by antisocial behavior paired with callousness, low empathy, and low interpersonal emotions. Psychopathic individuals reliably display complex atypicalities in emotion and attention processing that are evident when examining task performance, activation within specific neural regions, and connections between regions. Recent advances in neuroimaging methods, namely graph analysis, attempt to unpack this type of processing complexity by evaluating the overall organization of neural networks. Graph analysis has been used to better understand neural functioning in several clinical disorders but has not yet been used in the study of psychopathy. The present study applies a minimum spanning tree graph analysis to resting-state fMRI data collected from male inmates assessed for psychopathy with the Hare Psychopathy Checklist-Revised (n = 847). Minimum spanning tree analysis provides several metrics of neural organization optimality (i.e., the effectiveness, efficiency, and robustness of neural network organization). Results show that inmates higher in psychopathy exhibit a more efficiently organized dorsal attention network (β = =0.101, p_corrected = =0.018). Additionally, subcortical structures (e.g., amygdala, caudate, and hippocampus) act as less of a central hub in the global flow of information in inmates higher in psychopathy (β = =−0.104, p_corrected = =0.048). There were no significant effects of psychopathy on neural network organization in the default or salience networks. Together, these shifts in neural organization suggest that the brains of inmates higher in psychopathy are organized in a fundamentally different way than other individuals.

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

Background

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

Objectives

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

Data sources

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

Methods

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

Results

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

Conclusions

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

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.

Psychopathic traits associated with abnormal hemodynamic activity in salience and default mode networks during auditory oddball task

Psychopathy is a personality disorder accompanied by abnormalities in emotional processing and attention. Recent theoretical applications of network-based models of cognition have been used to explain the diverse range of abnormalities apparent in psychopathy. Still, the physiological basis for these abnormalities is not well understood. A significant body of work has examined psychopathy-related abnormalities in simple attention-based tasks, but these studies have largely been performed using electrocortical measures, such as event-related potentials (ERPs), and they often have been carried out among individuals with low levels of psychopathic traits. In this study, we examined neural activity during an auditory oddball task using functional magnetic resonance imaging (fMRI) during a simple auditory target detection (oddball) task among 168 incarcerated adult males, with psychopathic traits assessed via the Hare Psychopathy Checklist-Revised (PCL-R). Event-related contrasts demonstrated that the largest psychopathy-related effects were apparent between the frequent standard stimulus condition and a task-off, implicit baseline. Negative correlations with interpersonal-affective dimensions (Factor 1) of the PCL-R were apparent in regions comprising default mode and salience networks. These findings support models of psychopathy describing impaired integration across functional networks. They additionally corroborate reports which have implicated failures of efficient transition between default mode and task-positive networks. Finally, they demonstrate a neurophysiological basis for abnormal mobilization of attention and reduced engagement with stimuli that have little motivational significance among those with high psychopathic traits.

Emotional reactivity and regulation in individuals with psychopathic traits: Evidence for a disconnect between neurophysiology and self-report

Individuals with psychopathic traits often demonstrate blunted reactivity to negative emotional stimuli. However, it is not yet clear whether these individuals also have difficulty regulating their emotional responses to negative stimuli. To address this question, participants with varying levels of psychopathic traits (indexed by the Triarchic Measure of Psychopathy; Patrick, 2010) completed a task in which they passively viewed, increased, or decreased their emotions to negative picture stimuli while electrocortical activity was recorded. During passive viewing of negative images, higher boldness, but not higher disinhibition or meanness, was associated with reduced amplitude of the late positive potential (LPP), an ERP that indexes reactivity to emotionally relevant stimuli. However, all participants demonstrated expected enhancement of the LPP when asked to increase their emotional response. Participants did not show expected suppression of the LPP when asked to decrease their emotional response. Contrary to the electrophysiological data, individuals with higher boldness did not self-report experiencing blunted emotional response during passive viewing trials, and they reported experiencing greater emotional reactivity relative to other participants when regulating (e.g., both increasing and decreasing) their emotions. Results suggest inconsistency between physiological and self-report indices of emotion among high-bold individuals during both affective processing and regulation.

Differentiating emotional processing and attention in psychopathy with functional neuroimaging

Individuals with psychopathy are often characterized by emotional processing deficits, and recent research has examined the specific contexts and cognitive mechanisms that underlie these abnormalities. Some evidence suggests that abnormal features of attention are fundamental to emotional deficits in persons with psychopathy, but few studies have demonstrated the neural underpinnings responsible for such effects. Here, we use functional neuroimaging to examine attention-emotion interactions among incarcerated individuals (n = 120) evaluated for psychopathic traits using the Hare Psychopathy Checklist-Revised (PCL-R). Using a task designed to manipulate attention to emotional features of visual stimuli, we demonstrate effects representing implicit emotional processing, explicit emotional processing, attention-facilitated emotional processing, and vigilance for emotional content. Results confirm the importance of considering mechanisms of attention when evaluating emotional processing differences related to psychopathic traits. The affective-interpersonal features of psychopathy (PCL-R Factor 1) were associated with relatively lower emotion-dependent augmentation of activity in visual processing areas during implicit emotional processing, while antisocial-lifestyle features (PCL-R Factor 2) were associated with elevated activity in the amygdala and related salience network regions. During explicit emotional processing, psychopathic traits were associated with upregulation in the medial prefrontal cortex, insula, and superior frontal regions. Isolating the impact of explicit attention to emotional content, only Factor 1 was related to upregulation of activity in the visual processing stream, which was accompanied by increased activity in the angular gyrus. These effects highlight some important mechanisms underlying abnormal features of attention and emotional processing that accompany psychopathic traits.

Dysfunctional error-related processing in female psychopathy

Neurocognitive studies of psychopathy have predominantly focused on male samples. Studies have shown that female psychopaths exhibit similar affective deficits as their male counterparts, but results are less consistent across cognitive domains including response modulation. As such, there may be potential gender differences in error-related processing in psychopathic personality. Here we investigate response-locked event-related potential (ERP) components [the error-related negativity (ERN/Ne) related to early error-detection processes and the error-related positivity (Pe) involved in later post-error processing] in a sample of incarcerated adult female offenders (n = 121) who performed a response inhibition Go/NoGo task. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R). The ERN/Ne and Pe were analyzed with classic windowed ERP components and principal component analysis (PCA). Consistent with previous research performed in psychopathic males, female psychopaths exhibited specific deficiencies in the neural correlates of post-error processing (as indexed by reduced Pe amplitude) but not in error monitoring (as indexed by intact ERN/Ne amplitude). Specifically, psychopathic traits reflecting interpersonal and affective dysfunction remained significant predictors of both time-domain and PCA measures reflecting reduced Pe mean amplitude. This is the first evidence to suggest that incarcerated female psychopaths exhibit similar dysfunctional post-error processing as male psychopaths.

Theta phase coherence in affective picture processing reveals dysfunctional sensory integration in psychopathic offenders

Psychopathic offenders are described as emotionally cold, displaying deficits in affective responding. However, research demonstrates that many of the psychopathy-related deficits are moderated by attention, such that under conditions of high attentional and perceptual load psychopathic offenders display deficits in affective responses, but do not in conditions of low load. To date, most studies use measures of defensive reflex (i.e., startle) and conditioning manipulations to examine the impact of load on psychopathy-related processing, but have not examined more direct measures of attention processing. In a sample of adult male offenders, the present study examined time-frequency EEG phase coherence in response to a picture-viewing paradigm that manipulated picture familiarity to assess neural changes in processing based on perceptual demands. Results indicated psychopathy-related differences in the theta response, an index of readiness to perceive and integrate sensory information. These data provide further evidence that psychopathic offenders have disrupted integration of sensory information.

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.

Initial development of an implicit and explicit approach to assess psychopathy

Four studies outline the ACL (Affective, Cognitive and Lifestyle) assessment, a new means of assessing psychopathy capturing implicit and explicit functioning. Studies 1 and 2 comprised students (Study 1, n=42, 14 men, 28 women; Study 2, n=50 men), Study 3 comprised 80 young prisoners (men) and Study 4, 40 forensic psychiatric patients (men). It was predicted that the ACL affective, cognitive and interpersonal components would positively correlate with the interpersonal factor of another measure of psychopathy (PCL-SV), whereas the ACL Lifestyle component would correlate with the criminal history/lifestyle component of the PCL-SV. Evidence for internal reliability for the ACL was noted. The ACL correlated as expected with the PCL-SV although variation across samples was noted. Implicit affect and specific aspects of cognition positively correlated with increased psychopathy on the PCL-SV. Implicit affect correlated differently across samples. Findings are discussed regarding implications. Directions for future research are indicated.

Psychopaths Show Enhanced Amygdala Activation during Fear Conditioning

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths.

Error-related processing in adult males with elevated psychopathic traits

Psychopathy is a serious personality disorder characterized by dysfunctional affective and behavioral symptoms. In incarcerated populations, elevated psychopathic traits have been linked to increased rates of violent recidivism. Cognitive processes related to error processing have been shown to differentiate individuals with high and low psychopathic traits and may contribute to poor decision making that increases the risk of recidivism. Error processing abnormalities related to psychopathy may be attributable to error-monitoring (error detection) or posterror processing (error evaluation). A recent 'bottleneck' theory predicts deficiencies in posterror processing in individuals with high psychopathic traits. In the current study, incarcerated males (n = 93) performed a Go/NoGo response inhibition task while event-related potentials (ERPs) were recorded. Classic time-domain windowed component and principal component analyses were used to measure error-monitoring (as measured with the error-related negativity [ERN/Ne]) and posterror processing (as measured with the error positivity [Pe]). Psychopathic traits were assessed using Hare's Psychopathy Checklist-Revised (PCL-R). PCL-R Total score, Factor 1 (interpersonal-affective traits), and Facet 3 (lifestyle traits) scores were positively related to posterror processes (i.e., increased Pe amplitude) but unrelated to error-monitoring processes (i.e., ERN/Ne). These results support the attentional bottleneck theory and further describe deficiencies related to elevated psychopathic traits that could be beneficial for new treatment strategies for psychopathy.

Empirically based comparisons of the reliability and validity of common quantification approaches for eyeblink startle potentiation in humans

Startle potentiation is a well‐validated translational measure of negative affect. Startle potentiation is widely used in clinical and affective science, and there are multiple approaches for its quantification. The three most commonly used approaches quantify startle potentiation as the increase in startle response from a neutral to threat condition based on (1) raw potentiation, (2) standardized potentiation, or (3) percent‐change potentiation. These three quantification approaches may yield qualitatively different conclusions about effects of independent variables (IVs) on affect when within‐ or between‐group differences exist for startle response in the neutral condition. Accordingly, we directly compared these quantification approaches in a shock‐threat task using four IVs known to influence startle response in the no‐threat condition: probe intensity, time (i.e., habituation), alcohol administration, and individual differences in general startle reactivity measured at baseline. We confirmed the expected effects of time, alcohol, and general startle reactivity on affect using self‐reported fear/anxiety as a criterion. The percent‐change approach displayed apparent artifact across all four IVs, which raises substantial concerns about its validity. Both raw and standardized potentiation approaches were stable across probe intensity and time, which supports their validity. However, only raw potentiation displayed effects that were consistent with a priori specifications and/or the self‐report criterion for the effects of alcohol and general startle reactivity. Supplemental analyses of reliability and validity for each approach provided additional evidence in support of raw potentiation.

Psychopathy, attention, and oddball target detection: New insights from PCL-R facet scores

Psychopathy is a disorder accompanied by cognitive deficits including abnormalities in attention. Prior studies examining cognitive features of psychopaths using ERPs have produced some inconsistent results. We examined psychopathy-related differences in ERPs during an auditory oddball task in a sample of incarcerated adult males. We extend previous work by deriving ERPs with principal component analysis (PCA) and relate these to the four facets of Hare's Psychopathy Checklist Revised (PCL-R). Features of psychopathy were associated with increased target N1 amplitude (facets 1, 4), decreased target P3 amplitude (facet 1), and reduced slow wave amplitude for frequent standard stimuli (facets 1, 3, 4). We conclude that employing PCA and examining PCL-R facets improve sensitivity and help clarify previously reported associations. Furthermore, attenuated slow wave during standards may be a novel marker for psychopaths' abnormalities in attention.

Error-related brain activity in the age of RDoC: A review of the literature

The ability to detect and respond to errors is critical to successful adaptation to a changing environment. The error-related negativity (ERN), an event-related potential (ERP) component, is a well-validated neural response to errors and reflects the error monitoring activity of the anterior cingulate cortex (ACC). Additionally, the ERN is implicated in several processes key to adaptive functioning. Abnormalities in error-related brain activity have been linked to multiple forms of psychopathology and individual differences. As such, the component is likely to be useful in NIMH's Research Domain Criteria (RDoC) initiative to establish biologically-meaningful dimensions of psychological dysfunction, and currently appears as a unit of measurement in three RDoC domains: Positive Valence Systems, Negative Valence Systems, and Cognitive Systems. In this review paper, we introduce the ERN and discuss evidence related to its psychometric properties, as well as important task differences. Following this, we discuss evidence linking the ERN to clinically diverse forms of psychopathology, as well as the implications of one unit of measurement appearing in multiple RDoC dimensions. And finally, we discuss important future directions, as well as research pathways by which the ERN might be leveraged to track the ways in which dysfunctions in multiple neural systems interact to influence psychological well-being.

Altering the Cognitive-Affective Dysfunctions of Psychopathic and Externalizing Offender Subtypes with Cognitive Remediation

Cognitive remediation is a treatment approach with the potential to translate basic science into more specific, mechanism-based interventions by targeting particular cognitive skills. The present study translated understanding of two well-defined cognitive-emotion dysfunctions into novel deficit-matched interventions and evaluated whether cognitive remediation would demonstrate specific and generalizable change. Two antisocial-subtypes, individuals with psychopathy and externalizing traits, are characterized by cognitive-affective problems that predispose them to engage in significant substance abuse and criminal behavior, culminating in incarceration. Whereas individuals with psychopathy fail to consider important contextual information, individuals with externalizing traits lack the capacity to regulate affective reactions. Training designed to remedy these subtype-specific deficits led to improvement on both trained and non-trained tasks. Such findings offer promise for changing neural and behavioral patterns, even for what many consider to be the most recalcitrant treatment population, and presage a new era of translating cognitive-affective science into increasingly specific and effective interventions.

Emotion recognition and cognitive empathy deficits in adolescent offenders revealed by context-sensitive tasks

Emotion recognition and empathy abilities require the integration of contextual information in real-life scenarios. Previous reports have explored these domains in adolescent offenders (AOs) but have not used tasks that replicate everyday situations. In this study we included ecological measures with different levels of contextual dependence to evaluate emotion recognition and empathy in AOs relative to non-offenders, controlling for the effect of demographic variables. We also explored the influence of fluid intelligence (FI) and executive functions (EFs) in the prediction of relevant deficits in these domains. Our results showed that AOs exhibit deficits in context-sensitive measures of emotion recognition and cognitive empathy. Difficulties in these tasks were neither explained by demographic variables nor predicted by FI or EFs. However, performance on measures that included simpler stimuli or could be solved by explicit knowledge was either only partially affected by demographic variables or preserved in AOs. These findings indicate that AOs show contextual social-cognition impairments which are relatively independent of basic cognitive functioning and demographic variables.

Psychopathic and externalizing offenders display dissociable dysfunctions when responding to facial affect

Despite similarity in their disinhibited behaviors, the cognitive-affective mechanisms that characterize psychopathy and externalizing are relatively distinct. One theoretical perspective suggests that psychopathy is associated with an early attention bottleneck that precludes the processing of contextual information, leading to a rigid goal-directed focus. Alternatively, externalizing may be associated with an overallocation of processing resources to motivationally salient information, which disrupts the use of cognitive control. In this study, male prisoners assessed on psychopathic and externalizing traits performed a new gaze detection task involving affective faces. As predicted, psychopathy but not externalizing was associated with superior performance on the gaze-detection task when the necessity of using contextual affect to regulate goal-directed behavior was minimized. Conversely, externalizing but not psychopathy was associated with increased errors on trials that required participants to use affective expressions, specifically fear, as a cue to inhibit dominant responses. These results have theoretical and applied significance for both psychopathic and externalizing forms of disinhibition. Recognition and utilization of facial affect are important for socialization and interpersonal interactions; therefore, any cognitive-affective processes that interrupt the fluency with which this information is processed may be important for understanding the underpinnings of disinhibition.

Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience

Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.

Feature-based attention and conflict monitoring in criminal offenders: interactive relations of psychopathy with anxiety and externalizing

As predicted by the response modulation model, psychopathic offenders are insensitive to potentially important inhibitory information when it is peripheral to their primary focus of attention. To date, the clearest tests of this hypothesis have manipulated spatial attention to cue the location of goal-relevant versus inhibitory information. However, the theory predicts a more general abnormality in selective attention. In the current study, male prisoners performed a conflict-monitoring task, which included a feature-based manipulation (i.e., color) that biased selective attention toward goal-relevant stimuli and away from inhibitory distracters on some trials but not others. Paralleling results for spatial cuing, feature-based cuing resulted in less distracter interference, particularly for participants with primary psychopathy (i.e., low anxiety). This study also investigated the moderating effect of externalizing on psychopathy. Participants high in psychopathy but low in externalizing performed similarly to primary psychopathic individuals. These results demonstrate that the abnormal selective attention associated with primary psychopathy is not limited to spatial attention but, instead, applies to diverse methods for establishing attentional focus. Furthermore, they demonstrate a novel method of investigating psychopathic subtypes using continuous analyses.

Deficient fear conditioning in psychopathy as a function of interpersonal and affective disturbances

The diminished fear reactivity is one of the most valid physiological findings in psychopathy research. In a fear conditioning paradigm, with faces as conditioned stimulus (CS) and electric shock as unconditioned stimulus (US), we investigated a sample of 14 high psychopathic violent offenders. Event related potentials, skin conductance responses (SCR) as well as subjective ratings of the CSs were collected. This study assessed to which extent the different facets of the psychopathy construct contribute to the fear conditioning deficits observed in psychopaths. Participants with high scores on the affective facet subscale of the Psychopathy Checklist-Revised (PCL-R) showed weaker conditioned fear responses and lower N100 amplitudes compared to low scorers. In contrast, high scorers on the affective facet rated the CS+ (paired) more negatively than low scorers regarding the CS- (unpaired). Regarding the P300, high scores on the interpersonal facet were associated with increased amplitudes to the CS+ compared to the CS-, while the opposed pattern was found for the antisocial facet. Both, the initial and terminal contingent negative variation indicated a divergent pattern: participants with pronounced interpersonal deficits, showed increased cortical negativity to the CS+ compared to the CS-, whereas a reversed CS+/CS- differentiation was found in offenders scoring high on the antisocial facet. The present study revealed that deficient fear conditioning in psychopathy was most pronounced in offenders with high scores on the affective facet. Event related potentials suggest that participants with distinct interpersonal deficits showed increased information processing, whereas the antisocial facet was linked to decreased attention and interest to the CS+. These data indicate that an approach to the facets of psychopathy can help to resolve ambiguous findings in psychopathy research and enables a more precise and useful description of this disorder.

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

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

Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience

Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.