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.     

Response perseveration in psychopathic women.

Recent attempts to validate the Psychopathy Checklist-Revised (PCL-R) as a measure of psychopathy in female offenders have been limited by a failure to examine laboratory correlates of the syndrome. We assessed 112 incarcerated women by using the PCL-R and examined their performance on a card perseveration task that has been used to demonstrate response perseveration in psychopathic men. Contrary to prediction, psychopathic women did not perseverate responding when the PCL-R was used either dimensionally or categorically. The authors discuss the implications of the results for the PCL-R and for female psychopathy more generally.     

Brain potentials implicate temporal lobe abnormalities in criminal psychopaths

Psychopathy is associated with abnormalities in attention and orienting. However, few studies have examined the neural systems underlying these processes. To address this issue, the authors recorded event-related potentials (ERPs) while 80 incarcerated men, classified as psychopathic or nonpsychopathic via the Hare Psychopathy Checklist--Revised (R. D. Hare, 1991, 2003), completed an auditory oddball task. Consistent with hypotheses, processing of targets elicited larger frontocentral negativities (N550) in psychopaths than in nonpsychopaths. Psychopaths also showed an enlarged N2 and reduced P3 during target detection. Similar ERP modulations have been reported in patients with amygdala and temporal lobe damage. The data are interpreted as supporting the hypothesis that psychopathy may be related to dysfunction of the paralimbic system--a system that includes parts of the temporal and frontal lobes.     

P3 event-related potentials and childhood maltreatment in successful and unsuccessful psychopaths

Although P3 event-related potential abnormalities have been found in psychopathic individuals, it is unknown whether successful (uncaught) psychopaths and unsuccessful (caught) psychopaths show similar deficits. In this study, P3 amplitude and latency were assessed from a community sample of 121 male adults using an auditory three-stimulus oddball task. Psychopathy was assessed using the Psychopathy Checklist-Revised (Hare, 2003) while childhood physical maltreatment was assessed using the Conflict Tactic Scale (Straus, 1979). Results revealed that compared to normal controls, unsuccessful psychopaths showed reduced parietal P3 amplitudes to target stimuli and reported experienced more physical abuse in childhood. In contrast, successful psychopaths exhibited larger parietal P3 amplitude and shorter frontal P3 latency to irrelevant nontarget stimuli than unsuccessful psychopaths. This is the first report of electrophysiological processing differences between successful and unsuccessful psychopaths, possibly indicating neurocognitive and psychosocial distinctions between these two subtypes of psychopathy.     

Hare Psychopathy Checklist-Revised

The Hare Psychopathy Checklist-Revised (PCL-R) is among the most frequently used instruments for the assessment of psychopathic traits. In the scope of the German adaptation of the PCL-R, normative data were collected from a sample of adult male offenders. Based on these data the factor structure and reliability of the German language version of the PCL-R are discussed in the first section of the article. The assessment of a model with four facets and two superordinate factors showed a very good agreement with the empirical data. In addition, examination of interrater agreement and internal consistency indicated that the PCL-R is a reliable measure. In the second part of the paper recommendations are provided for the correct application of the PCL-R. The focus lies on the correct performance, evaluation and interpretation of PCL-R test results with respect to key indices and the dimensional structure of the psychopathy construct.     

Anomalous moral intuitions in juvenile offenders with psychopathic traits

Since the historical conception of psychopathy, researchers have been interested in understanding moral functioning among psychopathic individuals. The present study investigated the association between psychopathic traits and moral intuitions among incarcerated juvenile offenders (N = 178). Participants were assessed using the Psychopathy Checklist:Youth Version (Forth, Kosson, & Hare, 2003) and the Moral Foundations Questionnaire (Graham et al., 2011), which defines five core moral foundations: Harm/care, Fairness/reciprocity, Ingroup/loyalty, Authority/respect, and Purity/sanctity. As expected, psychopathy in juvenile offenders negatively predicted endorsement of all five foundations. This study is the first to demonstrate broad abnormalities in Haidt et al.’s moral foundations in a juvenile sample and can help explain delinquent behavior in juveniles with psychopathic traits. Implications for theories of psychopathy are discussed.     

The inclusion of antisocial behavior in the construct of psychopathy: A review of the research

The psychopathic personality, or the construct of this disorder, has a long and contentious history. Psychopathy has been identified anecdotally for centuries; however, the ability to accurately define this construct continues to challenge researchers and clinicians. Of preliminary concern is the relevance of antisocial behavior to this disorder. Theoretical conceptualizations of psychopathy have changed over the past 65 years. Some have stressed the interpersonal and affective deficits of psychopathy [Cleckley, H. (1941). The mask of sanity (1st ed.). St. Louis, MO:C.V. Mosby.], while later conceptualizations have included both personality traits as well as antisocial behavior as criteria of psychopathy [Hare, R. D. (1991/2003). The Hare Psychopathy Checklist—Revised. Toronto, Canada: Multi-Health Systems]. This article will review the literature, particularly the relevance of antisocial behavior to the core personality structure of the psychopath. In doing so, historical theories will be reviewed, followed by later theoretical and empirical research. A great deal of this research has been conducted over the past 15 years, since the publication of the Psychopathy Checklist (PCL) and the Psychopathy Checklist-Revised (PCL-R; [Hare, R. D. (1991/2003). The Hare Psychopathy Checklist—Revised. Toronto, Canada: Multi-Health Systems]). The PCL-R has provided the field of psychopathy research with a consistent measurement device, and, therefore will be discussed at length. The limitations of the psychopathy construct will be discussed as well as needed future research and the policy implications of such research.     

Are all psychopathic individuals low-anxious?

Theorists commonly assume that true or primary psychopathic individuals experience little anxiety or neurotic conflict. This study examined the relationship between psychopathy and anxiety in 104 Caucasian and 113 African American incarcerated men using the Psychopathy Checklist--Revised (PCL-R; R. D. Hare, 1991) and multiple self-report measures to tap diverse interpretations of the anxiety construct (i.e., neuroticism, traditional definitions of anxiety, and fear). Analyses involving zero-order, semipartial, and point-biserial correlations indicate that PCL-R psychopathy and the anxiety construct are essentially independent. These findings suggest that either (a) the traditional belief that all psychopathic individuals are low-anxious is incorrect or (b) the PCL-R is not an adequate measure of primary psychopathy.     

Two subtypes of psychopathic violent offenders that parallel primary and secondary variants

Although psychopathy usually is treated as a unitary construct, a seminal theory posits that there are 2 variants: Primary psychopathy is underpinned by an inherited affective deficit, whereas secondary psychopathy reflects an acquired affective disturbance. The authors investigated whether psychopathy phenotypically may be disaggregated into such types in a sample of 367 prison inmates convicted of violent crimes. Model-based cluster analysis of the Revised Psychopathy Checklist (PCL-R; R. D. Hare, 2003) and trait anxiety scores in the psychopathic subgroup (n = 123; PCL-R > or = 29) revealed 2 clusters. Relative to primary psychopaths, secondary psychopaths had greater trait anxiety, fewer psychopathic traits, and comparable levels of antisocial behavior. Across validation variables, secondary psychopaths manifested more borderline personality features, poorer interpersonal functioning (e.g., irritability, withdrawal, poor assertiveness), and more symptoms of major mental disorder than primary psychopaths. When compared with the nonpsychopathic subgroup (n = 243), the 2 psychopathic variants manifested a theoretically coherent pattern of differences. Implications for etiological research and violence prevention are discussed.     

Reconstruing the "reconstruction" of psychopathy: a comment on Cooke, Michie, Hart, and Clark

In this comment we highlight critical problems in the estimation of parameters for their hierarchical three-factor model of psychopathy, as assessed with the Hare Psychopathy Checklist, and their interpretation of these factors as causally related to socially deviant behavior. We argue that there is nothing "causal" about a model in which cross-sectional data are used to assert that antisocial tendencies are consequences of other more fundamental psychopathic traits. We present an equally viable model, based on the PCL-R four-factor solution, in which antisocial tendencies play a fundamental role in the construct of psychopathy, consistent with previous research and clinical tradition.     

High psychopathic trait females exhibit reduced startle potentiation and increased p3 amplitude

While there has been steady progress in identifying psychophysiological traits associated with psychopathy, most of the existing research has been carried out using incarcerated male participants, and data that include females are particularly rare. This study examined both affective startle blink modulation and P3 amplitude in a sample of female undergraduates grouped by scores on the Psychopathic Personality Inventory-Revised (PPI-R). Those scoring high for psychopathic traits lacked startle blink potentiation and demonstrated larger P3 amplitudes during auditory and visual oddball tasks. These data support the generalizability of deficient startle potentiation to non-incarcerated females with psychopathic traits, and add to a growing body of literature suggesting that psychopathic traits are associated with distinctive information-processing characteristics as indexed by P3 amplitude.     

Psychopathy and Trait Emotional Intelligence

Psychopathic individuals are infamous for their chronic and diverse failures of social adjustment despite their adequate intellectual abilities. Non-cognitive factors, in particular trait emotional intelligence (EI), offer one possible explanation for their lack of success. This study explored the association between psychopathy and EI, as measured by the Psychopathy Checklist - Revised (PCL-R; Hare, 2003) and Trait Meta-Mood Scale (TMMS, Salovey, Mayer, Golman, Turvey & Palfai, 1995). Consistent with the Response Modulation (RM) model of psychopathy (Newman & Lorenz, 2003), low-anxious psychopathic individuals had significantly lower scores on TMMS Repair and Attention compared to controls. Consistent with proposals by Patrick and Lang (1999) regarding PCL-R factors, these EI deficits related to different aspects of the psychopathy construct. Correlations revealed significant inverse associations between PCL-R factor 1 and Attention and PCL-R factor 2 and Repair. We propose that the multi-dimensional EI framework affords a complementary perspective on laboratory-based explanations of psychopathy.     

Psychopathy and physiological response to emotionally evocative sounds

Despite considerable evidence that psychopathic criminals are deviant in their emotional reactions, few studies have examined responses to both pleasurable and aversive stimuli or assessed the role of different facets of psychopathy in affective deviations. This study investigated physiological reactions to emotional sounds in prisoners selected according to scores on the 2 factors of Hare's Psychopathy Checklist--Revised (PCL-R; R. D. Hare, 1991). Offenders high on the PCL-R emotional-interpersonal factor, regardless of scores on the social deviance factor, showed diminished skin conductance responses to both pleasant and unpleasant sounds, suggesting a deficit in the action mobilization component of emotional response. Offenders who scored high only on the social deviance factor showed a delay in heart rate differentiation between affective and neutral sounds. These findings indicate abnormal reactivity to both positive and negative emotional stimuli in psychopathic individuals, and suggest differing roles for the 2 facets of psychopathy in affective processing deviations.     

An empirical investigation of psychopathy in a noninstitutionalized and noncriminal sample

This study examined the construct of psychopathy using the Psychopathy Checklist-Revised (PCL-R) in 54 participants from the general population. To obtain a sample of community participants with psychopathic characteristics, participants were recruited using advertisements for a "personality study" that incorporated the characteristics of psychopathy in a nonpejorative manner. The methodology successfully recruited community participants with moderately elevated PCL-R scores. Participants exhibited the personality features of psychopathy (Factor 1) to a greater extent than the behavioral features (Factor 2), which is consistent with the results obtained with the PCL-R normative samples. Roughly 40% of the sample reported no history of involvement with the criminal justice system, yet these participants exhibited moderately elevated PCL-R scores. Moreover, a sizeable portion of the noncriminal participants reported a substantial history of violent behavior. Comparisons of PCL-R scores between participants with and without a criminal history suggest that these two groups differ in ways unrelated to criminal justice system involvement.     

Domestic violence and psychopathic traits: distinguishing the antisocial batterer from other antisocial offenders

The proliferation of specialized domestic batterer treatment programs suggests that batterers differ from other offenders in important ways. The psychopathic personality represents a constellation of personality traits, which may be relevant to the differentiation of batterers from other offenders. In a sample of 172 county jail inmates, we examined whether antisocial batterers can be distinguished from the larger pool of antisocial offenders on the basis of the four-facet model of psychopathy identified for the Psychopathy Checklist-Revised (PCL-R). Batterer/non-batterer status was positively related to the PCL-R affective facet and negatively related to the lifestyle facet, but there was no significant relationship between PCL-R total scores and this criterion. Results suggest that antisocial batterers are characterized by deficient affective experience and by reduced impulsivity and irresponsibility compared with other antisocial offenders. Implications are discussed in light of specialized treatments for batterers.     

Reconstructing psychopathy: clarifying the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder

A survey of clinical views suggests that the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder is unclear. To investigate this issue, we evaluated Psychopathy Checklist-Revised ratings (PCL-R; Hare, 1991) using structural equation modeling. One model, referred to as the measurement model, included PCL-R ratings related to antisocial behavior as primary symptoms of psychopathy; a second, referred to as the causal model, included the same PCL-R ratings as secondary symptoms or consequences. Compared to the measurement models, the causal model included more PCL-R items, was more parsimonious, and had equal or superior fit indices. These findings suggest that antisocial behavior is best viewed as a secondary symptom or consequence of psychopathy, In addition, the findings have important implications for future research and clinical-forensic practice, especially concerning the assessment of risk for criminality and violence.     

The interpersonal measure of psychopathy: construct and incremental validity in male prisoners

The authors examined the construct and incremental validity of the Interpersonal Measure of Psychopathy (IM-P), a relatively new instrument designed to detect interpersonal behaviors associated with psychopathy. Observers of videotaped Psychopathy Checklist-Revised (PCL-R) interviews rated male prisoners (N = 93) on the IM-P. The IM-P correlated significantly with the PCL-R total score. Moreover, the IM-P was preferentially related to the interpersonal rather than the affective and antisocial lifestyle features of psychopathy. IM-P scores were significantly correlated with age, antisocial behaviors, and self-reported fear, anxiety, and socialization (in reverse). Hierarchical multiple regression analyses demonstrated that although the IM-P exhibited incremental validity beyond the PCL-R total score in detecting self-reported fear, anxiety, and several personality traits, it did not exhibit much incremental validity beyond PCL-R Factor 1. These findings raise questions concerning the unique assessment contribution of the IM-P beyond PCL-R Factor 1. Potential reasons for these findings and alternative means of enhancing the interpersonal assessment of psychopathy are discussed.     

Psychopathic Traits Associate Differentially to Anger,Disgust and Fear Recognition among Men and Women

Psychopathy is characterized by deficits in empathy and violation of the rights of others. Recent data link psychopathy-based lack of empathy to deficits in emotion recognition (ER), in particular fear and sadness. However, questions remain about emotions like anger and disgust and some studies even report a positive relationship between psychopathy and ER. Notably, the overwhelming majority of these studies have been conducted only with men, and studies in the general population suggest that women have better ER than men. To our knowledge, only two small studies have explicitly examined ER and psychopathy among women and they did find deficits in anger and disgust recognition. Therefore, mixed findings about ER and psychopathy may be due to gender differences that need to be clarified. This study aimed at bridging this gap using a large sample of 129 male (49 %) and 132 female (51 %) participants who completed psychopathy self-reports, and a computerized facial ER task. Among women there were deficits and advantages in ER: High social dominance and lack of anxiety traits were related to decreased fear and anger recognition respectively. Traits characterized by impulsiveness and rebelliousness were associated with better disgust and anger recognition respectively. For men, psychopathic traits characterized by ruthless manipulation of others, as well as lack of fear, were related to deficits recognizing anger. These results suggest that among women some psychopathic traits may confer an advantage in ER and give impetus for studies examining gender differences in the neurobiological substrates and manifestation of the syndrome.     

Psychopathy, antisocial personality, and suicide risk

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.     

Psychopathy,charisma, and success: A moderation modeling approach to successful psychopathy

Psychopathic traits are associated with negative outcomes; however, they have also been associated with adaptive outcomes (e.g., corporate success, etc.). We tested the Moderated-Expression Model of psychopathy in a sample of community adults (N = 315; 50.8% female; 22–65 years) utilizing a battery of self-report measures (Self-Report Psychopathy Scale; Triarchic Psychopathy Measure; Conger & Kanungo Scale of Charismatic Leadership; General Charisma Inventory; Evading Detection/Punishment; and Occupational Success). The effect of psychopathic traits on evading detection and punishment (not occupational success) was moderated by leadership (and to a lesser extent, general) charisma, net of the effects of pathological narcissism and several other covariates. These results support the Moderated-Expression Model and warrant further research on the associations among psychopathy, charisma, and success.