Psychopathy: A psychobiological perspective

After critically examining the concept of psychopathy and reviewing the major existing theories of psychopathy in the light of a psychobiological conception of abnormal behaviour (Öhman, 1981), this paper attempts to present an integrated, psychobiological model of psychopathy. Essentially this analyses psychopathy in terms of the predisposing influences, the triggering environmental events which initiate psychopathic behaviour, and the neurophsychological mechanisms which mediate it. It is suggested that individuals who show chronic antisocial behaviour, conforming to the North American term ‘sociopath’, may demonstrate a maturational deficit but do not necessarily show a psychopathic personality disorder. The latter is said to be characterised, at a personality trait level, by high Impulsiveness and Psychopathy (Blackburn, 1982 a, b), reflecting interactive deficits in goal direction and affect. At a dynamic (state) level, a psychopathic personality disorder is said to be characterised by a lack of coping, reflecting either, in the case of the secondary psychopath, a deficit in primary appraisal, (over-perception of threat), or in the case of the primary psychopath, a deficit in secondary appraisal (low perceived control over aversive environmental events). It is further suggested that a genetic predisposition to social withdrawal and exposure to an uncontrollably aversive early environment may interact to predispose an individual to develop a psychopathic personality disorder in adulthood.     

Stigma,staring, and discomfort: A novel-stimulus hypothesis

Three experiments were conducted in order to assess the validity of the novel-stimulus hypothesis as an explanation for why people who are physically different (i.e., novel) are avoided. The hypothesis states that avoidance is mediated by conflict over a desire to stare at novel stimuli and a desire to adhere to a norm against staring when the novel stimulus is another person. In the first two field experiments, subjects viewed photographs of novel (handicapped or pregnant) and familiar (physically normal) people under conditions where staring was sanctioned or not. It was found that staring increased with novelty when staring was unobserved (sanctioned); however, the reverse obtained when an observer was present. In the third experiment, subjects interacted with a crippled, pregnant, or physically normal partner. Half of the subjects were first given the opportunity to observe their partner through a one-way mirror. The reduction in stimulus novelty for this group resulted in reduced avoidance. The question of whether such avoidance of the disabled results from feelings of dislike or disgust as previously suggested, or from discomfort created by novelty, is discussed.     

Alcohol and unpleasant stimulation: subjective shock calibration and pain and discomfort perception

In an experiment 8 men participated in an alcohol and a sober condition in a rotated order. In both conditions subjects first calibrated a shock scale to a subjective criterion and then rated their subjective pain and total discomfort. Subjects calibrated the shock scale higher when intoxicated and rated the calibrated level equally painful in the sober and intoxicated conditions, but when intoxicated subjects actually rated the higher shock level as less uncomfortable. The shock scale was calibrated higher under intoxication not because subjects wanted to impress the experimenter but because less pain and discomfort was actually experienced.     

Impulsivity, aggression, and serotonin: a molecular psychobiological perspective

The expression of aggressiveness, which constitutes many facets of behavior, is influenced by a complex interaction of biologic, psychologic, and social variables. Even though individual differences in impulsivity and the behavioral consequences, such as aggression, addiction, and suicidality, are substantially heritable, they ultimately result from an interplay between genetic variations and environmental factors. While formation and integration of multiple neural networks is dependent on the actions of neurotransmitters, such as serotonin (5HT), converging lines of evidence indicate that genetically determined variability in serotonergic gene expression influences complex traits including that of inappropriately aggressive behavior. This contribution reviews studies of major gene effects in inbred and knockout strains of mice with increased aggression-related behavior and discusses the relevance of several serotonergic gene variations in humans which include high aggressiveness as part of the phenotype. Although special emphasis is given to the molecular psychobiology of 5HT in aggression-related behavior in rodents, nonhuman primates, and humans, relevant conceptual and methodological issues in the search for candidate genes for impulsivity and aggressiveness and for the development of mouse models of aggressive and antisocial behavior in humans are also considered.     

Repression-sensitization,gender, and discrepancies in psychobiological reactions to examination stress

Psychobiological responses to examination stress in repressors and sensitizers have rarely been investigated with respect to intraindividual response discrepancies. Furthermore, possible sex differences have rarely been taken into consideration. Therefore the present study investigated if repressors and sensitizers differ in their psychobiological responses to stress and if gender plays a modulating role. 30 and 29 students of both sexes selected from a total group of 96 students were classified as repressors or sensitizers each according to the repression-sensitization-coping-inventory (RSCI, Huwe et al.). State anxiety, heart rate, and cortisol in saliva served as indicators of stress. Sensitizers reported higher state anxiety and showed higher physiological stress responses than repressors. On the intraindividual level sensitizers reported high anxiety as compared to their low cortisol responses whereas repressors reported low anxiety as compared to their high cortisol increases. Gender had no modulating influence on stress responses in repressors and sensitizers.     

Ambivalence, discomfort, and motivated information processing

In two studies we examined the nature and consequence of ambivalent attitudes. In the first study, we assessed whether holding ambivalent attitudes was aversive, and tested whether this aversion was resolved through biased information processing. To do this we manipulated participants’ attributions of the discomfort associated with an ambivalent message through a pill manipulation (tense vs. relaxed). Participants who attributed their discomfort to their ambivalence reported more negative emotions and generated more one-sided thoughts than participants who attributed their discomfort to the pill. In the second study, we examined the conditions necessary for ambivalence reduction. Results suggest that people spontaneously engage in biased information processing in order to resolve their ambivalence.     

Alimentary epigenetics: A developmental psychobiological systems view of the perception of hunger, thirst and satiety

Hunger, thirst and satiety have an enormous influence on cognition, behavior and development, yet we often take for granted that they are simply inborn or innate. Converging data and theory from both comparative and human domains, however, supports the conclusion that the phenomena hunger, thirst and satiety are not innate but rather emerge probabilistically as a function of experience during individual development. The metatheoretical perspective provided by developmental psychobiological systems theory provides a useful framework for organizing and synthesizing findings related to the development of the perception of hunger, thirst and satiety, or alimentary interoception. It is argued that neither developmental psychology nor the psychology of eating and drinking have adequately dealt with the ontogeny of alimentary interoception and that a more serious consideration of the species-typical developmental system of food and fluid intake and the many modifications that have been made therein is likely necessary for a full understanding of both alimentary and emotional development.     

A causal analysis of chronic pain and depression

There is considerable controversy in the literature regarding the extent to which chronic pain and depression are associated and the possible causal relationship of such an association. The present study examines these issues with a sample of 243 patients diagnosed with rheumatoid arthritis (RA) who were mailed questionnaires for six waves of data collection. The results indicated that RA patients experience higher levels of depressive symptomatology than community samples. Using a two-latent-variable, cross-lagged design, covariance structural modeling was conducted on self-report measures of pain and depression over 6-month intervals. Results most strongly supported a causal model in which pain predicts depression during the last 12 months of the study.     

Menstrual discomfort, psychological defenses, and feminine identification

Theorists have suggested that menstrual complaints occur more frequently in women who have a weaker sense of feminine identification. To test this hypothesis 50 women were administered the Body Symptom Questionnaire and the Defense Mechanisms Inventory (DMI). The DMI scales have been linked to differences in sexual identification. Results affirmed a relationship between personality dynamics and the degree of menstrual discomfort experienced by women relative to their other body problems. As predicted, the higher the percentage of menstrual symptoms, the more likely it was that a woman made use of "masculine mode" externalizing defenses and the less apt she was to use "feminine mode" non-externalizing defenses. A composite index of the tendency to externalize hostility when faced with conflict was highly correlated with the percentage of menstrual complaints. The defense pattern findings suggest that a woman who has a strong acceptance of herself as a female will experience fewer of her somatic symptoms as menstrual.     

Another psychobiological view of sexual differentiation

The major psychobiological theory of sex differences is based on the hypothesis that hormones induce sex differences in neural organization. Hormonally masculinized or feminized brains are thought to underlie subsequent behavioral sex differences. This theory and the constructs, arguments, and evidence used in its support are closely examined. Some conceptual problems with widely used arguments are identified and discussed. Behavioral, physiological, and anatomical evidence from studies of animal sexual behavior is reviewed. It is concluded that the evidence fails to support generally accepted views that early hormones affect behavior through direct effects on brain differentiation and that behavioral differences must be located in the brain. It is argued instead that hormones coact and interact with other factors throughout development, that brain differences may result from as well as cause functional differences, and that hormone-based sources of sex differences may be located throughout the body and in the social surround. Directions for new research are suggested and implications for interpretation of human sex differences are discussed.     

Diet, exercise, and physical discomfort in college students

778 students in a 4-yr. urban commuter college were tested to determine the effects of exercise and diet on self-reported discomfort. High exercisers reported significantly less physical discomfort than moderate or low exercisers. Greater consumption of sweets and fast food were significantly related to reported physical discomfort regardless of levels of exercise. High levels of fruit and vegetable consumption were associated with less discomfort in high exercisers. High dairy consumption was significantly related to fewer symptoms for high exercisers. Men who reported high ingestion of caffeine had significantly more discomfort than those who reported moderate to lower ingestion of caffeine.     

Forgiveness and psychopathology: psychobiological and evolutionary underpinnings

We present a case of psychotherapy where a process of forgiveness occurs. Then we review the relevant cognitive-affective neuroscience and clinical implications. Resentment and forgiveness emerge within particular kinds of social interactions and can now increasingly also be conceptualized as embodied in particular neurocircuitry. There may be an association between increased psychopathology and decreased fogiveness, and the implications of this for assessment and treatment deserve further study. There may be gender differences in forgiveness;a highly speculative hypothesis suggests that these would reflect sexual divergence in the evolutionary origins of reconciliatory behavior.     

Social anxiety disorder: psychobiological and evolutionary underpinnings

Social anxiety disorder (SAD) also know as social phobia is increasingly recognized as a highly prevalent and disabling psychiatric disorder. SAD patients demonstrate cognitive-affective distortions in relation to social situations and abnormal activation patterns in limbic structures during functional imaging. Behavioral inhibition is an endophenotype that may be useful in understanding vulnerability to SAD, and that has specific imaging and genetic correlates. From an evolutionary perspective, it has been speculated that SAD represents a false appeasement alarm. It is notable that SAD responds to selective serotonin reuptake inhibitors and monoamine oxidase inhibitors, but not to most tricyclic antidepressants; this finding is consistent with the importance of serotonin and dopamine in mediating this disorder.     

The influence of parenting on infant emotionality: A multi-level psychobiological perspective

Infant temperament is theorized to have a strong genetic basis. Yet, studies of the stability of temperament and molecular genetics research on temperament have revealed inconsistent findings. One reason may be because research has not taken into account the influence of early social experiences. We review research on aspects of infant emotionality presumed to be temperamental in origin, emotion reactivity and emotion regulation, and integrate research addressing parenting influences on physiology and genetics of infant emotionality with traditional research on behavioral expression of emotionality. Empirical research supports the theory that sensitive and appropriately responsive parenting in infancy is related to more optimal patterns of behavioral and physiological reactivity and regulation. Molecular genetics research with both animal and human populations has produced consistent results when environmental experiences are taken into account. Findings suggest that the short allele of the serotonin transporter gene and the long allele of the DRD4 dopamine receptor gene may be related to distinct patterns of infant emotionality and to later problems with depression, impulse control problems, and externalizing/antisocial behaviors, primarily when paired with insensitive parenting, abuse or neglect, or other adverse family environments. Future directions and limitations in the field are discussed.     

Transcendence techniques and psychobiological mechanisms underlying religious experience

In this paper the author explores the process by which the combined influence of specific cultural factors and individual transcendence techniques activates psychobiological mechanisms that, in turn, trigger the appearance of special states of consciousness, namely religious trance. Most of these religious and spiritual experiences rationalize a threat common to all cultures, namely the risk of losing one's Ego.

The activation of individual transcendence techniques paraphrases denial defence mechanisms insofar as it involves avoidance of the external reality to preserve homeostasis. The mentioning in psychoanalytic terms of a ‘death instinct’ (i.e. a drive opposite to the attachment/life instinct) as a possible source of detachment/transcendence phenomena is still worth considering.

The Freudian example of ‘the cotton-reel mother’, whom the child could make disappear and then reappear again, is a powerful one of the phenomenon of detachment dynamics.

Cross-cultural research on the varieties of trance shows that Altered States of Consciousness can be induced by both collective and personal rituals that allow the subject to reach the altered states of consciousness by making the whole world appear or disappear in fantasy. While some of the highest forms of supernatural experience, such as ecstasy, mysticism and the communion with the Absolute, engender enough social approval to allow to believe that such experiences mitigate or prevent mental disorders, when the supernatural experiences occur in bizarre features they are indicators of a clear psychopathology.

The perspective of transcultural psychiatry offers the best method of outlining the great ethnographic variety of these experiences and, subsequently, making a comparative analysis of the links that exists among culture, psychopathology and the supernatural in a given situation.

From a clinical point of view, it becomes increasingly clear that psychiatrists need expertise to draw clinical inferences based on the specific patient's culture and his psychopathological presentation, especially when the patient's life history is characterized by the multi-faceted activity of transcendence techniques.     

Hysteresis behaviour of psychobiological variables during exercise

ObjectivesThe rating of perceived exertion (RPE) and the heart rate (HR) have been widely studied and monitored during exercise, but their hysteresis behaviour is still unexplored. Our aim was to study the hysteresis behaviour of RPE and HR in triathletes and non-athletes.DesignCross-sectional study.MethodEighteen triathletes at different competitive levels (elite n = 9, non-elite n = 9) and ten students were tested while cycling and running, using a pyramidal protocol (incremental/decremental workloads). The hysteresis area, considered positive when values of the dependent variables (RPE and HR) at the same workload were higher in the decremental phase than in the incremental phase, and vice versa for the negative areas, was calculated in all tests. The Wilcoxon matched-pairs test and Kruskal Wallis ANOVA were applied to detect intra- and inter-group differences, respectively, of RPE and HR values during the incremental and decremental phases, as well as between cycling and running.ResultsThe following results were observed: a) an incoherent relationship of RPE with HR and workload, b) positive hysteresis areas of RPE and HR in all groups during cycling and running, c) a partial negative hysteresis area of RPE, but not of HR, in the triathlete groups, d) larger hysteresis areas of RPE and HR in students than in triathletes, and e) larger hysteresis areas in cycling than in running.Conclusionsthe study of the hysteresis behaviour of RPE and HR reveals the history dependency of both variables, highlights their incoherent or non-unique relationship during a pyramidal exercise, and questions their widely assumed linear association to workload intensity. The hysteresis area is proposed as a new non-invasive marker of exercise stress and tolerance that should be further investigated.     

Expectations of sensations,discomfort and fear in dental treatment

A hundred dental patients and 40 dentists were asked to describe the sensations, discomfort and fear which they associated with a number of dental treatments. A number of patients were also asked to describe their experiences immediately after routine conservation procedures. It was concluded that although patients could accurately anticipate the pattern of sensations involved in treatment (even if they had not experienced some of the procedures), they expected more intense sensations and greater discomfort and apprehension than they were likely to experience. Dentists expressed more realistic ideas about the sensations produced by dental treatment. The discrepancy in patients' expectations appears to persist in spite of many discontinuing experiences, the fear of treatment being fostered by discomfort and the intensity of sensations expected, by lack of experience and, to a modest degree, by uncertainty about the sensations anticipated. Cognitive theories of fear do not appear to explain all these influences adequately. These observations support the need for information about sensations in treatment to help not so much with the experience of dentistry but rather with its anticipation.     

Inattention and hyperactivity-impulsivity: psychobiological and evolutionary underpinnings of ADHD

Attention-deficit/hyperactivity disorder is a prevalent and disabling disorder that is characterized by inattention and/or hyperactivity-impulsivity, impairment in executive functions, structural and functional abnormalities in frontal-striatal circuitry, associations with particular catecholamine gene variants, and responsiveness to dopaminergic and noradrenergic agents. There is a growing integration of findings from basic and clinical studies, of data from different methods (eg, genetics and imaging), and of empirical data with hypotheses drawn from evolutionary thinking. Here we briefly summarize work on the cognitive-affective neuroscience of attention-deficit/hyperactivity disorder.     

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain,anxiety and interoceptive fear

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.