Emotion processing in Psychopathy Checklist — assessed psychopathy: A review of the literature
Introduction
Psychopathy is a personality disorder characterized by impulsive antisocial behavior, lack of emotional depth, callous treatment of others, and poor judgment. It is both a dangerous disorder and a costly one. Psychopathic inmates are charged with more crimes, more violent crimes, and a greater diversity of crimes than other inmates (Hare, 2003, Kosson et al., 1990). They are more likely than other inmates to fail treatment (Ogloff & Wong, 1990) and conditional release programs (Hart et al., 1988, Porter et al., 2001), and psychopathy is a strong predictor of criminal recidivism (Laurell & Daderman, 2005) and violence (Hare and Neumann, 2009, Walsh et al., 2009).
Although the costs of psychopathy are increasingly recognized, and the construct increasingly used in forensic contexts (T. Walsh & Walsh, 2006), the mechanisms underlying the disorder are not well understood. For over 50 years, the field of psychopathy research has been dominated by clinical descriptions and theories that emphasize emotional deficits as core features of this disorder. Moreover, a growing body of empirical evidence has contributed to the development of several credible hypotheses that explain the mechanisms underlying psychopathy in terms of anomalous emotional processing. Whereas there appears to be substantial evidence consistent with each of these hypotheses, there are no recent systematic reviews of the evidence bearing on them. The purpose of this paper is to address this gap in the literature.
Contemporary hypotheses regarding emotional processing in psychopathy can be bifurcated into two primary perspectives regarding the level of specificity of observed affective deficits. According to the general emotional deficit perspective, psychopaths are characterized by a blunted capacity for experiencing emotion in general, which interferes with understanding the emotional significance of events and the meaning of their actions (Cleckley, 1941). As such, they are basically rational or cognitively intact, but, because they lack emotional depth, their appraisals of situations are deficient in a way that renders them unable to anticipate the emotional consequences of actions for themselves or others. According to this viewpoint, psychopaths' cognitive deficits are secondary to the pathology of the emotion processing system.1 Alternatively, the specific emotional deficit perspective holds that psychopaths are characterized by an incapacity for only specific types of emotional experiences. Several distinct variants of this perspective have received substantial research attention. According to the low fear hypothesis (e.g. Lykken, 1957, Lykken, 1995), psychopaths experience some emotions but have a reduced capacity or heightened threshold for activating fear/defense/withdrawal systems. Similarly, according to the violence inhibition mechanism hypothesis (VIM; Blair, 1995), later elaborated into the integrated emotions theory (Blair, 2005), psychopaths experience some emotions but are impaired in their understanding of interpersonal distress cues associated with sadness and fear. Consequently, psychopaths fail to recognize cues that would otherwise lead them to inhibit aggressive behavior by activating the neural networks involved in empathic processing. According to both these hypotheses, amygdala dysfunction is at the core of psychopaths' emotional deficits, resulting in impaired processing of certain kinds of fear-related emotional information (i.e., punishment cues in the case of the low fear hypothesis, interpersonal distress cues in the case of the VIM hypothesis), and relatively intact processing of other kinds of emotional stimuli (Blair, 2003, Patrick, 1994).2 With regard to empirical findings then, the general emotional deficit perspective predicts that psychopathy should be associated with overall deficits in emotional processing regardless of specific emotion type. Conversely, the low fear hypothesis predicts selective impairment in processing fear, and the violence inhibition hypothesis predicts selective impairment in processing fear and sadness, in the context of relatively preserved processing of other emotions.
A thorough understanding of emotional deficits in psychopathy and their underlying psychological and neural mechanisms has obvious implications for the understanding and treatment of the disorder. It is safe to say that empirical research on the topic to date suggests that psychopaths do manifest significant abnormalities in emotion processing. However, implications of these findings for the development of comprehensive theories of psychopathy and the ultimate translation of research to clinical interventions depend, to a large extent, on whether the affective deficits are pervasive across the emotional spectrum and across situations, or are specific to certain types of emotion processing, neural systems, or environmental contexts. The current review addresses these questions and offers directions for future research.
Section snippets
Method
To ensure a comprehensive set of studies to review, we searched PsycINFO and PubMed databases for subject headings related to psychopathy and emotional functioning. Studies were included in the review if they met the following criteria: used empirical methodology including formal statistical analyses, directly examined an aspect of emotion processing using a behavioral, psychophysiologic, or neuroimaging paradigm, utilized a study sample that was not primarily psychiatric (e.g., schizophrenic
Studies of affect detection
The most basic level of analysis of emotion processing is the mere detection of an emotional stimulus. Day and Wong (1996) tachistoscopically presented psychopathic and nonpsychopathic inmates with lateralized pairs of emotional and neutral faces and with lateralized pairs of emotional and neutral words in a choice reaction time task. There were no group differences in the ability to detect which face and which word depicted emotion. Whereas nonpsychopaths showed a robust right-hemisphere
Psychophysiologic studies of emotion processing
Researchers have used a wide variety of psychophysiologic indices to examine physiologic responsiveness to emotional information. Physiologic arousal and behavior are two of the three emotional response systems commonly distinguished (Lang, 1979), and indices of activity in these systems are often correlated; moreover, some researchers have argued that physiologic indices provide a more direct measure of an individual's response to affective information than behavioral indices, because many
Neuroimaging studies of emotion processing
Contemporary brain imaging technologies allow the study of regional brain activation in response to emotional information with greatly improved spatial resolution over ERP methods; six neuroimaging studies addressed functional differences associated with emotion processing in psychopathy. Intrator et al. (1997) used single photon emission computerized tomography (SPECT) to study cerebral blood flow within the midventricular axial slice of the brain in psychopathic and nonpsychopathic substance
Subjective ratings of emotion
Most psychophysiologic and imaging studies also examined subjective self-report ratings of stimulus valence, stimulus intensity, or self arousal in response to emotional information. We briefly review these findings here.
Summary and implications of findings
We reviewed published findings from empirical investigations of PCL assessed psychopathy, including studies using behavioral, psychophysiologic, brain imaging, and self-report indices of emotion processing. Overall, most studies reported some sort of diminished responsiveness to emotional cues in psychopathic compared with control samples; however, our review identified substantial variability in findings across different types of emotion, participant samples, and dimensions of psychopathy. In
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