 |
|
Emotion in Criminal Offenders With Psychopathy and Borderline Personality Disorder
Sabine C. Herpertz, MD;
Ulrike Werth;
Gerald Lukas, MSc;
Mutaz Qunaibi, BSc;
Annette Schuerkens, BSc;
Hanns-Juergen Kunert, PhD;
Roland Freese, MD;
Martin Flesch, MD;
Ruediger Mueller-Isberner, MD;
Michael Osterheider, MD;
Henning Sass, MD
Arch Gen Psychiatry. 2001;58:737-745.
ABSTRACT
| |
Background Criminal offenders with a diagnosis of psychopathy or borderline personality
disorder (BPD) share an impulsive nature but tend to differ in their style
of emotional response. This study aims to use multiple psychophysiologic measures
to compare emotional responses to unpleasant and pleasant stimuli.
Methods Twenty-five psychopaths as defined by the Hare Psychopathy Checklist
and 18 subjects with BPD from 2 high-security forensic treatment facilities
were included in the study along with 24 control subjects. Electrodermal response
was used as an indicator of emotional arousal, modulation of the startle reflex
as a measure of valence, and electromyographic activity of the corrugator
muscle as an index of emotional expression.
Results Compared with controls, psychopaths were characterized by decreased
electrodermal responsiveness, less facial expression, and the absence of affective
startle modulation. A higher percentage of psychopaths showed no startle reflex.
Subjects with BPD showed a response pattern very similar to that of controls,
ie, they showed comparable autonomic arousal, and their startle responses
were strongest to unpleasant slides and weakest to pleasant slides. However,
corrugator electromyographic activity in subjects with BPD demonstrated little
facial modulation when they viewed either pleasant or unpleasant slides.
Conclusions The results support the theory that psychopaths are characterized by
a pronounced lack of fear in response to aversive events. Furthermore, the
results suggest a general deficit in processing affective information, regardless
of whether stimuli are negative or positive. Emotional hyporesponsiveness
was specific to psychopaths, since results for offenders with BPD indicate
a widely adequate processing of emotional stimuli.
INTRODUCTION
CURRENT research aims to identify psychological and psychopathologic
dimensions underlying violent behavior in personality disorders.1
In particular, the style of emotional response is regarded as one of the most
important psychological mechanisms constituting normal and abnormal personality,
including a person's interaction with the environment. Whereas the DSM-IV category of antisocial personality disorder2
does not provide a description of specific emotional features, the classic
diagnostic criteria for psychopathy by Cleckley3
include a specific emotional style that can best be described as a generalized
emotional deficit or emotional detachment.4, 5
Some data from experimental studies on emotions in criminal offenders with
psychopathy already exist. However, to our knowledge, studies have not yet
been conducted on the problem of diagnostic specificity. Therefore, this article
focuses on investigating emotional responses, not only in psychopaths but
also in criminal offenders diagnosed as having borderline personality disorder
(BPD). Although individuals with BPD have been reported to be at risk for
engaging in criminal, antisocial behavior,6, 7, 8
experimental studies of emotion in offenders with BPD are hardly available.
With the exception of Arnett et al,9
who examined appetitive response to reward cues, studies dealing with psychopaths
focus on anxiety. Psychophysiologic findings of decreased electrodermal responsiveness
to anxiety- or punishment-related stimuli10, 11, 12
are thought to indicate low levels of fear13, 14
and to lead to stimulus-seeking and hence risk-taking impulsive behavior.13, 15 Further studies on psychopaths have
borne evidence of an absence of the so-called fear-potentiated startle reflex.16, 17
In contrast to electrodermal activity, which reflects the arousal dimension
of emotion (activation vs calmness), the blink response to a sudden, intense
acoustic probe is primarily considered to be a measure of valence (pleasure
vs aversion). Previous research indicates that this primitive defensive reflex
mirrors the underlying action disposition of an organism. Proceeding from
a theoretical framework based on reciprocal motivational priming, Lang et
al18 postulated that the startle response is
usually augmented when stimuli-inducing negative emotions are presented, since
the negative valence of the reflex matches the valence of the ongoing motivational
disposition of the organism (defense or withdrawal). Conversely, the startle
response is decreased during pleasant states because of a mismatch between
the defensive reflex and an ongoing appetitive (approach) disposition. Patrick
et al5 reported an absence of startle potentiation
in psychopaths during the presentation of aversive slides. Since most of the
unpleasant slides used by Patrick et al were evaluated as frightening by normal
subjects,5 these data suggest that psychopaths
have a low capacity for experiencing fear when faced by threatening or punishing
situations. For BPD, the emotional modulation of the startle response has
only been studied in a clinical female sample, showing a normal modulation
pattern in response to various slide valence categories.19, 20
Apart from psychophysiologic measurements, the corrugator electromyographic
(EMG) (frown) response can be used as a further indicator of aversive emotional
response,21 reflecting the expressive dimension
of emotion.
Abnormal emotional processing may not be restricted to fear, but may
include negative and even positive emotions in general. This study aims to
compare responses to standardized unpleasant and pleasant stimuli in male
criminal offenders diagnosed as having psychopathy with those of offenders
diagnosed as having BPD. We ran various psychophysiologic tests related to
the 2 basic emotional dimensions of valence and arousal. Our hypothesis was
that psychopaths would show weaker modulation of the startle response magnitude
while watching unpleasant and pleasant slides and weaker facial expression
and lower autonomic responses compared with noncriminal control subjects.
It was further expected that criminal offenders with BPD would—compared
with controls—show decreased electrodermal responses, which are supposed
to predispose respondents to stimulus-seeking and disinhibited, impulsive
behavior.13, 15 They would, however,
differ from psychopaths in the main aspects of emotional response, showing
a normal pattern of startle response and facial expression.
SUBJECTS AND METHODS
SUBJECTS
Fifty male inmates from 2 high-security forensic treatment facilities
underwent screening for participation in the study, 25 with a clinical diagnosis
of psychopathy and 25 with BPD. All were convicted of capital crimes. Subjects
were selected for 1 of the 2 study groups—psychopaths or BPD—based
on their total scores in the screening version of the Psychopathy Checklist:
Screening Version (PCL:SV22, 23)
and the number of International Personality Disorder Examination (IPDE)24 BPD items that they fulfilled. The screening version
of 12 items for a maximum score of 24 consists of the following 2 major dimensions:
factor 1 includes characterological features such as emotional detachment,
lack of empathy and remorse; factor 2 includes impulsiveness and antisocial
behavioral style. The PCL:SV has high interrater agreement and internal consistency
and correlates well with the Psychopathy Checklist–Revised (PCL-R).22, 25 According to the diagnostic cutoff
criteria recommended by Hart et al,23 psychopathic
subjects scored at least 18 and subjects with BPD scored no more than 14 on
the total PCL:SV. Borderline personality disorder was diagnosed in accordance
with the cutoff given in the DSM-IV ( 5 criteria).2
Two of us (S.C.H. and U.W.) who were unaware of the clinical diagnosis
independently evaluated scores on the PCL:SV and on the IPDE. The PCL:SV evaluation
included institutional data, ie, criminal record, psychiatric profile, and
behavior reports. Only those subjects were included for whom both raters evaluated
the required inclusion criteria. Individuals with mental deficiencies, dementia,
schizophrenia, paranoid disorder, or current alcohol or other drug abuse were
not included in the study. For at least 3 months, all subjects had been free
of medication (eg, antidepressants, anticholinergics, anxiolytics, and antipsychotic
agents) that could have influenced responses.
Twenty-five noncriminal male controls with no history of psychiatric
treatment or diagnosis of antisocial or borderline personality disorder were
additionally recruited through bulletin board announcements. This produced
a control group composed of one third each of college students, nonacademic
hospital staff, and vocational trainees. Of the 75 subjects undergoing screening
for participation in the study, 18 subjects with BPD, 25 psychopaths, and
24 controls were eventually included. Group age and intelligence were highly
comparable (Table 1). Nonsignificant
differences in education ( 22 = 4.93; P = .08) may result from social maladjustment rather than from any
lesser intelligence of criminal offenders compared with controls.
|
|
|
|
Table 1. Demographics, Personality Trait Data, and Diagnostic Data
of the Sample*
|
|
|
The type of criminal offenses and the offender-victim relationship were
assessed. A standardized procedure based on formal records was also used to
classify violent acts as impulsive or premeditated.27
All subjects underwent testing for basic measures of personality with
the use ofthe Temperament and Character Inventory (TCI),29, 30
the Barratt Impulsiveness Scale (BIS-10),31
and the Assessment of Factors of Aggressiveness (FAF).28
The TCI describes the following 3 temperamental factors: novelty seeking,
reward dependence, and harm avoidance (a disposition to respond strongly to
aversive stimuli, leading the individual to inhibit behavior and avoid punishment).
The FAF is a German adaptation of the Buss-Durkee Hostility Inventory.32 Before experimentation, the emotional state of the
subjects was assessed with regard to valence and arousal with the use of a
visual analog scale called the Self-Assessment Manikin.33
All subjects were paid for participating in the study and gave written informed
consent after receiving a comprehensive description of the study.
EMOTIONAL MATERIAL AND DESIGN
Stimulus material consisted of 24 slides taken from the International
Affective Picture System.34 This standardized
pool included 8 pleasant (romantic couples, family and sports scenes, erotica,
and pets), 8 neutral (household objects and plants), and 8 unpleasant slides
(crying and wounded children, mutilated bodies, people in despair, and violent
scenes). The slides were selected to provoke a range of various qualities
of negative and positive emotions. Slides appeared for 6 seconds each in random
order. After each slide, subjects were asked to rate the intensity of their
affective response using the Self-Assessment Manikin.33
Self-report ratings (0-9) range from feeling extremely unpleasant or being
in a state of very low emotional arousal to feeling extremely pleasant or
being in a state of very high arousal.
PHYSIOLOGICAL MEASUREMENTS
Physiological measurements of skin conductance and EMG activity were
recorded using a modular system (ZAK Medical Technics, Marktheidenfeld, Germany),
and the startle reflex was measured with a commercial startle system (San
Diego Instruments, San Diego, Calif). Physiological signals were recorded
using silver–silver chloride electrodes—miniature EMG electrodes
and 1-cm skin conductance electrodes—filled with electrolyte paste (Spectra
360; Parker Laboratories, Fairfield, NJ). Impedances were kept below 5 k .
To record skin conductance activity, electrodes were centered on the
thenar and hypothenar eminences of the nondominant hand; activity was sampled
every 20 milliseconds. The magnitude of the skin conductance response (SCR)
was defined as the largest increase standardized to the intraindividual maximum
within 0.9 and 4.0 seconds of beginning each slide. It has been shown that
range-corrected scores make SCR data more orderly and psychologically meaningful.35 Finally, values were transformed logarithmically
to improve the symmetry of the distribution curves.
Facial expression operationalized as corrugator EMG activity was recorded
from the region of the frowning muscle above the right eye and sampled at
50 Hz. For data analysis, EMG activity was expressed as the mean change during
a period of 0.5 to 3.0 seconds after slide onset, beginning from the 1-second
baseline immediately preceding slide onset.
To measure the blink component of the startle reflex, EMG activity of
the left orbicularis oculi muscle was recorded by means of 2 miniature electrodes
placed under the left eye and below the outer canthus. The acoustic startle
stimulus delivered binaurally consisted of a 50-millisecond burst of white
noise; its intensity had been calibrated at 100 dB using an artificial ear.
Startle probes were delivered randomly within 3.0 to 5.0 seconds of slide
onset. The EMG activity was recorded in a 20- to 150-millisecond time window
after startle probe onset. The software used for offline analysis stored the
startle response values in arbitrary analog-digital units. A startle reflex
was considered to have occurred when EMG activity surpassed the baseline level
by at least 10 U. The criterion for startle nonresponders was defined as fewer
than 25 U for the mean of response amplitudes.36
DATA ANALYSIS
Before statistical analyses, all variables were tested for normal distribution.
Group effects of most clinical and questionnaire data were tested using contingency
tables, 2-tailed t tests, and analyses of variance
(ANOVAs). Nonparametric procedures were used for clinical variables that were
not normally distributed.
Within the experimental design, we applied repeated-measures ANOVAs
to examine changes of self-ratings as a function of affective stimulus valence
in addition to group effects. We used the diagnostic group for the between-subjects
factor and the slide valence category (pleasant, neutral, or unpleasant) for
the within-subject factor. Besides testing for overall stimulus valence effects,
we performed pairwise comparisons of slide valence categories.
Because distributions of mean raw scores across subjects failed to meet
assumptions of normality with regard to all physiological response measures,
nonparametric tests were used. To test for diagnostic group effects, we performed
Kruskal-Wallis tests. We further analyzed group effects using post hoc Mann-Whitney
tests for pairwise comparisons of independent samples. To examine changes
of physiological parameters as a function of affective stimulus (slide) valence
in addition to the group effects, we performed Friedman tests for repeated
measures. We also performed post hoc pairwise comparisons of slide valence
categories using Wilcoxon signed rank tests for paired samples. Based on a
priori hypotheses, we tested the relationship between slide valence and psychophysiologic
measures separately for each diagnostic group.
Post hoc pairwise comparisons of diagnostic group effects (psychopath-control,
BPD-control, and BPD-psychopath) and post hoc pairwise comparisons of slide
valence categories (pleasant-neutral, neutral-unpleasant, and pleasant-unpleasant)
were followed by Bonferroni-Holm type I error adjustment to identify which
pair showed a significant effect for that variable. The Bonferroni-Holm37 procedure maintains the overall error rate at the
.05 level and tests pairwise effects at certain prescribed significance levels.
Specifically, among the P values, Pi, is ordered from smallest (i = 1) to largest (i = 3)
among the 3 comparisons. The groups or categories corresponding to Pi are declared to be significantly different at the overall
.05 level if Pi  .05/[(M + 1) -
i], where M is the number of comparisons. The sequential procedure stops when
a comparison has to be declared to be nonsignificant for the first time. To
maintain consistency throughout the text, the prescribed significance level
and consequently the quoted P value have been adjusted
to correspond with error rate of .05 (ie, Pi x [(M + 1) - i].
Within-subject t tests were calculated in such
a way that raw scores for each subject were deviated from the individual's
mean score and divided by the subject's SD, producing a score distribution
with a mean of 50 and an SD of 10 for each subject. Such standardization does
not change the relationship between the intraindividual responses but establishes
a common measure for the subjects and, thus, makes them comparable.5 We performed repeated-measures ANOVAs on these individually
standardized data and within-subject t tests on the
basis of a priori hypotheses to assess startle modulation through various
slide categories in each diagnostic group, again followed by Bonferroni-Holm
type I error adjustment.
Figures include means and SEMs. Statistical analyses were performed
with commercially available software (SAS 6.12; SAS Institute Inc, Cary, NC;
or SPSS 9.01; SPSS Inc, Chicago, Ill).
RESULTS
DIAGNOSTIC DATA
To compare diagnostic data between both groups of criminal offenders,
we used 2-tailed t tests. By design, psychopaths
were characterized by PCL:SV factor 1 and 2 scores that were significantly
higher than those assessed for subjects with BPD. Regarding IPDE criteria,
subjects with BPD were characterized by a higher number of fulfilled BPD criteria
(P<.001), whereas psychopaths showed a higher
number of antisocial criteria (P<.001) (Table 1).
Using an exact version of a 3 x 2 contingency table test for homogeneity
of behavior characteristics across groups, no differences were found between
the 2 groups of criminal offenders with regard to type of crime, type of relationship
to the victim, or length of imprisonment or forensic hospitalization. With
the use of Mann-Whitney tests, a higher degree of premeditated aggression
was found within the psychopathy group (P = .05),
but no clear difference was shown in the degree of impulsive aggression (P = .12) (Table 2).
|
|
|
|
Table 2. Characteristics of Criminal Offenses*
|
|
|
One-way ANOVA results of the questionnaire variables deomonstrated group-specific
effects in impulsiveness and aggressiveness. Both groups of criminal offenders
scored higher than controls but did not differ from each other on the BIS
and FAF. An additional group effect was found in relation to harm avoidance.
Subjects with BPD scored higher than the psychopaths and the controls on this
TCI subscale. No group differences were found for the novelty-seeking or reward-dependence
TCI subscales (Table 1).
SELF-REPORT RATINGS OF EMOTIONAL RESPONSES
According to data from 1-way ANOVA, self-ratings showed that the emotional
state did not differ among the 3 groups before the onset of the experiment
(valence, F2 = 0.76 [P = .47]; arousal,
F2 = 1.57 [P = .21]).
The slides selected from the IAPS were suitable for inducing different
self-report ratings, since repeated-measures ANOVAs showed a strong overall
slide valence effect (valence, F2,128 = 304.61 [P<.001]) with post hoc contrasts indicating that pleasant slides
were rated significantly higher and unpleasant slides significantly lower
than neutral slides in valence. An additional overall slide valence affect
was found for arousal ratings (F2,128 = 159.12 [P<.001]) with significantly higher scores for pleasant and unpleasant
slides than for neutral slides. Self-report data did not demonstrate group
effects or group x slide valence interaction effects (Table 3).
|
|
|
|
Table 3. Group Means for Self-report Ratings*
|
|
|
PHYSIOLOGICAL MEASURES
Skin Conductance Response
As expected, the Friedman test for repeated measures showed that the
electrodermal response was sensitive to the arousal dimension of the slides.
The SCR amplitudes changed as a function of the slide valence in the overall
group (P<.001), with post hoc Wilcoxon signed
rank tests showing that SCRs were higher when viewing pleasant (P<.001) and unpleasant slides (P<.001)
than when viewing neutral slides. A slide valence effect was also found in
each diagnostic group (P<.001). By using the Kruskal-Wallis
test, an overall diagnostic group effect was identified (P = .006), with post hoc Mann-Whitney tests, indicating that psychopaths
had significantly decreased electrodermal responses compared with controls
(P = .02) and subjects with BPD (P = .04); however, subjects with BPD and controls did not differ from
each other (P = .73). Means and SEMs are shown in Figure 1, the test statistics, in Table 4 and Table 5).
|
|
|
|
Figure 1. Skin conductance response (SCR)
during presentation of pleasant, neutral, and unpleasant slides to psychopaths,
subjects with borderline personality disorder (BPD), and control subjects.
In addition to overall slide valence effect, group effect is seen, with subjects
with BPD and controls showing higher SCRs than psychopaths. Means and SEMs
(error bars) are presented.
|
|
|
|
|
|
|
Table 4. Group Effects of Psychophysiologic Data*
|
|
|
|
|
|
|
Table 5. Stimulus Valence Effects of Psychophysiologic Data*
|
|
|
Corrugator EMG Response
With the use of the Friedman test, EMG activity of the corrugator muscle
showed a slide valence effect within the sample as a whole (P = .03). Testing each diagnostic group separately, subjects with BPD
(P = .02) and controls (P
= .03) also showed a significant change in corrugator EMG responses compared
with slide valence categories, whereas psychopaths did not (P = .44). Post hoc Wilcoxon signed rank tests indicated that only controls
showed larger EMG responses to unpleasant slides compared with their responses
to pleasant ones (P = .01), whereas subjects with
BPD showed no difference in their response to unpleasant or pleasant slides
(P = .46). Instead, subjects with BPD exhibited significant
changes in corrugator activity in response to unpleasant slides (P = .01) and a nonsignificant change to pleasant slides (P = .06) compared with neutral slides. As shown by the Kruskal-Wallis
test, a clear group effect was also found (P<.001)
with post hoc Mann-Whitney tests, indicating that controls exhibited more
facial expression than BPD (P = .02) and psychopathic
subjects (P<.001). Means and SEMs are presented
in Figure 2; test statistics, in Table 4 and Table 5.
|
|
|
|
Figure 2. Electromyographic (EMG) activity
of the corrugator muscle during presentation of pleasant, neutral, and unpleasant
slides to psychopaths, subjects with borderline personality disorder (BPD),
and controls. Group effect is seen, with controls showing higher EMG activity
than subjects with BPD and psychopaths. Slide valence effect is seen in controls
and subjects with BPD but not in psychopaths. Means and SEMs (error bars)
are presented.
|
|
|
Startle Response
Nine psychopaths, along with 1 BPD subject and 2 controls, were shown
to be nonresponders to the startle probe, ie, psychopaths failed more frequently
to respond, irrespective of the valence of the slides presented (exact version
of a 3 x 2 contingency table, P = .01).
As expected, the Friedman test for repeated measures showed a slide
valence effect in the total sample (P<.001), with
post hoc Wilcoxon signed rank tests showing that startle amplitudes differed
across all 3 slide valence categories (pleasant-neutral, P<.001; neutral-unpleasant, P = .05; pleasant-unpleasant, P<.001). Taking each diagnostic group separately, Friedman
tests yielded slide valence effects across the 3 categories in the control
group (P = .002) and in the BPD group (P = .03), but not in the psychopaths, which failed to show any slide
valence effect (P = .77). Post hoc Wilcoxon pairwise
comparisons of slide valence categories indicated that subjects with BPD and
controls showed higher startle amplitudes when viewing unpleasant rather than
pleasant (BPD group, P = .009; control group, P<.001) and neutral (BPD, P
= .04; controls, P = .08) slides and lower startle
amplitudes when viewing pleasant rather than neutral slides (BPD group, P = .03; control group, P = .002).
No overall group difference of raw startle amplitude was found when the Kruskal-Wallis
test was used (P = .22) (Table 4).
Analysis of the standardized blink magnitude scores by repeated-measures
ANOVAs produced an overall group effect (F2,52 = 3.18; P = .04); however, a group x slide valence interaction was not
found (F4,104 = 1.25; P = .29). Otherwise,
analyses of the standardized blink magnitude scores produced very similar
results (Figure 3).
|
|
|
|
Figure 3. Standardized startle response
amplitude scores during presentation of pleasant, neutral, and unpleasant
slides in psychopaths, subjects with borderline personality disorder (BPD),
and controls. In addition to overall group effect, slide valence effect is
seen in controls and subjects with BPD, but not in psychopaths. Means and
SEMs (error bars) are presented.
|
|
|
COMMENT
This is the first study, to our knowledge, to compare emotional processing
in psychopathic subjects and subjects with BPD in a forensic setting using
different psychophysiologic emotional correlates. The findings for psychopaths
confirmed our hypotheses. Compared with controls and offenders with BPD, psychopaths
showed decreased electrodermal responses to emotional slides, and a higher
percentage of psychopathic subjects failed to show any startle reflex. By
focusing on differential patterns of response within each diagnostic group,
we demonstrated that psychopaths were the only group to show no modulation
of startle response in relation to any kind of emotional stimulus. Finally,
the corrugator muscle response of psychopaths indicated rare aversive facial
expression. Although all psychophysiologic data suggest emotional hyporesponsiveness,
this deficiency was not reflected in the self-reports by psychopaths of their
emotional responses. This dissociation between self-report and physiological
data, also reported for other forensic and nonforensic populations,5, 19, 38 suggests that questionnaire
data tend to reflect intact associative processing faculties allowing for
"text-appropriate self-report ratings" rather than emotional experiences per
se.38
Criminal offenders with BPD exhibited a response pattern very similar
to that of controls, ie, they showed no electrodermal hyporesponsiveness and
an adequate emotional modulation of startle response. However, like psychopaths,
offenders with BPD showed less frowning muscle activity than did controls,
who vividly expressed their negative emotions. In contrast to psychopaths,
however, offenders with BPD showed a significant increase of the frowning
EMG activity when viewing emotional compared with neutral slides, but their
facial expressions were remarkably uniform regardless of whether pleasant
or unpleasant slides were being shown. Although the implications of this result
are far from clear, these data may tend to reflect a restrictive, negatively
biased communication of emotions.
Our results of low autonomic responsivity in psychopaths correspond
with those of a number of earlier studies.9, 11, 14
Two theoretical interpretations have been proposed to explain hypoarousal
in psychopaths. The first proposes that low arousal is experienced as strongly
aversive and results in stimulus-seeking and disinhibited behavior to restore
arousal levels.13, 15 The second
theory suggests that low autonomic arousal is a marker of low levels of fear
that predisposes subjects to antisocial behavior inasmuch as it renders them
unable to learn from punishment.13, 14, 39, 40
Since autonomic hypoarousal was not found in BPD, our data did not support
the hypothesis that autonomic hypoarousal is related to a disinhibited behavioral
style that psychopaths share with subjects with BPD. To our knowledge, the
current study is the first to demonstrate a more general pattern of weak electrodermal
response to emotional stimuli in psychopaths, suggesting that autonomic hyporesponsiveness
is not restricted to fear-related stimuli but occurs regardless of valence.
The lack of any startle reflex in more than a third of the psychopaths
suggests a deficit of automated self-protective behavior and, thus, underlines
the significance of fearlessness in psychopathy. Consistent with startle data
by Patrick et al5, 41 the diagnostic
group x slide valence interaction was not significant in our study,
but the expected pattern of results was obtained in the a priori hypothesis
tests for the individual groups, with psychopaths showing an absence of startle
potentiation when viewing aversive slides. In contrast to Patrick et al,5 who reported a clear startle inhibition in psychopaths
when viewing pleasant stimuli, psychopaths in our study showed no modulation
of their startle response to stimuli related to feelings of fear or threat
or to those related to joy or affection for others. This discrepancy may result
from differences in the population and the emotional material selected. Although
Patrick et al5 used mainly erotic pictures
as pleasant stimuli for a group of sexual offenders, our study used happy
interpersonal events along with sports and erotic scenes for a group of psychopaths
convicted of various criminal offenses. Low emotional arousal in psychopaths
may also contribute to the lack of affective modulation of startle responses,
since this effect is particularly pronounced with highly arousing stimuli.42
In summary, our data support the theory that psychopaths are characterized
by a pronounced lack of fear toward aversive, frightening events. Beyond that,
the results suggest a general deficit in processing affective information,
regardless of whether the stimuli are of aversive or appetitive valence. In
contrast to findings in psychopaths, offenders with BPD showed a startle response
pattern identical to that of controls. This finding is of particular interest
because it suggests an intact capacity in offenders with BPD for aversive
affective states to prime aversion actions, in this case to increase the strength
of a defensive reflex, but also probably a broader tendency to avoid situations
involving pain or danger.5 Distinct types of
emotional responsiveness might be attributed to differences between subjects
with BPD and psychopaths on the harm avoidance scale. Furthermore, differences
in emotional responsiveness may be associated with differences in violent
crimes, since psychopaths showed a higher degree of premeditated aggression
than offenders with BPD.
Limitations of this study concern sample characteristics. First, test
groups were rather small and of different sizes. Nevertheless, sample size
was comparable to those in other psychophysiologic studies,5, 18, 41
and much care was taken to recruit rather distinct diagnostic groups of psychopathic
subjects and subjects with BPD underlined by highly significant differences
in PCL:SV scores. Second, sample representativeness is limited by recruiting
subjects from psychiatric inpatient facilities who were found to have diminished
responsibility for the index crime because of a substantial impairment of
their control capacity. Data on criminal offenses may be different among prison
inmates; however, sample characteristics do not attenuate the experimental
findings, since group differences between psychopaths and subjects with BPD
tend to be greater rather than smaller in prison populations, which are more
likely to include psychopaths convicted of highly premeditated crimes. Third,
because of the forensic recruitment context, the BPD group showed rather pronounced
antisocial features. This problem corresponds to objections often raised for
the DSM-IV criteria for antisocial personality disorder,
which claim that they fail to distinguish between simple antisocial behavior
and a specific pervasive personality disturbance.43
Finally, it cannot be ruled out that controls differed on psychophysiologic
measures because of their nonincarcerated status rather than because of the
absence of a personality disorder diagnosis. Differences in emotional responsiveness,
however, were not only found between controls and offenders but also between
the criminal subgroups.
CONCLUSIONS
Hypoemotionality in psychopaths may predispose them to violence, because
it prevents them from experiencing emotions that naturally inhibit the execution
of violent impulses.44, 45 Although
a basically normal processing of emotional stimuli was found in offenders
with BPD, this result might be different for stimuli identified by individuals
as specific stressors. Further research is needed to understand the psychological
roots of violent behavior in personality disorders.
AUTHOR INFORMATION
Accepted for publication March 1, 2001.
This research was supported by the Interdisciplinary Center for Clinical
Research, Medical Faculty, RWTH Aachen, Aachen, Germany.
The authors thank Alejandro Rodón for language and general editing
and Sheilag Hodgins, PhD, from the University of Montreal, Montreal, Quebec,
for comments on the manuscript.
From the Department of Psychiatry and Psychotherapy, Aachen Technical
University (Reinisch-Westfaelische Technische Hochschule Aachen), Aachen (Drs
Herpertz, Kunert, and Sass, Mss Werth and Schuerkens, and Messrs Lukas and
Qunaibi), Haina Forensic Psychiatric Hospital, Haina (Drs Freese and Mueller-Isberner),
and Westphalian Center for Forensic Psychiatry, Lippstadt (Drs Flesch and
Osterheider), Germany.
Corresponding author and reprints: Sabine C. Herpertz, MD, Department
of Psychiatry and Psychotherapy of the Medical Faculty, Aachen Technical University,
Pauwelsstr. 30, D-52057 Aachen, Germany (e-mail: sherpertz{at}post.klinikum.rwth-aachen.de).
REFERENCES
| |
1. Herpertz S, Sass H. Personality disorders and the law, with a German perspective. Curr Opin Psychiatry. 1999;12:689-693.
FULL TEXT
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition. Washington, DC: American Psychiatric Association; 1994.
3. Cleckley H. The Mask of Sanity: An Attempt to Clarify Some Issues
About the So-called Psychopathic Personality. 5th ed. St Louis, Mo: Mosby–Year Book Inc; 1976.
4. Hare RD. Without Conscience: The Disturbing World of the Psychopaths
Among Us. New York, NY: Simon & Schuster; 1993.
5. Patrick CJ, Bradley MM, Lang PJ. Emotion in the criminal psychopath: startle reflex modulation. J Abnorm Psychol. 1993;102:82-92.
FULL TEXT
|
ISI
| PUBMED
6. Coid JW. DSM-III diagnosis in criminal psychopaths:
a way forward. Criminal Behav Ment Health. 1992;2:78-94.
7. Else L, Wonderlich SA, Beatty WW, Christie DW, Staton RD. Personality characteristics of men who physically abuse women. Hosp Community Psychiatry. 1993;44:54-58.
FREE FULL TEXT
8. Raine A. Features of borderline personality and violence. J Clin Psychol. 1993;49:277-281.
ISI
| PUBMED
9. Arnett PA, Smith SS, Newman JP. Approach and avoidance motivation in psychopathic criminal offenders
during passive avoidance. J Pers Soc Psychol. 1997;72:1413-1428.
FULL TEXT
|
ISI
| PUBMED
10. Hare RD. Psychopathy. New York, NY: John Wiley & Sons Inc; 1970.
11. Hare RD. Electrodermal and cardiovascular correlates of psychopathy. In: Hare RD, Schalling D, eds. Psychopathic Behavior:
Approaches to Research. New York, NY: John Wiley & Sons Inc; 1978:107-143.
12. Hare RD. Psychopathy and electrodermal responses to nonsignal stimulation. Biol Psychol. 1978;6:237-246.
FULL TEXT
|
ISI
| PUBMED
13. Raine A. Autonomic nervous system factors underlying disinhibited, antisocial,
and violent behavior. Ann N Y Acad Sci. 1996;794:46-59.
ISI
| PUBMED
14. Arnett PA. Autonomic responsivity in psychopaths: a critical review and theoretical
proposal. Clin Psychol Rev. 1997;17:903-936.
FULL TEXT
|
ISI
| PUBMED
15. Zuckerman M. Sensation-Seeking: Beyond the Optimal Level of Arousal. Hillsdale, NJ: Lawrence A Erlbaum Associates; 1979.
16. Brown JS, Kalish HI, Farber IE. Conditioned fear as revealed by magnitude of startle response to an
auditory stimulus. J Exp Psychol. 1951;41:317-328.
FULL TEXT
|
ISI
| PUBMED
17. Davis M. Pharmacological and anatomical analysis of fear conditioning using
the fear-potentiated startle paradigm. Behav Neurosci. 1986;100:814-824.
FULL TEXT
|
ISI
| PUBMED
18. Lang PJ, Bradley MM, Cuthbert BN. Emotion, attention, and the startle reflex. Psychol Rev. 1990;97:377-395.
FULL TEXT
|
ISI
| PUBMED
19. Herpertz S, Kunert HJ, Schwenger UB, Sass H. Affective response in borderline personality disorder: a psychophysiological
approach. Am J Psychiatry. 1999;156:1550-1556.
FREE FULL TEXT
20. Herpertz SC, Schwenger UB, Kunert HJ, Lukas G, Gretzer U, Nutzmann J, Schuerkens A, Sass H. Emotion in borderline personality disorder: experimental data in comparison
to avoidant personality disorder. J Personal Disord. 2000;14:339-351.
ISI
| PUBMED
21. Greenwald MK, Cook III EW, Lang PJ. Affective judgment and psychophysiological response: dimensional covariation
in the evaluation of pictorial stimuli. Psychophysiology. 1989;3:51-64.
22. Hare RD, Cox DN, Hart SD. Manual for the Psychopathy Checklist: Screening Version. Toronto, Ontario: Multi-Health Systems Inc; 1994.
23. Hart SD, Cox D, Hare RD. Manual for the Hare Psychopathy Checklist: Screening
Version (PCL:SV) mit deutschsprachiger Handbuchbeilage. Freese R, trans. Toronto, Ontario: Multi-Health Systems Inc; 1995.
24. Loranger AW, Susman VL, Oldham HM, Russakoff LM. International Personality Disorder Examination (IPDE):
A Structural Interview for DSM-IV and ICD-10 Personality Disorders. Mombour W, Zoudig M, Berger P, Gutierrez K, Berner W, Berger K, von
Cranach M, Giglhuber O, von Bose M, trans. Bern, Switzerland: Hans Huber Verlag;
1999.
25. Hart SD, Hare RD. Psychopathy and the big 5: correlations between observers' ratings
of normal and pathological personality. J Personal Disord. 1994;8:32-40.
26. Tewes U. Hamburg-Wechsler-Intelligenztest für Erwachsene–Revision [Hamburg-Wechsler Intelligence Test for Adults–Revised]. Göttingen, Germany: Huber Verlag; 1991.
27. Barratt ES, Stanford MS, Dowdy L, Liebman MJ, Kent TA. Impulsive and premeditated aggression: a factor analysis of self-report
acts. Psychiatry Res. 1999;86:163-173.
FULL TEXT
|
ISI
| PUBMED
28. Hampel R, Selg H. FAF-Fragebogen zur Erfassung von Agressivitätsfaktoren. Göttingen, Germany: Hogrefe Verlag; 1975.
29. Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD. The Temperament and Character Inventory (TCI): A
Guide to Its Development and Use. St Louis, Mo: Center for Psychobiology of Personality; 1994.
30. Richter J, Brandstroem S, Przybeck T. Assessing personality: the Temperament and Character Inventory in a
cross-cultural comparison between Germany, Sweden, and the USA. Psychol Rep. 1999;84:1315-1330.
31. Barratt ES. Impulsiveness subtraits: arousal and information processing. In: Spence JT, Izard CE, eds. Motivation, Emotion,
and Personality. Amsterdam, the Netherlands: Elsevier Science Publishers;
1985:137-146.
32. Buss AH, Durkee H. An inventory for assessing different kinds of hostility. J Consult Clin Psychol. 1957;21:343-349.
33. Lang PJ. Behavioral treatment and bio-behavioral assessment: computer applications. In: Sidowski JB, Johnson JH, Williams TA, eds. Technology in Mental Health Care Delivery Systems. Norwood, NJ: Ablex;
1980:119-137.
34. Lang PJ, Bradley MM, Cuthbert BN. International Affective Picture System (IAPS): Technical
Manual and Affective Ratings. Gainesville: University of Florida, Center for Research in Psychophysiology;
1999.
35. Lykken DT, Rose R, Luther B, Maley M. Correcting psychophysiological measures for individual differences
in range. Psychol Bull. 1996;66:481-484.
FULL TEXT
36. Braff DL, Grillon C, Geyer MA. Gating and habituation of the startle reflex in schizophrenic patients. Arch Gen Psychiatry. 1992;49:206-215.
FREE FULL TEXT
37. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65-70.
38. Cook III EW, Davis TL, Hawk LW, Spence EW, Gautier CH. Fearfulness and startle potentiation during aversive visual stimuli. Psychophysiology. 1992;29:633-645.
ISI
| PUBMED
39. Lykken DT. A study of anxiety in the sociopathic personality. J Abnorm Psychol. 1957;55:6-10.
FULL TEXT
|
ISI
| PUBMED
40. Lykken DT. The Antisocial Personalities. Hillsdale, NJ: Lawrence A Erlbaum Associates; 1995.
41. Patrick CJ, Cuthbert BN, Lang PJ. Emotion in the criminal psychopath: fear image processing. J Abnorm Psychol. 1994;103:523-534.
FULL TEXT
|
ISI
| PUBMED
42. Cuthbert BN, Bradley MM, Lang PJ. Probing picture perception: activation and emotion. Psychophysiology. 1996;33:103-111.
ISI
| PUBMED
43. Cunningham MD, Reidy TJ. Antisocial personality disorder and psychopathy: diagnostic dilemmas
in classifying patterns of antisocial behavior in sentencing evaluations. Behav Sci Law. 1998;16:333-351.
FULL TEXT
|
ISI
| PUBMED
44. Hart SD, Hare RD. Psychopathy and risk assessment. Curr Opin Psychiatry. 1996;9:380-383.
FULL TEXT
45. Hart SD, Dempster RJ. Impulsivity and psychopathy. In: Webster CD, Jackson MA, eds. Impulsivity: Theory,
Assessment, and Treatment. New York, NY: Guildord Publications; 1997:212-232.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Response to Emotional Stimuli in Boys With Conduct Disorder
Herpertz et al.
Am. J. Psychiatry 2005;162:1100-1107.
ABSTRACT
| FULL TEXT
Corpus Callosum Abnormalities in Psychopathic Antisocial Individuals
Raine et al.
Arch Gen Psychiatry 2003;60:1134-1142.
ABSTRACT
| FULL TEXT
|
