Aggression and Violent Behavior 18 (2013) 620–629

Contents lists available at ScienceDirect

Aggression and Violent Behavior

Behaving badly: A perspective on mechanisms of dysfunction

in psychopathy
Olga V. Berkout ⁎, Alan M. Gross, Karen Kate Kellum
University of Mississippi, United States

a r t i c l e i n f o a b s t r a c t

Article history: Psychopathy is a personality construct defined by lack of empathy, impulsivity, grandiosity, callous and ma-
Received 26 September 2012 nipulative interpersonal interactions, and the tendency to engage in socially deviant behavior. Psychopathy
Received in revised form 1 December 2012 has been associated with aggression, recidivism, and other behaviors harmful to others. Individuals high in
Accepted 23 July 2013
psychopathy have been thought to be notoriously difficult to treat. Many scholars have suggested that
Available online 29 July 2013
considering mechanisms of dysfunction in psychological difficulties will lead to the development of more
Keywords:
effective and efficacious treatments. Fearlessness, lack of empathy, and response modulation difficulties
Psychopathy have commonly been discussed as mechanisms of dysfunction in psychopathy. The current review provides
Callousness a brief overview of examinations of these mechanisms of dysfunction in psychopathy, comments on
Fearlessness research methodology, and provides suggestions for remedying potential pitfalls.
Perseveration © 2013 Elsevier Ltd. All rights reserved.
Dysfunction

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620
2. Fearlessness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
2.1. Summary of fearlessness review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
3. Lack of empathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
3.1. Summarizing perspective taking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
4. Response modulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
4.1. Behavioral perseveration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
4.2. Passive avoidance learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
4.3. Summarizing response modulation research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 626
5. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
6. Future directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628

1. Introduction other signs of mental illness. Psychopathy (defined as scores above a

Psychopathy has been defined as a constellation of traits, including
lack of guilt and empathy, grandiosity, callous and manipulative
relationships, shallow emotions, impulsivity, and tendency towards
persistent engagement in socially deviant behavior (Hare, Hart, &
Harpur, 1991). Cleckley (1941, 1976) described psychopathic patients
as having behavioral difficulties while appearing to lack distress and
⁎ Corresponding author at: Department of Psychology, University of Mississippi, 205
Peabody Hall, University, Mississippi, 38677, United States. Tel.: + 1 662 613 0008;
fax: + 1 662 915 5398.
E-mail address: oberkout@gmail.com (O.V. Berkout).
diagnostic cut off) has been demonstrated to be present in about 1% of
the general population (Forth, Brown, Hart, & Hare, 1996) and 20% to
30% of offenders (Edens, 2006; Hare, 1993). Psychopathy has predicted
recidivism (Hemphill, Hare, & Wong, 1998; Pedersen, Kunz, Rasmussen,
& Elass, 2010), physical aggression, and institutional misconduct (Guy,
Edens, Anthony, & Douglas, 2005). Offenders high in psychopathy
have been more likely to reoffend and receive probation suspensions
and much more likely to reoffend violently (Hart, Kropp, & Hare,
1988; Pedersen et al., 2010).
Psychopaths appear qualitatively different from other clients
(Hare, 1993; Karpman, 1941, 1948) and have come to be viewed as
“untreatable” by many (Salekin, 2002). Treatment (through a peer

1359-1789/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.avb.2013.07.013
 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
therapeutic community program) seemed iatrogenic, with treated
psychopathic offenders being more likely to reoffend than untreated
(Harris, Rice, & Cormier, 1994). Psychopathic mentally ill offenders
who went through a therapeutic treatment community program
were found to be more likely to reoffend violently (although lower
violent recidivism among treated offenders low in psychopathy
was obtained; Rice, Harris, & Cormier, 1992). Psychopathic sex
offenders, who therapists believed to be doing well in treatment,
were more likely to reoffend violently and sexually than those seen
as doing poorly (Seto & Barbaree, 1999). Kernberg (1998) asserted
that psychopaths were particularly difficult to treat because their
“major gratification in life is the destruction of those who are
attempting to help them” (Kernberg, 1998 p. 391). Rollins (1975)
added that psychopaths are not only unlikely to benefit from tradi-
tional inpatient treatment, but also likely to harm other patients.
While psychopathic clients undoubtedly present a unique challenge,
Skeem, Monahan, and Mulvey (2002) point out that appropriateness of
interventions must be considered. For example, Rice et al. (1992) re-
ported therapeutic community data that used an intervention including
mandatory nude encounter groups, hallucinogens, and compulsory
treatment receipt (Skeem et al., 2002). Given this form of treatment,
negative effects of treatment reported by Rice et al. (1992) are not
entirely surprising. Scared straight programs and military style boot
camps have similarly demonstrated harmful effects among a portion
of youth with behavioral difficulties (Lilienfeld, 2007), although a num-
ber of other treatments have been found effective (Eyberg, Nelson, &
Boggs, 2008). Psychopathic clients present unique challenges because
of the characteristics defining the construct. Lack of empathy has been
thought to attenuate the non-specific therapeutic relationship benefits
psychopathic clients may derive; shallow emotions and lack of distress
decrease motivation for treatment, and difficulties modifying behavior
(sometimes termed an inability to learn) among psychopathic individ-
uals pose additional barriers (Hare & Neumann, 2009; Salekin, 2002;
Wallace & Newman, 2004).
Despite these difficulties, researchers have suggested that some
avenues may be useful to pursue with psychopathic clients. Salekin
(2002) reviewed a number of treatment studies and noted that
some interventions have shown promise; specifically, 62% psycho-
pathic participants evidenced some improvement in cognitive be-
havioral treatments, 59% in psychodynamic treatments, and 86% in
treatments combining cognitive behavioral and insight techniques.
Wallace and Newman (2004) suggested that a combination of moti-
vational interviewing strategies, self regulation (pausing before
responding), and cognitive restructuring of antisocial beliefs, may
provide useful avenues for future treatment development research.
Hare and Neumann (2009) similarly cautiously consider the possi-
bility that harm reduction and cognitive behavioral programs may
be useful in the treatment of psychopathic clients.
Kazdin (2008) and Kazdin and Nock (2003) suggested that consider-
ing mechanisms of dysfunction and therapeutic change could prove
fruitful in increasing intervention effectiveness. Fearlessness, lack of
empathy, and response modulation difficulties have commonly been
proposed to be mechanisms of dysfunction in psychopathic pathology
(Patrick, 2010). Consideration of the existing research on mechanisms
of dysfunction may provide an improved conceptualization of psychop-
athy. The purpose of this paper is to provide a brief overview of relevant
research and consider the methodology used.
2. Fearlessness
Hare (1965, 1968) argued that lack of negative emotion in response
to punishment led to the development of maladaptive psychopathic
behavior. Without aversive emotions, psychopathic individuals were
thought to lack sufficient motivation to avoid taking risks and breaking
social norms. Researchers have used autonomic arousal as a proxy
for negative emotional response. Hare (1968) evaluated autonomic
621
response among 51 maximum security male inmates, classified as
primary psychopaths (classic definition), secondary psychopaths
(meeting criteria for psychopathy with neurotic features), and
non-psychopaths using prison staff ratings. Primary psychopathic
participants demonstrated lower resting skin conductance than
the non-psychopathic. After baseline, autonomic activity was mea-
sured while participants were: asked to inflate a balloon until it
burst, exposed to a series of novel tones, and asked to solve math
problems. Skin conductance response of both psychopathic groups
decreased to below resting levels throughout the tone portion of
the study, whereas non-psychopathic participants did not display
significant changes. Autonomic response increased for all partici-
pants while solving arithmetic, although primary psychopathic par-
ticipants had a greater increase in the number of responses than the
non-psychopathic. Primary psychopathic participants demonstrated
less heart rate habituation than the non-psychopathic group during
the tone portion. When autonomic activity measures were corrected
for an individual's range (using their greatest and smallest responses),
group response at rest or during tone and arithmetic periods did not dif-
fer. Hare (1968) asserted that findings supported decreased autonomic
response hypothesis and elucidated that smaller responses among
psychopathic participants may indicate a similar relative magnitude as
greater ones among the non-psychopathic. Hare (1968) suggested
that psychopathic individuals may be less responsive to their surround-
ings, or at least to those aspects they do not perceive to be important.
Fung et al. (2005) analyzed skin conductance response and parent
rated psychopathy among 335 adolescents from the Pittsburg Youth
Study (selected on the basis of high or low risk for antisocial behavior).
Risk was determined using antisocial behavior data collected when par-
ticipants were in the first grade. Participants were separated into high
and low psychopathy groups on the basis of obtaining scores in the
top and bottom 20%, respectively. Measures of IQ, a diagnostic ADHD
interview, SES estimated based on family member occupation, and
self, parent, and teacher reports of antisocial behavior were collected.
Skin conductance was assessed at rest and in response to predictable
(by a visual countdown) and unpredictable aversive noises. Participants
did not differ in rates of non-responding or average size of skin conduc-
tance response when awaiting noise without a countdown. When a
countdown predicted noise, a greater proportion of participants high
compared to low in psychopathy failed to respond (63.1% vs. 41.5%,
respectively), although magnitude of skin conductance response did
not differ. A greater proportion of high psychopathy participants failed
to respond after noise was presented both unpredictably (47.7% high
psychopathy vs. 23.1% low psychopathy) and after a countdown
(30.8% high psychopathy vs. 15.4% low psychopathy). Participants of
low SES (68%) were less likely to respond when awaiting noise with a
countdown than those of high SES (47%). Participants with higher
scores on parent, teacher, and self report delinquency were more likely
to be non-responders than those with lower delinquency scores. Delin-
quent participants high and low in psychopathy did not differ in skin
conductance responsiveness. Fung et al. (2005) concluded that deficits
in autonomic response were associated with both psychopathy and
antisocial behavior in youth.
Glenn, Raine, Venables, and Mednick (2007) measured psychopathy
in 335 Mauritian adults whose autonomic responding and tempera-
ment were assessed at age three as part of another study. Participants
in the current study tended to be of a lower SES at age three than
those in the larger cohort (d = −.147), but did not differ on tempera-
mental or physiological measures. Participants completed a self report
measure of psychopathy at age 28. Childhood behavioral observation
data related to temperament, social responsiveness, and fear were
collected. Participants obtaining scores one standard deviation above
and below the mean on psychopathy were categorized as high and
low scorers, respectively. Those scoring high in psychopathy as adults
displayed more disinhibition (d = 0.46), verbalizations (d = 0.28),
friendliness towards the researcher (d = 0.39), and social play with
622 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
other children (d = 0.41), and fewer fearful behaviors during physio-
logical measurement (d = 0.40) than those low in psychopathy. High
psychopathy scorers emitted more nonspecific skin conductance
responses (d = 0.41), greater skin conductance responses to the first
presentation of a neutral tone (d = 0.38), and longer skin conductance
recovery times (thought to indicate less responsiveness) to aversive
sound (d = 0.53) as children. Glenn et al. (2007) noted that high
psychopathy participants appeared less fearful and disinhibited, and
had longer skin conductance recovery times as children, consistent
with the expectation of greater fearlessness. However, high psychopathy
scorers also evidenced greater orienting and non-specific responding.
Glenn et al. (2007) conjectured that this finding may have been a result
of participants being “successful” or non-criminal psychopaths, because
participants were not incarcerated at age 28 when the study was
conducted.
Hare and Quinn (1971) examined classical conditioning of autonom-
ic responding to electric shock and female nudes among 54 male maxi-
mum security inmates. Participants were classified as psychopathic,
somewhat psychopathic, and non-psychopathic on the basis of prison
staff reports. Tones served as conditioned stimuli for shock (aversive),
female nude (appetitive), or other tone (neutral) stimuli. Psychopathic
offenders were less electrodermically responsive to shock prior to
conditioning than other groups and did not differ in response to varied
conditioned stimuli. Only the non-psychopathic participants showed
differential responding, with greater skin conductance response to
shock associated tones than to those predicting nudes or other tones.
No group differences were obtained in conditioned cardiac (heart
rate) or vasomotor (blood vessel constriction). Hare and Quinn (1971)
noted that lower electrodermal arousal at rest and in response to
predictors of shock among psychopathic participants were consistent
with extant research. Researchers suggested that lack of group differ-
ences in cardiovascular responding may indicate that this physiological
indicator measures attention rather than fear (Hare & Quinn, 1971).
Startling in response to a new stimulus has been thought to measure
reaction to threat. Exposure to stimuli indicating danger is thought to
increase (or potentiate) startle responding and exposure to pleasant
stimuli to decrease it by modulating autonomic arousal. Patrick,
Bradley, and Lang (1993) argued that startle responding may be
more clearly associated with fear than electrodermal and heart rate
reactions, which may assess generalized arousal or attention to
task, respectively.
Patrick et al. (1993) analyzed associations between psychopathy
(assessed using the PCL-R; Hare, 1991) and startle responding (blinking),
heart rate, facial corrugator muscle response (frowning), and skin
conductance among 54 male sex offender inmates. Participants viewed
pleasant (e.g., food, opposite sex nudes), neutral (e.g., household objects),
and unpleasant (e.g., mutilations, guns) images followed by a burst of
noise. Participants tended to blink the most after unpleasant and the
least after pleasant images with no significant group differences in startle
latency or magnitude. However, when researchers examined responding
separately for each group, they found that non-psychopathic and moder-
ately psychopathic offenders blinked the least after pleasant images, a
moderate amount after neutral images, and the most after unpleasant
images. Psychopathic offenders, on the other hand, blinked most after
neutral images, with no differences between the pleasant and unpleasant
conditions. Non-psychopathic and moderately psychopathic participants
displayed less corrugator muscle response to pleasant compared to
unpleasant slides, whereas psychopathic participant response did not dif-
fer. Group differences in skin conductance or heart rate responding were
not obtained. Patrick et al. (1993) suggested that psychopathic offenders'
greater startle responding during neutral as opposed to pleasant or
unpleasant image conditions suggested that they may be generally less
emotionally responsive than other criminals.
Autonomic responding was examined among 54 sex offender in-
mates classified as simple antisocial (low interpersonal/affective deficit
with high antisocial/lifestyle deficit), detached antisocial (high deficits
on both aspects), or socialized offender (low on both aspects) using
PCL-R (Hare, 1991) scores (Patrick, Cuthbert, & Lang, 1994). Participants
were asked to imagine themselves in neutral (e.g., relaxing on the
couch) or unpleasant (e.g., having an intruder break into one's home)
situations while heart rate, skin conductance, and facial corrugator mus-
cle responding (frowning) were assessed (Patrick et al., 1994). Mean
participant baseline values were subtracted from their mean reaction
values to adjust scores for individual differences. Simple and detached
antisocial participants demonstrated smaller heart rate, skin conduc-
tance, and corrugator muscle responses to neutral compared to
unpleasant sentences than the socialized offender group. All groups
reported experiencing less dominance and pleasure and higher arousal
during fearful compared to neutral imagery. Interestingly, the simple
antisocial group reported less arousal during fearful and more for neu-
tral sentences than the detached antisocial group. Patrick et al. (1994)
concluded that psychopathic decreased responding to unpleasant as
compared to neutral imagery was consistent with the fearlessness
hypothesis. Scholars noted that, despite evidence of decreased physio-
logical response, psychopathy was not related to differences in self
report ratings of unpleasantness. Researchers considered results in
light of Patrick et al.'s (1993) failure to find differential autonomic
responding to imagery in association with psychopathy. Patrick et al.
(1994) contended that use of language rather than imagery may have
been responsible for differential findings due to a possible deficit in
associating verbal cues with unpleasant situations among the psycho-
pathic. Defective emotional relation of words and negative conse-
quences was proposed to potentially account for maladaptive behavior
and failures in verbally focused treatments among psychopathic individ-
uals (Patrick et al., 1994).
Lorber (2004) analyzed autonomic response, psychopathy, and anti-
social behavior in a meta-analytic review of 95 studies published
between 1997 and 2001. Given varied methods of assessing auto-
nomic reactions, data were examined separately for task response
(raw scores obtained during experiment) and reactivity (difference
between measures obtained at baseline and during the experi-
ment). Resting heart rate was inversely associated with aggression
(d = − 0.38; 95% CI − 0.50 to − 0.26) and conduct problems
among youth (d = − 0.33; 95% CI − 0.43 to − 0.23), but not
psychopathy. Task heart rate was unrelated to aggression, psychop-
athy, or youth conduct problems. Mean effect size was computed as
an average of d's if constructs were assessed in several preparations.
In studies of aggression, task heart rate was inversely related to
negative stimuli (mean d = − 0.23) and positively to stimuli that
were not negative (mean d = − .28). Heart rate reactivity was
associated with conduct problems among youth (d = 0.20) and
unrelated to aggression and psychopathy. In examinations of
aggression studies only, heart rate reactivity was associated with
use of negative stimuli (mean d = 0.31) and inversely related to
use of non-negative stimuli (mean d = − 0.34). Resting skin
conductance was inversely associated with psychopathy (mean
d = −0.30), but unrelated to aggression or youth conduct problems.
Task skin conductance was negatively related to psychopathy (mean
d = −0.25) with the effect found among adults (mean d = −0.43)
but not adolescents. Task skin conductance was inversely associated
with youth conduct problems (mean d = −0.23), with a greater rela-
tionship for children (mean d = −0.46) than adolescents (mean
d = −0.10) and unrelated to aggression. In studies of psychopathy,
task skin conductance response to negative stimuli was inversely
related to conduct problems (mean d = −0.47) with a small effect
found for non-negative stimuli (mean d = −0.11). Skin conductance
reactivity was negatively related to psychopathy (mean d = −0.31)
and unrelated to aggression, although when adult samples only were
examined, a small positive relationship was demonstrated (mean
d = 0.34). Lorber (2004) concluded that some support for inverse rela-
tionships between psychopathy and skin conductance reactivity had
been obtained, but noted that skin conductance and heart rate reactivity
 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
were also positively associated with aggression among adults, converse-
ly to expectations.
Ishikawa, Raine, Lencz, Bihrle, and Lacasse (2001) explored rela-
tionships between psychopathy, socioeconomic status (SES), memory
(assessed using the Wechsler Memory Scale—Revised; WMS-R),
Wisconsin Card Sorting Test (WCST) performance, criminal convictions,
and self report of experience of childhood stressors among 91 males
recruited from temporary employment agencies. Participants were
divided into psychopathic and control groups (top and bottom third
PCL-R scorers) and into successful and unsuccessful psychopath groups
dependent upon whether they had been convicted of a crime. Auto-
nomic responding was assessed during an emotional manipulation
task within which participants had 2 min to prepare and 2 min to give
a videotaped speech on their worst qualities while being observed by
a research assistant. WCST and WMS-R provided measures of executive
and memory function and five subscales from the Wechsler Adult Intel-
ligence Scale—Revised (WAIS-R) were used to estimate IQ. Successful
and unsuccessful psychopaths did not differ in self reported criminality.
After SES was accounted for, controls and successful psychopaths dem-
onstrated greater autonomic response than unsuccessful psychopaths.
Interestingly, the heart rate increase from baseline to task completion
was greater among successful psychopaths than both unsuccessful
psychopaths (d = 1.15) and controls (d = 0.80). Unsuccessful psycho-
paths and controls did not differ from each other in heart rate change.
Groups did not differ in skin conductance response, with all groups
increasing in response over the stressful task. After SES and ethnicity
were controlled for, successful psychopaths demonstrated better execu-
tive function than both unsuccessful psychopaths (d = 1.04) and
controls (d = 0.86), who did not differ. Successful psychopaths were
more likely to report childhood parental absence than controls (d =
1.14), whereas unsuccessful psychopaths did not significantly differ
from other groups. Ishikawa et al. (2001) argued that the deficits in
autonomic arousal and executive function previously thought to be
associated with psychopathy were actually more relevant for convicted
psychopaths in particular. Researchers noted that the successful and
unsuccessful groups did not differ in self-reported crime or SES, and
argued that successful psychopaths may avoid conviction through
better executive function and ability to effectively process threatening
stimuli (Ishikawa et al., 2001). Furthermore, researchers argued that pa-
rental absence may lead to dysfunction among successful psychopaths
(Ishikawa et al., 2001).
This conclusion runs contrary to historical conceptualizations of
primary or “true” psychopaths, thought to develop the disorder due to
deficient negative affect (Cleckley, 1941, 1976; Karpman, 1941;
Lilienfeld, 1994; Lykken, 1957; Skeem, Poythress, Edens, Lilienfeld, &
Cale, 2003). Primary psychopathy has been distinguished from sec-
ondary psychopathy, which is conceptualized as acquired due to
negative environmental influences and allowing guilt and empathy
to be experienced in some instances (Karpman, 1948). Primary
psychopathic offenders have been found to be more violent than
secondary (Swogger & Kosson, 2007), whereas secondary psycho-
pathic offenders endorse greater engagement in criminal behavior
(Lee & Salekin, 2010).
2.1. Summary of fearlessness review
Some support for lower autonomic response in psychopathy has
been demonstrated (Fung et al., 2005; Hare, 1968; Hare & Quinn,
1971), although this finding has not been universal. Patrick et al.
(1993) obtained no differences in autonomic responding between
psychopathic and non-psychopathic sex offenders. Hare (1968) found
normative autonomic increase among psychopathic offenders while
solving arithmetic problems. Glenn et al. (2007) obtained evidence of
autonomic responding among three year olds obtaining higher as
compared to lower psychopathy scores as adults. Ishikawa et al.
(2001) found that successful psychopaths demonstrated greater heart
623
rate and equivalent skin conductance response during a stressful task
compared to unsuccessful psychopaths and controls.
Interestingly, SES has also been found to be associated with de-
creased response to predictable aversive noise among youth (Fung
et al., 2005). Fewer delinquent than non-delinquent youth produce
skin conductance responses to aversive noise and high and low psy-
chopathy delinquents did not differ from each other (Fung et al.,
2005). Furthermore, in Lorber's (2004) meta-analytic review mea-
sures of autonomic arousal that were inversely related to psychopa-
thy were often unrelated to aggression or behavioral difficulties. As
Ishikawa et al. (2001) argued, fearlessness may be more strongly
associated with exposure to threatening stimuli (as a result of
poverty or delinquency), rather than psychopathy per se. Taken
together, these data suggest that decreased autonomic response
may result from exposure to dangerous stimuli due psychopathic
maladaptive behavior rather than serve as its cause.
3. Lack of empathy
Psychopathic individuals have been thought to lack empathy,
avoiding aversive emotions upon mistreating others (Hare, 1993;
Karpman, 1941, 1948). Decreased response to others' distress in par-
ticular, has been discussed as the pathological process leading to fail-
ures of normative socialization among the psychopathic (Blair, 2001;
Blair, Peschardt, Budhani, Mitchell, & Pine, 2006). As a behavior,
empathy can be thought of as taking on another's perspective. Under-
standing others' social roles, thoughts, and motives has been termed
cognitive perspective taking (Singer & Fehr, 2005). Sharing others' emo-
tions and feeling concern for their wellbeing entail affective perspective
taking (i.e., empathy; Singer & Fehr, 2005). Singer (2006) argues that
understanding and predicting one's own and others' emotions are
necessary to experience of empathy (i.e., affective perspective taking).
Perspective taking may arise through sharing others' neurobiological
activation to some extent (Gallesse & Goldman, 1998). Viewing images
of others' in pain has been associated with activation of pain processing
brain regions (Jackson, Meltzoff, & Decety, 2005). Taking on others'
perspectives appears to underlie prosocial behavior and reciprocity
(Batson et al., 1995; de Waal, 2008; Eisenberg & Miller, 1987; Knafo,
Steinberg, & Goldner, 2011). Lower childhood perspective taking has
been predictive of adult psychopathology (Schiffman et al., 2004).
Perspective taking has been associated with prosocial behavior
(Batson et al., 1995; de Waal, 2008; Eisenberg & Miller, 1987; Knafo
et al., 2011) and negatively related to aggression (Loudin, Loukas, &
Robinson, 2003; Richardson, Hammock, Smith, Gardner, & Signo,
1994). Lack of negative emotional response to others distress has been
thought to serve as a mediator of maladaptive psychopathic behavior
(Blair, 2001).
Glass and Newman (2006) measured facial affect recognition among
111 offenders classified as psychopathic and non-psychopathic using
PCL-R scores. Participants identified emotion in photographs of faces.
IQ was estimated using the Shipley Institute of Living Scale (Zachary,
1986) and high and low anxiety groups were created using a median
split with a self report measure. Psychopathic and non-psychopathic
offenders did not differ in estimated IQ. Low anxious psychopathic
participants (thought to be closer to the original conceptualization of
the disorder) did not differ from non-psychopathic in emotion recogni-
tion. Glass and Newman (2006) noted that, although this finding was
contrary to expectations (particularly for the emotion of fear), others
have also failed to find affect recognition deficits in association with
psychopathy. Researchers posited that affective processing deficits
among the psychopathic may be context dependent (Glass & Newman,
2006).
Richell et al. (2003) considered emotion recognition in eye region
images among 37 inmates classified as psychopathic and non-
psychopathic using PCL-R scores. Intelligence was estimated using
the Raven's progressive matrices test. Researchers did not obtain
624 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
statistically significant group differences in emotion recognition.
Participant scores were compared to published emotion recognition
task scores for individuals with Autism spectrum disorders and the
general population. In the current study, 17% of non-psychopathic
but 42% of psychopathic inmates performed below the published
Autism spectrum disorder group mean (although this difference was
not statistically significant). Interestingly 61% of non-psychopathic but
only 47% of psychopathic offenders scored below the published general
population emotion recognition task performance mean (the difference
between groups was not statistically significant). Richell et al. (2003)
concluded that the current study did not support emotion recognition
deficits among psychopathic offenders, but noted that other examinations
using functional neuroimaging have evidenced deficits. Researchers
suggested that it is possible that psychopathic individuals have impaired
amygdala functioning, but other brain regions compensate leading to a
lack of performance deficits.
Mullins-Nelson, Salekin, and Leistico (2006) administered measures
of psychopathy (Psychopathic Personality Inventory-Short Form, PPI-SF;
Lilienfeld, 2004) and antisocial behavior and assessed self-report and
behavioral perspective taking (recognition of emotion in voices and
faces) among 174 undergraduates. Psychopathy was inversely related
to self-reported empathy (r = −.41), but not to cognitive perspective
taking or performance in the emotion recognition task. Psychopathy
was inversely related to reported reactions of guilt (r = −0.30) and
shame (r = −0.28) in social vignette scenarios. The PPI-SF items were
separated into personality (PPI-SF I) and behavioral (PPI-SF II) psychop-
athy components. When PPI-SF components were examined separately,
PPI-SF II was negatively related to both cognitive (r = −.28) and affec-
tive (r = −.40) self-reports of perspective taking and emotion recogni-
tion performance (r = −.18). Interestingly, the interpersonal/affective
psychopathy component was positively related to cognitive perspective
taking (r = .16), with the relationship holding for males only when
genders were examined separately (r = .31; Mullins-Nelson et al.,
2006). Some support for a negative association between perspective
taking and psychopathy was obtained.
Ali and Chamorro-Premuzic (2010) explored relationships between
psychopathy, Machiavellianism, and empathy questionnaires and a
behavioral emotion identification accuracy task among 112 undergrad-
uates. The emotion identification task required participants to identify
emotions expressed in images of eyes and faces as well as in recorded
vocal tone. Researchers found that both Factor I (r = −0.47) and Factor
II (r = −0.40) were negatively related to empathy questionnaire
scores. Factor I was inversely associated with emotion identification in
images of faces (r = −0.26), eyes (r = −0.24) and in vocal expres-
sions (r = −0.24). Factor II was negatively related to recognition of
emotion in images of eyes (r = −0.21). Ali and Chamorro-Premuzic
(2010) assessed relationships between psychopathy and negative
emotional expressions due to emphasis on distress recognition impair-
ment among individuals high in psychopathy (see Blair, 2001). Factor I
or Factor II was not significantly related to recognition of negative
emotional expressions in eyes, faces, or vocal tone. Factor I was inversely
associated with accurate identification of neutral (e.g. thoughtful)
emotional expressions in facial (r = −0.24) and eye (r = −0.29)
images and vocal tone (r = −0.30), and Factor II showed a similar rela-
tionship with identification of positive emotions from images of eyes
(r = −0.30). Machiavellianism was negatively correlated with self
reported empathy and identification of emotion in facial expressions
(r = −0.21) and neutral vocalizations (r = −0.19). Ali and Chamorro-
Premuzic (2010) suggested that Factor I may be inversely related to
identification of neutral emotions because more extreme emotional states
may be more useful in manipulating others. Furthermore, researchers
concluded that stronger relationships between perspective taking deficits
and Factor I was consistent with Factor I focus on interpersonal and
affective deficits (Ali & Chamorro-Premuzic, 2010).
Iria and Barbosa (2009) assessed emotion identification among 62
criminal psychopathic, criminal non-psychopathic, non-criminal
psychopathic, and non-criminal non-psychopathic Caucasian male
participants. Participant psychopathy was assessed using a screen-
ing version of the gold standard Psychopathy Checklist (PCL:SV;
Hart, Cox, & Hare, 1995). Criminal participants were recruited from
prisons and police stations and non-criminal participants from
employment agencies. Criminal records and self report were used
to determine criminal or non-criminal status. Participants were
instructed to respond when a fearful facial expression was displayed
in an emotion recognition task. Psychopathy was associated with
poorer facial identification performance (Cohen's d calculated from
presented data = 1.04). Criminality or the interaction between
criminality and psychopathy was not related to overall fear identifi-
cation scores. Psychopathy (but not criminality) was associated
with failure to act when a fearful face was presented (d = 1.20).
Interestingly (considering the relationship between psychopathy
and impulsivity; Newman, Widom, & Nathan, 1985) psychopathy
and criminality were not significantly associated with greater
responding to non-fearful faces. Iria and Barbosa (2009) noted that
psychopaths and criminal non-psychopaths were twice as likely to
respond to non-fearful faces as non-criminal non-psychopaths.
This effect was not statistically significant, although the finding
may have been influenced by a small sample size. Iria and Barbosa
(2009) concluded that deficits in fear recognition among both crim-
inal and non-criminal psychopaths provided support for the idea
that distress recognition serves as a mechanism of dysfunction in
psychopathy.
Blair et al. (2002) explored relationships between psychopathy
(assessed using the PCL-R; Hare, 1991) and identification of emotion
in vocalizations of neutral words in 39 male inmates. Non-verbal intel-
ligence test scores (Raven's Advanced Progressive Matrix; Raven, 1965)
did not evidence group differences. IQ was inversely related to mistakes
in identifying fear (r = −0.61) and disgust (r = −0.50). Psychopathic
participants performed more poorly in emotion identification than non-
psychopathic after IQ was controlled. When specific emotions were
examined, analyses revealed psychopathic deficits in identification
of fear but not other emotions. Notably, psychopathic and non-
psychopathic inmates made similar emotion recognition errors; mis-
taking sadness for fear and happiness, happiness for disgust, and
disgust for anger. Blair et al. (2002) concluded that findings provided
support for impaired response to others' distress (i.e., the violence
inhibition model) as a mechanism of dysfunction in psychopathy.
Dadds et al. (2009) explored relationships between parent reports of
callous–unemotional traits (CU traits; analogous to interpersonal and
affective deficits in psychopathy), empathy, and antisocial behavior of
2,760 youth aged three to 13. Participants were divided into high and
low psychopathy and antisocial behavior groups (on the basis of scoring
in the top and bottom 25% compared to peers of their gender). Parent
reported cognitive and affective components of empathy demonstrated
a small relationship (r = 0.06), suggesting that these aspects were not
strongly related. Nine to 13 year-old youth obtained lower antisocial
behavior scores than younger children. Cognitive empathy was nega-
tively related to CU traits among both males (r = −0.41) and females
(r = −0.39), and affective empathy demonstrated this relationship
for males alone (r = −0.17). Females were generally higher in cogni-
tive and affective empathy and lower in CU traits compared to males.
Cognitive empathy in males high in CU traits was deficient in early
childhood but reached normative levels by the time they entered the
nine to 13 age group (participants were analyzed in five age groups).
Females high in CU traits continued to be lower in cognitive empathy
than their peers. Dadds et al. (2009) noted that, given parent report
methodology, the study spoke to observable behaviors associated with
empathy. Researchers posited that the lack of a relationship between
affective empathy and psychopathic traits among females may imply a
differential developmental path for antisocial behavior (i.e., greater
vulnerability to stress and emotion dysregulation). Dadds et al. (2009)
pointed out that high psychopathy males appeared to catch up to
 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
their peers in cognitive empathy, but cautioned that the finding may
indicate learning to perform more socially acceptable behaviors as
parent report assessment was used. Dadds et al. (2009) suggested that
sharing others emotions may motivate the development of cognitive
perspective taking, leading to its delay among males high in psycho-
pathic traits.
3.1. Summarizing perspective taking
Findings on perspective taking deficits in psychopathy have been
mixed. Cognitive perspective taking was unrelated to psychopathy
in several studies using offender samples (Glass & Newman, 2006;
Richell et al., 2003). Other researchers have found the expected def-
icit among offenders, particularly when identification of fear was
examined (Blair et al., 2002; Iria & Barbosa, 2009). When deficits
were demonstrated, psychopathy rather than criminality predicted
poorer performance (Iria & Barbosa, 2009). Cognitive perspective
taking was lower among high psychopathy youth in the community,
although cognitive perspective of high psychopathy male youth was
normative by the nine to 13 age bracket group (Dadds et al., 2009).
Self-report and behavioral measure findings of cognitive perspective
taking were mixed among undergraduates, with one study but not the
other finding an effect (Ali & Chamorro-Premuzic, 2010; Mullins-
Nelson et al., 2006). Affective perspective taking was inversely related
to psychopathy among male youth using parent report methodology
(Dadds et al., 2009) and in self-report data among undergraduates (Ali
& Chamorro-Premuzic, 2010; Mullins-Nelson et al., 2006). Findings
suggest that psychopathic individuals may experience some difficulties
in identifying expressions of distress among others and that affective,
rather than cognitive perspective taking, may play a bigger role among
non-offenders.
4. Response modulation
Inability to learn from experience (i.e., modify behavior in response
to aversive consequences) has been proposed as a mechanism of
dysfunction in psychopathic behavior. Karpman (1948) argued that
psychopathic patients committing relatively minor offenses (e.g., theft,
larceny) should never be released due to inability to modify behavior.
Psychopathy researchers have discussed maladaptive resistance to
extinction among previously reinforced behaviors (i.e., perseveration;
Freeman & Gathercole, 1966) and failure to inhibit behavior to avoid
aversives (i.e., passive avoidance learning; Newman et al., 1985). Neuro-
physiological explanations (i.e., reinforcement sensitivity theory; Gray,
1970, 1987 and its revision; Gray & McNaughton, 2000) have been
proposed to account for these behavioral tendencies. Broadly speaking,
psychopathic individuals are thought to be more sensitive to appetitive
and less sensitive to aversive stimuli (Fowles, 1980; Fowles & Dindo,
2006). Temperamental differences likely interact with context.
4.1. Behavioral perseveration
Siegel (1978) compared behavioral perseveration in 50 male violent
sex offender psychiatric patients to 25 non-offenders drawn from col-
lege students and hospital employees. Offender psychopathy was
assessed using therapist ratings and a median split method was used
to divide participants into high and low psychopathy groups. Partici-
pants played a card game for poker chips redeemable for one cent
each at the end of the study. Eleven decks, with proportion of reward
cards varying from 100% to 0% in 10% increments were presented in
random order. Participants could stop the game at any time and move
on to the next deck or continue playing until all of the cards were turned
over. Psychopathic participants were more likely to continue playing
than non-psychopathic offenders and controls. Differential psychopath-
ic perseveration was most apparent in decks when loss of reward was
uncertain (40% to 70% loss cards) and psychopathic participants did
625
not differ from other groups under more certain conditions (10–30%
and 100% loss cards). Predictably, psychopathic participant persevera-
tion led them to win less money than other groups, interpreted by
Siegel (1978) as evidence of maladaptive behavior. Participants did
not evidence group differences in recalling proportion of loss cards
during the 30% and 70% loss card decks. After the 70% loss card deck,
psychopathic participants tended to underestimate the probability
that the next card would result in chip loss, performing less accurately
than non-psychopathic offender and control groups (mean estimates
of loss: psychopathic: 55.21%, non-psychopathic offender: 69.11%,
control: 71.20%). Siegel (1978) concluded that psychopathy was
associated with decreased responsiveness to uncertain punishment
and argued that this was analogous to legal consequences for crime
commission. Siegel (1978) noted that qualitative observations of
psychopathic participant verbal behavior indicated potential
reliance on superstition in decision making (e.g., references to ESP,
decision to stop playing after turn over a queen due to little luck
with the ladies).
Newman, Patterson, and Kosson (1987) remarked that the probabil-
ity of punishment did not vary within decks in Siegel (1987) study and
argued that such variability was needed to evaluate response to changes
in context. Researchers contended that Siegel's (1978) high reward cost
(90% and 100% loss) decks did not allow a perseverative response to be
established. Newman et al. (1987) altered Siegel's (1978) procedure so
that proportion of loss cards increased systematically by 10% with each
deck (starting with 10%). Participants were 36 psychopathic and 36
non-psychopathic (assessed with the PCL; Hare, 1980) male inmates.
Individuals were randomly assigned to three conditions; responding
immediately with feedback on gain or loss, responding immediately
with information on current action and overall winnings, and forced
five second delay prior to responding with current and overall
rates of winning. Psychopathic offenders earned less money than
non-psychopathic when receiving both immediate and cumulative
feedback. However, forcing a five-second delay between feedback
and the ability to respond increased the earnings of psychopathic
offenders to match those of non-psychopathic offenders in the
response delay condition (Newman et al., 1987). Newman et al.
(1987) argued that the forced delay may have interrupted the
perseverative behavioral repertoire and allowed psychopathic par-
ticipants to attend to feedback.
4.2. Passive avoidance learning
Passive avoidance can be defined as inhibition of behavior to
evade aversive consequences (Newman et al., 1985). Schmauk
(1970) examined the effectiveness of varied consequences in shap-
ing psychopathic behavior. Measures of anxiety and personality
(MMPI) were used to classify participants as primary psychopaths,
secondary/neurotic psychopaths, and non-psychopaths. 30 primary
psychopathic participants were drawn from county prison, 30
secondary psychopathic participants from the county prison and
forensic psychiatric unit, and 30 controls from among local farm
workers and hospital employees. Participants navigated a maze 10
times while an equal number from each group received one of
three aversives for incorrect choices; shock (physical), loss of
money (tangible, loss of quarter from initial 40), and being told
they were wrong (social). Subjective anxiety ratings and skin con-
ductance responses were assessed. Participants were less likely to
make incorrect responses when the consequence was loss of
money rather than negative social feedback or shock. Controls
made fewer errors in response to shock than primary psychopaths
and in response to social feedback than both primary and secondary
psychopaths (who did not differ). Notably, no group differences
were found in response to loss of money. All groups were more
autonomically reactive to shock compared to other aversives and
no group differences in skin conductance response were obtained.
626 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
Autonomic adaptation (defined as difference in response between
trials two and nine) was greater in the shock and loss of money con-
ditions compared to the social feedback condition. Participants
were asked to provide subjective anxiety ratings before the maze,
after the first trial, and after maze completion.
Primary psychopaths reported less anxiety prior to attempting the
maze, but did not differ from other participants on subsequent ratings.
Interestingly, when loss of money was the consequence, primary psy-
chopaths rated themselves as more anxious after maze completion
than in the shock or social aversive condition, more anxious compared
to secondary psychopaths and (non-significantly) more anxious than
controls. Participants were asked if there had been any relationship be-
tween their responses and consequences. Primary psychopaths were
more likely to report a connection between response and consequence
in loss of money compared to other conditions and did not differ in this
report compared to other groups. Primary psychopaths were less likely
to report noticing relationship between response and consequence in
the shock condition compared to other groups and in the social condi-
tion compared to controls. Schmauk (1970) pointed out that avoidance
learning was thought to be motivated by fear and anxiety, with a deficit
in these emotions underlying psychopathic dysfunction. He argued that
primary psychopaths appeared to be capable of normative responding
but may require different consequences (Schmauk, 1970).
Newman et al. (1985) assessed passive avoidance learning in 90 ad-
olescent male offenders residing at a juvenile correctional facility. Par-
ticipants were given the MMPI and a self report measure of anxiety
and classified into high and low psychopathy (on the basis of psycho-
pathic deviate scale scores) and high and low anxiety groups using a
median split. Participants played two card games for poker chips ex-
changed for tangible rewards (candy or cigarettes). In the first game,
participants could either win or lose chips, in the second, chips could
only be won and there was no loss for incorrect decisions. Primary psy-
chopathic (high psychopathy and low anxiety) participants were more
likely to make passive avoidance errors in the loss and gain of reward
task than secondary psychopathic (high anxiety and psychopathy)
and non-psychopathic (low anxiety and psychopathy). Notably second-
ary psychopathic and non-psychopathic participants did not differ,
suggesting that anxiety may serve as a protective factor. When loss of
reward was not possible, group differences in incorrect decisions were
not apparent. Newman et al. (1985) noted that while Schmauk (1970)
demonstrated that psychopathic participants were responsive to mone-
tary consequences, this effect was not obtained in their study. Re-
searchers suggested that psychopathic individuals may focus on the
immediate desire to obtain a reward to the exclusion of further consid-
eration of consequences.
Newman, Kosson, and Patterson (1992) assessed delay of gratifica-
tion in 158 Caucasian male inmates of normative intelligence designat-
ed as psychopathic and non-psychopathic on the basis of PCL (Hare,
1985) scores. Participants provided self report anxiety data and were
given the Shipley scale to obtain an estimate of intelligence. Delay of
gratification was assessed using a money earning behavioral task with
two choices providing varied rates of reward or reward loss. Participants
were tested in three conditions. In the reward condition an immediately
available choice resulted in winning 40% of the time and a delayed (by
ten seconds) choice lead to winning 80% of the time. In reward and pun-
ishment the immediately available choice resulted in winning 70% and
losing money 30% of the time and the delayed choice in winning 90%
and losing 10% of the time. The equal condition was identical to the re-
ward condition, except that participants had to wait 10 s before
selecting either choice. Intelligence was unrelated to task performance.
Performance of high and low anxious psychopathic participants differed
across condition, whereas the same was not true of non-psychopathic
participants. Performance of highly anxious psychopathic and non-
psychopathic participants did not differ. Low anxious psychopathic par-
ticipants were less likely than low anxious controls to select the high re-
ward delayed option in the reward compared to equal condition. Low
anxious psychopaths earned the most in the equal condition, followed
by reward, and reward and punishment. Researchers concluded that
the study provided support for the idea that low anxious psychopathic
participants experience more difficulties delaying gratification and
noted that the effect appeared to be associated with decreased sensitiv-
ity to punishment (Newman et al., 1992).
Arnett, Smith, and Newman (1997) measured performance of 63 in-
mates in response to reward and punishment. Participant psychopathy
(PCL-R), anxiety (self report, median split), estimated IQ (Shipley Insti-
tute of Living Scale; Zachary, 1986), heart rate, electrodermal response,
and response speed were assessed. Participants completed a task in
which they were to quickly press buttons when a green light was lit
and avoid pressing as a red light was presented. The task began with a
reward phase, in which participants started with one dollar and could
earn five cents through successfully pressing five correct buttons quick-
ly enough. Subsequently, reward and punishment became available in
the passive avoidance phase, at which time participants would lose 25
cents for pushing a red light button. High anxiety non-psychopathic re-
sponse was more delayed than that of high anxiety psychopathic and
low anxiety non-psychopathic participants. Notably, no significant dif-
ference in the number of passive avoidance errors between low anxious
psychopathic and non-psychopathic participants was obtained. In the
reward phase, psychopathic participants tended to respond faster than
controls. Response speed increased faster for low anxious psychopathic
compared to low anxious non-psychopathic participants in the reward,
but not passive avoidance phase. Psychopathic participants tended to
demonstrate smaller skin conductance responses than non-
psychopathic in passive avoidance, although low anxious psychopathic
and non-psychopathic groups did not differ. High anxious psychopathic
participants tended to speed up responding in the passive avoidance
phase, whereas high anxious non-psychopathic participants tended to
decrease response speed. Low anxious psychopathic participants in-
creased response speed more than low anxiety controls in the passive
avoidance phase. Researchers argued that findings supported a strong
behavioral approach system (sensitivity to reinforcement) model of
psychopathy.
In the second part of the examination, Arnett et al. (1997) replaced
the initial reward phase with an active avoidance phase, again followed
by passive avoidance and similar methodology in 71 inmates. The sec-
ond study differed in that participants began the task with seven dollars.
The active avoidance phase involved a loss of five cents every time par-
ticipants failed to provide responses within the allotted time. Low anx-
ious controls made more passive avoidance errors than low anxious
psychopathic participants. Other differences were not statistically sig-
nificant. Researchers concluded that the studies provided support for
reward oversensitivity as a mechanism of dysfunction in psychopathy.
Arnett et al. (1997) argued that failure to find association between pas-
sive avoidance learning error and psychopathy may have been an arti-
fact of immediate pairing between response and aversive in the
examination.
4.3. Summarizing response modulation research
Effectiveness of varied consequences in shaping psychopathic be-
havior has been considered. Schmauk (1970) demonstrated that psy-
chopathic participants responded normatively to loss of money,
though they were less responsive to shock and negative social feedback
than controls. Schmauk's findings may have been confounded by draw-
ing psychopathic participants from forensic settings and controls from
the community; nonetheless researchers have focused on tangible re-
wards in examinations of response modulation. When working for tan-
gible rewards, the behavior of psychopathic participants has been
shaped by context. Psychopathic offenders were likely to continue
with a course of action when the probability of reward was uncertain
and to underestimate the probability of loss (Siegel, 1978). This re-
sponse pattern could be interrupted with a forced delay, bringing the
 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
performance of psychopathic offenders up to that of non-psychopathic
(Newman et al., 1987). Findings suggest that when consequences are
uncertain, psychopathic participants may have greater difficulty shifting
their behavioral pattern, although they are capable of doing so. Persev-
erative response pattern may be associated with impulsivity and ten-
dency to seek immediate gratification; psychopathic offenders have
been less likely to select more frequently rewarding responses that
require a delay (e.g., delay discounting; Newman et al., 1992). Changing
behavior in response to aversives appears to be particularly challenging
for psychopathic participants, with a deficit presenting when loss of re-
ward rather than reward alone was a potential consequence (Newman
et al., 1985). Response modulation deficits have not been universally
demonstrated, with Arnett et al. (1997) finding no difference in passive
avoidance errors between low anxious psychopathic and non-
psychopathic participants.
5. Discussion
Maladaptive behaviors in individuals high in psychopathy have been
viewed as notoriously difficult to treat (Kernberg, 1998; Rollins, 1975;
Seto & Barbaree, 1999) due to unique challenges associated with abnor-
mal emotional response to aversive consequences, lack of empathy to-
wards others, and difficulties in response modulation (Patrick, 2010).
The existing research base provides rich information allowing these
mechanisms of dysfunction to be considered.
Psychopathy has been associated with lower autonomic response to
aversive stimuli (Fung et al., 2005; Hare, 1968; Hare & Quinn, 1971;
Lorber, 2004; Patrick et al., 1994), consistent with the fearlessness
hypothesis of psychopathic dysfunction. Despite these associations,
some have found evidence of higher childhood autonomic activity
among adults higher in psychopathy (Glenn et al., 2007), suggesting
that decreased autonomic reactivity may be an effect rather than a
cause of psychopathy. Individuals high in psychopathy may be more
likely to be exposed to danger due to engagement in antisocial and
impulsive behavior, leading to extinction of autonomic reaction to
lower levels of threat. Consistent with this hypothesis, Fung et al.
(2005) found no differences in autonomic responsiveness between
delinquent adolescents high and low in psychopathy, suggesting that
exposure to danger through risky behavior may play a bigger role
than psychopathy.
While autonomic response research provides useful information, a
caveat must be considered. Autonomic arousal does not necessarily
represent negative emotions. As discussed by Lilienfeld and Landfield
(2008) in relation to polygraph testing, autonomic arousal merely indi-
cates a strong emotional response. Mild aversives (shock, unpleasant
sound, etc.) may not evoke a particular strong response, particularly
among offenders with a broad criminal behavior repertoire (an item
contributing to higher PCL-R scores). Identifying stimuli functioning as
aversives for offenders (e.g., wearing a wig in front of other inmates)
combined with autonomic measures may provide for more precise
measurement of negative affect. If deficits in autonomic response
serve as a mechanism of dysfunction leading individuals high in
psychopathy to engage in maladaptive behaviors, these deficits should
precede engagement in misbehavior and mediate the relationship.
Longitudinal examinations would allow researchers to establish tempo-
ral precedence and clarify the issue of whether autonomic response is a
cause or effect in the relationship between psychopathy and socially
deviant behavior. Studies examining development of psychopathy
from childhood would be particularly useful.
Researchers have explored effects of varied positive and negative
consequences on psychopathic behavior. Changing behavior in response
to aversive (but not appetitive) consequences appears to be more
challenging for psychopathic participants (Newman et al., 1985).
Nonetheless certain aversives may be more salient to psychopathic indi-
viduals. Although psychopathic offenders were less responsive than
controls to shock and negative social feedback, they did not demonstrate
627
a responsiveness deficit when loss of money was used as an aversive
(Schmauk, 1970). This finding may also be considered from a learning
history perspective. Negative emotional response among individuals
who have been frequently exposed to physical pain and negative social
feedback may decrease in strength or extinguish.
When both positive and negative consequences were present,
psychopathic participants demonstrated behavioral deficits. Psycho-
pathic individuals may continue in a course of action after it is no longer
advantageous to do so, particularly when possibility of appetitive as
opposed to aversive is uncertain (Siegel, 1978). Notably, this response
may be interrupted with a forced delay (Newman et al., 1987), provid-
ing an avenue for shaping. This behavioral repertoire may also have
been shaped by a learning history in which selecting an appetitive and
disregarding consequences has been advantageous. Psychopathic indi-
viduals may be able to disrupt that pattern, as evidenced by the forced
delay findings.
Response modulation findings provide invaluable contributions;
however, examinations have typically focused on forensic samples.
Ability to modify behavior in response to contextual changes may
be less impaired among “successful” psychopaths, individuals high
in psychopathy who have been able to avoid criminal charges or
institutionalization due to skill or resources (Widom, 1977). Psycho-
pathic individuals able to avoid getting caught may differ from those
who have failed to do so. While researchers have recently turned
their attention to studying psychopathy within the business world
and the community (Babiak, 1995; Babiak, Neumann, & Hare,
2010; Wilson, Demetrioff, & Porter, 2008) the literature on mecha-
nisms of dysfunction within this population is limited. Examinations
of the behavior of these individuals may provide insight into which
psychopathic characteristics are associated with psychopathy rather
than criminality. Moreover, such research may provide evidence of
potential protective factors maintaining a relatively higher level of
function among such individuals.
Psychopathic individuals have been thought to be particularly
callous and lacking in empathy in their interactions with others,
leading to a decreased desire to alter behavior that is harmful to
others. Although this hypothesis has intuitive sense and may play a
role in psychopathic dysfunction, it does not capture the whole
picture. Psychopathy has been negatively related to cognitive per-
spective taking (Ali & Chamorro-Premuzic, 2010; Glass & Newman,
2006; Richell et al., 2003), particularly to expressions of distress
among others (Blair et al., 2002; Iria & Barbosa, 2009). Self report
and parent observed empathy was similarly negatively related to
psychopathy (Ali & Chamorro-Premuzic, 2010; Dadds et al., 2009;
Mullins-Nelson et al., 2006). Negative internal emotion is thought
to be deficient among psychopathic participants leading to maladap-
tive behavior. Failure to either recognize or share the distress of
others could be responsible.
Research on the lack of empathy in relation to psychopathy has
provided some evidence of emotion recognition deficits (e.g., cognitive
perspective taking), however inability to share the distress of victims
has been considered to be more important in psychopathic dysfunction
(Blair, 2001; Blair et al., 2006). Empathy (sharing emotion) has typically
been assessed using self and observer report methodology, with func-
tional brain imaging techniques providing an additional avenue. Self
report methodology has a number of potential pitfalls. Individuals
may present any number of response biases (e.g., social desirability,
over- and under-reporting) and be unable to provide accurate reports.
Psychopathic participants reporting on empathy may not have an
accurate conceptualization of the construct, if they have never suffi-
ciently experienced it. As empathy is a private behavior, use of
observer reports may measure engagement in behaviors thought to
stem from an empathic response, rather than the experience of
empathy itself (as noted by Dadds et al., 2009). Functional brain
imaging techniques provide a rich and useful avenue of research,
but are generally expensive and inaccessible to many. Development
628 O.V. Berkout et al. / Aggression and Violent Behavior 18 (2013) 620–629
of alternative measures of affective empathy would greatly benefit
the psychopathy research community.
6. Future directions
Extant examinations of psychopathy provide a rich basis for future
research. Development of more precise preparations measuring
autonomic response to aversives, new measures of empathy, and
study of “successful” psychopathic individuals would greatly benefit
conceptualizations of mechanisms of dysfunction. Larger sample
sizes and sophisticated statistical analyses (e.g., structural equation
modeling, hierarchical linear modeling) would provide new
avenues to examine these as mediators of psychopathic dysfunction.
Longitudinal and developmental data would strengthen assertions
of causality. Multimethod assessment of empathy (e.g., self report,
observer report, behavioral measures) and fear (e.g., self report,
facial muscle response, autonomic response to stimulus functioning
as aversive) would allow for more complete and valid measurement
of constructs. While these methodologies are undoubtedly more
costly and difficult to implement, their contribution would justify
the additional resources. Exploration of protective mechanisms in
addition to mechanisms of dysfunction would further add to under-
standing of maladaptive expressions of psychopathy.
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