A Rorschach comparison of psychopaths, sexual homicide perpetrators, and nonviolent pedophiles: where angels fear to tread

Nonsexually offending psychopaths (N = 32) were compared to sexual homicide perpetrators (N = 38) and nonviolent pedophiles (N = 39) on select Comprehensive System Rorschach variables (Exner et al., 1993). Results indicate similarities among the groups in pathological narcissism, formal thought disorder, and borderline level reality testing. Nonsexually offending psychopaths are distinguished by their lack of interest in and attachment to others and their seemingly conflict-free internal world. While both sexually deviant groups evidenced interest in others and appear to experience a very dysphoric internal world, the sexual homicide perpetrators are distinguished by high levels of obsessional thought and an inability to disengage from environmental stimuli. Pedophiles show significantly more characterological anger, which may stem from their general inadequacy, cognitive rigidness, less alloplastic (acting out) style, and their introversive inability to gratify their needs. Rorschach differences add to our understanding of sexual deviation and violence among these three groups.     

How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse

This paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders. Some testable predictions from the hypothesis are presented, together with its implications; most importantly, that measures to prevent serious antisocial behaviour in adulthood should target at-risk individuals prior to their commencing heavy drinking during adolescence.     

Childhood trauma, borderline personality symptomatology, and psychophysiological and pain disorders in adulthood

In the empirical literature, there is support for the idea of a relationship between childhood trauma and various psychophysiological as well as pain disorders, and between borderline personality symptomatology and somatic preoccupation, as well as chronic pain. However, to date, no single study has examined the relationships between childhood trauma and borderline personality symptomatology, and the number of psychophysiological and pain disorders in adulthood. In this study, the authors examined these relationships and found no significant correlation between borderline personality symptomatology and the number of psychophysiological and pain disorders. However, there were positive and significant correlations between childhood physical abuse, emotional abuse, and witnessing violence and the number of psychophysiological and pain disorders in adulthood. Using hierarchical-regression analyses to determine which specific childhood traumas significantly predicted the number of psychophysiological and pain disorders, only witnessing violence emerged, accounting for 12% of the variance. These data suggest that a general factor associated with various forms of trauma predicts number of psychophysiological and pain disorders and that a specific predictor may be witnessing violence in childhood.     

Does sexual violence contribute to elevated rates of anxiety and depression in females?

BACKGROUND: It is well documented that females have higher rates of internalizing disorders (anxiety, depression) than males. It is also well known that females have higher exposure to childhood sexual abuse and sexual assault. Recently, it has been proposed that the higher levels of internalizing disorders in females may be caused by their greater exposure to sexual violence. METHOD: Data were gathered as part of the Christchurch Health and Development Study. In this study a cohort of 1265 children born in Christchurch, New Zealand, in 1977 have been studied from birth to age 21 years. The measures collected included: major depression and anxiety, childhood sexual abuse and adolescent sexual assault. RESULTS: Findings confirmed the established conclusion that internalizing disorders are over twice as common in females than males (ORs 2.2-2.7). In addition, it was found that females were exposed to higher rates of sexual violence than males (ORs 5.1-8.4). Statistical control for gender related differences in exposure to sexual violence reduced the associations between gender and anxiety and depression. Nonetheless, even after such control, gender was significantly (P < 0.0001) related to both anxiety (OR = 1.8; 95% CI, 1.3-2.4) and depression (OR = 1.9; 95% CI, 1.4-2.3). CONCLUSIONS: Greater female exposure to sexual violence may be a factor that contributes to greater female susceptibility to internalizing disorders. However, even after adjustment for gender differences in exposure to sexual violence it is clear that a substantial relationship between gender and internalizing disorder persists.     

Emotion processing in Psychopathy Checklist — assessed psychopathy: A review of the literature

Deficient emotional experience is recognized as one of the central features of psychopathy and an impressive body of empirical findings regarding emotion processing in psychopathy has amassed over the past several decades, resulting in two broad theoretical perspectives. The general emotional deficit perspective postulates a globally reduced capacity for emotional experience and processing across the emotional spectrum. In contrast, according to the specific emotional deficit perspective, psychopathy is associated with abnormal experience of only specific types of emotion; several distinct hypotheses have been proposed under this latter perspective. We systematically and critically review findings from peer-reviewed research of emotion processing in psychopathy in relation to the two theoretical perspectives. In general, findings suggest that, compared to controls, psychopaths exhibit behavioral, psychophysiologic, and regional brain activation anomalies when processing emotion, but their ratings of self-arousal and stimulus valence/intensity do not differ from controls. However, when behavioral findings are examined separately by emotion type, the overall pattern of findings is not clearly consistent with any of the dominant theoretical perspectives of emotion processing in psychopathy. We summarize the current state of the field, including consistencies and inconsistencies in the literature, offer alternative explanations for the findings, and outline directions for future research.     

Posttraumatic stress symptoms and victimization among Japanese American women

This study of Japanese American women and immigrant women from Japan investigated the relationship between posttraumatic stress (PTS) symptoms and the perceived abusiveness of partners' emotional and physical violence, with a community-based randon sample. Women who experienced injuries and/or fear for their lives, in addition to partners' emotional and physical violence, had significantly higher PTS symptom counts than those with no lifetime experience of partners' violence. Victimization by nonintimates also increased PTS symptom counts. Satisfaction with social support significantly mitigated the negative effect of childhood abuse for reexperiencing and avoidance symptoms.     

Impaired emotional contagion following severe traumatic brain injury

Empathy deficits are widely-documented in individuals after severe traumatic brain injury (TBI). This study examined the relationship between empathy deficits and psychophysiological responsivity in adults with TBI to determine if impaired responsivity is ameliorated through repeated emotional stimulus presentations. Nineteen TBI participants (13 males; 41 years) and 25 control participants (14 males; 31 years) viewed five repetitions of six 2-min film clip segments containing pleasant, unpleasant, and neutral content. Facial muscle responses (zygomaticus and corrugator), tonic heart rate (HR) and skin conductance level (SCL) were recorded. Mean responses for each viewing period were compared to a pre-experiment 2-min resting baseline period. Self-reported emotional empathy was also assessed. TBI participants demonstrated identical EMG response patterns to controls, i.e. an initial large facial response to both pleasant and unpleasant films, followed by habituation over repetitions for pleasant films, and sustained response to unpleasant films. Additionally, an increase in both arousal and HR deceleration to stimulus repetitions was found, which was larger for TBI participants. Compared to controls, TBI participants self-reported lower emotional empathy, and had lower resting arousal, and these measures were positively correlated. Results are consistent with TBI producing impairments in emotional empathy and responsivity. While some normalisation of physiological arousal appeared with repeated stimulus presentations, this came at the cost of greater attentional effort.     

Can self-pain sensitivity quantify empathy for others' pain?

Empathy is essential for the survival of social species. In many studies, especially those with animal models, empathy for pain was evaluated by the modulation of pain sensitivity. However, the relationship between pain sensitivity and empathy for pain is not well established. Here, by performing two experiments, we aimed to investigate their relationship at both behavioral and electrophysiological levels. In Experiment 1, we characterized individual pain sensitivity using pain threshold and tolerance in a cold pressor test, self-report empathy using Interpersonal Reactivity Index, and pain-related psychological factors, including pain-related anxiety, depression, pain catastrophizing, and pain-related fear, using well-validated questionnaires. We observed that pain sensitivity was positively correlated with emotional empathy, and their relationship was mediated by pain-related anxiety, pain catastrophizing, and pain-related fear. In Experiment 2, we quantified empathy for pain using pain intensity and unpleasantness as well as event-related potentials (ERPs) in an empathy for pain task. Positive correlations were observed between pain sensitivity and psychophysiological empathic responses (i.e., the P3 component and the late positive potential in ERPs), and their relationship was mediated by pain-related fear. These results suggested that being influenced by some pain-related psychological factors, individuals with higher pain sensitivity tended to have stronger empathy for pain, manifested as stronger emotional reactions to others' pain. Our results indicated that the conventional strategy of using pain sensitivity to quantify empathy should be treated with caution, as their relationship could be disturbed by experimental manipulations or pathological modulations that could influence individual emotional states or cognitive processes.     

Prefrontal substrates of empathy: Psychometric evidence in a community sample

Empathy is a vicarious experience of others’ emotions, and is crucial to many forms of adaptive social interaction. Clinical, experimental, and functional neuroimaging studies convergently suggest a role for prefrontal-limbic circuits in mediating empathy. This study examined the prefrontal basis of empathy in a community sample using self-report measures: the frontal systems behavior scale (FrSBe), Barratt impulsiveness scale (BIS), and the interpersonal reactivity index (IRI). Multiple correlations emerged supporting an inverse relationship between prefrontal system dysfunction and empathy, particularly emotional empathy and perspective taking. Many of these relationships persisted after controlling for age, sex, and education. However, FrSBe scales did not correlate with one's identification with fictional characters, and motor impulsivity correlated positively, presumably due to the different cognitive and emotional context (i.e. real versus fictional individuals). These studies parallel others using objective methodologies and suggest a graded relationship between prefrontal function and empathy and likely reflect normal variations in prefrontal-limbic function.     

Neighborhood sexual violence moderates women's perceived safety in urban neighborhoods

Perceptions of neighborhood safety are positively associated with perceptions of neighborhood violence. However, research has yet to examine whether this relationship is moderated by specific types of violence, such as sexual violence, that are more salient for women. Using street‐intercept interviews with 343 adults in 9 neighborhoods of a U.S. city with high rates of poverty, unemployment, and crime, we examine the relationship of perceived neighborhood violence to perceived safety in the context of gender while controlling for neighborhood assets that moderate perceptions of neighborhood safety and violence. We hypothesized that gender would moderate the relationship between perceived neighborhood violence and safety, and that women's perceptions of neighborhood safety would be significantly influenced by neighborhood sexual violence, but not other types of violence. Although women and men in these high crime, urban neighborhoods did not differ in their perceptions of neighborhood safety or violence, perceived sexual violence did significantly moderate safety by gender; women's perceptions of neighborhood sexual violence predicted perceived safety in their neighborhood. Importantly, gender did not moderate perceived safety for other types of violence. These results illustrate the importance of taking gender and perceived sexual violence into account to understand neighborhood safety in adults, particularly women.     

Prefrontal substrates of empathy: psychometric evidence in a community sample

Empathy is a vicarious experience of others’ emotions, and is crucial to many forms of adaptive social interaction. Clinical, experimental, and functional neuroimaging studies convergently suggest a role for prefrontal-limbic circuits in mediating empathy. This study examined the prefrontal basis of empathy in a community sample using self-report measures: the frontal systems behavior scale (FrSBe), Barratt impulsiveness scale (BIS), and the interpersonal reactivity index (IRI). Multiple correlations emerged supporting an inverse relationship between prefrontal system dysfunction and empathy, particularly emotional empathy and perspective taking. Many of these relationships persisted after controlling for age, sex, and education. However, FrSBe scales did not correlate with one's identification with fictional characters, and motor impulsivity correlated positively, presumably due to the different cognitive and emotional context (i.e. real versus fictional individuals). These studies parallel others using objective methodologies and suggest a graded relationship between prefrontal function and empathy and likely reflect normal variations in prefrontal-limbic function.     

The connections between childhood sexual abuse and human immunodeficiency virus infection: Implications for interventions

A qualitative study was conducted with 28 women who are human immunodeficiency virus (HIV)–positive and have experienced childhood sexual abuse (CSA) in order to examine (1) the challenges generated by the experience of sexual abuse and related coping strategies, (2) the impact of the HIV diagnosis on their coping strategies, and (3) the links perceived by the women between their CSA and HIV infection. The interviews revealed that CSA raised challenges in four areas: disclosure of the abuse, sexual problems, relationship difficulties, and psychological distress. The women used two strategies to cope with their CSA: illicit substances to numb their emotional distress and sexual activity, and alienation to gain control in relationships. When diagnosed with HIV, the women initially coped with their illness by using these two strategies. The women reported that, over time, they were able to accept their HIV illness, seek social support, find alternative sources of significance, and use spirituality to sustain their growth. However, they continued to suffer psychological distress related to their sexual trauma. Further, most of the women did not perceive any connection between the two traumas. Implications of these findings for secondary prevention interventions with women who have HIV and experience of CSA are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 655–672, 2005.     

The differences in neural network activity between methamphetamine abusers and healthy subjects performing an emotion-matching task: functional MRI study

Methamphetamine (MA) abusers commonly exhibit socially problematic behaviors, such as diminished empathy, decreased emotional regulation and interpersonal violence, which may be attributable to alterations in emotional experience. However, few studies have used functional MRI to examine directly the emotional experience of threatening or fearful non-face images in MA abusers. In this study, we investigated possible differences in neural correlates of negative emotional experiences between abstinent MA abusers and healthy subjects using complex visual scenes depicting fear or threat derived from the International Affective Picture System. In within-group analyses, healthy subjects and MA abusers activated a similarly distributed cortical network, prominently including the amygdala, fusiform gyrus, parahippocampal gyrus, ventrolateral prefrontal cortex and inferior frontal cortex. In between-group analyses, however, MA abusers showed a reduced activation in the bilateral dorsolateral prefrontal cortex and insula, and increased activation in the fusiform gyrus, hippocampus, parahippocampal gyrus and posterior cingulate cortex, relative to healthy subjects. Hypoactivation of the insula in MA abusers relative to healthy subjects suggests that the ability to have an emotional response to threatening scenes and empathy for another's pain could be compromised in MA abusers. Hyperactivity in the fusiform gyrus, parahippocampal gyrus and posterior cingulate cortex in MA abusers relative to healthy subjects indicates that threatening and fearful images from the International Affective Picture System may remind MA abusers of episodic memory related to similar experiences. Therefore, functional impairment of these neural networks in MA abusers may contribute to altered emotional experience in social interactions, which could lead to increased negative mood and stress in interpersonal communication.     

The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.     

The aggression response and the Rorschach.

We propose the addition of four aggressive indices for Rorschach scoring: aggressive content, aggressive potential, aggressive past, and sado-masochism scores. Interrater agreement is presented and ranges from 92-100%. Nomothetic comparisons are made between groups with higher base rates for violence with mixed results, although the sado-masochism frequency was significantly higher in severe psychopaths than in moderate psychopaths. Idiographic use of the aggression indices is emphasized, with a particular focus upon inferring the quality, intensity, and directionality of intrapsychic aggression in relation to self and object representations.     

Maternal bond and mother–child interaction in severe postpartum psychiatric disorders: Is there a link?

Summary Mothers in the puerperium are vulnerable to a wide spectrum of postpartum psychiatric disorders. One of the central psychological processes of the puerperium is the development of an emotional relationship with the baby. The bond to the infant as well as the interaction with the baby are two aspects of the mother–infant relationship that can be disturbed by mothers with postpartum psychiatric disorders. Dysfunctional maternal cognitions may also influence the development of an emotional bonding and the establishment of a positive interaction with the child. The aim of this study is to investigate differences in the self-perceived experience of bonding and the observed mother–child interaction of severely ill postpartum depressive and psychotic mothers. In addition the association between subjective experience of bonding and objective measurement of mother–child interaction will be described. Results show that depressive mothers perceived their bonding to the baby more negatively than psychotic mothers. No differences could be found in the objective interactional behaviour of the mothers in both groups, with the exception that the infants of psychotic mothers showed more eye contact avoidance towards their mothers. The subjective experience of motherhood clearly influences the maternal interactional behaviour with depressive mothers as well as with psychotic mothers.     

Intimate partner violence and health outcomes in mid-life women: a population-based cohort study

Summary Aim: To investigate the association between experience of intimate partner violence (IPV) and health outcomes measured prospectively. Method: Eleven-year prospective study of a population-based cohort of 438 Australian-born women aged 45–55 years at baseline (in 1991). Annual face-to-face interviews measured health status and quality of life; questionnaires on intimate partner physical, emotional and sexual violence and on experiences of childhood abuse completed in year 6 of follow-up. Results: In year 11 of follow-up 233 women (mean age 59.9 SD 2.5 years) were interviewed of whom 62 (27%) reported experiencing physical and/or emotional and/or sexual IPV prior to the 6^th year of follow-up. In bi-variate analysis a history of IPV was significantly associated with mental and sexual health variables and marital status at baseline and follow-up. Multivariate analysis found that at follow-up after allowing for baseline measures and other co-variates: Frequency of Sexual Activities was lower in women who had experienced IPV (p < 0.05); and negative mood was higher in women with the experience of IPV during the 12 months prior to completing the violence questionnaire (p < 0.05). Conclusion: IPV was a significant contributor to mental and sexual health status measured prospectively in this cohort of mid-aged Australian-born women.     

The role of sleep in aesthetic perception and empathy: A mediation analysis

The ability to experience aesthetics plays a fundamental role in human social interactions, as well as the capacity to feel empathy. Some studies have shown that beauty perception shares part of the neural network underlying emotional and empathic abilities, which are also known to affect sleep quality and duration. In this study, we evaluated for the first time the effects of sleep on the relation between aesthetic perception and empathic abilities in healthy subjects using a mediation analysis approach. One‐hundred and twenty‐six subjects participated in this study. One‐hundred and one subjects slept at home (Sleep Group). The remaining 25 subjects were tested as controls after 1 night of sleep deprivation to assess the effects of lack of sleep on aesthetic perception and empathy (Sleep‐Deprived Group). All participants underwent one testing session in which they performed a battery of empathy tests and an aesthetic perception task (Golden Beauty). The results showed that sleep duration mediates the relationship between empathy and aesthetic perception in the sleep group. The mediation effect of sleep was more evident on the emotional empathy measures. Conversely, in the sleep deprivation group the lack of correlations among empathy, aesthetic perception and sleep variables did not allow to perform the mediation analysis. These results suggest that adequate sleep duration may play a significant role in improving cognitive and emotional empathic abilities as well as the capability to give accurate aesthetic judgements.     

Emotion and psychopathy: startling new insights

Abnormal affective response in psychopaths is conceptualized within a broad theory of emotion that emphasizes reciprocal appetitive and defensive motivational systems. The startle response is proposed as a specific measure of the directional component of emotional activation. I review the literature that indicates that criminal psychopaths do not show the expected potentiation of the startle reflex that normally occurs during processing of aversive stimuli such as unpleasant photographs or punishment cues. Evidence is presented to demonstrate that this deviant response pattern is specific to individuals who display the classic affective symptoms of psychopathy. The core emotional deviation in psychopathy could be a deficit in fear response, which is defined as a failure of aversive cues to prime normal defensive actions. This emotional deficit may represent an extreme variant of normal temperament.