Impaired processing of threat in psychopathy: A systematic review and meta-analysis of factorial data in male offender populations

Autoři: Petya Kozhuharova aff001;  Hannah Dickson aff001;  John Tully aff001;  Nigel Blackwood aff001
Působiště autorů: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom aff001;  Centre for Cognition, Neuroscience and Neuroimaging (CNNI), Department of Psychology, Roehampton University, London, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Psychopathy is a personality disorder characterised by two underlying factors. Factor 1 (affective and interpersonal deficits) captures affective deficits, whilst Factor 2 (antisocial and impulsive/disorganised behaviours) captures life course persistent antisocial behaviours. Impaired processing of threat has been proposed as an aetiologically salient factor in the development of psychopathy, but the relationship of this impairment to the factorial structure of the disorder in adult male offenders is unclear.


To investigate whether threat processing deficits are characteristic of psychopathy as a unitary construct or whether such deficits are specifically linked to higher scores on individual factors.

Data sources

A systematic review of the literature was conducted by searching PubMed, Web of Science and PsycINFO.


Studies were included if they (1) reported physiological measures of threat response as the primary outcome measure (2) indexed psychopathy using a well-validated clinician rated instrument such as the PCL-R (3) investigated male offenders between 18 and 60 years of age (4) reported threat processing analyses using both Factor 1 and Factor 2 scores (5) provided sufficient data to calculate effect sizes and (6) were published in English-language peer-reviewed journals. We identified twelve studies with data on 1112 participants for the meta-analysis of the relationship with Factor 1 scores, and nine studies with data on 801 participants for the meta-analysis of the relationship with Factor 2 scores. We conducted the meta-analyses to calculate correlations using random-effects models.


PCL-R/SV Factor 1 scores were significantly and negatively related to threat processing indices (r = -0.22, (95%CI [-0.28, -.017]). Neither PCL-R/SV Factor 2 scores (r = -0.005, 95%CI [-0.10, 0.09]), nor PCL-R total score (r = -0.05, (95%CI [-0.15, -0.04]) were related to threat processing indices. No significant heterogeneity was detected for the Factor score results.


The meta-analyses of the distinct psychopathy factors suggest that the threat processing deficits observed in male offenders with psychopathy are significantly associated with higher scores on Factor 1. A similar relationship does not exist with Factor 2 scores. Our findings highlight the importance of investigating the potentially discrete relationships between aetiological variables and the two factor constructs in the disorder.

Klíčová slova:

Antisocial behavior – Conditioned response – Database searching – Emotions – Fear – Personality disorders – Systematic reviews


1. Frick PJ, Viding E. Antisocial behaviour from a developmental psychopathology perspective. Development and psychopathology. 2009 Nov;21(4):1111–31. doi: 10.1017/S0954579409990071 19825260

2. Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003.

3. Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391. doi: 10.1037//0021-843x.100.3.391 1918618

4. Hoppenbrouwers SS, Bulten BH, Brazil IA. Parsing fear: A reassessment of the evidence for fear deficits in psychopathy. Psychological bulletin. 2016 Jun;142(6):573. doi: 10.1037/bul0000040 26854867

5. LeDoux JE. Coming to terms with fear. Proceedings of the National Academy of Sciences. 2014 Feb 25;111(8):2871–8.

6. Mauss IB, Robinson MD. Measures of emotion: A review. Cognition and emotion. 2009 Feb 1;23(2):209–37. doi: 10.1080/02699930802204677 19809584

7. Calder AJ, Lawrence AD, Young AW. Neuropsychology of fear and loathing. Nature Reviews Neuroscience. 2001 May;2(5):352. doi: 10.1038/35072584 11331919

8. Cacioppo JT, Berntson GG, Larsen JT, Poehlmann KM, Ito TA. The psychophysiology of emotion. Handbook of emotions. 2000 May 25;2:173–91.

9. Bradley MM, Lang PJ. Measuring emotion: Behavior, feeling, and physiology. Cognitive neuroscience of emotion. 2000;25:49–59.

10. Buzsáki G. Theta rhythm of navigation: link between path integration and landmark navigation, episodic and semantic memory. Hippocampus. 2005;15(7):827–40. doi: 10.1002/hipo.20113 16149082

11. Lakatos P, O'Connell MN, Barczak A, Mills A, Javitt DC, Schroeder CE. The leading sense: supramodal control of neurophysiological context by attention. Neuron. 2009 Nov 12;64(3):419–30. doi: 10.1016/j.neuron.2009.10.014 19914189

12. Lykken DT. A study of anxiety in the sociopathic personality. The Journal of Abnormal and Social Psychology. 1957 Jul;55(1):6.

13. Verona E, Patrick CJ, Curtin JJ, Bradley MM, Lang PJ. Psychopathy and physiological response to emotionally evocative sounds. Journal of abnormal psychology. 2004 Feb;113(1):99. doi: 10.1037/0021-843X.113.1.99 14992662

14. Newman JP, Curtin JJ, Bertsch JD, Baskin-Sommers AR. Attention moderates the fearlessness of psychopathic offenders. Biological psychiatry. 2010 Jan 1;67(1):66–70. doi: 10.1016/j.biopsych.2009.07.035 19793581

15. Hare RD. Psychopathy, fear arousal and anticipated pain. Psychological Reports. 1965 Apr;16(2):499–502.

16. Ogloff JR, Wong S. Electrodermal and cardiovascular evidence of a coping response in psychopaths. Criminal Justice and Behaviour. 1990 Jun;17(2):231–45.

17. Hare RD, Frazelle J, Cox DN. Psychopathy and physiological responses to threat of an aversive stimulus. Psychophysiology. 1978 Mar 1;15(2):165–72. doi: 10.1111/j.1469-8986.1978.tb01356.x 652911

18. Patrick CJ. Emotion and psychopathy: Startling new insights. Psychophysiology. 1994 Jul 1;31(4):319–30. doi: 10.1111/j.1469-8986.1994.tb02440.x 10690912

19. Patrick CJ, Bradley MM, Lang PJ. Emotion in the criminal psychopath: startle reflex modulation. Journal of abnormal psychology. 1993 Feb;102(1):82. doi: 10.1037//0021-843x.102.1.82 8436703

20. Levenston GK, Patrick CJ, Bradley MM, Lang PJ. The psychopath as observer: Emotion and attention in picture processing. Journal of abnormal psychology. 2000 Aug;109(3):373. 11016107

21. Carmen Pastor M, Moltó J, Vila J, Lang PJ. Startle reflex modulation, affective ratings and autonomic reactivity in incarcerated Spanish psychopaths. Psychophysiology. 2003 Nov 1;40(6):934–8. doi: 10.1111/1469-8986.00111 14986846

22. Benning SD, Patrick CJ, Iacono WG. Psychopathy, startle blink modulation, and electrodermal reactivity in twin men. Psychophysiology. 2005 Nov 1;42(6):753–62. doi: 10.1111/j.1469-8986.2005.00353.x 16364071

23. Pissiota A, Frans Ö, Michelgård Å, Appel L, Långström B, Flaten MA, et al. Amygdala and anterior cingulate cortex activation during affective startle modulation: a PET study of fear. European Journal of Neuroscience. 2003 Sep 1;18(5):1325–31. doi: 10.1046/j.1460-9568.2003.02855.x 12956731

24. Cook EW, Davis TL, Hawk LW, Spence EL, Gautier CH. Fearfulness and startle potentiation during aversive visual stimuli. Psychophysiology. 1992 Nov 1;29(6):633–45. doi: 10.1111/j.1469-8986.1992.tb02038.x 1461954

25. Bechara A, Damasio H, Damasio AR, Lee GP. Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. Journal of Neuroscience. 1999 Jul 1;19(13):5473–81. doi: 10.1523/JNEUROSCI.19-13-05473.1999 10377356

26. Kiehl KA, Smith AM, Hare RD, Mendrek A, Forster BB, Brink J, et al. Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging. Biological psychiatry. 2001 Nov 1;50(9):677–84. doi: 10.1016/s0006-3223(01)01222-7 11704074

27. Birbaumer N, Veit R, Lotze M, Erb M, Hermann C, Grodd W, et al. Deficient fear conditioning in psychopathy: a functional magnetic resonance imaging study. Archives of general psychiatry. 2005 Jul 1;62(7):799–805. doi: 10.1001/archpsyc.62.7.799 15997022

28. Mitchell DG, Fine C, Richell RA, Newman C, Lumsden J, Blair KS, et al. Instrumental learning and relearning in individuals with psychopathy and in patients with lesions involving the amygdala or orbitofrontal cortex. Neuropsychology. 2006 May;20(3):280. doi: 10.1037/0894-4105.20.3.280 16719621

29. Cohn MD, Popma A, Van Den Brink W, Pape LE, Kindt M, Van Domburgh L, Doreleijers TA, et al. Fear conditioning, persistence of disruptive behavior and psychopathic traits: an fMRI study. Translational psychiatry. 2013 Oct;3(10):e319.

30. Marsh AA, Blair RJ. Deficits in facial affect recognition among antisocial populations: a meta-analysis. Neuroscience & Biobehavioral Reviews. 2008 Jan 1;32(3):454–65.

31. Marsh AA, Finger EC, Mitchell DG, Reid ME, Sims C, Kosson DS, et al. Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders. American Journal of Psychiatry. 2008 Jun;165(6):712–20 doi: 10.1176/appi.ajp.2007.07071145 18281412

32. Venables NC, Hall JR, Yancey JR, Patrick CJ. Factors of psychopathy and electrocortical response to emotional pictures: Further evidence for a two-process theory. Journal of abnormal psychology. 2015 May;124(2):319. doi: 10.1037/abn0000032 25603361

33. Vaidyanathan U, Hall JR, Patrick CJ, Bernat EM. Clarifying the role of defensive reactivity deficits in psychopathy and antisocial personality using startle reflex methodology. Journal of Abnormal Psychology. 2011 Feb;120(1):253. doi: 10.1037/a0021224 20973594

34. Dvorak‐Bertsch JD, Curtin JJ, Rubinstein TJ, Newman JP. Psychopathic traits moderate the interaction between cognitive and affective processing. Psychophysiology. 2009 Sep 1;46(5):913–21. doi: 10.1111/j.1469-8986.2009.00833.x 19497014

35. Dindo L, Fowles D. Dual temperamental risk factors for psychopathic personality: Evidence from self-report and skin conductance. Journal of personality and social psychology. 2011 Mar;100(3):557. doi: 10.1037/a0021848 21186933

36. Frick PJ, Lilienfeld SO, Ellis M, Loney B, Silverthorn P. The association between anxiety and psychopathy dimensions in children. Journal of abnormal child psychology. 1999 Oct 1;27(5):383–92. doi: 10.1023/a:1021928018403 10582839

37. Hicks BM, Patrick CJ. Psychopathy and negative emotionality: analyses of suppressor effects reveal distinct relations with emotional distress, fearfulness, and anger-hostility. Journal of abnormal psychology. 2006 May;115(2):276. doi: 10.1037/0021-843X.115.2.276 16737392

38. Vanman EJ, Mejia VY, Dawson ME, Schell AM, Raine A. Modification of the startle reflex in a community sample: do one or two dimensions of psychopathy underlie emotional processing?. Personality and Individual Differences. 2003 Dec 1;35(8):2007–21.

39. Dawel A, O’kearney R, McKone E, Palermo R. Not just fear and sadness: meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy. Neuroscience & Biobehavioral Reviews. 2012 Nov 1;36(10):2288–304.

40. Baskin-Sommers AR, Curtin JJ, Newman JP. Altering the cognitive-affective dysfunctions of psychopathic and externalizing offender subtypes with cognitive remediation. Clinical Psychological Science. 2015 Jan;3(1):45–57. doi: 10.1177/2167702614560744 25977843

41. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009 Jul 21;6(7): e1000097. doi: 10.1371/journal.pmed.1000097 19621072

42. Hall JR, Benning SD. The “successful” psychopath: Adaptive and subclinical manifestations of psychopathy in the general population. Patrick C.J. (Ed.), Handbook of psychopathy, Guilford Press, New York, NY (2006), pp. 459–478.

43. Mahmut MK, Homewood J, Stevenson RJ. The characteristics of non-criminals with high psychopathy traits: Are they similar to criminal psychopaths?. Journal of Research in Personality. 2008 Jun 1;42(3):679–92.

44. Neumann CS, Hare RD, Pardini DA. Antisociality and the construct of psychopathy: Data from across the globe. Journal of personality. 2015 Dec 1;83(6):678–92. doi: 10.1111/jopy.12127 25181550

45. Cooke DJ, Michie C, Hart SD, Hare RD. Evaluating the Screening Version of the Hare Psychopathy Checklist—Revised (PCL: SV): An item response theory analysis. Psychological Assessment. 1999 Mar;11(1):3.

46. Hedges LV. Estimation of effect size from a series of independent experiments. Psychological bulletin. 1982 Sep;92(2):490.

47. Cale EM, Lilienfeld SO. Sex differences in psychopathy and antisocial personality disorder: A review and integration. Clinical psychology review. 2002 Nov 1;22(8):1179–207. 12436810

48. Salekin RT, Rogers R, Sewell KW. Construct validity of psychopathy in a female offender sample: A multitrait–multimethod evaluation. Journal of abnormal psychology. 1997 Nov;106(4):576. doi: 10.1037//0021-843x.106.4.576 9358688

49. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Strobe Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS medicine. 2007 Oct 16;4(10): e296. doi: 10.1371/journal.pmed.0040296 17941714

50. Schwarzer G. meta: An R package for meta-analysis. R News. 2007 7(3):40–45.

51. Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. Journal of clinical epidemiology. 2000 Nov 1;53(11):1119–29. doi: 10.1016/s0895-4356(00)00242-0 11106885

52. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. John Wiley & Sons; 2011 Aug 24.

53. Peterson RA, Brown SP. On the use of beta coefficients in meta-analysis. Journal of Applied Psychology. 2005 Jan;90(1):175. doi: 10.1037/0021-9010.90.1.175 15641898

54. Field A. Discovering statistics using SPSS. Sage publications; 2009 Jan 21.

55. Cohen J. Statistical power analysis for the behavioural sciences 2nd edn.

56. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003 Sep 6;327(7414):557. doi: 10.1136/bmj.327.7414.557 12958120

57. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994 Dec 1:1088–101.

58. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997 Sep 13;315(7109):629–34. doi: 10.1136/bmj.315.7109.629 9310563

59. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Bmj. 2011 Jul 22;343: d4002. doi: 10.1136/bmj.d4002 21784880

60. Veit R, Konicar L, Klinzing JG, Barth B, Yilmaz Ö, Birbaumer N. Deficient fear conditioning in psychopathy as a function of interpersonal and affective disturbances. Frontiers in Human Neuroscience. 2013 Oct 25;7:706. doi: 10.3389/fnhum.2013.00706 24298245

61. Baskin-Sommers AR, Curtin JJ, Newman JP. Emotion-modulated startle in psychopathy: Clarifying familiar effects. Journal of abnormal psychology. 2013 May;122(2):458. doi: 10.1037/a0030958 23356218

62. Drislane LE, Vaidyanathan U, Patrick CJ. Reduced cortical call to arms differentiates psychopathy from antisocial personality disorder. Psychological Medicine. 2013 Apr;43(4):825–35. doi: 10.1017/S0033291712001547 22850322

63. Baskin-Sommers AR, Newman JP, Sathasivam N, Curtin JJ. Evaluating the generalizability of a fear deficit in psychopathic African American offenders. Journal of Abnormal Psychology. 2011a Feb;120(1):71.

64. Sadeh N, Verona E. Visual complexity attenuates emotional processing in psychopathy: Implications for fear-potentiated startle deficits. Cognitive, Affective, & Behavioral Neuroscience. 2012 Jun 1;12(2):346–60.

65. Casey H, Rogers RD, Burns T, Yiend J. Emotion regulation in psychopathy. Biological psychology. 2013 Mar 1;92(3):541–8. doi: 10.1016/j.biopsycho.2012.06.011 23079384

66. Verona E, Sprague J, Sadeh N. Inhibitory control and negative emotional processing in psychopathy and antisocial personality disorder. Journal of abnormal psychology. 2012 May;121(2):498. doi: 10.1037/a0025308 22288907

67. Baskin-Sommers AR, Curtin JJ, Newman JP. Specifying the attentional selection that moderates the fearlessness of psychopathic offenders. Psychological Science. 2011b Feb;22(2):226–34.

68. Tillem S, Ryan J, Wu J, Crowley MJ, Mayes LC, Baskin-Sommers A. Theta phase coherence in affective picture processing reveals dysfunctional sensory integration in psychopathic offenders. Biological psychology. 2016 Sep 1;119:42–5. doi: 10.1016/j.biopsycho.2016.06.011 27373371

69. Smith SF, Lilienfeld SO. The response modulation hypothesis of psychopathy: A meta-analytic and narrative analysis. Psychological bulletin. 2015 Nov;141(6):1145. doi: 10.1037/bul0000024 26302165

70. Fowles DC, Dindo L. A dual-deficit model of psychopathy. Handbook of psychopathy. 2006:14–34.

71. Patrick CJ, Bernat EM. Neurobiology of psychopathy: A two process theory. Handbook of neuroscience for the behavioural sciences. 2009: 1110–1131.

72. Grillon C. Startle reactivity and anxiety disorders: aversive conditioning, context, and neurobiology. Biological psychiatry. 2002 Nov 15;52(10):958–75. doi: 10.1016/s0006-3223(02)01665-7 12437937

73. Decety J, Chen C, Harenski C, Kiehl KA. An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy. Frontiers in human neuroscience. 2013 Sep 24;7:489. doi: 10.3389/fnhum.2013.00489 24093010

74. Boccardi M, Frisoni GB, Hare RD, Cavedo E, Najt P, Pievani M, et al. Cortex and amygdala morphology in psychopathy. Psychiatry Research: Neuroimaging. 2011 Aug 30;193(2):85–92. doi: 10.1016/j.pscychresns.2010.12.013 21676597

75. Blair RJ. Neuroimaging of psychopathy and antisocial behavior: a targeted review. Current psychiatry reports. 2010 Feb 1;12(1):76–82. doi: 10.1007/s11920-009-0086-x 20425314

76. Blair RJ. Psychopathy, frustration, and reactive aggression: the role of ventromedial prefrontal cortex. British journal of psychology. 2010 Aug 1;101(3):383–99.

77. Anderson NE, Kiehl KA. The psychopath magnetized: insights from brain imaging. Trends in cognitive sciences. 2012 Jan 1;16(1):52–60. doi: 10.1016/j.tics.2011.11.008 22177031

78. Decety J, Skelly L, Yoder KJ, Kiehl KA. Neural processing of dynamic emotional facial expressions in psychopaths. Social neuroscience. 2014 Jan 2;9(1):36–49. doi: 10.1080/17470919.2013.866905 24359488

79. Öhman A. Of snakes and faces: An evolutionary perspective on the psychology of fear. Scandinavian journal of psychology. 2009 Dec 1;50(6):543–52. doi: 10.1111/j.1467-9450.2009.00784.x 19930253

80. Sylvers PD, Brennan PA, Lilienfeld SO. Psychopathic traits and preattentive threat processing in children: a novel test of the fearlessness hypothesis. Psychological Science. 2011 Oct;22(10):1280–7 doi: 10.1177/0956797611420730 21881061

81. Viding E, Sebastian CL, Dadds MR, Lockwood PL, Cecil CA, De Brito SA, et al. Amygdala response to preattentive masked fear in children with conduct problems: the role of callous-unemotional traits. American journal of psychiatry. 2012 Oct;169(10):1109–16. doi: 10.1176/appi.ajp.2012.12020191 23032389

82. Salekin RT, Worley C, Grimes RD. Treatment of psychopathy: A review and brief introduction to the mental model approach for psychopathy. Behavioral Sciences & the Law. 2010 Mar 1;28(2):235–66.

83. O'Neil ML, Lidz V, Heilbrun K. Adolescents with psychopathic characteristics in a substance abusing cohort: Treatment process and outcomes. Law and human behavior. 2003 Jun;27(3):299. 12794966

84. Olver ME, Lewis K, Wong SC. Risk reduction treatment of high-risk psychopathic offenders: The relationship of psychopathy and treatment change to violent recidivism. Personality Disorders: Theory, Research, and Treatment. 2013 Apr;4(2):160.

85. Baskin-Sommers AR, Newman JP. Differentiating the cognition-emotion interactions that characterize psychopathy versus externalizing. Handbook of cognition and emotion. 2013:501–20.

86. Brook M, Kosson DS. Impaired cognitive empathy in criminal psychopathy: Evidence from a laboratory measure of empathic accuracy. Journal of abnormal psychology. 2013 Feb;122(1):156. doi: 10.1037/a0030261 23067260

87. Ermer E, Kahn RE, Salovey P, Kiehl KA. Emotional intelligence in incarcerated men with psychopathic traits. Journal of personality and social psychology. 2012 Jul;103(1):194. doi: 10.1037/a0027328 22329657

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden