Rachel Blair

Psychopaths continue to be demonised by the media and estimates suggest that a disturbing percentage of the population has psychopathic tendencies. This timely and controversial new book summarises what we already know about psychopathy and antisocial behavior and puts forward a new case for its cause - with far-reaching implications. Presents the scientific facts of psychopathy and antisocial behavior. Addresses key questions, such as: What is psychopathy? Are there psychopaths amongst us? What is wrong with psychopaths? Is psychopathy due to nature or nurture? And can we treat psychopaths? Reveals the authors' ground-breaking research into whether an underlying abnormality in brain development leaves psychopaths with an inability to feel emotion or fear. The resulting theory could lead to early diagnosis and revolutionize the way society, the media and the state both views and contends with the psychopaths in our midst.

This chapter argues that (1) four classes of norms can be distinguished from a neuro-cognitive perspective: harm based, disgust based, social conventions, and justice based; and that (2) learning the prohibitive power of these norms for behavior relies on relatively independent emotional learning systems. It presents data that these emotional learning systems can be selectively impaired, leading to a reduced ability to acquire the prohibitive power of specific forms of norms (e.g., the reduced prohibited power of care-based and justice-based norms for individuals with psychopathy). Finally, it argues that emotion-based systems alone do not allow full moral development. An individual’s moral reasoning also involves (1) access to culturally specified, conceptual rules regarding behaviors that seem immoral—and not just considered “bad”; and/or (2) calculations of intent provided by theory of mind.

Background Men with antisocial personality disorder show lifelong abnormalities in adaptive decision making guided by the weighing up of reward and punishment information. Among men with antisocial personality disorder, modifi cation of the behaviour of those with additional diagnoses of psychopathy seems particularly resistant to punishment. Methods We did a case-control functional MRI (fMRI) study in 50 men, of whom 12 were violent off enders with antisocial personality disorder and psychopathy, 20 were violent off enders with antisocial personality disorder but not psychopathy, and 18 were healthy non-off enders. We used fMRI to measure brain activation associated with the representation of punishment or reward information during an event-related probabilistic response-reversal task, assessed with standard general linear-model-based analysis. Findings Offenders with antisocial personality disorder and psychopathy displayed discrete regions of increased activation in the posterior cingulate cortex and anterior insula in response to punished errors during the task reversal phase, and decreased activation to all correct rewarded responses in the superior temporal cortex. This finding was in contrast to results for off enders without psychopathy and healthy non-off enders. Interpretation Punishment prediction error signalling in off enders with antisocial personality disorder and psychopathy was highly atypical. This finding challenges the widely held view that such men are simply characterised by diminished neural sensitivity to punishment. Instead, this fi nding indicates altered organisation of the information processing system responsible for reinforcement learning and appropriate decision making. This difference between violent offenders with antisocial personality disorder with and without psychopathy has implications for the causes of these disorders and for treatment approaches.

The effect of inducing negative, positive or neutral affect on the recall of moral and conventional transgressions and positive moral and conventional acts was examined. It was found that inducing negative affect was associated with higher recall of moral transgressions while inducing positive affect was associated with higher recall of positive moral acts. Affect induction condition did not have a significant effect on the recall of the conventional transgressions or positive acts. The results are interpreted within the Violence Inhibition Mechanism model of moral development (Blair, 1995) and by reference to a new, hypothesised system, the Smiling Reward Response.

The current study examined whether Callous-Unemotional (CU) traits, a core component of psychopathy, modulate neural responses of participants engaged in a social exchange game. In this task, participants were offered an allocation of money and then given the chance to punish the offerer. Twenty youth participated and responses to both offers and the participant’s punishment (or not) of these offers were examined. Increasingly unfair offers were associated with increased dorsal anterior cingulate cortex (dACC) activity but this responsiveness was not modulated by CU traits. Increasing punishment of unfair offers was associated with increased dACC and anterior insula activity and this activity was modulated by CU traits. Higher CU trait participants showed a weaker association between activity and punishment level. These data suggest that CU traits are associated with appropriate expectations of other individual’s normative behavior but weaker representations of such information when guiding behavior of the self.

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy.

In this study, we examined decision-making to rewarding or punishing stimuli in individuals with psy- chopathy (n = 21) and comparison individuals (n = 19) using the Differential Reward/Punishment Learn- ing Task. In this task, the participant chooses between two objects associated with different levels of reward or punishment. Thus, response choice indexes not only reward/punishment sensitivity but also sensitivity to reward/punishment level according to inter-stimulus reinforcement distance. Individuals with psychopathy showed significant impairment when choosing between objects associated with differential levels of reward but also significantly greater impairment when choosing between objects associated with differential levels of punishment. However, the two groups were comparably affected by inter-stimulus reinforcement distance. The results are discussed with reference to current models of psychopathy.

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy.

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed.

I focus on a number of issues arising from Depue & Collins's target article that require further consideration: (1) data that fail to confirm extraversion effects in positive incentive experiments; (2) the role of personality factors, other than extraversion, in dopamine agonism on positive mood states; (3) the role of extraversion in nonspecific arousal, indicating that extraversion may not be an homogeneous trait; and (4) the problem of identifying neurobiologically important traits from existing structural models of personality. I applaud the heuristic value of the model presented and suggest ways in which aspects of the model may be used to identify the personality traits associated with positive incentive motivation.

In lieu of an abstract, here is a brief excerpt of the content:What Emotional Responding Is to Blame It Might Not Be to ResponsibilityR. J. R. Blair (bio)Keywordsblame, responsibility, emotional responses, psychopathyIn this interesting paper, Levy argues that by failing the moral/conventional distinction task (Blair 1995), individuals with psychopathy show a fundamental inability to categorize moral harms and as such their moral responsibility for their actions is reduced. He argues that, although we might still wish to incarcerate such individuals to prevent them inflicting further harm on others, we should be less enthusiastic to blame them for their actions.In many respects, I agree with much of Levy's treatise. I certainly do not regard ascriptions of blame as useful in my own work with this population. I believe that our goal should be to fully understand the nature of their emotional deficit to be able to treat it similarly to other researchers who work to treat other emotional disorders. To me, Levy's argument appears sound.However, I offer three considerations and raise questions within these considerations that might further the debate. First, not all rules involve care-based emotional responses to victims. As Levy notes, this is the origin of the moral/conventional distinction. The problem here is that we do consider someone responsible if they break a conventional transgression. The student talking in class is generally considered blameworthy for this action as long as they knew that the rule of not talking during the lesson applied to that classroom. Yet, there is no victim and no care-based emotional response. Here, the only thing necessary to ascribe blame and responsibility is that the individual knew that a rule exists. Given this holds for conventional transgressions, why must we necessarily make a special case, with respect to responsibility, for moral transgressions?I believe that Levy is fully aware of this concern. He specifically makes reference to moral responsibility and writes that:the kind and degree of wrongness, and therefore blame, which attaches to infringements of the rules [against double parking or line-jumping] is very different, and usually much less significant, than the kind and degree attaching to moral wrongs. For psychopaths, all offences are merely conventional, and therefore—from their point of view—none of them are all that serious.(2007, p. 132)But the danger here is that issues of blame and responsibility may become highly relativistic and hinge on the strength of the emotional reaction. This is a problem because, although we might judge someone as more blameworthy if he intentionally [End Page 149] runs over five people rather than one, do we really consider that there is a distinction in moral responsibility between these two cases? If not, might not responsibility relate to factual knowledge of the existence of the rule against the transgression rather than the emotional response to the transgression?Second, there is considerable debate regarding whether psychopathy represents a taxon or a continuum (e.g., Vasey et al. 2005; Edens et al. 2006). Assuming it does represent a continuum, then we have an additional concern. How little of an emotional response to the transgression reduces one's moral responsibility and blame? Is it only the very reduced (although usually not absent) levels of emotional response that are shown by individuals with psychopathy? Or should we consider moral responsibility and blame proportional to the level of the emotional response? If this latter option is adopted, then what should we do about individuals who show heightened emotional responses, for example, patients with specific anxiety disorders (Rauch, Shin, and Wright 2003)? There are already some data that inhibited children (a developmental precursor to some anxiety disorders; Kagan and Snidman 1999) show heightened conscience development (Asendorpf and Nunner-Winkler 1992). If such children commit moral transgressions, should we regard them as more morally responsible and more blameworthy than regular folks?Third, the issue of intention received little attention in this paper. I have been considered to show a similar lack of attention to intention in the past (Nichols 2002) and, moreover, in some respects the issue was of limited concern given Levy's main goals. However, I mention it because so much of whether we consider someone responsible for their actions and...

Psychopathy is a developmental disorder associated with specific forms of emotional dysfunction and an increased risk for both frustration-based reactive aggression and goal-directed instrumental antisocial behavior. While the full behavioral manifestation of the disorder is under considerable social influence, the basis of this disorder appears to be genetic. At the neural level, individuals with psychopathy show atypical responding within the amygdala and ventromedial prefrontal cortex. Moreover, the roles of the amygdala in stimulus-reinforcement learning and responding to emotional expressions and vmPFC in the representation of reinforcement expectancies are compromised. The implications of these functional impairments for responsibility are discussed.

In this paper it is proposed that important components of moral development and moral judgment rely on two forms of emotional learning: stimulus-reinforcement and response-outcome learning. Data in support of this position will be primarily drawn from work with individuals with the developmental condition of psychopathy as well as fMRI studies with healthy individuals. Individuals with psychopathy show impairment on moral judgment tasks and a pronounced increased risk for instrumental antisocial behavior. It will be argued that these impairments are developmental consequences of impaired stimulus-aversive conditioning on the basis of distress cue reinforcers and response-outcome learning in individuals with this disorder.

Psychopathy can be considered one of the prototypical disorders associated with empathic dysfunction. Reference to empathic dysfunction is part of the diagnostic criteria of psychopathy (Hare, 1991). The very ability to inflict serious harm to others repeatedly can be, and is (Hare, 1991), an indicator of a profound disturbance in an appropriate ‘empathic’ response to the suffering of another. The goal of this chapter will be to consider the nature of the empathic impairment in psychopathy. First, I will consider the disorder of psychopathy and the definition of empathy. Second, I will consider whether individuals with psychopathy are impaired in ‘cognitive empathy’ or Theory of Mind. Third, I will consider the cognitive and neural architecture mediating ‘emotional empathy’. Fourth, I will consider whether individuals with psychopathy are impaired in ‘emotional empathy’.

Moral judgments about an action are influenced by the action’s intentionality. The reverse is also true: judgments of intentionality can be influenced by an action’s moral valence. For example, respondents judge a harmful side-effect of an intended outcome to be more intentional than a helpful side-effect. Debate continues regarding the mechanisms underlying this “side-effect effect” and the conditions under which it will persist. The research behind this chapter tested whether the side-effect effect is intact in adolescents with psychopathic traits, who are characterized by persistent immoral behavior, deficient moral emotions, and impairments in some forms of moral judgment. Results showed no differences between healthy adolescents and those with psychopathic traits: both groups judged harmful side-effects to be more intentional than helpful side-effects by an approximately 2:1 ratio. The chapter discusses these results in light of hypothesized mechanisms underlying the side-effect effect, and in light of our current understanding of moral reasoning deficits in psychopathy.

The current paper examines the functional contributions of the amygdala and ventromedial prefrontal cortex (vmPFC) and the evidence that the functioning of these systems is compromised in individuals with psychopathy. The amygdala is critical for the formation of stimulus–reinforcement associations, both punishment and reward based, and the processing of emotional expressions. vmPFC is critical for the representation of reinforcement expectancies and, owing to this, decision making. Neuropsychological and neuroimaging data from individuals with psychopathy are examined. It is concluded that these critical functions of the amygdala and vmPFC, and their interaction, are compromised in individuals with the disorder. It is argued that these impairments lead to the development of psychopathy.

Previous work has inconsistently reported difficulties with response reversal/extinction in children with psychopathic tendencies. Method: We tested the hypothesis that the degree of impairment seen in children with psychopathic tendencies is a function of the salience of contingency change. We investigated the performance of children with psychopathic tendencies on a novel prob- abilistic response reversal task involving four conditions with gradated reward–punishment contin- gencies (100–0, 90–10, 80–20 and 70–30; i.e., for the 100–0 contingency, responding to one object is always rewarded while responding to the other is always punished). Results: In line with predictions, the impairment seen in the children with psychopathic tendencies was an inverse function of the salience of the contingency change. Conclusions: We suggest that this data is consistent with suggestions of subtle orbital frontal cortex impairment in children with psychopathic tendencies.

Various social animal species have been noted to inhibit aggressive attacks when a conspecific displays submission cues. Blair (1993) has suggested that humans possess a functionally similar mechanism which mediates the suppression of aggression in the context of distress cues. He has suggested that this mechanism is a prerequisite for the development of the moral/conventional distinction; the consistently observed distinction in subject's judgments between moral and conventional transgressions. Psychopaths may lack this violence inhibitor. A causal model is developed showing how the lack of this mechanism would explain the core behavioural symptoms associated with the psychopathic disorder. A prediction of such a causal model would be that psychopaths should fail to make the moral/conventional distinction. This prediction was confirmed. The implication of this finding for other theories of morality is discussed.

Recent interest in emotion as the basis for moral development began with work involving individuals with psychopathic tendencies, and a recent paper with this population has allowed fresh insights (Glenn, Iyer, Graham, Koleva, & Haidt, 2009). Two main conclusions suggested by this paper are: (i) that systems involved in different forms of morality can be differentiated; and (ii) that systems involved in justice reasoning likely include amygdala and/or ventromedial prefrontal cortex, even if the specifics of their functional contribution to justice development remain unidentified.

Generalized anxiety disorder (GAD) and social phobia (SP) are major anxiety disorders identified by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). They are comorbid, overlap in symptoms, yet present with distinct features (worry in GAD and fear of embarrassment in SP). Both have also been explained in terms of conditioning-based models. However, there is little reasoning currently to believe that GAD in adulthood reflects heightened conditionability or heightened threat processing—though patients with SP may show heightened processing of social threat stimuli. Moreover, the computational architectures that maintain these disorders in adulthood are different. For GAD this may reflect the development of an inefficient “worrying” strategy of emotional regulation. For SP this appears to reflect the atypical processing of self-referential information.

Decety (2011) considers the cognitive neuroscience of empathy and, in particular, his three-component model of empathic responding. His position is highly influential with its emotional awareness/understanding and emotional regulation components representing clear extensions of previous theorizing on empathy. In this brief commentary, I will critically consider the third of his components: affective arousal. In particular, I will consider the implications of the literature to the proposed computations, based on perception—action coupling, that underlie this component of his model. I will suggest that perception—action coupling does not underlie affective arousal but rather that this is mediated by far more simple mechanisms of emotional arousal based on conditioning.

Empathy is a lay term that is becoming increasingly viewed as a unitary function within the field of cognitive neuroscience. In this paper, a selective review of the empathy literature is provided. It is argued from this literature that empathy is not a unitary system but rather a loose collection of partially dissociable neurocognitive systems. In particular, three main divisions can be made: cognitive empathy, motor empathy, and emotional empathy. The two main psychiatric disorders associated with empathic dysfunction are considered: autism and psychopathy. It is argued that individuals with autism show difficulties with cognitive and motor empathy but less clear difficulties with respect to emotional empathy. In contrast, individuals with psychopathy show clear difficulties with a specific form of emotional empathy but no indications of impairment with cognitive and motor empathy.