empathic dysfunction in psychopathic individuals · empathic dysfunction in psychopathic...

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Empathic dysfunction in psychopathicindividuals

R. James R. BlairMood and Anxiety Disorders Program, National Institute of Mental Health

Correspondence concerning the article should be addressed to James Blair, Ph.D., Chief, Unit on Affective

Cognitive Neuroscience, Mood and Anxiety Disorders Program, National Institute of Mental Health, 15 K North

Drive, Room 206, MSC 2670, Bethesda, Maryland 20892–2670. Email: [email protected]

1.1 Introduction

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 dis-

turbance 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’.

1.1.1 The disorder of psychopathy

The origins of the concept of psychopathy probably originate in the writings of

Pritchard (1837); see Pichot (1978). Pritchard developed the concept of ‘moral

insanity’ to account for socially damaging or irresponsible behaviour that was not

associated with known forms of mental disorder. He attributed morally objection-

able behaviour to be a consequence of a diseased ‘moral faculty’. While the notion

of a ‘moral faculty’ has been dropped, modern psychiatric classifications such as

the American Psychiatric Association’s Diagnostic and Statistical Manual (currently,

DSM-IV) make reference to syndromes associated with high levels of antisocial

behaviour: conduct disorder (CD) in children and antisocial personality disorder

(APD) in adults.

3


Unfortunately, the psychiatric diagnoses of CD and APD are flawed. Partly

because they only focus on the presence of antisocial behaviour, these diagnoses

tend to identify highly heterogeneous samples. This heterogeneity is even acknowl-

edged in DSM-IV where two forms of CD are specified: childhood- and adolescent-

onset types. Because of their lack of precision, the diagnostic rate of CD can reach

16% of boys in mainstream education (American Psychiatric Association, 1994)

while the diagnostic rate of APD can reach over 80% in adult forensic institutions

(Hare, 1991). Unsurprisingly, therefore, diagnoses of CD and APD are relatively

uninformative regarding an individual’s prognosis.

The classification of psychopathy, in contrast, is informative. This classification

was introduced by Hare (1980; 1991) and has proved to be a useful predictor of

future risk (Hare, 1991). The classification involves both affective-interpersonal

(e.g. such as lack of empathy and guilt) and behavioural components (e.g. criminal

activity and poor behavioural controls) (Frick & Hare, 2001; Hare, 1991).

Psychopathy represents a developmental disorder. In childhood and adolescence,

psychopathic tendencies are identified principally by either the use of the

Antisocial Process Screening Device (Frick & Hare, 2001) or by the Psychopathy

Checklist: Youth Version. In adulthood, psychopathy is identified though use of

the Psychopathy Checklist – Revised (Hare, 1991).

As noted above, psychopathy can be considered one of the prototypical disor-

ders associated with empathic dysfunction. In this chapter, I will consider the

nature of the empathic impairment in psychopathy.

1.1.2 Defining empathy

Empathy has been defined as ‘an affective response more appropriate to someone

else’s situation than to one’s own’ (Hoffman, 1987; p. 48); it is an emotional

reaction in an observer to the affective state of another individual. This form of

definition of empathy will underpin this paper. Unfortunately, however, the term

empathy has been used in a variety of ways by a variety of authors (Hoffman,

1987). At least three different types of empathy can be considered. The differences

between these types are important to identify as they must implicate notably

different cognitive architectures. The three types of empathy are: (1) motor

empathy where the individual mirrors the motor responses of the observed

actor; (2) ‘cognitive’ empathy where the individual represents the internal mental

state of the other (effectively Theory of Mind); (3) an emotional response to

another individual that is congruent with the other’s emotional reaction. In this

chapter, I will briefly consider ‘cognitive empathy’, from here onwards referred to

only as Theory of Mind, and emotional empathy with respect to psychopathy

(a distinction will be made between the two forms outlined above later in the

paper). I will not consider motor empathy in this chapter.

4 ‘Dysempathy’ in psychiatric samples


1.1.3 Theory of Mind and psychopathy

Theory of Mind refers to the ability to represent the mental states of others,

i.e. their thoughts, desires, beliefs, intentions and knowledge (Frith, 1989).

Theory of Mind allows the attribution of mental states to self and others in

order to explain and predict behaviour.

The classic measure of Theory of Mind is the Sally-Anne task (Wimmer &

Perner, 1983). In this task, the participant is shown two dolls, Sally and Anne, and

a basket and a box. The participant watches as Sally places her marble in the basket

and then leaves the room. While Sally is out, naughty Anne moves Sally’s marble

from the basket to the box. Then she, too, leaves the room. Now Sally comes back

into the room. The participant is asked the test question: ‘Where will Sally look for

her marble?’. In order to pass this task, the participant must represent Sally’s

mental state, her belief that the marble is in the basket. Without this representa-

tion, the participant will answer on the basis of the marble’s real location, i.e. the

box. Most healthy developing individuals from the age of 4 years pass this task

(Wimmer & Perner, 1983).

In addition to being considered a form of empathy in its own right, the ability to

represent the mental states of others has been considered to be necessary for

‘emotional empathy’ to occur (Batson, Fultz, & Schoenrade, 1987; Feshbach,

1987). Within these positions, representations of the internal mental state of

another are assumed to act as stimuli for the activation of the affective, empathic

response (Batson et al., 1987). Feshbach (1987), for example, viewed empathy to

be a function of three processes: first, the cognitive ability to discriminate affective

cues in others; second, the more mature cognitive skills entailed in assuming the

perspective and role of another person; third, emotional responsiveness (i.e. the

ability to experience emotions) (Feshbach, 1987). According to Feshbach (1987),

‘empathy is conceived to be the outcome of cognitive and affective processes that

operate conjointly’ (p. 273).

There are no indications of Theory of Mind impairment in individuals with

psychopathy. Three out of four studies assessing the ability of individuals with

psychopathy on Theory of Mind measures have reported no impairment (Blair

et al., 1996; Richell et al., 2003; Widom, 1978). Only one study has reported

impairment and this used a rating scale that is not a typical measure of Theory

of Mind (Widom, 1976).

Blair et al. (1996) assessed the ability of individuals with psychopathy to

perform the Advanced Theory of Mind test (Happe, 1994). This is a story

comprehension measure that assesses understanding of mental states.

Individuals with autism, a population with known Theory of Mind impairment

(Frith, 1989), are impaired on this measure (Happe, 1994). However, the individ-

uals with psychopathy were not (Blair et al., 1996).

5 Empathic dysfunction in psychopathic individuals


Richell et al. (2003) examined the ability of individuals with psychopathy to

perform the ‘Reading the Mind in the Eyes’ task. In this task, participants must

judge the complex social emotion being displayed by an individual based on

information only from the eye region (Baron-Cohen et al., 1997). Individuals

with autism are impaired on this task (Baron-Cohen et al., 2001). However, again,

the individuals with psychopathy were not (Richell et al., 2003).

In addition to the above work with individuals with psychopathy, it is impor-

tant to note that even in the broader spectrum of antisocial individuals, there are

few data suggesting any link between Theory of Mind impairment and antisocial

behaviour. Hughes and colleagues did find some indication of Theory of Mind

impairment in their ‘hard-to-manage’ preschoolers relative to the comparison

group (Hughes et al., 1998). However, Happe and Frith found no impairment in

their children with emotional and behavioural difficulties (Happe & Frith, 1996).

Similarly a study of school bullies found no indications of Theory of Mind

impairment (Sutton et al., 1999). In addition, Sutton and colleagues also found

no relationship between Theory of Mind performance on the advanced Eyes task

and ‘disruptive behaviour disorder’ symptoms in children aged 11–13 years

(Sutton et al., 2000).

1.1.3.1 Summary

The profound empathic dysfunction reported in the clinical description of psy-

chopathy (Hare, 1991) does not involve Theory of Mind impairment. Individuals

with psychopathy are unimpaired on measures of Theory of Mind. Indeed, there

are no indications that any populations who show heightened levels of antisocial

behaviour are associated with Theory of Mind impairment.

1.2 Emotional empathy

Figure 1.1 represents a simple schematic of the cognitive processes that I consider

to underpin empathy. Here empathy is being defined as the emotional response

to another individual’s visual or vocal expression of emotion. This schematic

assumes that there may be at least two routes to the generation of an emotional

empathic response: one which relies on the ‘semantic processing’ of the expres-

sion and one which does not. This follows suggestions that information on the

emotional expressions of others can be conveyed either by a sub-cortical pathway

(retinocollicular–pulvivar–amygdalar) or by a cortical pathway (retinogeniculostriate–

extrastriate–fusiform) (Adolphs, 2002).

These two routes for expression processing mirror those previously suggested to

be involved in aversive conditioning (LeDoux, 2000). The sub-cortical route is



thought to provide coarse stimulus processing while the cortical route is thought

to allow more precise stimulus encoding and allow discrimination learning. The

cortical route would underpin the ‘semantic processing’ of the expression; i.e. it

would allow the expression to be named and would allow goal-directed behaviour

to be initiated in response to the expression (e.g. initiate helping behaviour to a

crying individual).

In Figure 1.1, there is reference to the systems involved in ‘the orchestration of

the emotional response’. I have stressed elsewhere that the facial expressions of

emotion each have a communicatory function, that they impart specific infor-

mation to the observer (Blair, 2003a). The systems involved in ‘the orchestration

of the emotional response’ are those systems which respond automatically to

the communicatory value of the expression. In short, an empathic response

is a translation of a non-verbal communicatory signal. Because of the different

implications of these communicatory signals, I have argued that they are

translated in several separable systems (Blair, 2003a). I will consider this com-

munication and the systems that orchestrate the response to this communication

below.

I have suggested that fearfulness, sadness and happiness are reinforcers that

modulate the probability that a particular behaviour will be performed in the

Emotional expression

Semantic processing of expression

Orchestration of the emotional response

Empathic response

Visual (or auditory) processing of expression

Figure 1.1. A schematic of the cognitive processes thought to underpin empathy. The dotted line refers

to the suggested (sub-cortical) route that bypasses the semantic processing of the expression



future (Blair, 2003a). Indeed, fearful faces have been seen as aversive uncondi-

tioned stimuli that rapidly convey information to others that a novel stimulus is

aversive and should be avoided (Mineka & Cook, 1993). Similarly, I have sug-

gested that sad facial expressions also act as aversive unconditioned stimuli,

discouraging actions that caused the display of sadness in another individual

and motivating reparatory behaviours. Happy expressions, in contrast, are appe-

titive unconditioned stimuli which increase the probability of actions to which

they appear causally related.

The amygdala has been implicated in aversive and appetitive conditioning

including instrumental learning (LeDoux, 2000). It is thus unsurprising, given

the suggested role of fearful, sad and happy expressions as reinforcers, that neuro-

imaging studies, with a few exceptions, have generally found that fearful, sad and

happy expressions all modulate amygdala activity (see, for a review, Blair, 2003a).

The neuropsychological literature supports the neuroimaging literature as regards

the importance of the amygdala in the processing of fearful expressions. There

have been occasional suggestions that amygdala damage leads to general expression-

recognition impairment but these reports are typically from patients whose

lesions extend considerably beyond the amygdala (Rapcsak et al., 2000). Instead,

amygdala lesions have been consistently associated with impairment in the recog-

nition of fearful expressions (Adolphs, 2002; Blair, 2003a). Impairment in the

processing of sad expressions is not uncommonly found in patients with amygdala

lesions (Blair, 2003a). However, amygdala lesions rarely result in impairment in

the recognition of happy expressions although this may reflect the ease with which

happy expressions are recognized (Blair, 2003a).

Disgusted expressions are also reinforcers but are used most frequently to

provide information about foods (Rozin et al., 1993). In particular, they allow

the rapid transmission of taste aversions; the observer is warned not to approach

the food to which the emoter is displaying the disgust reaction. Thus, the sugges-

tion is that the disgusted expressions of others activate in particular the insula

allowing taste aversion [the disgust expression is the unconditioned stimulus

(US) that is associated with the novel food conditioned stimulus (CS)] to occur

(Blair, 2003a).

I have argued that displays of anger or embarrassment do not act as uncon-

ditioned stimuli for aversive conditioning or instrumental learning (Blair, 2003a).

Angry expressions are known to curtail the behaviour of others in situations where

social rules or expectations have been violated (Averill, 1982). Instead, they are

important signals to modulate current behavioural responding, particularly in

situations involving hierarchy interactions (Blair, 2003a). They appear to serve to

inform the observer to stop the current behavioural action rather than to convey

any information as to whether that action should be initiated in the future.



In other words, angry expressions can be seen as triggers for response reversal.

Orbital and ventrolateral frontal cortex is crucially implicated in response reversal

(Cools et al., 2002). Interestingly, similar areas of lateral orbital frontal cortex are

activated by angry expressions and response reversal as a function of contingency

change (Blair, 2003b).

1.2.4.2 Summary

In short, emotional expressions are non-verbal communications. Empathy is a

prime component of the translation of this communication within the observer.

This translation is potentially reliant on both cortical and sub-cortical routes.

These routes convey the communication to regions of the brain involved in

emotional processing (the amygdala, insula and orbital and ventrolateral frontal

cortex). These regions orchestrate a response to this communication; mediating

emotional learning about objects or food or initiating response reversal.

1.3 Psychopathy and emotional empathy

As noted in the introduction, there can be no doubt that psychopathy is associated

with empathic dysfunction. However, the question remains regarding the form of

this dysfunction. I outlined above that the empathic dysfunction in psychopathy

does not include impairment in Theory of Mind. What about emotional empathy?

In Section 1.2, I outlined a schematic of the empathic process. Currently, no data exist

regarding the two routes to the systems that allow the orchestration of the emotional

response. We do not know whether psychopathy is associated with dysfunction in

systems involved in face processing. However, one reason to believe that there is no

obvious general dysfunction in the systems involved in facial processing is that while

individuals with psychopathy are impaired in expression processing, their impair-

ment appears to be selective. Given this selectivity (see below), it is unlikely that there

is notable dysfunction in the systems involved in face processing.

Two main forms of paradigm have been used to index empathy in individuals

with psychopathy: skin conductance responses (SCRs) to empathy-inducing stim-

uli and the ability to recognize facial expressions. Three studies have examined

vicarious conditioning in individuals with psychopathy; i.e. the extent to which the

participant will learn an autonomic response to a stimulus associated with another

individual’s distress (Aniskiewicz, 1979; House & Milligan, 1976; Sutker, 1970).

Two of these three studies reported reduced vicarious conditioning in the indi-

viduals with psychopathy, the third did not.

Two studies have examined SCRs to sad faces in individuals with psycho-

pathic tendencies: one examined adults with psychopathy, the other children

with psychopathic tendencies (Blair, 1999; Blair et al., 1997). In these studies,



the participants were presented with images of sad faces, threatening stimuli (e.g.

pointed guns but also including an angry face) or neutral stimuli (e.g. a book).

Both the adults with psychopathy and the children with psychopathic tendencies

showed reduced SCRs to the sad faces relative to their respective comparison

populations. Interestingly, both adults with psychopathy and the children with

psychopathic tendencies showed relatively appropriate SCRs to the angry face

amidst the threatening stimuli. This was the first indication that the empathic

impairment in individuals with psychopathy might be selective for particular

expressions.

Studies have examined the ability of individuals with psychopathy to recognize

the facial or vocal emotional expressions of others (Blair et al., 2001, 2002, 2004,

2006; Kosson et al., 2002; Stevens et al., 2001). In most of these studies, the children

with psychopathic tendencies/adults with psychopathy have been impaired in the

recognition of sad/fearful expressions. Typically, the children with psychopathic

tendencies have shown impairment in the recognition of sad expressions (Blair

et al., 2001; Stevens et al., 2001). However, this has not been found in the

adults with psychopathy (with one exception; Dolan, personal communication).

In all of the studies, except that of Kosson et al. (2002), the children with

psychopathic tendencies and the adults with psychopathy have been impaired in

the recognition of fearful expressions. Kosson et al. (2002) reported some difficulty

with the recognition of disgusted expressions (but only when the participants

were responding with the left hand). Blair et al. (2004) also found some impair-

ment in the adults with psychopathy for the recognition of disgusted expressions,

however this deficit was not present if the effect of intelligence quotient (IQ) was

co-varied out.

The above data suggest a relative selectivity in the empathic dysfunction shown

by individuals with psychopathy. Individuals with psychopathy are impaired when

processing fearful, sad (in adulthood if responsiveness is indexed by SCRs, in

childhood whether by SCR or recognition score) and possibly disgusted expres-

sions. No study has yet reported that individuals with psychopathy show impair-

ment in the processing of angry, happy or surprised expressions. The absence of

impairment for angry expressions is particularly interesting. Neurological patients

following lesions of orbital and ventral frontal cortex or psychiatric conditions

which are thought to detrimentally affect orbital and ventrolateral regions, such as

childhood bipolar disorder or intermittent explosive disorder, all show general

difficulties with processing expressions but their difficulty is particularly marked

for angry expressions (Best et al., 2002; Blair & Cipolotti, 2000; Hornak et al., 1996;

McClure et al., 2003).

In the Section 1.2, I suggested that there were at least three systems responsible

for orchestrating responses to expressions; i.e. the core component of empathy



(Blair, 2003a). One system responsive to the aversive and appetitive uncondi-

tioned stimuli of fearful, sad and happy expressions and consequently modulating

the probability that any stimulus associated with these expressions will be avoided

or approached in the future. A second system responsive to the aversive uncon-

ditioned stimulus of a disgusted expression will reduce the probability that any

stimulus (particularly food) associated with this expression will be avoided in the

future. A third system is particularly responsive to displays of anger and embar-

rassment which modulates on-going social interactions (eliciting responses

according to the hierarchy level of the communicator amongst other factors).

I claim that individuals with psychopathy have dysfunction primarily in the

first system (that responsive to fearful, sad and happy expressions). They may

also have dysfunction in the second system (that responsive to disgusted expres-

sions). However, in the absence of additional data that possibility will not be

considered here.

As noted above, the primary neural system responsible for orchestrating an

emotional response to fearful, sad and happy expressions is the amygdala (see

Blair, 2003a). This suggests amygdala dysfunction in psychopathy. There are

considerable data in line with this suggestion (Blair, 2003b). Thus, individuals

with psychopathy show reduced amygdaloid volume relative to comparison indi-

viduals and reduced amygdala activation during emotional memory and aversive

conditioning tasks. Human and animal neuropsychological work has informed

us that the effects of amygdala lesions include impairment in: (1) aversive con-

ditioning; (2) the augmentation of the startle reflex to visual threat primes; and

(3) passive avoidance learning. If psychopathy is associated with amygdala dys-

function, the neuropsychological approach would predict that individuals with

psychopathy are impaired in the above tasks. Considerable data show that they are

(see, for a review, Blair, 2004).

While individuals with psychopathy are impaired in the processing of fearful

and sad expressions, they show no impairment for the processing of happy

expressions (Blair et al., 2001, 2002, 2003b, 2006; Kosson et al., 2002; Stevens

et al., 2001). While this is consistent with the neuropsychological literature

documenting the consequences of amygdala lesions, it is less consistent with the

neuroimaging literature (see above) which suggests a role for the amygdala in the

processing of happy expressions. Of course, the absence of impairment for happy

expressions in individuals with psychopathy might reflect the ease with which they

are recognized (i.e. an intact amygdala is not necessary for naming).

However, a more interesting possibility is that this absence of impairment

reflects the selectivity of their impairment. The amygdala is involved in the

formation of stimulus–reward and stimulus–punishment associations; animals

with amygdala lesions show impairment in both reward- and punishment-related



behaviour (Baxter & Murray, 2002). Yet, the impairment in individuals with

psychopathy is far more marked for processing dependent on stimulus–punishment

associations than for stimulus–reward associations (Levenston et al., 2000). Thus,

whereas individuals with psychopathy do not show augmentation of the startle

reflex following a negative visual prime relative to comparison individuals, they do

show a comparable reduction in startle reflex following a positive visual prime

relative to comparison individuals (Levenston et al., 2000). Moreover, in

a decision-making study, individuals with psychopathy showed particular diffi-

culty, relative to controls, when choosing between stimuli associated with different

levels of punishment. Their impairment in choosing between stimuli associated

with different levels of reward was far less marked (K. S. Peschardt, A. Leonard,

J. Morton, & R. J. R. Blair, Differential stimulus–reward and stimulus–punishment

learning in individuals with psychopathy. Submitted for publication). I argue that

happy faces are appetitive unconditioned stimuli. In other words, the absence of

impairment in individuals with psychopathy for happy expressions might also

reflect the selectivity of their impairment for the processing of punishment

information as opposed to reward information.

1.3.4.3 Summary

I assume that individuals with psychopathy have no impairment in the systems

which convey facial expression information to those neural systems that are

involved in orchestrating an emotional response to these expressions. This

assumption is made because individuals with psychopathy show considerable

selectivity in their facial-expression-processing impairment. They are not

impaired for all expressions. They are not impaired when processing angry,

surprised or happy expressions. They are, however, impaired when processing

fearful, sad and, possibly, disgusted expressions. This impairment is likely related

to the amygdala dysfunction seen in patients with this disorder.

1.4 Conclusion

Empathic dysfunction is one of the major features of psychopathy. The goal of this

chapter was to consider the nature of this empathic dysfunction. Two main forms of

empathy were considered: ‘cognitive empathy’ or Theory of Mind and ‘emotional

empathy’. Considerable work indicates that there is no Theory of Mind impairment

in psychopathy. Moreover, it also appears clear that Theory of Mind impairment is

not associated with more general populations of antisocial individuals.

Emotional empathy can be considered the results of the translation of the

non-verbal communications that are the emotional expressions of others. It is

potentially reliant on both cortical and sub-cortical face processing routes. These



routes convey the communication to regions of the brain involved in emotional

processing (the amygdala, insula and orbital and ventrolateral frontal cortex).

These regions allow a dedicated response to the facial expressions of others. For

example, fearful and sad expressions, processed by the amygdala, initiate emo-

tional learning. In contrast, angry expressions, primarily processed by ventro-

lateral prefrontal cortex, initiate the termination of on-going behaviour.

Individuals with psychopathy have a relatively selective empathy deficit. They

are impaired in the processing of fearful, sad and possibly disgusted expressions.

Impairment in the processing of particularly fearful expressions is a common

consequence of amygdala lesions. Patients with psychopathy show many other

impairments associated with amygdala dysfunction. In short, it appears likely that

their reduced responsiveness to the fearful and sad expressions of others is related

to their more general amygdala dysfunction.

I, and others, consider the empathy dysfunction seen in individuals with

psychopathy to be at the heart of the disorder (Blair, 1995). Individuals who

are indifferent to the fear and sadness of others are individuals who are

difficult to socialize through effective socialization practices such as empathy

induction. Empathy induction involves the socializer focusing the attention of

the transgressor on the distress of the victim (and presumably heightens the

salience of the aversive stimulus of the victim’s distress). While the greater use of

empathy induction and other positive forms of parenting reduce the probability

of antisocial behaviour in healthy children, they have no significant effect on the

probability of antisocial behaviour in children with psychopathic tendencies

(Wootton et al., 1997). In other words, if we could find means to increase the

empathic reaction of children with psychopathic tendencies, we might be able to

considerably improve the prognosis of this disorder. The investigation of such

means is one of the main foci of our research at the moment.

REFERENCES

Adolphs, R. (2002). Neural systems for recognizing emotion. Current Opinion in Neurobiology,

12(2), 169–177.

Aniskiewicz, A. S. (1979). Autonomic components of vicarious conditioning and psychopathy.

Journal of Clinical Psychology, 35, 60–67.

Averill, J. R. (1982). Anger and Aggression: An Essay on Emotion. New York: Springer-Verlag.

Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The ‘reading the mind in

the eyes’ test revised version: a study with normal adults, and adults with asperger syndrome or

high-functioning autism. Journal of Child Psychology and Psychiatry, and Applied Disciplines,

42(2), 241–251.



Baron-Cohen, S., Wheelwright, S., & Joliffe, T. (1997). Is there a ‘language of the eyes’? Evidence

from normal adults, and adults with autism or asperger syndrome. Visual Cognition, 4(3),

311–331.

Batson, C. D., Fultz, J., & Schoenrade, P. A. (1987). Adults’ emotional reactions to the distress of

others. In N. Eisenberg & J. Strayer (eds.), Empathy and its Development (pp. 163–185).

Cambridge: Cambridge University Press.

Baxter, M. G., & Murray, E. A. (2002). The amygdala and reward. Nature Reviews Neuroscience,

3(7), 563–573.

Best, M., Williams, J. M., & Coccaro, E. F. (2002). Evidence for a dysfunctional prefrontal circuit

in patients with an impulsive aggressive disorder. Proceedings of the National Academy of

Sciences of the USA, 99(12), 8448–8453.

Blair, R. J., Mitchell, D. G., Richell, R. A., Kelly, S., Leonard, A., Newman, C., et al. (2002).

Turning a deaf ear to fear: impaired recognition of vocal affect in psychopathic individuals.

Journal of Abnormal Psychology, 111(4), 682–686.

Blair, R. J. R. (1995). A cognitive developmental approach to morality: investigating the psy-

chopath. Cognition, 57, 1–29.

Blair, R. J. R. (1999). Responsiveness to distress cues in the child with psychopathic tendencies.

Personality and Individual Differences, 27, 135–145.

Blair, R. J. R. (2003a). Facial expressions, their communicatory functions and neuro-cognitive

substrates. Philosophical Transactions of the Royal Society of London. Series B, Biological

Sciences, 358(1431), 561–572.

Blair, R. J. R. (2003b). Neurobiological basis of psychopathy. British Journal of Psychiatry, 182, 5–7.

Blair, R. J. R., Budhani, S., Colledge, E., & Scott, S. K. (2006a). Deafness to fear in boys with

psychopathic tendencies. Journal of Child Psychology and Psychiatry, in press.

Blair, R. J. R., & Cipolotti, L. (2000). Impaired social response reversal: a case of ‘acquired

sociopathy’. Brain, 123, 1122–1141.

Blair, R. J. R., Colledge, E., Murray, L., & Mitchell, D. G. (2001). A selective impairment in the

processing of sad and fearful expressions in children with psychopathic tendencies. Journal of

Abnormal Child Psychology, 29(6), 491–498.

Blair, R. J. R., Jones, L., Clark, F., & Smith, M. (1997). The psychopathic individual: a lack of

responsiveness to distress cues? Psychophysiology, 34, 192–198.

Blair, R. J. R., Mitchell, D. G. V., Colledge, E., Leonard, R. A., Shine, J. H., Murray, L. K., et al.

(2004). Reduced sensitivity to other’s fearful expressions in psychopathic individuals.


Blair, R. J. R., Sellars, C., Strickland, I., Clark, F., Williams, A., Smith, M., et al. (1996). Theory of

mind in the psychopath. Journal of Forensic Psychiatry, 7, 15–25.

Cools, R., Clark, L., Owen, A. M., & Robbins, T. W. (2002). Defining the neural mechanisms of

probabilistic reversal learning using event-related functional magnetic resonance imaging.

Journal of Neuroscience, 22(11), 4563–4567.

Feshbach, N. D. (1987). Parental empathy and child adjustment/maladjustment. In N. Eisenberg

& J. Strayer (eds.), Empathy and its Development. New York: Cambridge University Press.

Frick, P. J., & Hare, R. D. (2001). The Antisocial Process Screening Device. Toronto: Multi-Health

Systems.



Frith, U. (1989). Autism: Explaining the Enigma. Oxford: Blackwell.

Happe, F. G. E. (1994). An advanced test of theory of mind: understanding of story characters’

thoughts and feelings in able autistic, mentally handicapped, and normal children and adults.

Journal of Autism and Developmental Disorders, 24, 129–154.

Happe, F. G. E., & Frith, U. (1996). Theory of mind and social impairment in children with

conduct disorder. British Journal of Developmental Psychology, 14(4), 385–398.

Hare, R. D. (1991). The Hare Psychopathy Checklist – Revised. Toronto, Ontario: Multi-Health

Systems.

Hare, R. D. (1980). A research scale for the assessment of psychopathy in criminal populations.


Hoffman, M. L. (1987). The contribution of empathy to justice and moral judgment. In

N. Eisenberg & J. Strayer (eds.), Empathy and its Development (pp. 47–80). Cambridge:

Cambridge University Press.

Hornak, J., Rolls, E. T., & Wade, D. (1996). Face and voice expression identification in patients

with emotional and behavioural changes following ventral frontal damage. Neuropsychologia,

34, 247–261.

House, T. H., & Milligan, W. L. (1976). Autonomic responses to modeled distress in prison

psychopaths. Journal of Personality and Social Psychology, 34, 556–560.

Hughes, C., Dunn, J., & White, A. (1998). Trick or treat? Uneven understanding of mind and

emotion and executive dysfunction in ‘hard-to-manage’ preschoolers. Journal of Child

Psychology and Psychiatry, 39(7), 981–994.

Kosson, D. S., Suchy, Y., Mayer, A. R., & Libby, J. (2002). Facial affect recognition in criminal

psychopaths. Emotion, 2(4), 398–411.

LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23, 155–184.

Levenston, G. K., Patrick, C. J., Bradley, M. M., & Lang, P. J. (2000). The psychopath as observer:

emotion and attention in picture processing. Journal of Abnormal Psychology, 109, 373–386.

McClure, E. B., Pope, K., Hoberman, A. J., Pine, D. S., & Leibenluft, E. (2003). Facial expression

recognition in adolescents with mood and anxiety disorders. American Journal of Psychiatry,

160(6), 1172–1174.

Mineka, S., & Cook, M. (1993). Mechanisms involved in the observational conditioning of fear.

Journal of Experimental Psychology: General, 122, 23–38.

Pichot, P. (1978). Psychopathic behavior: a historical review. In R. D. Hare & D. S. Schalling

(eds.), Psychopathic Behavior: Approaches to Research. Chichester: Wiley.

Rapcsak, S. Z., Galper, S. R., Comer, J. F., Reminger, S. L., Nielsen, L., Kaszniak, A. W., et al. (2000).

Fear recognition deficits after focal brain damage: a cautionary note. Neurology, 54, 575–581.

Richell, R. A., Mitchell, D. G., Newman, C., Leonard, A., Baron-Cohen, S., & Blair, R. J. (2003).

Theory of mind and psychopathy: can psychopathic individuals read the ‘language of the

eyes’? Neuropsychologia, 41(5), 523–526.

Rozin, P., Haidt, J., & McCauley, C. R. (1993). Disgust. In M. Lewis & J. M. Haviland (eds.),

Handbook of Emotions (pp. 575–594). New York: The Guilford Press.

Stevens, D., Charman, T., & Blair, R. J. R. (2001). Recognition of emotion in facial expressions

and vocal tones in children with psychopathic tendencies. Journal of Genetic Psychology,

162(2), 201–211.



Sutker, P. B. (1970). Vicarious conditioning and sociopathy. Journal of Abnormal Psychology, 76,

380–386.

Sutton, J., Reeves, M., & Keogh, E. (2000). Disruptive behaviour, avoidance of responsibility and

theory of mind. British Journal of Developmental Psychology, 18(1), 1–11.

Sutton, J., Smith, P. K., & Swettenham, J. (1999). Social cognition and bullying: social inade-

quacy or skilled manipulation? British Journal of Developmental Psychology, 17(3), 435–450.

Widom, C. S. (1976). Interpersonal and personal construct systems in psychopaths. Journal of

Consulting and Clinical Psychology, 44, 614–623.

Widom, C. S. (1978). An empirical classification of female offenders. Criminal Justice and

Behavior, 5, 35–52.

Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: representation and the constraining

function of wrong beliefs in young children’s understanding of deception. Cognition, 13,

103–128.

Wootton, J. M., Frick, P. J., Shelton, K. K., & Silverthorn, P. (1997). Ineffective parenting and

childhood conduct problems: the moderating role of callous-unemotional traits. Journal of

Consulting and Clinical Psychology, 65, 292–300.


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