Emotion, empathic and moral processing in personality disordered offenders

This thesis provides a diverse and detailed account of research that has examined emotion, empathic and moral processing in antisocial personality disordered (ASPD) and dissocial personality disordered (DPD) populations with and without co-morbid psychopathy. It incorporates a systematic review, empirical research and a psychometric critique and in doing so provides a comprehensive overview of the methods employed to examine these constructs and findings which inform how emotion, empathic and moral processing manifest in these groups. The rationale for this topic is founded on theories and research which suggest that deficient emotion, empathic and moral processing plays a central role in the development and maintenance of antisocial behaviour and violence. Chapter 1 provides an introduction to the thesis. Chapter 2 is comprised of a systematic review which assesses what emotion processing and empathy deficits exist in ASPD/DPD groups with and without co-morbid psychopathy. The rationale for this systematic review was to resolve ambiguity regarding whether emotion processing and empathy deficits differentiate populations with ASPD/DPD and co- morbid psychopathy (ASPD+P) from those with ASPD/DPD only (ASPD-P). A total of 22 studies were quality assessed and sampling bias was highlighted as a key methodological limitation. However, whilst a synthesis of the findings from these studies highlighted substantial evidence of emotion processing deficits in ASPD/DPD groups, the review was unable to conclusively determine the extent to which ASPD/DPD groups with and without co-morbid psychopathy could be differentiated in terms of emotional dysfunction because the majority of reviewed studies employed mixed ASPD/DPD populations consisting of some participants with and some without co-morbid psychopathy (ASPD+/-P or DPD+/-P) and did not examine emotion processing or empathy in participants with ASPD/DPD-P independently of those with ASPD/DPD+P. Consequently, chapter 3 describes empirical research which employed self-report and behavioural measures to examine emotional and empathic processing in adult male patients with ASPD/DPD with and without co- morbid psychopathy (combined ASPD), an ASPD/DPD group without co- morbid psychopathy (ASPD-P), an ASPD/DPD group with co-morbid psychopathy (ASPD+P) group and non-offending, non-personality disordered adult male controls. The rationale for this study was to enhance the current literature base regarding emotion and empathic processing in ASPD/DPD by determining whether patients with ASPD/DPD (the combined ASPD group) exhibit emotion processing and empathy deficits when compared to non-personality disordered controls and then examining whether delineated ASPD-P and ASPD+P patients can be differentiated in terms of these deficits. Whilst a comparison of the combined ASPD and control group suggested emotion processing deficits in ASPD, a three group comparison (comparing ASPD-P, ASPD+P and control groups) indicated co-morbid psychopathy mediated both emotion processing and empathy deficits in ASPD. In contrast, no significant differences were found between ASPD-P and control groups once analyses were adjusted to control for confounding variables. Still, a primary limitation of this research was the small sample sizes for the three group analysis and possibility that this study lacked statistical power, thereby increasing the likelihood of type 2 error. Chapter 4 then builds upon the empirical research in chapter 3 and examines moral processing in the same ASPD and control groups. The rationale for this study was to determine the relationship between empathic and moral processing, to examine whether ASPD groups (combined ASPD, ASPD-P and ASPD+P) would differ in their identification with moral emotions (i.e., guilt, compassion, self-anger and other-anger) and endorsement of utilitarian solutions to sacrificial moral dilemmas (i.e., choosing to sacrifice the life of one individual to save multiple individuals) when compared to non-personality disordered adult male controls and whether patients with ASPD+P would identify with fewer moral emotions and endorse more utilitarian solutions when compared to those with ASPD-P. Findings suggested that co-morbid psychopathy did mediate moral emotions deficits in ASPD but these deficits did not promote significantly higher endorsement of utilitarian solutions in response to impersonal or personal moral dilemmas. Furthermore, all groups were more willing to endorse utilitarian solutions to moral dilemmas that involved impersonal rather than personal contact, thereby highlighting that moral emotions deficits do not prevent those with ASPD+P from distinguishing behaviour that is commonly considered morally acceptable from that which is not. Still, this research was subject to a range of limitations including the use of hypothetical scenarios which may not elicit responses typical of those that would be incurred in real-life situations. Chapter 5 provides a psychometric critique of the Interpersonal Reactivity Index (IRI; Davis, 1980) which was employed as an assessment tool for research outlined in Chapter 3. The IRI was examined for its utility, validity and reliability and its suitability for use with violent offending when compared to non-offending populations, for whom it was initially designed. The key finding from this critique was that the IRI is neither valid or reliable when employed with violent offender groups and that it should not be employed with forensic populations in its current form. Chapter 6 reflects on the aims of the thesis, provides a summary of the findings from each chapter and concludes that whilst emotion, empathic and moral processing deficits do exist in ASPD, evidence of reduced emotional reactivity in ASPD-P populations is limited and it is in fact largely co-morbid psychopathy which acts to mediate these deficits. Still, whilst chapter six highlights the valuable contribution that this thesis has made in identifying the differences between these groups, it not only identifies the need for researchers and treatment providers to recognise differences between and distinguish ASPD-P and ASPD+P populations but also emphasises the need to address heterogeneity in the origins of impairment and deficits manifest in those with ASPD+P. Equally, it argues that in view of the limited evidence to support effective interventions with ASPD populations, further methodologically rigorous and transparent research is required to determine the effectiveness of targeted treatment approaches employed with delineated ASPD populations. It then concludes that there should be an increased emphasis on early intervention strategies as a means to not only broaden current knowledge of the developmental origins which underlie the deficits observed in those with ASPD+P but also to address these deficits when they may be more amenable to change