Etiological Heterogeneity in Psychopathic Personality

One main goal of our research is to elucidate the different pathways to criminal and violent behavior, particularly in regards to identifying differential etiological correlates for the different facets of psychopathy (impulsive-antisocial traits vs. affective-interpersonal deficits) or for primary psychopathy vs. externalizing/antisocial personality.
  • We published the first genetic study on psychopathic traits in youth (Sadeh et al., 2010, Journal of Abnormal Psychology), showing different genetic contributions to the impulsivity and interpersonal-affective deficits of psychopathy. This study reported that adolescents homozygous for the short allele of the serotonin transporter genotype (5HTTLPR) evidenced more impulsivity than those homozygous for the long allele. In addition, a gene-environment interaction was associated with the callous-unemotional and narcissistic features of psychopathy in these adolescents. In the latter instance, callous-unemotional and narcissistic traits increased as SES decreased only among youths with the homozygous-long (i.e. l/l) genotype, a novel finding replicated and extended in a different data set. These results suggest that the l/l genotype confers risk for the deficits in emotionality and predatory interpersonal traits associated with psychopathy among youths raised in disadvantaged environments. Visit the press release at http://www.news.illinois.edu/news/10/0805psychopathic_traits.html.
  • The above results were recently replicated in our lab using data from community-dwelling adults with criminal histories and jail inmates. Sadeh, Javdani, and Verona (in press) found that the emotional deficits characterizing the affective factor of psychopathy, as measured by the Psychopathy Checklist: Screening Version, were highest among carriers of the 5-HTT long allele. Further, the impulsive and irresponsible lifestyle features of psychopathy were higher among low-activity than high-activity MAO-A carriers. Results suggest that psychopathy may be etiologically multi-determined.
  • In Sadeh, Verona, Javdani, & Olson (2009), a combination of self- and parent-reports on the Antisocial Process Screening Device (APSD) revealed that the three-facet model of psychopathic tendencies in youth was characterized by a similar constellation of personality traits as the psychopathic construct in adulthood (e.g., Hall, Benning, & Patrick, 2004). Specifically, low anxiety and trait aggression characterized the APSD Callous/Unemotional dimension, social dominance and trait aggression characterized the APSD Narcissism dimension, and disinhibition and low harm-avoidance characterized the APSD Impulsivity dimension. The results add credence to the hypothesis that personality relationships to psychopathic tendencies emerge from an early age (Lynam, 2002) and dimensions of psychopathy in youth are associated with distinct personality profiles.
  • Several of our studies have uncovered differential patterns of cognitive and affective processing in primary psychopathy (or Factor 1) and externalizing (or Factor 2).
    • In a study on cognitive functioning, we found that traits typically associated with primary psychopathy (e.g., low anxiety, social dominance, fearlessness) were related to diminished basic attentional capacity, whereas traits linked to secondary psychopathy (e.g., social alienation, hostility) were related to impaired working memory functioning and cognitive control (Sadeh & Verona, 2008). The former results explain the psychopath's tendencies to screen out environmental information that is irrelevant to goal attainment, such as distress cues that engender empathy or threatening consequences that deter antisocial behavior. The latter findings explain the higher levels of impulsivity, risk-taking, and anger dysregulation in antisocial offenders. Together, these results suggest that psychopathic traits are differentially related to selective impairments in attentional functioning, which may account for the observed heterogeneity in psychopathic manifestations.
    • A follow up to this study using electrophysiological measures in a forensic-clinical sample (Sadeh & Verona, 2012) showed that the affective-interpersonal features of psychopathy related to aberrant processing of emotion at initial perception (visual N1) and deficits in later defensive fear reactivity (FPS), but only when picture stimuli were visually-complex. In contrast, the impulsive-antisocial features of psychopathy were associated with decreased sensitivity to picture complexity (visual N1) and unrelated to emotional processing as assessed by ERP and startle.
    • In another electrophysiological study (Verona, Sprague, & Sadeh, 2012), we reported that inhibitory control demands (No-Go vs. Go) failed to modulate frontal-P3 amplitude to negative emotional words in persons scoring high on psychopathy and persons with antisocial personality disorder (APD), but in different ways. The psychopathic group showed blunted processing of negative emotional words regardless of inhibitory control demands, consistent with research on emotional deficits in psychopathy. In contrast, the APD group demonstrated enhanced processing of negative emotion words in both Go and No-Go trials, suggesting a failure to modulate negative emotional processing when inhibitory control is required.
    • Among normal young adults, we examined executive functioning deficits more broadly and psychopathic traits. This study reported that the social deviance features of psychopathy (aggression, impulsivity, irresponsibility) were associated with deficits in general executive functioning and response inhibition on neuropsychological tests, whereas the affective-interpersonal features (low fear, social dominance) were associated with enhanced executive functioning (Sellbom & Verona, 2007).
Together, this line of work has established that the development of criminal deviance may involve multiple etiological processes, with one involving core deficits in defensive emotional activation, selective attention but normal executive functioning and another involving emotional dysregulation and deficits in executive functioning. Current work continues to examine distinct cognitive-affective deficits and brain mechanisms involved in emotional and behavioral problems in these individuals.

Risk for Aggression and Violence

Individual Difference Moderators of Stress-Aggression Link

A series of our studies show that key individual differences (gender, personality, genes) modulate the extent to which stress leads to aggressive behavior, and this work has identified emotional processes that may differ across these groups.
  • First, in a series of studies we have shown that gender seems to moderate the stress-aggression relationship. Acute stress exposure is associated with increases in laboratory aggression and hostile feelings in men but not women (Verona & Curtin, 2006, Emotion). In women, stress exposure is associated with decreases in laboratory aggression and with the experience of internalizing emotions, such as sadness or fear (Verona & Curtin, 2006; Verona & Kilmer, 2007; Verona, Reed, Curtin, & Pole, 2007). These results suggest that stress may lead to different manifestations of distress in men and women.
  • Increases in emotional activation (defensive startle response) in response to stress are related to engagement in aggressive behavior among men high on negative emotional traits or hostility (Verona, Patrick, & Lang, 2002) and among normal men but not women (Verona & Curtin, 2006; Verona & Kilmer, 2007).
  • In a cross-sectional study (Sprague, Verona, Kalkhoff, & Kilmer, 2011), we found that participants with relatively low executive function (measured with a battery of validated and established neuropsychological tests) showed a stronger relationship between reports of stressful life events and enacting aggressive behavior in the last month. In addition, experiences of anger and hostility in the last month mediated the relationship between perceived stress (aggregate) and aggressive behavior among those low, but not high, in executive functioning.
  • We have identified a potential genetic marker for stress-related aggression in men. Acute exposure to stress moderates the effect of the serotonin transporter gene on aggressive behavior in men, suggesting a genetic predisposition to behavior activation in the form of aggression under stress (Verona, Joiner, Johnson, & Bender, 2006). This is the first demonstration of a gene-environment interaction on laboratory aggressive behavior, and further implicates the serotonin system in externalizing and impulsive behaviors in men but not women.
These set of results suggests that those at higher risk for aggression seem to show stronger associative links between negative affective systems and behavioral activation, which may explain their problems with controlling aggression under emotional situations .

Physiological and emotional mechanisms in violence and aggression

Our work has also focused on identifying specific emotional and physiological mechanisms that may explain chronic violence and aggression.
  • In a study that has been submitted for publication (Finy, Bresin, Korol, & Verona, 2012), analyses revealed that stress exposure led to either increases or decreases in disinhibited laboratory behaviors depending on the personality traits of the youth studied. Of particular interest, youth scoring low on constraint showed LESS risky behavior under stress than no stress, along with greater cortisol reactivity to the stressor. These results suggest that adolescents low in CON may mobilize greater resources (e.g., cognitive control, cortisol reactivity) in stressful relative to non-stressful situations. Negative emotional traits, in contrast, were associated with less impulsivity under no-stress, and more impulsivity under stress.
  • We examined emotional risk for two forms of violence, self-directed (suicide attempts, self-injury) and other-directed (physical fights, unprovoked attacks). Interestingly, we found trait anger (i.e., difficulty controlling one's temper) was associated with other-directed violence selectively in men, whereas trait hostility (i.e., suspiciousness and alienation) was associated with self- and other-directed violence among women. Anhedonic depression was negatively and positively associated with other- and self-directed violence, respectively, in both genders. The divergent findings for trait anger and hostility underscore the need to examine gender-specific risk factors for violence to avoid excluding potentially useful clinical features of these mental health outcomes. This paper was published in the Journal of Consulting and Clinical Psychology (Sadeh, Javdani, Finy, & Verona, 2011).
  • In Verona & Sullivan (2008), we identified two different pathways through which emotional arousal may prime aggressive actions, which we referred to as the "physiological activation" and "physiological reinforcement" pathways. We found that engaging in aggressive responses during frustration was associated with reductions in heart rate (tension-reduction), except during a stressful context. At the same time, tension-reduction following aggressive responses was associated with the most intense aggression in a subsequent block, evidence of the reinforcing effects of tension-reduction. This pathway is contrasted with the one described above, in which emotional activation leads to direct engagement of behavior systems to promote aggression, especially in some individuals. This work helps to integrate classic models of catharsis theory and associative models of emotion to create a more nuanced picture of physiology-aggression relationships.
  • In Verona, Sadeh, & Curtin (2009), we tested the hypothesis that the activation of behavior approach mechanisms may underlie stress-induced increases in aggression. We demonstrated that exposure to stress led to greater left prefrontal EEG activity (commonly interpreted as evidence of enhanced approach motivation) and subsequent increases in laboratory aggression. Importantly, left frontal asymmetry in response to stress exposure predicted increases in subsequent aggressive behavior, a finding that did not emerge in the no-stress condition. These results suggest that stress reactivity involving approach activation represents risk for behavioral dysregulation and possibly externalizing disorders.
Current research is exploring the physiological and emotional processes involved in other forms of aggression, including self-harm.

Externalizing, Psychopathy, and Comorbid Syndromes

Some of our work has focused on identifying broader dimensions of psychopathology by examining the co-occurrence of externalizing disorders, psychopathic traits, and related syndromes (borderline, narcissism, suicidality).
  • In Schoenleber, Sadeh, and Verona (2011), we described how the vulnerable and grandiose dimensions of narcissism respectively parallel primary and secondary forms of psychopathy in terms of inter-relationships and their correlates. These findings may inform current dimensional conceptualizations of personality disorders and common etiology across them.
  • In Javdani, Sadeh, and Verona (2011), we detected an interesting gender difference, in that teen girls with higher scores on callous-unemotional traits showed less risk for suicide attempts. Also of interest, although depression was associated with higher levels of suicidality and history of attempts and self-injury, the effect of depression on suicide-related behaviors was no longer significant when accounting for impulsive traits, which predicted greater levels of suicidality in both girls and boys. These findings help to disentangle the heterogeneity of antisocial/externalizing propensities (such as impulsivity vs. callous-unemotional traits) and their associations with suicide risk, such that some psychopathic facets are risk factors for and some are protective of suicidality - even though they are all associated with antisocial behavior and aggression.
  • In female prison inmates, prior suicide attempts were positively associated with antisocial behavior and aggression and negatively associated with the affective-interpersonal features of psychopathy (Verona, Hicks, & Patrick, 2005). Path analyses demonstrated that personality traits and a history of childhood abuse mediated the relationship between antisocial behavior and suicide attempts. Abuse and personality variables accounted for minimal variance in the affective-interpersonal features of psychopathy. These results provide further evidence that antisocial deviance is associated with risk for other emotional problems, and a personality profile of negative emotionality/low constraint and a history of childhood adversity may represent common vulnerabilities for a spectrum of externalizing/impulsive syndromes including antisocial behavior and impulsive suicide. The affective-interpersonal features of psychopathy, on the other hand, may be a protective factor for comorbid psychopathology.
  • Among a large community sample, externalizing psychopathology (antisocial personality disorder, drug dependence, alcohol dependence) was related to a history of suicide attempts, even after controlling for depression and anxiety (Verona, Sachs-Ericsson, & Joiner, 2004). This study demonstrated that suicidal behavior among externalizing individuals is not necessarily as a result of a comorbid depressive or other internalizing disorders.
  • Prior suicide attempts in male prison inmates was significantly related to social deviance as well as to a diagnosis of antisocial personality disorder but was unrelated to the affective-interpersonal features of psychopathy (Verona, Patrick, & Joiner, 2001). Importantly, higher-order personality dimensions of negative emotionality and low constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.
These studies illustrate dimensions of psychopathology that link antisocial, externalizing, vulnerable narcissism, and suicidality, presumably linked by trait behavioral dyscontraint and emotional reactivity. In contrast, the affective-interpersonal traits of psychopathy and grandiose narcissism show protection against emotional problems and internalizing disorders. Current work in our lab is examining links between psychopathy and Borderline Personality Disorder, especially in terms of how gender may moderate these associations. These data will help to clarify distinct manifestations of externalizing and psychoapthy in men vs. women.