Re-evaluation of Fear Processing in Psychopathy: New Evidence and Application to Other Psychiatric Disorders

Common drug may help PTSD patients dampen fear
Common drug may help PTSD patients dampen fear
This is the first meta-analysis to examine subjective emotion experience in psychopathy.

Investigators affiliated with Vrije University Amsterdam and Radboud University Nijmegen in the Netherlands examined whether persons diagnosed with psychopathy experience fear in a manner that is similar to that of typical, healthy individuals. They reported that individuals diagnosed with severe personality disorders such as psychopathy retain the ability of subjective experience of fear, but present with deficits in threat/fear detection and responsivity. The results were published in Psychological Bulletin.

According to the authors, “the difference between fear and anxiety has long been debated and may be one of the most important distinctions in the study of fear and psychopathy.” In order to distinguish between the two, and to determine whether persons with psychopathy present with the diminished subjective experience of fear or an impaired reactivity to fear, investigators focused on the crucial difference between the “automatic threat responding” (ie, a neurobiological mechanism that governs the fight-or-flight behavioral response) and the “conscious experience of fear” (ie, the correct identification of emotion, and the negative valance/subjective evaluation of experiencing an emotion).

“The experience of fear extends beyond recognition of others’ emotions and also involves the experience of a negatively valenced internal state,” the authors wrote.

Investigators performed a literature search, and they identified 18 suitable studies to include in their meta-analysis. To be included in the analyses, the studies had to have sample sizes >10 adults without a cognitive impairment or brain injury, a validated measure of psychopathy, and fear or threat had to be the main focus of the experiment.

Results show that individuals diagnosed with psychopathy present with impaired automatic threat processing and responsivity, but not with diminished conscious experience of fear. With regard to other emotions, investigators reported that individuals diagnosed with psychopathy present with diminished experience of happiness but with increased experience of anger.

According to the authors, previously published studies did not take negative valence into account and have included only emotion recognition measures. Thus, “By incorporating negative valence, we tested a more complete operationalization of fear experience, which is also a source of discrepancy with previous findings,” they concluded.

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Hoppenbrouwers SS, Bulten BH, Brazil IA. Parsing fear: a reassessment of the evidence for fear deficits in psychopathy. Psychol Bull. 2016;142(6):573-600.