Richard C. Howard

Moral decision-making, ToM, empathy and the default mode network

Automatic intuitions and deliberate reasoning, sourcing internal representations of our personal norms and values, contribute to our beliefs of what is right and wrong. We used fMRI to directly compare moral (M) and non-moral (NM) decision-making processes using scenarios requiring conscious deliberation, whereby the main character declared an intention to take a course of action. Furthermore, we examined the relationship between BOLD signal, associated with M>NM decision-making, and moral judgment competence, psychopathy, and empathy. We observed greater activity in various parts of Theory of Mind, empathy and default mode networks during M>NM decision-making. There was a trend for high scores on primary psychopathy to correlate with decreased M>NM BOLD activation in an area extending from dorsolateral prefrontal cortex to medial prefrontal cortex. We suggest that moral decision-making entails a greater degree of internally directed processing, such as self-referential mental processing and the representation of intentions and feelings, than non-moral decision-making.

Alcohol-related violence defined by ultimate goals: a qualitative analysis of the features of three different types of violence by intoxicated young male offenders.

Based upon a functional approach to understanding aggression, we aimed to identify the occurrence of and to describe the features of three types of alcohol-related violence defined a priori by ultimate goals: (1) violence in pursuit of nonsocial profit-based goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. A sample of 149 young men with offences of violence that were alcohol related was interviewed. Cases were classified and detailed information from the first ten cases in each class (N=30) was subjected to thematic analysis. Intoxicated violence in pursuit of nonsocial profit-based goals was opportunistic and motivated by the desire for more alcohol or drugs. Violence, in these cases, although serious, appeared to be brief. Intoxicated violence in pursuit of social dominance goals was typically precipitated by past or current insult or injury, and was accompanied by strong anger and an adrenaline rush. Attacks were ferocious, and robbing the victim was not uncommon, perhaps to inflict additional humiliation. Feelings of pride and satisfaction were typical and expressions of remorse were uncommon. Regarding intoxicated violence as defence in response to threat, attacks were often expected, and in some cases the respondent made a pre-emptive strike. Weapon use was common in this group. Fear was experienced, but so too was anger. Feelings of excitement were not reported and remorse was common. Further validation of these types is warranted, and the potential implications of these findings for prevention and treatment are discussed.

The quest for excitement: a missing link between personality disorder and violence?

Despite its relative neglect by most emotion theorists, excitement has been found to be an important motive for criminal, and particularly violent, offending in young men. Exceptionally, reversal theory (Apter, M.J. (2007b). Reversal theory: The dynamics of motivation, emotion and personality (2nd ed.). Oxford: Oneworld Publications.) regards the quest for excitement as a powerful motive for human behaviour, including antisocial behaviour. The quest for excitement, manifesting as a desire to inflict harm and suffering on others, is prevalent in the dissocial domain of personality disorders and is arguably most prominent in those showing traits of ‘meanness’ and ‘disinhibition’ (Patrick, C. (2010). Conceptualizing the psychopathic personality: Disinhibited, bold…or just plain mean? In D.R. Lynam & R.J. Salekin (Eds.), Handbook of child and adolescent psychopathy (pp. 15–48). New York: Guilford Press.). Violence motivated by the desire for excitement is often facilitated by drug or alcohol use, overrides whatever feelings of empathy individuals might have for their victims, and represents a failure of emotion regulation characterised by an inability to down-regulate positive emotional states such as excitement and exhilaration. A quadripartite typology of violence is described which is intended as a working hypothesis and a framework to guide future research focusing on motivations for violent offending.

Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behaviour

This study tested the hypothesis that adolescent-onset alcohol abuse (AOAA) would both mediate and moderate the effect of childhood conduct disorder on antisocial behaviour in late adolescence and early adulthood. A sample comprising 504 young men and women strategically recruited from the community were grouped using the criteria of the Diagnostic and Statistical Manual (DSM-IV, American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA), as follows: neither childhood conduct disorder (CCD) nor alcohol abuse/dependence; CCD but no alcohol abuse or dependence; alcohol abuse/dependence but no CCD; both CCD and alcohol abuse/dependence. The outcome measure was the sum of positive responses to 55 interview items capturing a variety of antisocial behaviours engaged in since age 15. Severity of lifetime alcohol-related and CCD problems served as predictor variables in regression analysis. Antisocial behaviour problems were greatest in individuals with a history of co-occurring conduct disorder (CD) and alcohol abuse/dependence. While CCD was strongly predictive of adult antisocial behaviour, this effect was both mediated and moderated (exacerbated) by AOAA.

Personality disorders and violence: what is the link?

Despite a well-documented association between personality disorders (PDs) and violence, the relationship between them is complicated by the high comorbidity of mental disorders, the heterogeneity of violence (particularly in regard to its motivation), and differing views regarding the way PDs are conceptualised and measured. In particular, it remains unclear whether there is a causal relationship between PDs and violence, and what the psychological mechanisms might be that mediate such a relationship. Here, a perspective on PD and violence is offered that views the relationship between them through the lenses of the Five Factor Model of personality and a quadripartite typology of violence. Evidence is reviewed suggesting that emotion dysregulation/impulsiveness, psychopathy, and delusional ideation conjointly contribute to the increased risk of violence shown by people with PD, and do so by contributing to a broad severity dimension of personality dysfunction. This view is consistent with the abandonment of personality disorder categories in the forthcoming eleventh edition of the International Classification of Diseases (ICD-11), where severity of personality disorder is defined in terms of the degree of harm to self and others.

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.

The impact of structured risk assessments followed by management recommendations on aggression in patients with personality disorder

This study tested the proposition that structured risk assessments followed immediately by the risk assessment results and recommendations for management can reduce the frequency of aggression in high-risk personality-disordered patients. The study included three phases during which aggressive behaviour was recorded: (a) baseline, (b) daily risk assessment using the Dynamic Appraisal of Situational Aggression (DASA) and HCR-20 Clinical Scale, and (c) daily DASA risk assessment followed by risk assessment results and risk management recommendations. Following the third phase a staff survey was conducted to measure the clinical utility of the DASA and the risk management recommendations. Results revealed no significant difference in the frequency of aggression between the three phases. The staff survey revealed varied reactions to the DASA and to the utility of the risk assessment results and management recommendations. Possible reasons for the limited impact of the DASA and opportunities for future research are discussed.

Impaired Pavlovian conditioned inhibition in offenders with personality disorders.

Certain types of violent offending are often accompanied by evidence of personality disorders (PDs), a range of heterogeneous conditions characterized by disinhibited behaviours that are generally described as impulsive. The tasks previously used to show impulsivity deficits experimentally (in borderline personality disorder, BPD) have required participants to inhibit previously rewarded responses. To date, no research has examined the inhibition of responding based on Pavlovian stimulus–stimulus contingencies, formally “conditioned inhibition” (CI), in PDs. The present study used a computer-based task to measure excitatory and inhibitory learning within the same CI procedure in offenders recruited from the “personality disorder” and the “dangerous and severe personality disorder” units of a high-security psychiatric hospital. These offenders showed a striking and statistically significant change in the expression of inhibitory learning in a highly controlled procedure: The contextual information provided by conditioned inhibitors had virtually no effect on their prepotent associations. Moreover, this difference was not obviously attributable to nonspecific cognitive or motivational factors. Impaired CI would reduce the ability to learn to control associative triggers and so could provide an explanation of some types of offending behaviour.

Is delusional ideation a critical link in the nexus between personality disorder and violent offending

Evidence suggests that consideration of personality disorder (PD) severity, incorporating both externalising and internalising features of PD, might help to clarify the PD – violence relationship; moreover, that separate developmental pathways might link externalising and internalising personality pathology with criminal violence. This study of 96 forensic patients with confirmed PD and a history of violent offending addressed the question of whether delusional ideation, measured by the Peters Delusions Inventory, might play a significant role in the link between severe PD and criminal violence. Severe PD, defined by summing scores across DSM-IV PD criteria, was significantly associated with delusional thinking, with violence, and with high levels of both externalising and internalising personality features. Delusional thinking was associated with violence via internalising but not externalising PD features, suggesting that the link between severe PD and violence may be partly mediated by delusional thinking.

Is PCL-R psychopathy associated with either type or severity of personality disorder?

The extent to which assessment of personality disorders (PDs), and trans-diagnostic measures of PD severity, can capture the variance in psychopathy measured by the Psychopathy Checklist-Revised (PCL-R) was examined in 100 forensic patients with a history of violent offending. Correlational and linear regression analyses were carried out to establish whether (i) combinations of PDs would predict PCL-R scores for each of its two factors, interpersonal–affective (F1) and antisocial deviance (F2); (ii) ‘acting out’, a putative measure of externalising maladjustment that transcends PD categories, would predict PCL-R scores. Results showed that narcissistic and avoidant PDs contributed significantly to the prediction of F1, but only antisocial PD contributed to the prediction of F2. ‘Acting out’ predicted both F1 and F2, suggesting that core features of PCL-R psychopathy are embedded within and across different PD diagnoses. Results are discussed in relation to different sub-types of psychopathy described in the literature.