Psychopathy is a fascinating disorder which has been a source of inspiration for several books, television series and movies. In popular media and in science, the idea exists that individuals with psychopathy do not know what it is to feel fear.
While a lack of emotions was theoretically linked to psychopathy more than 2 centuries ago, it wasn't until the 1950s that empirical evidence emerged showing that the learning of threatening stimuli is impaired in psychopathy.
These findings were considered as proof that threats fail to elicit fear and anxiety in individuals with psychopathy. However, the close relationship between fear and anxiety has made it difficult to untangle these two emotions in scientific studies, and many different measures (e.g., physiological or self-report measures) of fear and anxiety have been lumped together under the label "fear."
However, it is unclear what is meant by fear. To give a well-known and simple example: when confronted with a bear, you may be fleeing before actually feeling fearful. This shows that the automatic detection of threat and responding to it may be a different process compared to actually feeling fearful.
In their systematic review and meta-analysis, Hoppenbrouwers, Bulten, and Brazil (2016) (PDF, 245KB) reviewed the available evidence for the potential existence of a relationship between fear and psychopathy in adult individuals. Importantly, their definition of fear was based on state of the art knowledge of the neurobiological and cognitive underpinnings of this emotion.
The researchers used this knowledge to generate a model that separates brain mechanisms involved in automatic detection and responding to threats from those involved in the conscious experience of fear as an emotion.
Using this model as reference, they first performed a conceptual analysis of the work of earlier theorists — going back to as early as 1806 — and found that only one theorist incorporated the construct of fear into an etiological model of psychopathy. Second, the researchers reviewed empirical brain data pertaining to fear and psychopathy and mainly found alterations in brain areas that are involved in the automatic detection of, and responsivity to threat.
The findings for brain areas involved in the experience of fear were less consistent than what is often assumed, providing an indication that the experience of fear may not be completely impaired in psychopathy.
Last, a meta-analysis was performed which conclusively showed that psychopathic individuals have trouble in the automatic detection and responsivity to threat but may in fact feel fear, providing direct empirical support for the claim that the conscious experience of fear may not be impaired in these individuals. An additional meta-analysis examining the 5 basic emotions found that there may also be impairments in the experience of happiness and anger, but the lack of consistency in the current literature precluded the generation of strong claims.
In general, this work is the first to provide empirical evidence for the need to separate the automatic and conscious processes involved in what is traditionally considered to represent fear reactions. The proposed model not only applies to psychopathy, but can also be used to further increase conceptual precision and generate new hypotheses for research on mood and anxiety disorders.
Regarding psychopathy, the authors show that the evidence for a lack of fearful experience in psychopathic individuals is far from compelling. As a consequence, some very influential theories that assign prominent roles to fearlessness in the aetiology of psychopathy will need to be reconsidered and made consistent with current neuroscientific evidence.
Such re-evaluations of key concepts (in psychology in general) will lead to increased precision in research and clinical practice which should ultimately help pave the way toward more targeted and more effective treatment interventions.
Citation:
- Hoppenbrouwers, S. S., Bulten, B. H., & Brazil, I. A. (2016). Parsing fear: A reassessment of the evidence for fear deficits in psychopathy. Psychological Bulletin, 142(6), 573–600. http://dx.doi.org/10.1037/bul0000040
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