Emotion recognition and empathy
Abnormal patterns of brain activity is observed in children with callous-unemotional
and psychopathic traits when viewing others in painful situations
A large body of research suggests that psychopathy is associated with atypical responses to distress cues (e.g. facial and vocal expressions of fear and sadness), including decreased activation of the fusiform and extrastriate cortical regions, which may partly account for impaired recognition of and reduced autonomic responsiveness to expressions of fear, and impairments of empathy. The underlying biological surfaces for processing expressions of happiness are functionally intact in psychopaths, although less responsive than those of controls. The neuroimaging literature is unclear as to whether deficits are specific to particular emotions such as fear. Some recent fMRI studies have reported that emotion perception deficits in psychopathy are pervasive across emotions (positives and negatives). Studies on children with psychopathic tendencies have also shown such associations. Meta-analyses have also found evidence of impairments in both vocal and facial emotional recognition for several emotions (i.e., not only fear and sadness) in both adults and children/adolescents.
A recent study using offenders with psychopathy found that under certain circumstances they could willfully empathize with others. Functional neuroimaging was performed while the subjects were watching videos of a person harming another individual. While reduced empathic brain activation relative to the controls was observed in the control condition, the empathic reaction of the psychopathic offenders initiated the same way it did for controls when they were instructed to empathize with the harmed individual, and the area of the brain relating to pain was activated when the psychopathic offenders were asked to imagine how the harmed individual felt. The research suggests that individuals with psychopathy could switch empathy on at will, which would enable them to be both callous as well as charming. The team who conducted the study say it is still unknown how to transform this willful empathy into the spontaneous empathy most people have, though they propose it could be possible to bring psychopaths closer to rehabilitation by helping them to activate their “empathy switch”. Others suggested that despite the results of the study, it remained unclear whether the experience of empathy by these psychopathic individuals was the same as that of controls, and also questioned the possibility of devising therapeutic interventions that would make the empathic reactions more automatic.
Work conducted by Jean Decety with large samples of incarcerated offenders with psychopathy offers additional insights. In one study, the offenders were scanned while viewing video clips depicting people being intentionally hurt. They were also tested on their responses to seeing short videos of facial expressions of pain. The participants in the high-psychopathy group exhibited significantly less activation in theventromedial prefrontal cortex, amygdala and periaqueductal gray parts of the brain, but more activity in the striatum and the insula when compared to control participants. In a second study, the subjects with psychopathy exhibited a strong response in pain-affective brain regions when taking an imagine-self perspective, but failed to recruit the neural circuits that were activated in controls during an imagine-other perspective—in particular the ventromedial prefrontal cortex and amygdala—which may contribute to their lack of empathic concern.
Despite studies suggesting deficits in emotion perception and imagining others in pain, professor Simon Baron-Cohen claims psychopathy is associated with intact cognitive empathy, which would imply an intact ability to read and respond to behaviors, social cues and what others are feeling. Psychopathy is, however, associated with impairment in the other major component of empathy—affective (emotional) empathy—which includes the ability to feel the suffering and emotions of others (what scientists would term as emotional contagion), and those with the condition are therefore not distressed by the suffering of their victims. Those with autism, on the other hand, often are impaired in both the affective and cognitive facets of empathy.
Emotion recognition and empathy
The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality is a book written by American psychiatrist Hervey M. Cleckley, first published in 1941, describing Cleckley’s clinical interviews with patients in a locked institution. The text is considered to be a seminal work and the most influential clinical description of psychopathy in the twentieth century. The basic elements of psychopathy outlined by Cleckley are still relevant today. The title refers to the normal “mask” that conceals the mental disorder of the psychopathic person in Cleckley’s conceptualization.
Cleckley then summarizes the material and provides a ‘clinical profile’, describing 16 behavioral characteristics of a psychopath (reduced from 21 in the first edition): 
- Superficial charm and good intelligence
- Absence of delusions and other signs of irrational thinking
- Absence of nervousness or psychoneurotic manifestations
- Untruthfulness and insincerity
- Lack of remorse and shame
- Inadequately motivated antisocial behavior
- Poor judgment and failure to learn by experience
- Pathologic egocentricity and incapacity for love
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
- Suicide threats rarely carried out
- Sex life impersonal, trivial, and poorly integrated
- Failure to follow any life plan.
Some of the criteria have obvious psychodynamic implications, such as a lack of remorse, poor judgment, failure to learn from experience, pathological egocentricity, lack of capacity for love, a general poverty in major affective reactions, and lack of insight into his own condition. Starting in 1972, newer editions of the book reflected a closer alliance with Kernberg‘s (1984) borderline level of personality organization, specifically defining the structural criteria of the psychopath’s identity integration, defensive operations and reality testing.
Fear, Obligation And Guilt: How We Allow Loved Ones To Control Us
In their 1997 book, Emotional Blackmail: When the People in Your Life Use Fear, Obligation and Guilt to Manipulate You, authors Susan Forward, Ph.D. and Donna Frazier state that “emotional blackmail is a powerful form of manipulation in which people close to us threaten to punish us for not doing what they want. Emotional blackmailers know how much we value our relationships with them. They know our vulnerabilities and our deepest secrets. They can be our parents or partners, bosses or coworkers, friends or lovers. No matter how much they care about us, they use this intimate knowledge to win our compliance.” According to Forward and Frazier, fear, obligation and guilt (“FOG”) are the tools of emotional manipulators.
“Emotional Blackmail” and “FOG”, terms coined by psychotherapist Susan Forward, Ph.D., are about controlling relationships and the theory that fear, obligation or guilt (“FOG”) are the transactional dynamics at play between the controller and the person being controlled. Understanding these dynamics are useful to anyone trying to extricate themselves from the controlling behavior by another person and deal with their own compulsions to do things that are uncomfortable, undesirable, burdensome, or self-sacrificing for others.
Fear, Obligation and Guilt (FOG)
The Challenge: A borderline personality disordered (BPD) individual has a very fragile and unpredictable personality. They may be highly educated and have very successful careers. However, they struggle with interpersonal relationships because they are too fragile to be effective. They are very much like emotional children locked in an adult body, expected to function in adult relationships. When things are going their way, they can be delightful and charming. As soon as they do not get their way, or someone crosses them, they will quickly resort to destructive means to stabilize their fragile sense of self.
Coping Mechanisms: The BPD’s greatest fear is to be abandoned and they will do just about anything to avoid the crushing blow of perceived rejection. They must feel they are loved at all times. They will create dependency in their child and will have difficulty seeing their child as separate. Sadly they “split” which means they view others, including their children, as either all good or all bad.
They do not allow themselves to acknowledge anything in the “gray” area of life where most of reality exists. For example, if their child loves the other parent, then the BPD parent will over-react and believe they are being rejected by their child. They teach their child that if they want to feel safe then they have to adore them. They make it known in every possible way that “You are for me or you are against me.” If there is more than one child, the BPD parent may even idealize one child and reject the other.
The Impact of Being Raised by a Borderline Personality Disordered Parent
Children of mothers with Borderline Personality Disorder (BPD) are a disadvantaged group of children that are at risk for future psychopathology. Crandell et al. (1997) demonstrated that, for these children, attachment status is not completely stable.
Some children are able to resolve early traumatic experiences and are able to obtain an ‘earned secure’ attachment status in adulthood. Adults with an earned secure status function comparably to adults who had secure attachment status as children (Crandell et al, 1997). These findings hold great promises for the prognosis of children of mothers with BPD. With adequate attention and intervention, there is hope that children of mothers with BPD will overcome the risks associated with this maternal psychopathology.
Have Your Parents Put You at Risk for Psychopathology
Borderline personality disorder (BPD) is characterized by emotional instability, unstable self-image (“who am I?”), unstable (“love-hate”) interpersonal relationships, and poor impulse control. BPD is the most prevalent personality disorder in clinical settings and is associated with severe functional impairment, substantial treatment utilization, and high rates of mortality by suicide. BPD is strongly associated with substance use disorders, mood disorders, anxiety disorders, and other personality disorders. BPD is not due to a medical or substance use disorder.
Lasts For Years/Lifetime
- Unemployment (interrupted education; sudden shifts in vocational aspirations; recurrent job losses)
Cooperation (Critical, Quarrelsome):
Unstable, Intense, Chaotic Relationships:
- Unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Unstable self-image or sense of self
- Frantic efforts to avoid real or imagined abandonment
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
- Inappropriate, intense anger or difficulty controlling anger
Justice (Disorganized, Careless):
- Impulsivity at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating)
Courage (Anxious, Easily Upset):
- Emotional instability due to a marked reactivity of mood
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Chronic feelings of emptiness
Borderline (Emotionally Unstable) Personality Disorder 301.83
This diagnosis is based on the following findings:
- Frantic efforts to avoid real or imagined abandonment ( still present )
- Unstable and intense ‘love-hate’ relationships ( still present )
- Identity disturbance: markedly and persistently unstable self-image or sense of self ( still present )
- Impulsivity in at least two areas that are potentially self-damaging ( still present )
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior ( still present )
- Rapidly shifting emotions ( still present )
- Chronic feelings of emptiness ( still present )
- Inappropriate, intense anger or difficulty controlling anger ( still present )
- Transient, stress-related paranoid ideation or severe dissociative symptoms ( still present )
Individuals with Borderline (Emotionally Unstable) Personality Disorder have impaired ability to regulate their emotions, have unstable perceptions of self and others that lead to intense and chaotic relationships, and are prone to act on impulses, including self-destructive impulses.
- Have emotions that can change rapidly and spiral out of control, leading to extremes of sadness, anxiety, and rage.
- “Catastrophize,” seeing problems as disastrous or unsolvable, and are often unable to soothe or comfort themselves without the help of another person.
- Become irrational when strong emotions are stirred up, showing a significant decline from their usual level of functioning.
- Lack a stable sense of self: Their attitudes, values, goals, and feelings about themselves may seem unstable or ever-changing, and they are prone to painful feelings of emptiness.
- Have difficulty maintaining stable, balanced views of others: When upset, they have trouble perceiving positive and negative qualities in the same person at the same time, seeing others in extreme, black-or-white terms. Consequently, their relationships tend to be unstable, chaotic, and rapidly changing.
- Fear rejection and abandonment, fear being alone, and tend to become attached quickly and intensely.
- Are prone to feeling misunderstood, mistreated, or victimized.
- While playing the role of “victim”, often elicit intense emotions in other people who they manipulate into playing the role of “villan” or “rescuer”.
- Stir up conflict or animosity between other people.
- Act impulsively.
- Their work life or living arrangements may be chaotic and unstable.
- May act on self-destructive impulses, including self-mutilating behavior, suicidal threats or gestures, and genuine suicidality, especially when an attachment relationship is disrupted or threatened.
- Goal: overcome fear of abandonment.
If this problem persists: She will continue to show frantic efforts to avoid real or imagined abandonment. Her frantic efforts to avoid abandonment might include impulsive actions such as self-mutilating or suicidal behaviors.
- Goal: have less unstable and intense “love-hate” relationships.
If this problem persists: She will continue to show a pattern of unstable and intense relationships. She will switch quickly from idealizing other people to devaluing them. She will see things in terms of extremes, either all good or all bad.
- Goal: develop a positive, stable self-image or sense of self.
If this problem persists: Her self-image (“who-am-I?”) will continue to be very unstable. There will be sudden and dramatic shifts in her self-image, characterized by shifting goals, values, and vocational aspirations. She will see herself as a “victim” (taking little responsibility for any problem).
- Goal: stop impulsive, self-damaging behavior.
If this problem persists: She will continue to show impulsivity in at least two areas that are potentially self-damaging (i.e., gambling, spending money irresponsibly, binge eating, abusing substances, engaging in unsafe sex, driving recklessly, or being impulsively suicidal).
- Goal: stop self-mutilating or suicidal behavior.
If this problem persists: She will continue to have recurrent suicidal gestures such as wrist cutting, overdosing, or self-mutilation. Her self-destructive acts will be precipitated by threats of separation or rejection.
- Goal: stop over-reacting to stress.
If this problem persists: She will continue to have rapidly shifting moods due to extreme reactivity to interpersonal stress (e.g., intense unhappiness, anger, or anxiety usually lasting a few hours and only rarely more than a few days).
- Goal: discover a meaning or purpose to life.
If this problem persists: She will continue to have chronic feelings of emptiness. She will be easily bored and constantly seeking something to do.
- Goal: better control anger.
If this problem persists: She will continue to be inappropriately angry. Her anger will be triggered when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning.
- Goal: stop becoming paranoid or dissociating under stress.
If this problem persists: During periods of extreme stress, she will continue to have transient paranoid ideation or dissociative symptoms (e.g., depersonalization). This will occur most frequently in response to a real or imagined abandonment.