Do adult males with antisocial personality disorder (with and without comorbid psychopathy) have deficits in emotion processing and empathy? A systematic review

Background: A lack of concern for the feelings, needs or suffering of others and lack of remorse after hurting or mistreating others are key characteristics of antisocial personality disorder (ASPD), otherwise identified as dissocial personality disorder (DPD) and suggest that impaired emotion processing and empathy may contribute to antisocial behaviour. Whilst psychopathy is more commonly associated with an absence of empathy and emotional affect, the nature of emotion processing and empathy deficits specific to adult male ASPD populations with and without co-morbid psychopathy has not been systematically reviewed. Aim: To determine the nature of emotion processing and empathy deficits specific to adult male ASPD populations with and without co-morbid psychopathy. Method: We conducted a literature search across seven electronic databases and a range of grey literature sites, hand-searched reference lists of relevant papers and contacted fourteen authors of published studies related to this topic. Inclusion and exclusion criteria were applied and quality assessments undertaken on eligible studies. Results: Searches located 10,217 records and 205 were eligible for full assessment. 22 studies were identified as suitable for inclusion in this review and 19 reported evidence of emotion processing deficits in ASPD/DPD groups with and without co-morbid psychopathy. Conclusion: This review found no evidence of empathy deficits in ASPD/DPD groups with or without co-morbid psychopathy and only limited evidence of diminished startle reactivity in those with ASPD alone. In contrast, ASPD groups with co-morbid psychopathy were found to exhibit aberrant patterns of affective reactivity and difficulty when processing negative/aversive stimuli which lends support to the notion that these groups may be differentiated in terms of emotional dysfunction. However, as the majority of reviewed studies employed ASPD/DPD groups that included participants with co-morbid psychopathy/psychopathic traits and did not delineate effects for ASPD/DPD groups with and without co-morbid psychopathy, the degree to which emotion processing deficits were mediated by co-morbid psychopathy or evident in ASPD/DPD alone could not be established. Therefore, further research to compare emotion processing and empathy in these groups is required before firm conclusions can be drawn about the extent of overlap between these populations and/or the differences that exist between them.