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Sabine C. Herpertz, MD; Ulrike Werth; Gerald Lukas, MSc; Mutaz Qunaibi, BSc; Annette Schuerkens, BSc; Hanns-Juergen Kunert, PhD; Roland Freese, MD; Martin Flesch, MD; Ruediger Mueller-Isberner, MD; Michael Osterheider, MD; Henning Sass, MD

Arch Gen Psychiatry. 2001;58:737-745.

Background  Criminal offenders with a diagnosis of psychopathy or borderline personality disorder (BPD) share an impulsive nature but tend to differ in their style of emotional response. This study aims to use multiple psychophysiologic measures to compare emotional responses to unpleasant and pleasant stimuli.

Methods  Twenty-five psychopaths as defined by the Hare Psychopathy Checklist and 18 subjects with BPD from 2 high-security forensic treatment facilities were included in the study along with 24 control subjects. Electrodermal response was used as an indicator of emotional arousal, modulation of the startle reflex as a measure of valence, and electromyographic activity of the corrugator muscle as an index of emotional expression.

Results  Compared with controls, psychopaths were characterized by decreased electrodermal responsiveness, less facial expression, and the absence of affective startle modulation. A higher percentage of psychopaths showed no startle reflex. Subjects with BPD showed a response pattern very similar to that of controls, ie, they showed comparable autonomic arousal, and their startle responses were strongest to unpleasant slides and weakest to pleasant slides. However, corrugator electromyographic activity in subjects with BPD demonstrated little facial modulation when they viewed either pleasant or unpleasant slides.

Conclusions  The results support the theory that psychopaths are characterized by a pronounced lack of fear in response to aversive events. Furthermore, the results suggest a general deficit in processing affective information, regardless of whether stimuli are negative or positive. Emotional hyporesponsiveness was specific to psychopaths, since results for offenders with BPD indicate a widely adequate processing of emotional stimuli.

From the Department of Psychiatry and Psychotherapy, Aachen Technical University (Reinisch-Westfaelische Technische Hochschule Aachen), Aachen (Drs Herpertz, Kunert, and Sass, Mss Werth and Schuerkens, and Messrs Lukas and Qunaibi), Haina Forensic Psychiatric Hospital, Haina (Drs Freese and Mueller-Isberner), and Westphalian Center for Forensic Psychiatry, Lippstadt (Drs Flesch and Osterheider), Germany.

Corresponding author and reprints: Sabine C. Herpertz, MD, Department of Psychiatry and Psychotherapy of the Medical Faculty, Aachen Technical University, Pauwelsstr. 30, D-52057 Aachen, Germany (e-mail: sherpertz{at}post.klinikum.rwth-aachen.de).

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