The Psychopath as Observer: Emotion and Attention in Picture Processing

Transcription

1 Journal of Abnormal Psychology Copyright 2000 by the American Psychological Association, Inc. 2000, Vol. 109, No. 3, X/00/$ )O1: // X The Psychopath as Observer: Emotion and Attention in Picture Processing Gary K. Levenston Florida State University Christopher J. Patrick University of Minnesota and University of Florida Margaret M. Bradley and Peter J. Lang University of Florida This study extended prior work showing abnormal affect-startle modulation in psychopaths. Male prisoners viewed specific categories of pleasant (erotic or thrilling) and unpleasant (victim or direct threat) slide pictures, along with neutral pictures. Acoustic startle probes were presented early (300 and 800 ms) and late (1,800, 3,000, and 4,500 ms) in the viewing interval. At later times, nonpsychopaths showed moderate and strong reflex potentiation for victim and threat scenes, respectively. For psychopaths, startle was inhibited during victim scenes and only weakly potentiated during threat. Psychopaths also showed more reliable blink inhibition across pleasant contents than nonpsychopaths and greater heart rate orienting to affective pictures overall. These results indicate a heightened aversion threshold in psychopaths. In addition, deficient reflex modulation at early times suggested a weakness in initial stimulus evaluation among psychopaths. Emotional deviation is central to the clinical conception of psychopathy (Cleckley, 1976; Hare, 1991), and a growing body of research has focused on the nature and bases of affective anomalies in psychopaths. Recently, Patrick, Bradley, and Lang (1993) reported a lack of normal acoustic startle potentiation during viewing of aversive pictures in psychopathic sex offenders, a provocative result that suggests a basic deficit in defensive emotional response. The current study was designed to replicate and extend this work by comparing, within a general prisoner population, reactions of psychopaths and nonpsychopaths to distinct subcategories of pleasurable and aversive pictures. In addition, we Gary K. Levenston, Department of Psychology, Florida State University; Christopher J. Patrick, Department of Psychology, University of Minnesota, and NIMH Center for the Study of Emotion and Attention, University of Florida; Margaret M. Bradley and Peter J. Lang, Department of Clinical and Health Psychology and NIMH Center for the Study of Emotion and Attention, University of Florida. This study was supported by Grants MH48657 and MH52384 from the National Institute of Mental Health. Preliminary findings were presented at the annual meetings of the Society for Research in Psychopathology, September 1996, and the Society for Psychophysiological Research, October This work was completed by Gary K. Levenston in partial fulfillment of thesis requirements for his master of science degree at Florida State University, under the supervision of Christopher J. Patrick. Thanks are extended to the residents and staff of the Federal Correctional Institution in Tallahassee, and in particular chief psychologist Allen Hanley, for their ongoing support of this work. We also thank Donna James, Stacey Lavoro, Mark Miller, David O'Connor, Arleen Goff, and Kristin Zempolich for their participation in the diagnostic and testing aspects of this work. Correspondence concerning this article should be addressed to Christopher J. Patrick, Department of Psychology, University of Minnesota, Minneapolis, Minnesota Electronic mail may be sent to [email protected]. examined the dynamic interplay of attention and emotion in the processing of these affective stimuli by measuring reflex reactions to noise probes at sequential times during the picture viewing interval. Emotion and Picture Viewing Emotions can be conceptualized as states of readiness for adaptive action (Izard, 1993; Lang, 1979), reflecting activity in two opponent motive systems: an appetitive system that governs approach behavior and engagement with the environment and a defensive system that promotes avoidance and Protection against danger (Konorski, 1967; Lang, 1995). Survival in natural settings depends on a dynamic balance between the two (Lang, Bradley, & Cuthbert, 1997). Affective states can be prompted either by reallife events (e.g., food or an imminent predator) or by symbolic depictions of such events (e.g., pictures or text). In either case, emotional arousal results from the activation of cognitiveperceptual representations that connect with the appetitive or defensive action system (Lang, 1994; LeDoux, 1995). Emotional pictures elicit characteristic patterns of physiological and self-report response (Greenwald, Cook, & Lang, 1989; Hare, Wood, Britain, & Shadman, 1970; Lang, Greenwald, Bradley, & Hamm, 1993; Winton, Putnam, & Krauss, 1984). Ratings of arousal and interest, elective viewing time, skin conductance response (SCR), and brain electrical potentials covary with picture intensity; that is, responses are more pronounced for both pleasant and unpleasant pictures than for neutral pictures. Other measures covary with the emotional valence (pleasantness) of pictures. Facial activity in zygomatic ("smile") and corrugator ("frown") regions increases specifically for pleasant and unpleasant pictures, respectively. Heart rate (HR) deceleration--the basic cardiac response to perceptual stimuli--tends to be greater for aversive pictures than neutral pictures and less for pleasant pictures. 373

2 374 LEVENSTON, PATRICK, BRADLEY, AND LANG Importantly, it has also been shown that the magnitude of the eyeblink startle response to a sudden noise probe is modulated by picture valence in normal individuals: The startle reflex is enhanced (potentiated) during viewing of unpleasant pictures and diminished (inhibited) during viewing of pleasant pictures, both in relation to neutral (Balaban, 1995; Bradley, Cuthbert, & Lang, 1990, 1991; Cook, Davis, Hawk, Spence, & Gautier, 1992; Stritzke, Patrick, & Lang, 1995; Vrana, Spence, & Lang, 1988). Lang, Bradley, and Cuthbert (1990) attributed these effects to a match or mismatch between the motivational state evoked by the picture and the defensive reaction to the noise probe: Unpleasant pictures prime a defensive action state, leading to reflex potentiation; pleasant pictures evoke an opposing state of appetitive engagement, leading to startle inhibition. Psychopathy and Startle Reflex Modulation Patrick et al. (1993) examined blink reactions to noise probes among prisoners low, moderate, and high in psychopathy during viewing of pictures. Diagnoses were made with Hare's (1991) Psychopathy Checklist-Revised (PCL-R), comprising items reflecting the core emotional detachment features of psychopathy (charm, egocentricity, deceit, lack of remorse or empathy, shallow affect, and denial of blame) and items defining an antisocial behavior factor (cf. Harpur, Hare, & Hakstian, 1989). Affective pictures involved both pleasant content (pet, baby, food, adventure, and erotic) and unpleasant content (snake, angry face, starving child, weapons, and mutilations). Startle probes occurred s after picture onset. Low and moderate PCL-R scorers showed a normal linear pattern (blinks inhibited during pleasant pictures and potentiated during aversive pictures), whereas psychopaths showed a deviant quadratic pattern, with blinks inhibited for both pleasant and unpleasant pictures in relation to neutral. A subsidiary analysis of groups formed on the basis of PCL-R factors revealed the most deviant startle pattern among highly antisocial inmates who also scored highest on the "emotional detachment" factor. Subsequently, Patrick (1994) examined blink potentiation during anticipation of noxious noise blasts. In comparison with nonpsychopaths and prisoners high on the PCL-R antisocial factor only, psychopaths showed reduced startle potentiation, as did individuals high on PCL-R emotional detachment only. Mejia, Vanman, Dawson, Raine, and Lencz (1997) reported that community volunteers high on both PCL-R factors failed to show startle potentiation during aversive pictures, in contrast to those high on the antisocial behavior factor alone. Thus, research has consistently revealed deficient startle potentiation in psychopathic individuals high on both facets of psychopathy, across different aversive cueing contexts. Also, one study (Patrick, 1994) has shown a parallel effect in high-detached-low-antisocial individuals during aversive anticipation. These data are notable in light of strong evidence that startle potentiation reflects fear. In animals and humans, startle increases during threat, and this effect is blocked by anxiolytic drugs (Davis, 1979, 1986; Patrick, Berthot, & Moore, 1996). In animals, Davis (1989) showed that fear-potentiated startle is mediated by the amygdala, a cornerstone of the aversive system (Fanselow, 1994; LeDoux, 1995). The absence of normal startle potentiation in psychopaths signifies a weakness in the capacity of aversive cues to prime defen- sive actions: in this case, to intensify a protective reflex but perhaps more broadly to interrupt goal seeking and promote avoidance of danger. This in turn coincides with the long-held idea that psychopathy involves a deficit in aversive reactivity or fear (Fowles, 1980; Hare, 1970; Lykken, 1957). Trait variations in fearfulness have presumably arisen through natural selection because the defense system opposes other survival instincts (i.e., exploration and goal seeking) that have differing priority in more or less austere environments. From this perspective, naturally fearless individuals (e.g., psychopaths; Lykken, 1995), although not impervious to immediate danger or pain, should be less readily moved toward avoidance or withdrawal from states of appetitive approach or engagement. In this regard, Patrick et al. (1993) proposed that the deviant inhibition of startle during unpleasant pictures in psychopaths might reflect a predominance of foreground attentional engagement over defensive reactivity. Recent research in control samples provides a firm foundation for this hypothesis. The Orienting to Defense Transition Cuthbert, Bradley, and Lang (1996) demonstrated in normal individuals that unpleasant pictures of low to moderate intensity produce startle inhibition, whereas more intense unpleasant pictures produce blink potentiation. The authors explained this in terms of a shift in the relative influence of attention (orienting) and emotion (defensive activation) on the startle reflex. Less intense aversive scenes engage attention, resulting in diminished processing of noise probes (Anthony & Graham, 1985), but highly aversive scenes elicit a defensive action state that overrides the inhibitory influence of attention (Lang et al., 1997). In this regard, scenes of vicarious threat (e.g., assaults on others or injuries) appear to reside nearer the threshold of transition than direct-threat scenes (e.g., aimed weapons or assailants): They engage more attention (Sarlo, Palomba, Angrilli, & Stegagno, 1998), evoke milder ratings of anxiety and fear (Lang, Bradley, Drobes, & Cuthbert, 1995), and yield weaker startle potentiation (Balaban & Taussig, 1994; Levenston & Patrick, 1995). The shift from attentional inhibition to defensive potentiation can also be seen in normal individuals during the early stages of picture viewing. Within the first few hundred milliseconds after a picture is presented, there is a general inhibition of the blink reflex to acoustic probes, reflecting a "gating out" and attenuation of new sensory input (i.e., probe) to ensure adequate processing of the prior foreground (Graham, 1975). For probes occurring 300 ms after picture onset, Bradley, Cuthbert, and Lang (1993) reported an enhancement of this "prepulse inhibition" effect for pleasant and unpleasant pictures relative to neutral pictures, indicating rapid detection of and increased processing protection for motivationally relevant stimuli (Lang et al., 1997). But by 800 ms, startle potentiation was evident for unpleasant pictures, signifying an ascendance of defensive priming, an effect that became more robust at later probe times (1,300.and 3,800 ms). Taken together, these findings indicate that the startle reflex is sensitive to the dynamic interplay of attention and emotion during picture viewing. Initially, the reflex is inhibited for both pleasant and aversive pictures, reflecting immediate prioritization of attention to stimuli of motivational significance. As processing continues, pictures with aversive connotations prime the defensive sys-

3 PSYCHOPATHY AND STARTLE MODULATION 375 tem, producing startle potentiation. This potentiation is maximal for potent, directly threatening pictures. Viewed in this light, startle inhibition during aversive pictur~es in psychopaths could reflect a predominance of attentional modulation in the absence of the defensive activation that normally emerges across time and with increasing picture intensity. Study Hypotheses The present study examined patterns of startle modulation in psychopaths and nonpsychopaths at 300 ms, 800 ms, and later times during a 6-s picture interval. We predicted that nonpsychopaths would show affect modulation at 800 ms and later, with blink potentiation for aversive pictures (Bradley et al., 1993), whereas psychopaths would show attentional inhibition for both pleasant and unpleasant pictures in relation to neutral pictures (Patrick et al., 1993). Groups were also predicted to differ in the early transition from attentional to emotional modulation. Nonpsychopaths were expected to show attentional modulation across the two earliest probe times, with aversive potentiation emerging at 800 ms. For psychopaths, we anticipated that deviant late startle modulation would reflect either (a) an abnormal persistence of early attentional modulation or (b) a delay in discriminating between neutral and affective stimuli (cf. Williamson, Harpur, & Hare, 1991). In the first instance, we expected to see reflex inhibition for pleasant and unpleasant pictures across the two early times with no aversive potentiation at 800 ms; in the second, we predicted minimal blink differentiation between affective and neutral materials at 300 ms (cf. Williamson et al., 1991). We also examined blink modulation for discrete picture contents. Specific predictions for aversive contents were based on the hypothesis that psychopathy involves a heightened threshold for shifting from orienting to defense. For victim scenes (assaults on others or injuries), which are highly engaging (Sarlo et al., 1998) but evoke some defensive activation in normal individuals (Levenston & Patrick, 1995), we predicted that nonpsychopaths would show modest startle potentiation, whereas psychopaths would show attentional inhibition. For directly threatening scenes (aimed weapons or menacing attackers), we predicted that psychopaths would show only emergent startle potentiation, in contrast to robust potentiation in nonpsychopaths. Pleasant picture content was also varied by including erotic pictures and thrill scenes entailing elements of excitement and risk (e.g., ski jump, roller coaster, and cliff diving). Autonomic, facial, and ratings measures were included to supplement startle and to assess dissociations between overt and covert emotional expression (cf. Cleckley, 1976). From prior work, we predicted that SCR would covary with picture arousal and that HR and facial reactivity would covary with picture valence. Patrick et al. (1993) did not find group differences in autonomic response, but other studies have shown such differences (for SCR in particular; Arnett, 1997; Siddle & Trasler, 1981), so we thought it useful to collect these measures. Because Cleckley described psychopaths as superficially normal in affective behavior, and because facial and ratings measures have yielded equivocal or null group results in prior research (Forth, 1992; Patrick et al., 1993; Patrick, Cuthbert, & Lang, 1994; Williamson et al., 1991), we predicted that psychopaths would show relatively normal results for these measures in contrast to startle. Participants Method Participants were 36 male inmate residents of the Federal Correctional Institution in Tallahassee, Florida, selected from a larger pool of volunteers (N = 186) assessed for psychopathy. Volunteers were recruited randomly from the master prison roster, subject to exclusionary criteria as follows: 45 years of age or less; no file evidence of a cognitive, psychotic, or moodrelated disorder; and no imminent release date. Those demonstrating conversational competency in English and the ability to read aloud a text description of the study were scheduled for further participation and supplied informed written consent. Semistructured interviews were conducted to elicit diagnostic information. The interviews were videotaped for purposes of independent secondary assessment. Interview data were supplemented by historical, behavioral, and medical-psychological data from prison files. The interview information and file information were used to assess each participant for psychopathy (via the PCL-R) and for antisocial personality disorder (ASPD) according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th edition; American Psychiatric Association, 1994). Raters were either bachelor's-level or master's-level psychology students trained and supervised by an experienced psychodiagnostician (Christopher J. Patrick). Meetings were held weekly to ensure adherence to the diagnostic criteria, and reliability assessments were performed periodically by the supervisor to guard against observer drift. Scores for the two raters were averaged to optimize stability. Within the overall assessment pool, the intraclass correlation for the mean of the two raters' PCL-R total scores was.94; for the emotional detachment and antisocial behavior factors, the intraclass correlations were.87 and.93, respectively. Using cutoffs specified in the PCL-R manual (Hare, 1991), we assigned prisoners with mean total scores of 20 or below to the nonpsychopath group (n = 18) and those with scores of 30 or above to the psychopath group (n = 18). Because deviant startle modulation in the Patrick et al. (1993) study was confined to participants high in PCL-R emotional detachment as well as antisocial behavior (i.e., those high in antisocial behavior only showed normal startle modulation), mean emotional detachment ratings two thirds of the possible maximum or greater were also required for inclusion in the psychopath group; 2 interviewees with overall PCL-R scores of 30 or higher were excluded on this basis. All participants in the psychopath group, and none of the nonpsychopaths, met criteria for ASPD. Six individuals who participated in testing were replaced because of equipment failure (1 nonpsychopath) or unscoreable startle responses (3 nonpsychopaths and 2 psychopaths). Mean PCL-R scores (emotional detachment, antisocial behavior, and total) for groups were as follows: nonpsychopath group, 5.8, 5.0, and 12.6, respectively, and psychopath group, 13.2, 14.1, and 31.7, respectively. Groups did not differ in racial composition, years of education, or age. Nonpsychopaths included 8 African Americans and 10 Caucasians (4 Caucasian-Hispanic); psychopaths included 6 African Americans and 12 Caucasians (1 Caucasian-Hispanic). Mean years of education were and 11.94, respectively. The mean age in both groups was 31.6 years. Stimulus Materials Experimental participants viewed and rated color photographic slides (22 pleasant, 22 neutral, and 22 unpleasant) selected from the International Affective Picture System (IAPS; Center for the Study of Emotion and

4 376 LEVENSTON, PATRICK, BRADLEY, AND LANG Attention, 1995). Fifty-four of the slides involved specific content, as follows, l Pleasant content: pictures depicting erotic scenes (n = 9; female nudes and intimate couples) and thrill scenes (n = 9; e.g., roller coaster, ski jump, and cliff diving). Neutral content: pictures depicting inactive people, kitchen utensils, appliances, buildings, and plants (n = 18). Unpleasant content." pictures depicting mutilation scenes (n = 6; faces, limbs, and bodies), assault on others (n = 6; aggression, physical brutality, and combat), and threat to self (n = 6; aimed weapons and looming attackers). Pleasant and unpleasant pictures were chosen to be extreme in rated valence (pleasantness) according to IAPS norms, as well as extreme and equidistant from neutral pictures in rated arousal. Pleasant and unpleasant subeategories were also matched for normative arousal. For the 54 primary pictures, startle probes occurred either during the 6-s picture presentation period or during the intertrial interval (ITI). The series also included three initial "habituation" picture-viewing trials (one pleasant, one neutral, and one unpleasant) and nine "buffer" trials (three per valence). The habituation trials were included to familiarize participants with the stimuli and ratings procedure and to habituate initial large startle reactions (cf. Patrick & Berthot, 1995); three probes were delivered during these trials, two during picture-viewing periods and one in between. The buffer trials were included to decrease the predictability of the probe stimulus; no noise probes were delivered either during or after these 9 pictures. Habituation and buffer trials were excluded from analyses of the data. During testing, participants sat in a padded recliner at a distance of 2.2 m from a 1 m 1 m opaque slide screen. Pictures were displayed with a Kodak Ektagraphic III-B projector, positioned in an adjoining equipment room. Stimulus presentation and response sampling were coordinated by a PC computer running VPM data acquisition software (Cook, Atkinson, & Lang, 1987). The ratings display and data collection were coordinated by a second PC. This display was presented on a monochrome monitor positioned to the right of the participant. Ratings were made via a computer joystick. The acoustic startle probe was a 50-ms burst of 105 db white noise with immediate (< l0/xs) rise time, presented binaurally through Telephonics stereo headphones. Probes occurred 300, 800, 1,800, 3,000, or 4,500 ms after picture onset. Probes were also presented intermittently during ITIs to reduce the predictability of the startle stimulus. Design Six stimulus orders were used to balance the presentation of pictures and noise probes across participants within diagnostic groups. Each order included 3 initial (habituation) trials followed by 54 probe (primary)trials, interspersed with 9 no-probe (buffer) trials. Within and between orders, the positioning of picture and probe stimuli was varied such that (a) all valence and probe time conditions were represented equally across orders at each serial position, and (b) the average serial positions of probes at each time point were systematically balanced within picture valence categories (pleasant, neutral, and unpleasant) and within separate pleasant and unpleasant content categories (erotic, thrill, mutilation, assault, and threat). As a means of reducing predictability, pictures of the same valence occurred no more than twice consecutively, and trials involving the same probe position never occurred consecutively. Within each third of an order, all combinations of picture valence and probe time were represented once, resulting in a total of three startle probes per condition over the procedure as a whole. Physiological Measures Blink responses to noise probes were recorded from Sensor Medics 0.25-cm Ag-AgC1 electrodes positioned over the orbicularis oculi muscle beneath the left eye, one below the pupil and the other immediately lateral. The raw electromyographic (EMG) signal was recorded with a Coulbourn $75-01 High Gain Bioamplifier with filter cutoffs of 90 and 1000 Hz and a Coulbourn $76-01 Contour Following Integrator (time constant: 80 ms). Data were sampled at 1000 Hz beginning 50 ms before probe onset and continuing for 250 ms after. Blinks were scored off-line for magnitude and latency (Bradley, 1989). 2 Psychopaths and nonpsychopaths did not differ in overall magnitude of blink reactions to noise probes (raw Ms = 7.47 and 7.30/xV, respectively; F < 1), but substantial variability in reactivity levels was evident across participants within groups. Magnitude scores were therefore z-score standardized across probe trials within individuals (cf. Anthony, 1985; Patrick et al., 1993) and then transformed to T scores (M = 50, SD = 10). This preserved the relationships among responses within participants but established a common metric across individuals, ensuring that all individuals contributed equally to group patterns. The standardized blink magnitude scores were used in all analyses. 3 Facial EMG activity was recorded from 0.25-cm electrodes positioned above the left eyebrow (corrugator supercilli muscle) and over the left cheek (zygomaticus major muscle; Fridlund & Cacioppo, 1986). Coulbourn couplers were used to amplify and integrate the signals (filter cutoffs: 90 and 1000 Hz; time constant: 500 ms). Activity was sampled at 20 Hz before and during picture viewing, and EMG response was defined as average change in microvolts during the initial 3 s of the picture from a 1-s prestimulus baseline. SCR was recorded from adjacent sites on the hypothenar eminence of the nondominant hand via Beckman 1-cm Ag-AgCI electrodes filled with Unibase paste (Lykken & Venables, 1971) and connected to a Coulbourn $71-23 Isolated Skin Conductance Coupler. SCR was defined as the largest increase between 0.9 and 4 s after picture onset (cf. Patrick et al., 1993). Raw scores were transformed (Iog[SCR + 1]) to reduce skewness (Bradley I The following are the 54 pictures, by IAPS identification number: erotic, 4180, 4210, 4220 [4150], 4250 [4300], 4290, 4680, 4310 [4320], 4690, 4770 [4660]; thrill 8080, 8170, 8180, 8190, 8200, 8260, 8030 [8490], 8370, 8400; neutral 2200 [2210], 5510, 5500 [5530], 6150, 7010, 7050, 7060, 7080 [7000], 7090, 7710 [9390], 7100, 7130 [7140], 7150, 7170, 7190, 7490, 7700, 9070; mutilation, 3000 [3071], 3010, 3060 [3110], 3080, 3170, 3400 [3150]; assault, 3500, 3530 [6570], 6350 [6560], 6540, 9250, 9410; threat, 6230, 6260, 6300, 6250, 6370, The bracketed numbers denote alternate pictures viewed by half of the participants within each diagnostic group; alternates were chosen to match the unbracketed pictures in content, normative valence, and normative arousal. The alternation was performed in connection with a second experiment, conducted after the picture viewing procedure, in which participants' reactions to new and previously viewed pictures were compared (cf. Bradley, Greenwald, Petry, & Lang, 1992). Because this experiment constituted a separate study with an independent rationale and because its methods and results are too extensive to report here, this work will be described elsewhere. a Because blink magnitude scores are more commonly reported in studies of emotion-modulated startle, and because the findings for latency scores paralleled those for magnitude, only the magnitude results are reported here. Results for blink latency can be obtained on request from Christopher J. Patrick. 3 With standard scores, group comparisons of relative reactivity across picture conditions are meaningful, whereas group comparisons of absolute reactivity for specific picture conditions are not. Therefore, consistent with most prior research involving the startle probe paradigm (cf. Anthony, 1985; Davis, 1989; Lang, 1995), present analyses focused on patterns of startle modulation, in particular, blink inhibition or potentiation for pleasant and unpleasant pictures in relation to the neutral reference condition. A distributional analysis of the standard score data revealed few (<0.6%) outlying scores greater than + 3 standard deviations); these scores were corrected by "fencing in."

5 PSYCHOPATHY AND STARTLE MODULATION 377 et al., 1990; Forth, 1992; Patrick et al., 1993). Equipment failure resulted in the loss of SCR data for I psychopath and 2 nonpsychopaths. HR activity was recorded from Sensor Medics l-cm Ag-AgCI electrodes positioned on the right and left inner forearms and connected to a Coulbourn $75-01 High Gain Bioamplifier. A Schmitt trigger detected the R component of the cardiac wave form. HR response was defined as average change during the 6-s picture viewing period from the 1-s baseline immediately preceding picture onset. 4 HR data for 1 psychopath were excluded from analyses owing to the presence of movement artifact during baseline in a substantial number of trials. Procedure On arrival, participants completed a form that screened for physical ailments, medication use, and auditory or visual impairments. After electrode attachment, participants were advised they would be viewing a series of pictures and rating their reactions to each. They were instructed to watch each picture the entire time it appeared on the screen and to disregard the brief noises they would hear occasionally through headphones. Participants were then given a demonstration of the computer rating procedure, in which reactions to each picture were rated on dimensions of valence (pleasantness), arousal, and dominance via Lang's (1980) self-assessment manikin (SAM). Participants also rated the extent to which each picture was interesting (from not at all to very interesting). Ratings for 1 psychopath were excluded because posttest questioning revealed that he misunderstood the instructions. Dominance ratings for 1 nonpsychopath were excluded for the same reason. Each of the 66 pictures was presented for 6 s. Seven seconds after picture offset, a display appeared on the ratings monitor prompting participants to rate how they felt while viewing the preceding picture. The period of time between completion of the ratings and the beginning of the next picture baseline period varied from 10 to 20 s, averaging 15 s. Data Analysis Hypotheses for each dependent variable were tested within a mixedmodel multivariate analysis of variance (MANOVA) in which group (psychopathic vs. nonpsychopathic) was the between-subjects variable and repeated measures were treated as variates (Stevens, 1992; Vasey & Thayer, 1987). Preliminary analyses were conducted for all measures with race (African American vs. Caucasian) included as a variable; no significant effects involving race were found in any of the analyses (all Fs < 1.5), and therefore results are reported for groups as a whole. A significance level of.05 was used for all statistical tests. An index of effect size (r12; SPSS, 1996) is reported for significant group interactions. Startle reflex. The key Group Picture Valence Probe Time interaction was partitioned into successive intervals (300 vs. 800 ms and 800 ms vs. late interval) to allow a_compafison of the temporal progression of attentional and emotional effects on startle in the two study groups (Bradley et al., 1993). (Scores for the late-interval probes [1,800, 3,000, and 4,500 msl were combined because a preliminary analysis of these times revealed no interaction of probe time with group or picture valence [cf. Levenston & Patrick, 1995].) The picture valence variable was parsed into orthogonal "quadratic" (i.e., pleasant-unpleasant vs. neutral) and "linear" (i.e., pleasant vs. unpleasant) contrasts reflecting modulatory effects of attention-activation and emotional valence, respectively (cf. Bradley et al., 1990, 1991, 1993; Patrick et al., 1993; Stritzke et al., 1995; Vrana et al., 1988). Blink modulation for specific affective content in relation to neutral pictures was examined with the late-probe data only (cf. Levenston & Patrick, 1995) because effects of emotional valence on blink modulation are more clearly established later in the picture interval (i.e., after the region of prepulse effects; Bradley et al., 1993). Startle responses did not differ for mutilation versus assault contents in either prisoner group, and so these contents were collapsed into a single victim category (cf. Levenston & Patrick, 1995). Facial EMG, visceral response, and picture ratings. Trials involving early-interval (300 and 800 ms) noise probes were uniformly omitted from analyses of facial EMG, SCR, and HR measures. Preliminary analyses of the remaining data for each measure assessed the impact of startle probes by including probe-no probe as a variable, along with picture valence and diagnostic group. No significant main effects or interactions were found for probe presentation, and the results therefore exclude this variable. In parallel with the startle response analyses, group differences in facial, visceral, and ratings measures were examined as a function of both picture valence (i.e., pleasant, neutral, or unpleasant) and specific pleasant and unpleasant content. Startle Reflex Magnitude Results Picture valence effects. Startle blink responses were generally smaller at earlier probe times, F(2, 33) = 23.33:300 versus 800 ms, F(I, 34) = 9.97, and 800 ms versus late interval, F(1, 34) = This overall "picture prepulse" effect (Bradley et al., 1993) did not vary with group, F < 1. However, groups did differ in their patterns of valence modulation across the three probe intervals, Group X Valence x Time F(4, 31) = 5.93,,q2 =.43. Across the two earliest probe times, nonpsychopaths showed relative blink inhibition for both pleasant and unpleasant pictures relative to neutral pictures (i.e., a normal attentional pattern; Bradley et al., 1993; Levenston & Patrick, 1995), quadratic valence F(1, 17) = 5.50, p =.03. However, at 800 ms, an emotional modulation pattern (i.e., reflex potentiation for unpleasant vs. pleasant pictures) became evident in this group, Linear Valence x Time F(I, 17) = (Figure 1, top). Psychopaths did not show inhibition for pleasant and unpleasant pictures across the two early times, F < 1. The data for this group suggested an emergence of this pattern at 800 ms (Figure 1, bottom), but the Quadratic Valence x Time effect did not achieve significance, F(1, 17) = 3.64, p =.07. Psychopaths showed no differentiation between pleasant and unpleasant pictures at either early probe time, overall linear valence and Linear Valence x Time Fs(1, 17) = 0.48 and 1.65, respectively. Across the 800-ms and late-probe times, nonpsychopaths showed startle inhibition for pleasant pictures and startle potentiation for unpleasant pictures, linear valence F(I, 17) = (quadratic F < 1). Psychopaths, on the other hand, showed an aberrant pattern of blink inhibition for both pleasant and unpleasant pictures in relation to neutral pictures (cf. Patrick et al., 1993), quadratic F(1, 17) = 6.83 (linear F < 1). Statistically, both the Group X Linear Valence and Group x Quadratic Valence interactions were significant, Fs(1, 34) = and 6.42, ~72s =.34 and.16, respectively. A Group x Linear Valence x Time interaction was also found, F(I, 34) = 8.56, r/z =.20. Nonpsychopaths showed robust linear modulation (unpleasant greater than pleasant) 4 The phasic cardiac response to photographic pictures is characteristically triphasic, involving initial deceleration succeeded by acceleration and then secondary deceleration (Greenwald, Cook, & Lang, 1989; Hare, Wood, Britain, & Shadman, 1970; Lang, Greenwald, Bradley, & Hamm, 1993). In the present study, analyses of these separate HR component scores (Gatchel & Lang, 1973) produced results that paralleled those for the 6-s HR change scores. For the sake of brevity, and to limit the number of analyses, only the latter findings are reported (cf. Patrick et al., 1993).

6 378 LEVENSTON, PATRICK, BRADLEY, AND LANG 55. Nonpsychopaths oo,= 50. "10 t--.= [] Pleasant [] Neutral [] Unpleasant 55. Psychopaths f (1) t-- m 45. r- rn 4(: 300 ms 800 ms Late Probe Time Figure I. Startle blink magnitude for nonpsychopaths (top) and psychopaths (bottom) as a function of picture valence (i.e., pleasant, neutral, or unpleasant) and probe time: 300 ms, 800 ms, and late interval (i.e., 1,800- ms, 3,000-ms, and 4,500-ms probe times combined). Means are presented in standard (T-score) units. at both the 800-ms and late-interval times, Fs(1, 17) = and 22.15, respectively. Psychopaths, on the other hand, showed an emergent linear effect at the late times only, F(1, 17) = 6.09, p =.03, with subsequent analyses providing clarification in terms of specific picture contents. Picture content effects. Within the late-probe interval, groups differed in blink modulation for both victim (mutilation-assault) and direct threat content in relation to neutral content, Group Aversive-Neutral Fs(1, 34) = 8.73 and 6.15, ~2s =.20 and.15, respectively. For the combined victim category, nonpsychopaths showed normal reflex potentiation, whereas psychopaths showed abnormal reflex inhibition (Figure 2, top), Fs(1, 17) = 4.31 and 4.42, respectively. For direct threat scenes, both groups showed relative potentiation; however, this effect was significant only in the nonpsychopath group, F(1, 17) = 21.52; for psychopaths, F(1, 17) = 2.76, p =.12. Among pleasant contents, erotic pictures produced reliable blink inhibition relative to neutral pictures, and this effect did not differ across groups, F < 1. However, for thrill scenes, psychopaths evidenced blink inhibition (F[ 1, 17] = 3.90), whereas nonpsychopaths showed significant blink potentiation (F[I, 17] = 8.56), Group Thrill-Neutral F(1, 34) = 11.04, vl z =.25 (Figure 2, bottom). Facial EMG Corrugator EMG. Responses of the corrugator ("frown") muscle were reliably greater for unpleasant than for pleasant pictures, linear valence F(1, 34) = 13.12, with neutral pictures falling in between, quadratic F < 1 (cf. Greenwald et al., 1989; Lang et al., 1993, 1995; Patrick et al., 1993). This effect did not vary by diagnostic group, and groups did not differ in overall EMG reactivity. Table 1 lists pleasant and aversive content means for the facial (and autonomic) measures. In contrasts of specific contents with neutral content, the following main effects were found for corrugator EMG: victim greater than neutral, threat greater than

7 PSYCHOPATHY AND STARTLE MODULATION O) Z E 8 r-- a "0 r* [] Erotic Thrill C O. -2, -6 Nonpsychopaths Psychopaths Figure 2. Group startle response means for unpleasant picture contents (top; mutilation, assault, and threat) and pleasant picture contents (bottom; erotic and thrill), expressed as the difference in blink magnitude from the neutral picture reference. Means represent values across the three late-interval probe times (1,800, 3,000, and 4,500 ms). Units are standard ~(T) scores. neutral, and thrill less than neutral, Fs(l, 34) = 6.80, 6.98, and 5.10, respectively. None of these effects varied by group. Zygomatic EMG. Zygomatic ("smile") EMG response did not differ as a function of picture valence; linear and quadratic contrasts were both nonsignificant, Fs(1, 34) < 1. Prisoner groups did not differ in overall zygomatic reactivity, and no Group x Valence interaction was found. Effects for content-neutral contrasts were also nonsignificant. Visceral Response SCR. Pleasant and unpleasant pictures evoked reliably larger SCR than neutral pictures, quadratic valence F(1, 31) = 8.97 (linear F = 2.41, ns; cf. Bradley et al., 1990; Greenwald et al., 1989; Lang et at., 1995; Winton et al., 1984), and this arousal pattern did not vary by group, F(1, 31) = Among specific contents, erotic, victim, and threat pictures prompted greater SCR than neutral scenes, Fs(l, 31) = 8.53, 5.53, and 8.22, respectively. A group difference was found only for thrill content: Nonpsychopaths showed enhanced SCR to thrill pictures in relation to neutral pictures, F(1, 15) = 5.43, whereas psychopaths did not (F < I), Group X Thrill-Neutral F(1, 31) = 4.98, ~12 =.14. HR. The cardiac response to pictures was predominantly deceleratory (Table 1). Greater HR deceleration was found for unpleasant than pleasant pictures, linear valence F(I, 33) = 9.96, and this effect did not vary by group, F < 1. However, psychopaths showed greatly enhanced deceleration for both affective picture categories in comparison with neutral pictures, quadratic valence F(t, 16) = 14.75, an effect not observed in the nonpsychopath

8 380 LEVENSTON, PATRICK, BRADLEY, AND LANG Table 1 Facial and Visceral Response Measures: Means by Picture Content Pleasant Unpleasant Erotic Thrill Neutral Mutilations Assaults Threat Measure M SD M SD M SD M SD M SD M SD Facial EMG Corrugat0r change Nonpsychopaths Psychopaths Overall a , b 0.55 Zygomatic change Nonpsychopaths Psychopaths Overall Visceral response Skin conductance response Nonpsychopaths Psychopaths Overall 0.033, b a , b Heart rate change Nonpsychopaths Psychopaths - 1, Overall ~ b ,b 2.00 Note. Units of measurement were as follows: heart rate change, beats per minute; skin conductance response, log (p~siemens + 1); facial electromyographic (EMG) change, p,v. Within pleasant and unpleasant picture categories, content differences were tested via planned contrasts (i.e., erotic vs. thrill, mutilation vs. assault, and mutilation-assault vs. threat). In the overall sample data, content means that differ significantly from one another (p <.05) are marked by differing subscripts; none of these effects varied as a function of group. group (F < 1), Group Quadratic Valence F(1, 33) = 9.79, 71 z =.28 (Figure 3). Furthermore, psychopaths showed more pronounced HR deceleration for all pleasant and aversive contents in relation to neutral: Group Content-Neutral Fs(1, 33) ranged from 4.23 for victim-neutral to 7.73 for erotic-neutral, and'o 2 values ranged from. 11 to. 19. Picture Ratings Overall, pleasant and unpleasant pictures prompted higher arousal and interest ratings than neutral pictures, quadratic valence Fs(1, 33) = and 53.92, respectively, and pleasant pictures elicited higher ratings of pleasure, dominance, arousal, and in O~ == 5 (9 n" "t~ "T [] Pleasant [] Neutral Unpleasant -2.5 Nonpsychopaths Psychopaths Figure 3. Average 6-s heart rate change (beats per minute) from a 1-s prepicture baseline, by picture valence (pleasant, neutral, or unpleasant) and diagnostic group (nonpsychopath or psychopath).

9 PSYCHOPATHY AND STARTLE MODULATION 38 l terest than unpleasant pictures, linear Fs(1, 32/33) = , 38.67, 4.92, and 30.00, respectively. However, psychopaths rated pleasant pictures as more pleasurable and aversive pictures as less unpleasant in relation to neutral than did nonpsychopaths, Group Quadratic Valence F(1, 33) = 5.51, W 2 =.14. All picture contents contributed to this pattern (Table 2), but separate contentneutral analyses revealed a reliable group effect for erotic content only, F(1, 33) = 4.38, 712 =.12. Psychopaths also reported higher dominance during unpleasant scenes in relation to neutral scenes than did nonpsychopaths, F(1, 32) = 8.07, r/z =.20. This pattern was evident in ratings of both victim and threat pictures but significant only for the latter, Group Threat-Neutral F(1, 32) = 4.67, r; 2 =.13 (for victim scenes, F[1, 32] = 2.77). No corresponding group differences were found in arousal or interest ratings, with all affective picture contents rated significantly more interesting and arousing than neutral pictures. Discussion Consistent with our a priori hypothesis based on previous work (Patrick et al., 1993), psychopaths showed deviant startle modulation during affective picture processing. Whereas nonpsychopaths (like normal college students) showed reflex potentiation for unpleasant pictures, psychopaths showed blink inhibition for both.pleasant and unpleasant scenes in relation to neutral. This group difference became evident by 800 ms after picture onset, a region of the viewing interval in which a shift from attentional to emotional modulation normally emerges (Bradley et al., 1993). Analyses of specific picture contents further clarified these results. Among aversive contents, the most striking group difference involved victim scenes (mutilated figures or attacks on others): As predicted, nonpsychopaths, like normals, showed reflex potentia- tion for victim scenes, whereas psychopaths showed robust startle inhibition. One interpretation of these results is that they reflect a specific deficit in empathy among psychopathic individuals (Aniskiewicz, 1979; Blair, Jones, Clark, & Smith, 1997), perhaps even a pleasurable response to the distress of others. However, psychopaths also showed evidence of diminished defensive activation during direct threat scenes: Although both study groups showed enhanced startle reactions for threatening pictures relative to neutral pictures, this effect was significant only in the nonpsychopath group. This suggests, together with prior findings (see reviews by Amett, 1997; Hare, 1978; Siddle & Trasler, 1981; see also Patrick, 1994), that defensive reactivity deficits in psychopathy are not limited to depictions of others' distress. Startle Inhibition During Aversive Picture Viewing in Psychopaths: The Role of Attention An alternative explanation for the finding that psychopaths showed inhibited startle during unpleasant pictures, particularly scenes of victimization, is that the inhibition reflected a predominance of attentional engagement. Anthony and Graham (1985) theorized that allocation of attention to a foreground reduces the startle response (see also Bradley et al., 1990) because attentional capacity is limited and resources are diverted from the noise probe. Picture viewing involves orienting to and processing visual foregrounds (Lang, 1995; Patrick & Lavoro, 1997). Pictures that are affectively arousing (whether pleasant or unpleasant) engage more attention than neutral foregrounds, as evidenced by heightened interest ratings, longer elective viewing times, larger cortical responses, and slower probe reaction times (Bradley et al., 1990, Table 2 Self-Report Ratings: Means by Picture Content Pleasant Unpleasant Erotic Thrill Neutral Mutilations Assaults Threat Rating measure M SD M SD M SD M SD M SD M SD Pleasantness Nonpsychopaths l Psychopaths Overall 14.8 a b ~ b c 3.4 Arousal Nonpsychopaths I Psychopaths Overall 13.3 a b Dominance Nonpsychopaths Psychopaths ll l Overall 12.9 a b 3.8 I Interest Nonpsychopaths Psychopaths Overall 15.9 a b ~ a b 5.0 Note. Range of scores for self-report rating scale is Within pleasant and unpleasant picture categories, content differences were tested via planned orthogonal contrasts (i.e., erotic vs. thrill, mutilation vs. assault, and mutilation-assault vs. threat). In the overall sample data, content means that differ significantly from one another (p <.05) are marked by differing subscripts; none of these effects differed across groups.

10 382 LEVENSTON, PATRICK, BRADLEY, AND LANG 1991; Bradley, Drobes, & Lang, 1996; Cuthbert, Schupp, Bradley, Birbaumer, & Lang, 2000; Patrick et al., 1993). Cuthbert et al. (1996) reported that startle reactions decreased for both pleasant and aversive pictures up to an intermediate level of picture intensity but that, at higher intensities, unpleasant pictures produced startle potentiation, whereas pleasant pictures produced increasing reflex inhibition. In part on the basis of this work, Lang et al. (1997) postulated that environmental stimuli that are motivationally relevant command greater attention than neutral stimuli (for a related view, see Tucker & Derryberry, 1992), but in the case of aversive cues, attentional orienting gives way automatically to defensive activation as cues increase in potency. Lang et al. theorized that this transition occurs in stages, with orienting and defense dispositions coexisting at moderate levels of cue intensity but shifting to pure defense (active fight-flight) when danger is imminent (cf. Fanselow, 1994). This staged transition is presumed to reflect an adaptive trade-off between two basic survival tendencies, appetitive approach and defensive withdrawal or attack. The present results could signify a heightened threshold for the transition from orienting to defense in psychopaths. This assumes that startle responses in the present sample were enhanced for direct threat versus victim pictures (as in normals; Balaban & Tanssig, 1994; Levenston & Patrick, 1995) because the former were more intensely activating and yielded a greater predominance of defense over orienting. Consistent with this, SCR was larger for threat than victim pictures in both prisoner groups (indicating stronger activation), whereas ratings of interest were lower for threat than victim pictures (implying weaker engagement). The latter result coincides with the finding in normal individuals that reaction times to a tone probe are faster during personal threat than mutilation scenes (Sarlo et al., 1998). That psychopathic individuals showed startle inhibition during victim scenes implies that their reaction to these scenes was mainly one of attentive engagement (orienting). The corresponding weak potentiation for threat pictures indicates that, among psychopaths, defensive reactivity began to supersede orienting only at a level of aversive cue intensity (threat imminence) at which nonpsychopaths and normals show predominantly defensive mobilization. The group results for pleasant pictures are tentatively interpretable within this same framework: For purely pleasurable erotic scenes, both groups showed primarily attentional inhibition; for thrill scenes that combined elements of danger and excitement (cf. Lang, 1995), psychopaths showed primarily attentional inhibition, whereas nonpsychopaths showed modest defensive potentiation. The HR data also fit with this attentional-orienting interpretation. Psychopaths showed stronger HR deceleration to both pleasant and unpleasant pictures than nonpsychopaths, indicating more pronounced and sustained sensory orienting to these affective stimuli (Graham & Clifton, 1966; Libby, Lacey, & Lacey, 1973). 2 Facial Expression and Self-Report: "'The Mask of Sanity" Groups did not differ in facial reactions to pictures. Neither group showed zygomatic ("smile") differentiation among picture categories. Increased zygomatic response to pleasant pictures has been shown in normal individuals, but this effect occurs more reliably in women than men and is evident mainly for joyful or nurturant content (Lang et al., 1993), which this study did not include. In corrugator ("frown") EMG, both prisoner groups showed enhanced reactivity to unpleasant pictures. In the ratings domain, psychopaths reported less displeasure and higher dominance for unpleasant pictures (vs. neutral) than nonpsychopaths while not differing in arousal or interest ratings, implying some reduction in the appraised aversiveness of these stimuli. However, consistent with prediction and in contrast to startle and HR, no marked group differences were found in rating patterns across picture valence categories. Taken together, the current data indicate that psychopathy involves a deviation in affective response at the most fundamental level--that of evoked action dispositions (Lang et al., 1990)- which is largely dissociated from overt expression. This coincides with Cleckley's clinical conception of psychopathy as a "mask of sanity" and with a growing body of empirical evidence from recent laboratory studies of emotional processing in psychopaths (Forth, 1992; Patrick et al., 1993, 1994; WiUiamson et al., 1991). Mechanisms of Abnormal Emotional Reactivity in Psychopaths The results for the "late" (1,800-4,500 ms) portion of the picture interval imply an abnormal predominance of attentional orienting over defensive reactivity in highly antisocial individuals possessing the core emotional detachment features of psychopathy. This result is consistent with the idea that psychopathy resides at the low end of a fearfulness continuum (Fowles, 1980; Hare, 1970, 1978; Lykken, 1957). Trait differences in defensive (fear) reactivity presumably have arisen through natural selection because the defense system opposes other survival instincts and because defensive readiness is adaptive to varying degrees in different environments (cf. Lykken, 1995). From this viewpoint, psychopaths are predatory individuals (cf. Hare, 1993) who are uniquely adapted to survive in settings in which resources are scarce and goal-seeking behavior must persist in the face of all but imminent danger. However, the early probe time results point to an interesting elaboration on this interpretation of the late-interval data. Consistent with predictions based on data for normal college students (Bradley et al,, 1993), nonpsychopaths showed startle inhibition for affective pictures relative to neutral pictures during the early portion of the picture interval. Psychopaths did not show evidence of this effect until later, implying a delay in "recognition" of the motivational significance of these stimuli (Lang et al., 1997, 1998). Independently, others have reported evidence for a deficit in automatic processing of the affective significance of stimuli by psychopaths. Williamson et al. (1991) reported that psychopaths failed to differentiate between neutral and emotional words in 5 This perspective differs from an attentional "overfocusing" interpretation (i.e., that psychopaths are generally less able to process peripheral events when attending to stimuli of immediate interest; Jutai & Hare, 1983; Kosson & Newman, 1986). In fact, recent empirical studies indicate that psychopaths do not show generally enhanced primary task performance or diminished responsiveness to secondary stimuli in divided-attention paradigms, as would be predicted by a simple "overfocusing hypothesis" (see reviews by Kosson & Harpur, and Newman & Wallace, 1993; see also Kosson, 1998). Our interpretation is instead that, in the absence of normal defensive priming, attentional engagement predominated in modulating the startle reflex.

11 PSYCHOPATHY AND STARTLE MODULATION 383 brain potential (P240 and P600) response, although they were able to discriminate words from pseudowords as efficiently as nonpsychopaths, and Christianson et al. (1996) reported that psychopaths did not show a normal "memory bias" for victim-related versus victim-unrelated details of an accident scene. Considered in this light, the present results could reflect superficial, undifferentiated processing of affective pictures by psychopaths. Perceptual cues, including picture stimuli, elicit emotion through links to associated action representations in memory (Lang, 1994). The abnormal late-interval startle pattern shown by psychopaths could result from an initial failure to process the emotional pictures at a deep, action-response level. This interpretation is compatible with the low fear hypothesis, but it is also potentially broader in that it could encompass appetitive as well as defensive action representations (cf. Cleckley, 1976). Limitations and Future Directions The present results replicate and extend prior findings (Patrick, 1994; Patrick et al., 1993) and suggest, in addition, that the threshold of transition from orienting to defense (Lang et al., 1997) is higher in psychopaths. As a next step toward establishing this, it will be useful to assess startle probe reactions in psychopaths and nonpsychopaths during processing of aversive pictures that vary systematically in affective intensity (cf. Cuthbert et al., 1996). The mechanism for diminished startle potentiation in psychopaths could be a specific weakness in the defense system or perhaps a more general deficiency in affective-elaborative processing. The early probe time data appear consistent with the latter hypothesis, but this new finding needs to be replicated before firm conclusions are advanced. Other measures could also help to evaluate this hypothesis. One might predict, for example, that brain-potential differentiation between emotional and neutral pictures (Cuthbert et al., 2000) would be weaker in psychopaths than controls (cf. Williamson et al., 1991), particularly during early stages of picture processing. With regard to the foregoing, it should be noted tha~ this study focused on individuals high on both factors of the PCL'-R, because it was this "detached-antisocial" group that showed deviant startle modulation in our earlier picture-processing study (Patrick et al., 1993), and we wished to replicate and further explore this effect. However, individuals high in overall psychopathy are likely to differ from nonpsychopaths on a variety of traits (e.g., dominance, aggressiveness, impulsivity, sensation seeking, and harm avoidance; Hare, 1991; Harpur et al., 1989; Lykken, 1957, 1995; Patrick, 994, 1995), and this raises the possibility that different facets of psychopathy might have accounted for different group effects. For example, it is conceivable that deficient late startle potentiation for aversive scenes was linked mainly to high emotional detachment (Patrick, 1994; Patrick et al., 1993), whereas separate traits associated with overall psychopathy or with the antisocial factor mediated other group effects for startle (e.g., the late-interval effect for thrill scenes or early attentional differences). Further research incorporating groups selected for elevations on one or the other PCL-R factor (cf. Patrick, 1994) and measures of potential trait mediators will be needed to resolve this issue. Follow-up studies involving participants high on one or the other PCL-R factor, as well as both factors, would also help to rule out the possibility that group differences reflect sequelae of a deviant, antisocial lifestyle (i.e., cumulative effects of incarceration, substance abuse, fighting, risk taking, etc.); this is potentially an issue in any study of adult psychopathic offenders. Patrick's (1994) findings that highly detached individuals, regardless of their history of antisocial behavior, showed diminished startle potentiation during anticipation of a stressor and that highantisocial-low-detached individuals showed normal startle potentiation in this context argue against this hypothesis. Studies of emotional reactivity in young children with symptoms of psychopathy (cf. Frick, Barry, & Bodin, in press) would also be informative in this regard. Another question is whether certain individual-differences factors might moderate the relationship between psychopathy and response to emotional pictures. For example, self-report traits such as anxiety (e.g., Arnett, Smith, & Newman, 1997; Schmauk, 1970) and socialization (Hare, Frazelle, & Cox, 1978) have been shown to moderate psychopathy group differences in reactivity and performance on some laboratory tasks. Other possible moderators include race-ethnicity (Kosson, Smith, & Newman, 1990), age (Harpur & Hare, 1994), and gender (Salekin, Rogers, & Sewell, 1997). The present study was not designed to systematically test for such effects. In future studies in which theoretical grounds exist for predicting moderator influences and available study populations show adequate variability in relevant characteristics, it will be useful to sample moderator subgroups in numbers that permit adequate power to detect hypothesized effects. A further priority for future research will be to systematically assess the reactions of psychopaths to pleasurable cues of different types. To date, most research on emotion and psychopathy has focused on aversive events. The cardiac and early-interval startle results reported here hint at some differences in elaborative processing of positive picture foregrounds, and prior research (Williamson et al., 1991) has yielded evidence of deficiencies in the processing of pleasant as well as unpleasant semantic (word) stimuli. Considering Cleckley's concept of psychopathy, it seems particularly likely that psychopaths would be unresponsive to pleasurable nuances of events that are tied in with communal motives (e.g., affiliation or nurturance). Although key questions remain to be addressed, the present experiment provides important new information about emotional reactivity in psychopaths. The data indicate that threat or punishment cues must be direct or intense to engage the defensive system and to interrupt ongoing orienting-approach behavior in psychopaths (cf. Patterson & Newman, 1993), and perhaps that affective response representations are generally weaker or less accessible in these individuals. 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