Skip to main content
SpringerLink
Log in

Mindfulness, Alexithymia, and Empathy Moderate Relations Between Trait Aggression and Antisocial Personality Disorder Traits

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Antisocial personality disorder (ASPD) has long been described focusing exclusively on behavioral features, like aggression. Although the role of mentalizing for aggression is well established, research on the role of mentalizing in ASPD remains limited. The present study examined the independent and interactive effects of mentalizing abilities and aggression in predicting ASPD traits in a violent male offender sample (N = 403). Participants completed self-report measures of ASPD traits, and a comprehensive assessment of mentalizing skills including measures of mindfulness, empathy, and alexithymia. Above and beyond the main effect of aggression, mindfulness, alexithymia, and empathy significantly explained an incremental amount of variance in ASPD traits in separate regression analyses. Further, mindfulness, alexithymia, and empathy significantly interacted with aggression in predicting ASPD scores. Findings suggest that among offenders with better mentalizing, aggression was significantly more strongly related to ASPD traits, indicating that at higher levels of mentalizing, only participants who also had higher levels of aggression scored higher on ASPD traits. Conversely, among offenders with poorer mentalizing, the positive association between aggression and ASPD traits was significantly weaker, indicating that poor mentalizing alone was sufficient to have high levels of ASPD traits (and aggression). Findings suggest that in some instances, mentalizing may not have a protective role on ASPD in the presence of very high levels of aggression. However, among offenders with poor mentalizing, treatments targeting aggression may not be successful in reducing ASPD traits. Interventions that aim at improving mentalizing may ultimately be more effective to treat aggression and ASPD among offenders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park: Sage.

    Google Scholar 

  • Allison, C., Baron-Cohen, S., Wheelwright, S. J., Stone, M. H., & Muncer, S. J. (2011). Psychometric analysis of the empathy quotient (EQ). Personality and Individual Differences, 51, 829–835. https://doi.org/10.1016/j.paid.2011.07.005.

    Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Book  Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504.

    Article  Google Scholar 

  • Bagby, R. M., & Taylor. (1997). Affect dysregulation and alexithymia. In Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: University Press.

    Google Scholar 

  • Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The 20-item Toronto alexithymia scale. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32.

    Article  Google Scholar 

  • Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient (EQ): an investigation of adults with Asperger syndrome and high-functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34, 163–175.

    Article  Google Scholar 

  • Baron-Cohen, S., Bowen, D. C., Holt, R. J., Allison, C., Auyeung, B., Lombardo, M. V., et al. (2015). The “Reading the Mind in the Eyes” test: complete absence of typical sex difference in ~400 men and women with autism. PLoS One, 10(8), e0136521. https://doi.org/10.1371/journal.pone.0136521.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: mentalization-based treatment. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Bateman, A., & Fonagy, P. (2011). Antisocial personality disorder. In A. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 357–378). Washington DC: American Psychiatric Publishing, Inc..

    Google Scholar 

  • Bateman, A., Bolton, R., & Fonagy, P. (2013). Antisocial personality disorder: a mentalizing framework. Focus, 11(2), 178–186.

    Article  Google Scholar 

  • Beeney, J. E., Stepp, S. D., Hallquist, M. N., Scott, L. N., Wright, A. G. C., & Ellison, W. D. (2015). Attachment and social cognition in borderline personality disorder: specificity in relation to antisocial and avoidant personality disorders. Personality Disorders: Theory, Research, and Treatment, 6, 207–215. https://doi.org/10.1037/per0000110.

    Article  Google Scholar 

  • Bertsch, K., Grothe, M., Prehn, K., Vohs, K., Berger, C., Hauenstein, K., et al. (2013). Brain volumes differ between diagnostic groups of violent criminal offenders. European Archives of Psychiatry and Clinical Neuroscience, 263(7), 593–606. https://doi.org/10.1007/s00406-013-0391-6.

    Article  PubMed  Google Scholar 

  • Black, D. W. (2015). The natural history of antisocial personality disorder. Canadian Journal of Psychiatry, 60(7), 309–314. https://doi.org/10.1177/070674371506000703.

    Article  PubMed  Google Scholar 

  • Black, D. W., Gunter, T., Loveless, P., Allen, J., & Sieleni, B. (2010). Antisocial personality disorder in incarcerated offenders: psychiatric comorbidity and quality of life. Annals of Clinical Psychiatry, 22, 113–120.

    PubMed  Google Scholar 

  • Bo, S., Abu-Akel, A., & Kongerslev, M. T. (2014). Metacognition as a framework to understanding the occurrence of aggression and violence in patients with schizophrenia. In P. H. Lysaker, M. Brune, & G. Dimaggio (Eds.), Social cognition and metacognition in schizophrenia: psychopathology and treatment approaches (pp. 137–145). London: Academic Press.

    Chapter  Google Scholar 

  • Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., et al. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of Psychosomatic Research, 41(6), 551–559.

    Article  Google Scholar 

  • Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63(3), 452–459.

    Article  Google Scholar 

  • Carcione, A., Nicolò, G., Pedone, R., Popolo, R., Conti, L., Fiore, D., et al. (2011). Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Research, 190, 60–71. https://doi.org/10.1016/j.psychres.2010.12.032.

    Article  PubMed  Google Scholar 

  • Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165(9), 1127–1135. https://doi.org/10.1176/appi.ajp.2008.07081360.

    Article  PubMed  Google Scholar 

  • Compton, W. M., Conway, K. P., Stinson, F. S., & Grant, B. F. (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and specific drug use disorders in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 677–685.

    Article  Google Scholar 

  • Dimaggio, G., & Lysaker, P. H. (Eds.). (2010). Metacognition and severe adult mental disorders: From basic research to treatment. London: Routledge.

    Google Scholar 

  • Dolan, M., & Fullam, R. (2004). Theory of mind and mentalizing ability in antisocial personality disorders with and without psychopathy. Psychological Medicine, 34(6), 1093–1102.

    Article  Google Scholar 

  • Engen, H. G., & Singer, T. (2013). Empathy circuits. Current Opinion in Neurobiology, 23(2), 275–282. https://doi.org/10.1016/j.conb.2012.11.003.

    Article  PubMed  Google Scholar 

  • Fonagy, P. (1991). Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. International Journal of Psychoanalysis, 72, 639–656.

    PubMed  Google Scholar 

  • Fonagy, P. (2003). The development of psychopathology from infancy to adulthood: the mysterious unfolding of disturbance in time. Infant Mental Health Journal, 24(3), 212–239. https://doi.org/10.1002/imhj.10053.

    Article  Google Scholar 

  • Fonagy, P., & Bateman, A. W. (2016). Adversity, attachment, and mentalizing. Comprehensive Psychiatry, 64, 59–66. https://doi.org/10.1016/j.comppsych.2015.11.006.

    Article  PubMed  Google Scholar 

  • Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21, 1355–1381.

    Article  Google Scholar 

  • Fossati, A., Maffei, C., Acquarini, E., & Di Ceglie, A. (2003). Multigroup confirmatory component and factor analyses of the Italian version of the aggression questionnaire. European Journal of Psychological Assessment, 19(1), 54–65.

    Article  Google Scholar 

  • Fossati, A., Vigorelli Porro, F., Maffei, C., & Borroni, S. (2012). Are the DSM-IV personality disorders related to mindfulness? An Italian study on clinical participants. Journal of Clinical Psychology, 68(6), 672–683. https://doi.org/10.1002/jclp.21848.

    Article  PubMed  Google Scholar 

  • Garofalo, C. & Velotti, P. (2017). Negative emotionality and aggression in violent offenders: The moderating role of emotion dysregulation. Journal of Criminal Justice, 51, 9-16. https://doi.org/10.1016/j.jcrimjus.2017.05.015.

  • Garofalo, C., Velotti, P., & Zavattini. (2018). Emotion regulation and aggression: the incremental contribution of alexithymia, impulsivity, and emotion dysregulation facets. Psychology of Violence, 8(4), 470–483. https://doi.org/10.1037/vio0000141.

    Article  Google Scholar 

  • Gawda, B. (2013). The emotional lexicon of individuals diagnosed with antisocial personality disorder. Journal of Psycholinguistic Research, 42(6), 571–580. https://doi.org/10.1007/s10936-012-9237-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Giovannini, C., Giromini, L., Bonalume, L., Tagini, A., Lang, M., & Amadei, G. (2014). The Italian five facet mindfulness questionnaire: a contribution to its validity and reliability. Journal of Psychopathology and Behavioral Assessment, 36(3), 415–423.

    Article  Google Scholar 

  • Goodwin, R. D., & Hamilton, S. P. (2003). Lifetime comorbidity of antisocial personality disorder and anxiety disorders among adults in the community. Psychiatry Research, 117(2), 159–166.

    Article  Google Scholar 

  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10, 144–156. https://doi.org/10.1093/clipsy/bpg016.

    Article  Google Scholar 

  • Kooiman, C. G., Spinhoven, P., & Trijsburg, R. W. (2002). The assessment of alexithymia: a critical review of the literature and a psychometric study of the TAS-20. Journal of Psychosomatic Research, 53, 1083–1090. https://doi.org/10.1007/s10936-012-9237-z.

    Article  Google Scholar 

  • Lieberman, M. D. (2007). Social cognitive neuroscience: a review of core processes. Annual Review of Psychology, 58, 259–289. https://doi.org/10.1146/annurev.psych.58.110405.085654.

    Article  PubMed  Google Scholar 

  • Lobbestael, J., Cima, M., & Arntz, A. (2013). The relationship between adult reactive and proactive aggression, hostile interpretation bias, and antisocial personality disorder. Journal of Personality Disorders, 27(1), 53–66. https://doi.org/10.1521/pedi.2013.27.1.53.

    Article  PubMed  Google Scholar 

  • Lovett, B. J., & Sheffield, R. A. (2007). Affective empathy deficits in aggressive children and adolescents: a critical review. Clinical Psychology Review, 27(1), 1–13.

    Article  Google Scholar 

  • Marsh, A. A., & Blair, R. J. (2008). Deficits in facial affect recognition among antisocial populations: a meta-analysis. Neuroscience and Biobehavioral Reviews, 32(3), 454–465.

    Article  Google Scholar 

  • McGauley, G., Yakeley, J., Williams, A., & Bateman, A. (2011). Attachment, mentalization and antisocial personality disorder: the possible contribution of mentalization-based treatment. European Journal of Psychotherapy, Counselling and Health, 13(4), 371–393.

    Article  Google Scholar 

  • Millon, T. (2006). MCMI-III manual. 3rd edition. Minneapolis: NCS Pearson. [Italian adaptation: Zennaro, A., Ferracuti, S., Lang, M., & Sanavio, E., Eds. Firenze: Giunti OS; 2008].

  • Misso, D., Schweitzer, R. D., & Dimaggio, G. (2018). Metacognition: a potential mechanism of change in the psychotherapy of perpetrators of domestic violence. Journal of Psychotherapy Integration. Advance online publication. https://doi.org/10.1037/int0000111.

  • Ogloff, J. R. (2006). Psychopathy/antisocial personality disorder conundrum. Australian and New Zealand Journal of Psychiatry, 40(6–7), 519–528. https://doi.org/10.1080/j.1440-1614.2006.01834.x.

    Article  PubMed  Google Scholar 

  • Preti, A., Vellante, M., Baron-Cohen, S., Zucca, G., Petretto, D. R., & Masala, C. (2011). The empathy quotient: £a cross-cultural comparison of the Italian version. Cognitive Neuropsychiatry, 16(1), 50–70. https://doi.org/10.1080/13546801003790982.

    Article  PubMed  Google Scholar 

  • Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M., & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10, 238–261. https://doi.org/10.1002/cpp.362.

    Article  Google Scholar 

  • Semerari, A., Carcione, A., Dimaggio, G., Nicolò, G., & Procacci, M. (2007). Understanding minds, different functions and different disorders? The contribution of psychotherapeutic research. Psychiatry Research, 17, 106–119. https://doi.org/10.1080/10503300500536953.

    Article  Google Scholar 

  • Swann, A. C., Lijffijt, M., Lane, S. D., Steinberg, J. L., & Moeller, F. G. (2009). Trait impulsivity and response inhibition in antisocial personality disorder. Journal of Psychiatric Research, 43, 1057–1063. https://doi.org/10.1016/j.jpsychires.2009.03.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Taubner, S., White, L. O., Zimmermann, J., Fonagy, P., & Nolte, T. (2013). Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. Journal of Abnormal Child Psychology, 41(6), 929–938.

    Article  Google Scholar 

  • Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorder of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4), 412–426. https://doi.org/10.1521/pedi.2010.24.4.412.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ullrich, S., & Coid, J. (2009). Antisocial personality disorder: co-morbid Axis I mental disorders and health service use among a national household population. Personality and Mental Health, 3, 151–164. https://doi.org/10.1002/pmh.70.

    Article  Google Scholar 

  • Velotti, P., Garofalo, C., D’Aguanno, M., Popolo, R., Salvatore, G., & Dimaggio, G. (2016). Mindfulness moderates the relationship between aggression and antisocial personality disorder traits: preliminary investigation with an offender sample. Comprehensive Psychiatry, 64, 38–45. https://doi.org/10.1016/j.comppsych.2015.08.004.

    Article  PubMed  Google Scholar 

  • Velotti, P., Garofalo, C., Callea, A., Bucks, R., Roberton, T., & Daffern, M. (2017). Exploring anger among offenders: the role of emotion dysregulation and alexithymia. Psychiatry, Psychology and Law, 28(1), 128–138. https://doi.org/10.1080/13218719.2016.1164639.

    Article  Google Scholar 

  • Velotti, P., Beomonte Zobel, S., Rogier, G., Tambelli, R. (2018). Exploring relationships: a systematic review on intimate partner violence and attachment. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.01166.

  • Werner, K. B., Few, L. R., & Bucholz, K. K. (2015). Epidemiology, comorbidity, and behavioral genetics of antisocial personality disorder and psychopathy. Psychiatric Annals, 45(4), 195–199. https://doi.org/10.3928/00485713-20150401-08.

  • Zafirakis, E. (2009). Examining empathy and perspective taking among high-risk and low-risk persistently antisocial and non antisocial young adults. International Journal of Interdisciplinary Social Sciences, 4(7), 193–204.

    Article  Google Scholar 

  • Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527–543. https://doi.org/10.1016/j.psc.2008.03.007.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Educational Sciences Department, Genoa University, Corso Andrea Podestà, 2, 16128, Genoa, Italy

    Patrizia Velotti

  2. Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands

    Carlo Garofalo

  3. Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore, 4, 00195, Rome, Italy

    Giancarlo Dimaggio

  4. Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology University College London, Gower Street, London, WC1E 6BT, UK

    Peter Fonagy

Authors
  1. Patrizia Velotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Garofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giancarlo Dimaggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Fonagy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PV: designed and executed the study and wrote the paper. CG: analyzed the data, wrote the first draft of the results, and collaborated in the writing and editing of the final version of the manuscript. GD and PF: collaborated in writing and editing the final version of manuscript.

Corresponding author

Correspondence to Patrizia Velotti.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Also, the study received formal approval both from the ethics committee of Sapienza University of Rome and the Italian Ministry of Justice.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Velotti, P., Garofalo, C., Dimaggio, G. et al. Mindfulness, Alexithymia, and Empathy Moderate Relations Between Trait Aggression and Antisocial Personality Disorder Traits. Mindfulness 10, 1082–1090 (2019). https://doi.org/10.1007/s12671-018-1048-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-018-1048-3

Keywords

Search

Navigation