Impaired social cognition in violent offenders: perceptual deficit or cognitive bias?

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1 Eur Arch Psychiatry Clin Neurosci (2017) 267: DOI /s ORIGINAL PAPER Impaired social cognition in violent offenders: perceptual deficit or cognitive bias? Aiste Jusyte 1,2 Michael Schönenberg 2 Received: 24 May 2016 / Accepted: 21 August 2016 / Published online: 13 September 2016 Springer-Verlag Berlin Heidelberg 2016 Abstract Aggressive behavior is assumed to be associated with certain patterns of social information processing. While some theories link aggression to a tendency to interpret ambiguous stimuli as hostile (i.e., enhanced sensitivity to anger), others assume an insufficient ability to perceive emotional expressions, particularly fear. Despite compelling evidence to support both theories, no previous study has directly investigated the predictions made by these two accounts in aggressive populations. The aim of the current study was to test processing patterns for angry and fearful facial expressions in violent offenders (VOs) and healthy controls (CTLs) and their association with self-reported aggression and psychopathy scores. In Experiment 1, we assessed perceptual sensitivity to neutral-emotional (angry, fearful, happy) blends in a task which did not require categorization, but an indication whether the stimulus is neutral or emotional. In Experiment 2, we assessed categorization performance for ambiguous fearful-happy and angry-happy blends. No group differences were revealed in Experiment 1, while Experiment 2 indicated a deficit in the categorization of ambiguous fearful blends in the VO group. Importantly, this deficit was associated with both self-reported psychopathy and aggression in the VO, but not the CTL group. The current study provides evidence for a deficient categorization of fearful expressions and its association with self-reported aggression and psychopathy in VOs, but * Aiste Jusyte aiste.jusyte@uni tuebingen.de 1 2 LEAD Graduate School and Research Network, University of Tübingen, Gartenstr. 29A, Tübingen, Germany Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany no support for heightened sensitivity to anger. Furthermore, the current findings indicate that the deficit is tied to categorization but not detection stages of social information processing. Keywords Hostile attribution bias Emotion recognition Aggression Psychopathy Introduction Aggressive behavior is a characteristic of a number of different severe psychopathologies such as conduct disorder, antisocial personality disorder (ASPD), and psychopathy. Two established theories assume that specific deficits and alterations in social information processing lie at the root of habitual aggressive and antisocial interpersonal styles. However, the theoretical accounts make very different predictions regarding the nature of these disruptions. One of these theoretical accounts was developed by Crick and Dodge [1, 2] assuming that aggressive behavior can result from deficiencies and biases during social information processing [1]. Particularly, alterations at the encoding and interpretation stages of the social information processing [1, 3], namely the tendency to ascribe hostile intent to others (hostile attribution bias, HAB [4, 5]), have been linked to aggressive behavior in children as well as adult samples [3, 6]. Although the model itself does not make specific predictions regarding the processing of facial affect in aggressive individuals, some researchers have recently suggested that aggression may in fact be related to an enhanced sensitivity to angry facial expressions [7, 8]. Accordingly, several studies have reported that aggressive individuals tend to misinterpret other facial expressions as angry [5, 9 12], are more likely to detect anger at lower intensity [7], and

2 258 Eur Arch Psychiatry Clin Neurosci (2017) 267: exhibit an enhanced tendency to label ambiguous emotion blends as angry [7, 13, 14]. These findings are in stark contrast to a wide range of studies conducted within another established theoretical framework, namely the violence inhibition mechanism model (VIM) developed by Blair [15, 16]. Contrary to the sensitivity assumptions derived from the HAB, the VIM actually assumes a deficient processing of facial affect to be an important etiological factor in the development of aggressive behavior. Particularly, the correct recognition of social signals of distress (e.g., facial expressions of fear and sadness) is assumed to be crucial for socialization and the development of moral understanding [15 17]. Accordingly, deficient processing of affective stimuli has been conclusively associated with psychopathic traits [18 25] as well as antisocial populations [26 29]. Despite the varying approaches regarding sample (ASPD, psychopathy vs. delinquency), stimulus material (static vs. animated stimuli, full-blown vs. ambiguous expressions) and design (assessing reaction times, recognition or detection performance), the majority of these studies have documented a deficient processing of particularly fearful facial cues [17, 18, 22, 27 32], but other facial expressions as well, including anger [28, 31, 33 37]. However, in a previous study, we investigated unconscious processing of emotional cues in antisocial and healthy individuals and did not find the predicted fear processing disadvantage in antisocial individuals per se, but only in individuals with unemotional traits within the antisocial group [31]. Importantly, the task did not require the participants to perform any type of categorization, but measured early detection performance without labeling. In sum, despite compelling evidence linking deficient fear processing to aggression and psychopathy, it remains unresolved whether it results from perceptual insensitivity or is related to categorization/labeling processes. Despite support for both theoretical accounts, they make very different predictions regarding facial affect processing in aggressive individuals, with HAB-derived accounts assuming sensitivity to angry expressions and the VIM postulating a deficient processing of fearful expressions. This may, for one, be due to a general disconnect and constructive vagueness related particularly to the encoding and interpretation stages. Although the HAB does distinguish between encoding and interpretation, the paradigmatic approaches used by previous research may not be adequate to distinguish between these two processing stages. Even in studies based on the VIM deficiency hypothesis, there, too, is a methodological and conceptual uncertainty, which we refer to as encoding processes versus as processes related to interpretation. It is important to note that these processing stages require different assessment methods. For instance, encoding processes are best captured by detection tasks which tap into perceptual sensitivity. Interpretation, however, involves top-down processes, starting with the categorization of the affective expression and extending to even higher-order stages that ascribe intent and predict behavioral tendencies. A better understanding of the mechanisms underlying altered processing of nonverbal cues in aggressive individuals is crucial not only for the understanding of aggressive psychopathology per se, but also for the development of intervention strategies tailored to address these mechanisms [14, 27]. Thus, the aim of the current study was to examine the relationship between aggression and the processing of facial expressions of anger and fear in violent offenders (VOs) and healthy controls (CTLs). We addressed this question in two experiments. In Experiment 1, we investigated perceptual sensitivity to angry, fearful and happy expressions of varying intensity in a task that did not require any categorization or labeling. In Experiment 2, we tested predictions derived from HAB by employing ambiguous stimulus material, consisting of blends between angry, happy, and fearful expressions. In accordance with the VIM perspective, we expected to find a deficient processing of fearful expressions in both tasks. With regard to angry expressions, the HAB-derived accounts postulate sensitivity to angry expressions for ambiguous expressions and in tasks that require interpretation (Experiment 2). Finally, we were interested in whether emotion processing patterns are associated with self-reported aggression and psychopathy, with VIM-derived account predicting a relationship between deficient fear processing and psychopathy, while HAB would predict an enhanced performance for angry expressions to be linked to aggression. Methods The violent offender sample was recruited from a German correctional facility (Justizvollzugsanstalt Heimsheim) through advertisement via pamphlets and notifications on the facility s black boards. Interested VO participants were contacted by the facility s psychological service. Experimental as well as clinical assessments were conducted in designated rooms of the facility by trained psychologists from our research group. Exclusion criteria were: conviction for drug-related crime, domestic violence or sexual assault, self-reported current or a history of psychotic symptoms, as well as insufficient knowledge of the German language. Out of 43 interested male VOs, 34 were included in the study (three individuals were excluded due to self-reported psychopathology and five due to insufficient language skills). The majority of the sample had been charged with two or more crimes (69.70 %), with an average sentence length of months (SD = 54.35). The types of crimes committed were as follows: assault (39.40 %), first degree murder

3 Eur Arch Psychiatry Clin Neurosci (2017) 267: (30.30 %), robbery (21.20 %), fraud (18.20 %), blackmail (12.10 %), sexual harassment (9.10 %), theft (6.10 %), rape (6.10 %), kidnapping (6.10 %), procuring (6,10 %), resisting arrest (3 %), threat (3 %), coercion (3 %), property damage, and torching (3 %). 35 male healthy controls with no current psychiatric morbidity or a history thereof were recruited through advertisements in newspapers and university s mailing list. All participants provided written informed consent and received monetary compensation for participation. The study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki. Procedure Upon arrival, the participants completed a questionnaire, which included demographic information and the German versions of several inventories. Aggressive behavior was measured using the 29-item Buss-Perry Aggression Questionnaire [BPAQ; 38], which assesses four components of aggression: physical and verbal aggression, anger, and hostility. Psychopathic traits were assessed using the 64-item Self-reported Psychopathy Scale [SRP-III; 39], which consists of 64 items assessing the four factors of psychopathy. To control for intelligence, the 18-item short-version of the Wiener Matrizen Test [WMT; 40, 41] was employed. The WMT is a nonverbal test derived from Raven s Progressive Matrices Test that assesses deductive reasoning and problem solving. Subsequently, participants were introduced to the experimental task and completed 12 practice trials. The experiment was run on a 15.4 WXGA wide TFT LCD notebook monitor and stimuli ( pixels) were presented centered at a viewing distance of about 50 cm against a gray background. Stimulus presentation and data collection was controlled by Presentation Version 14.1 (Neurobehavioral Systems). Experimental tasks Experiment 1: emotion sensitivity task Affective (angry, happy, fearful) and neutral pictures of three male models were selected from the Radboud Faces Database based on the accuracy of emotional expressions [42]. To create the stimulus material, neutral expressions of each model identity were blended (FantaMorph, Abrosoft, Beijing, China) with each emotional expression to create stimulus dimensions between neutral and emotional categories with 0 % (neutral), 40, 60, and 100 % (full-blown emotion) intensities (Fig. 1a). An additional set of stimuli ranging from 0 to 100 % emotion with an additional model identity was created for the practice trials using the same Fig. 1 Illustration of the experimental procedure and stimulus material for a experiment with neutral-emotional morphs of varying intensity and b experiment 2 with ambiguous morphs. c Depicts the trial structure for both experiments procedure. The dimensions of 0 and 100 % emotional intensity were included as anchor categories for more reliable data. Furthermore, full-blown happy expressions served to identify response patterns indicative of inattention. The stimulus material consisted of a total of 30 distinct stimuli [neutral expression set (3 identities) + emotional set (3 intensity levels (40, 60, and 100 %) 3 emotional expressions 3 identities)]. Each of these stimulus conditions were presented 10 times, resulting in a total of 300 trials. The trials were split into six blocks consisting of 50 trials each, providing the participants with the opportunity for a break in between blocks. The participants were informed that they would be presented with stimuli ranging in emotional intensity from neutral to full-blown emotion and that their task was to judge each stimulus as either rather neutral or rather emotional. Each trial began with a fixation cross display for 1000 ms, followed by a presentation of a face stimulus for 500 ms. Subsequently, the participants were asked to indicate whether the stimulus was rather neutral or rather emotional via a button press (Fig. 1c). Experiment 2: ambiguous expressions task Ambiguous stimuli were created by blending happy, angry, and fearful expressions of three male models in an analogous procedure using the Fantamorph Software (Abrosoft, Beijing, China). Each respective emotional expression was blended to create three affective dimensions (happy fearful, happy angry, and fearful angry). The fearful-angry dimension was included to avoid confounding between category labeling and emotional valence in the response format. The stimulus material (Fig. 1b) for the experiment

4 260 Eur Arch Psychiatry Clin Neurosci (2017) 267: Table 1 Demographic diagnostic sample description VO (N = 34) CTL (N = 35) Statistics Age (10.84) (11.84) t(67) = 2.66 ** WMT sum score 7.24 (3.27) 8.28 (2.76) t(67) = 1.44 Education (years) 9.65 (1.01) 9.89 (0.68) t(67) = 1.16 SRP Interpersonal manipulation (7.74) (7.40) t(67) =.80 Callous affect (7.02) (5.56) t(67) =.25 Erratic lifestyle (9.39) (9.65) t(67) =.08 Antisocial behavior (10.33) (8.29) t(67) = 6.57 *** Total score (22.66) (17.52) t(67) = 3.17 ** BPAQ Physical aggression (7.12) (6.22) t(67) = 2.02 * Verbal aggression (3.71) (2.45) t(67) =.15 Anger (4.54) (4.28) t(67) = 1.09 Hostility (5.31) (6.14) t(67) =.12 Total score (17.51) (15.89) t(67) = 1.17 The data represented in the table refers to means and standard deviations for each measure (in parentheses) CTL Healthy controls, VO violent offenders, WMT Wiener Matrizen Test, SRP Self-reported Psychopathy Scale, BPAQ Buss-Perry Aggression Questionnaire * Significant at p <.05, ** significant at p <.01, *** significant at p <.001 consisted of 18 distinct images [3 models 3 emotional dimensions (happy-fearful, happy-angry, fearfulangry) 2 ambiguity levels (40 and 6 0 %)], which were repeated a total of ten times during the experiment. Stimuli of one additional model identity were created in the same manner for the practice trials (3 emotional 2 ambiguity levels). The trials were split into five blocks consisting of 36 trials each providing the participants with the opportunity for a break in between blocks. The temporal trial structure was identical with that of Experiment 1, with the exception of the answering format, asking the participants to categorize the expression (happy, angry or fearful) via a button press (Fig. 1c). In both experiments, the participants were instructed to react as quickly and accurately as possible. Results Participant characteristics Demographic participant characteristics are described in Table 1. The VO and CTL samples were comparable in terms of years of education and intelligence (WMT), with the VOs tending to be older. Compared to CTLs, the BPAQ subscales indicated that the VOs self-reported physical aggression was significantly higher, but there were no differences in self-reported verbal aggression, hostility or anger. The VOs scored higher on the antisocial behavior subscale of the SRP. Seven participants from the VOs and two controls were excluded from further data analysis due to performance indicative of inattention/lack of understanding of the task (hit rates <20 % at 100 % happy expressions). A total of 27 VOs and 33 CTLs were included in the final data analysis for Experiment 1 and 2. Experiment 1 As a first step, an initial analysis was computed with the sum scores of emotional endorsements for all expressions (angry, happy, and fearful) and intensity levels (0, 40, 60, 100 %). A 3 (emotion) 4 (intensity) 2 (group: VO vs. CTLs) analysis of variance (ANOVA) yielded a significant main effect of emotion [F(2, 116) = 13.76, p <.001, η 2 =.19] and intensity [F(3, 174) = , p <.001, η 2 =.89], which was further qualified by an emotion intensity interaction [F(6, 348) = 15.20, p <.001, η 2 =.21]; no other effects or interactions reached significance. The intensity emotion interaction was due to more emotional endorsements for fearful versus angry or happy expressions at intermediate (40, 60 %) intensity levels (Fig. 2a). Signal detection theory (SDT) analysis Subsequent SDT analyses were conducted to investigate possible group differences in perceptual sensitivity; 40 and 60 % intensity blends were used to compute hit and false alarm rates for the calculation of the d-prime and β parameters (Macmillan and Creelman, 2004). D-prime reflects sensitivity to subtle intensity changes, with positive values indicating perceptual sensitivity (d-prime = 0 indicates no discriminatory ability), while β reflects a response bias,

5 Eur Arch Psychiatry Clin Neurosci (2017) 267: Fig. 2 Results of Experiment 1. a Mean number of emotional endorsements for happy, angry, and fearful stimuli of varying intensity. b Mean d-prime and c β-scores for happy, angry, and fearful categories. VO violent offenders, CTL healthy controls e.g., the tendency to label a stimulus as sad irrespective of the objective presence of sadness (β-scores = 1 signify no bias toward a yes or no response while values <1 indicate a bias toward responding with a yes ). D-prime scores were then analyzed with a 3 (emotion: angry, happy, sad) 2 (group: VO vs. CTLS) repeated measures ANOVA (Fig. 2b). There was a main effect of emotion [F(2, 116) = 29.32, p <.001, η 2 =.34], while no other effects reached significance (all ps >.10). Post hoc tests indicated significant differences between all emotion conditions, characterized by an angry > fearful > happy sensitivity pattern (p <.001). To investigate the response bias β, a 3 (emotion) 2 (group) repeated measures ANOVA was conducted, yielding only a significant main effect of emotion [F(2, 116) = 7.44, p <.01, η 2 =.11], which was characterized by an overall tendency toward a fear response bias, compared to angry and happy response categories (Fig. 2c). No other effects or interactions reached significance. Thus, the present results did not indicate that VOs and CTLs differed in their perceptual sensitivity or response bias. Experiment 2 To analyze the participants ability to categorize fearful and happy expressions in ambiguous blends, we first computed sum scores of correct categorizations for angry and fearful expressions in angry happy and fearful happy blends in both intensity conditions (40, 60 %). An initial analysis with these sum scores via a 2 (emotion) 2 (intensity) 2 (group) ANOVA yielded a main effect of group [F(1, 58) = 10.37, p <.01, η 2 =.15], emotion [F(1, 58) = 4.84, p <.001, η 2 =.22] and intensity [F(1,58) = , p <.001, η 2 =.89] and was further qualified by an emotion intensity [F(1, 58) = 30.86, p <.001, η 2 =.35] as well as an intensity group [F(1, 58) = 10.58, p <.01, η 2 =.15] interaction (Fig. 3a). Finally, a three-way emotion intensity group interaction emerged [F(1, 58) = 5.52, p <.05, η 2 =.09]. The emotion effect was characterized by an overall higher number of angry versus fearful endorsements and the intensity effect reflected an increase in both responses for 60 % intensity levels. The main effect of group was due to overall lower endorsements

6 262 Eur Arch Psychiatry Clin Neurosci (2017) 267: Fig. 3 Results of Experiment 2. a Mean number of fearful and angry endorsements in ambiguous angry happy and fearful happy morphs at 40 % and 60 % proportions of the target emotion. b Mean d-prime and c β-scores for ambiguous angry and fearful morphs. VO violent offenders, CTL healthy controls across all conditions in the VO versus CTL group. The intensity emotion interaction was characterized by a higher rate of angry endorsements of 40 % intensity. The group intensity interaction resulted from the tendency toward a higher number of correct endorsements at 60 % intensity levels in the CTL as compared to the VO group. The following SDT analysis served to elucidate and interpret the three-way interaction; thus, no further post hoc tests were computed on raw data. SDT analysis Repeated measures ANOVAs were conducted for the d-prime for fearful (in fearful-happy blends) and angry (in angry-happy blends) using 40 and 60 % intensity levels in an analogous manner to the procedure in Experiment 1. D-prime scores were then analyzed with a 2 (emotion: angry, happy) 2 (group: VO vs. CTLS) repeated measures ANOVA (Fig. 3b). The significant main effects of emotion [F(1, 58) = 55.29, p <.001, η 2 =.49] and group [F(1, 58) = 6.23, p <.05, η 2 =.10] were qualified by an interaction effect [F(1, 58) = 4.04, p <.05, η 2 =.07]. Post hoc tests indicated that the interaction effect stems from significantly lower d-primes for fearful expressions in the VO group [VO: M = 1.31; SD =.60; CTL: M = 1.78; SD =.57; t(58) = 3.04; p <.01] as compared to CTLs. No significant difference was evident between groups for angry expressions. An analogous 2 (emotion) 2 (group) ANOVA was also computed for the β scores, yielding only a significant main effect of emotion [F(1, 58) = 37.37, p <.001, η 2 =.31; Fig. 3c], which indicated an overall higher tendency to label ambiguously fearful versus angry expressions as happy. Association with aggression and psychopathy To explore the association between emotion recognition and self-reported aggression as well as psychopathy, bivariate correlations were computed for d-prime and SRP as well as BPAQ total and subscale scores for each experiment and group. No associations between the questionnaire measures and d-primes for happy, angry or fearful expressions emerged in Experiment 1. In Experiment 2, significant negative correlations emerged in the VO group between the d-prime scores for fearful expressions and both questionnaire measures, while there was no evidence for similar associations in the control group (Table 2). Discussion The goal of this study was to investigate the sensitivity to angry and fearful cues in VOs and examine which processing stages are affected by these alterations. In Experiment 1, there were no differences between VOs and CTLs, indicating that perceptual sensitivity was not altered in the aggressive group. In Experiment 2, the VOs exhibited a deficient categorization performance for ambiguous fearful expressions, while their performance for angry expressions was comparable to CTLs. Most importantly, this deficit was associated with self-reported aggression and psychopathy scores, while no similar patterns were evident in the control group. Fearful expressions: support for the deficiency hypothesis An impaired ability to recognize fearful expressions in antisocial populations has been documented by a large number

7 Eur Arch Psychiatry Clin Neurosci (2017) 267: Table 2 Correlations between d-primes and diagnostic measures for VO and CTL participants VO CTL D-prime happy D-prime angry D-prime fear D-prime happy D-prime angry D-prime fear Experiment 1 SRP-IPM SRP-CA.33 < SRP-EL SRP-AB SRP-Tot BP-PA BP-VA < BP-A BP-H BP-Tot < Experiment 2 SRP-IPM SRP-CA.10.38* SRP-EL SRP-AB.01.39* SRP-Tot.01.40* BP-PA.19.53** BP-VA.07.47* BP-A.32.39* BP-H BP-Tot.18.45* The data represented in the table refers to bivariate correlations between the indicated measures for the VO (top) and the CTL (bottom, gray) group VO Violent offenders, CTL healthy controls, SRP Self-reported Psychopathy Scale, SRP-IPM Interpersonal Manipulation Subscale, SRP-CA Callous Affect Subscale, SRP-EL Erratic Lifestyle Subscale, SRP-AB Antisocial Behavior Subscale, SRP-Tot SRP total score, BP Buss-Perry Aggression Questionnaire, BP-PA Physical Aggression Subscale, BP-VA Verbal Aggression Subscale, BP-H Hostility Subscale, BP-Tot BP total score p <.1; * Significant at p <.05; ** significant at p <.01; *** significant at p <.001 of studies [17 19, 22, 24, 25, 27 29, 43, 44]. Although the results of Experiment 2 are in accordance with these previous findings and the VIM perspective, an impaired sensitivity for fear was not evident in Experiment 1. It is likely that Experiment 1 taps into earlier processing stages, as it did not require labeling. Similar evidence stems from a previous study of ours using a task that did not require categorization either, which also found no specific impairment in the antisocial group per se, but an association between processing disadvantages for fearful expressions and psychopathy [31]. Taken together, the results of Experiments 1 and 2 indicate that the fear deficit reported so vastly in the literature on psychopathy, ASPD and aggression, is likely caused by an inability to correctly categorize (i.e., ascribe a verbal label) emotional expressions. Angry expressions: no evidence for enhanced sensitivity Across both experiments, we did not find any evidence for an increased sensitivity to angry expressions in VOs, neither in terms of perceptual sensitivity (Experiment 1) nor in categorization performance for ambiguous stimulus material (Experiment 2). Thus, the present study does not corroborate the HAB-derived theoretical assumptions regarding anger sensitivity in aggressive individuals. This contradicts not only previous studies that found evidence for a tendency to mislabel other expressions as angry [5, 9 12] but also those that used ambiguous stimulus material in an aggression-prone community sample as well as violent offenders [7, 13]. However, two previous studies also failed to find differences in baseline categorization performance between aggressive youths and controls for angry happy blends [14, 45]. In sum, the findings on HAB-predicted processing of angry expressions in aggressive individuals are inconclusive, which could be attributed to differences in aggressive subtypes in the investigated study populations. Emotion perception in aggressive subtypes Different developmental pathways can lead to subtypes of disorders that all underlie aggressive behavior, distinct in

8 264 Eur Arch Psychiatry Clin Neurosci (2017) 267: their etiology and maintaining factors [46 48]. Specifically, the HAB is thought to be uniquely associated with reactive aggression subtypes [2, 9], while the absence of emotionality (i.e., psychopathic traits) has been linked to the fear processing deficit [18, 22, 31]. Thus, the heterogeneous findings regarding the HAB-predicted perceptual sensitivity to anger in aggressive individuals may very well be attributable to sample differences. For instance, aggressive subtypes in children and adolescents have been shown to be associated with differential processing patterns of facial affect (i.e., an impaired ability to recognize fearful expressions in youths with high CU-traits) [32, 33, 35] as well as antisocial behavior [33, 45], while the recognition of angry expressions has been shown to be enhanced in children who are subjected to aggressive environments (e.g., physical abuse) [33, 49 51]. In the present study, we also explored links between self-reported aggression and psychopathy to patterns of emotion recognition as predicted by the VIM vs. HAB. In accordance with the VIM-account, we found associations between impaired categorization of fearful cues with both self-reported psychopathy and aggression, but no evidence for an enhanced sensitivity to angry expressions or self-reported aggression as predicted by the HAB. It is important to note that previous evidence links particularly psychopathy to impaired emotion recognition and it is possible that a different processing pattern for anger may emerge for aggressive subtypes low in psychopathy. However, recent data from our work group indicates that the fear processing deficit is evident in both rule-breaking and violent subtypes of criminal offenders [29] and even extends to patients with other externalizing disorders such as ADHD [52]. Notably, none of these previous studies reported enhanced categorization performance for angry expressions or associations with self-reported aggression [27 29, 52]. Taken together, much more work is needed to delineate possible behavior subtypes of aggression and their relationship with decoding, categorization and interpretation of facial affect. Processing stages and underlying mechanisms: directions for future studies To understand the mechanisms underlying alterations in emotion processing for fearful and angry facial expressions in different subtypes of aggression, it is also crucial to employ adequate paradigmatic approaches that delineate different processing stages, starting with very early detection performance [31, 32] and extending to later stages of encoding without labeling (as in Experiment 1) or requiring labeling performance [7, 13, 45]. In this context, it is particularly important to examine the source of a possible labeling deficit, which could, for instance, be related to less specific visual templates for the different categories of facial affect [53]. Results from a recent study on individuals with autistic traits may offer another possible explanation for the pattern of the current findings [54]. In this study, the authors investigated how social cues are incorporated in decision making processes using Bayesian modeling. The results revealed that participants scoring high on autistic traits showed deficiencies to incorporate eye gaze information in their decision making despite an intact ability to perceive social cues. An investigation of the impact of social cues on decision making processes in antisociality would be an interesting avenue to clarify and further delineate mechanisms underlying interactional difficulties in these populations. Given the large number of studies that did not report an enhanced ability to detect anger in highly aggressive and psychopathic samples, it is unlikely that the HAB can be expected to emerge at early processing stages. Instead, employing ambiguous stimulus material or providing other contextual cues [55, 56] that could result in ambiguous facial affect may be suitable approaches to investigate interpretation distortions. Finally, future studies are needed to determine how a possible insensitivity to and categorization deficit for fearful and/or angry expressions tie into biased processing and which neural mechanisms underlie the HAB. While the association between neural underpinnings (i.e., attenuated amygdala reactivity for fearful cues) is thought to be causally associated with the fear processing deficit in psychopathy [57, 58], it is unclear which neural underpinnings give rise to the HAB in facial affect processing. Finally, the reported deficits in the categorization of facial affect reflect impairments in social cognition that are restricted to a third-person or observational perspective. Recently, valid concerns have been raised whether and to which extent such impairments may explain the disorderspecific interactional difficulties [59]. Future studies are needed to determine the relevance of the current findings for real-time social interactions, which would provide important insights into the nature, etiology, and potential treatment strategies in antisocial populations. Summary and conclusion To our knowledge, this is the first study to directly assess and test the deficiency (VIM) and sensitivity (HAB) accounts for facial affect processing in aggressive populations. The current study provides evidence for a deficient performance in the categorization of fearful facial expressions and its association with self-reported aggression and psychopathy in VOs. However, our findings do not support a heightened sensitivity to anger in aggressive populations.

9 Eur Arch Psychiatry Clin Neurosci (2017) 267: The present study is also the first to distinguish between perceptual sensitivity in neutral-emotional blends and categorization stages that require labeling in ambiguous stimuli. Additional studies are necessary to further corroborate this preliminary evidence and shed light on the mechanisms underlying different patterns of social information processing and their association with aggressive subtypes. This knowledge is particularly crucial for the development of effective treatment protocols tailored to specific aggressive subgroups that could benefit from adjunct training procedures targeting the labeling [27] or interpretation of facial affect [14]. Acknowledgments The authors would like to thank Sandra Christian and Sarah Mayer for the support in data collection, and Ryan Dutton for language editing. Funding This research was funded by the LEAD Graduate School [GSC1028], a project of the Excellence Initiative of the German federal and state governments. Compliance with ethical standards Conflict of interest The authors have no conflict to declare. References 1. Crick NR, Dodge KA (1994) A review and reformulation of social information-processing mechanisms in children s social adjustment. Psychol Bull 115: Crick NR, Dodge KA (1996) Social information-processing mechanisms in reactive and proactive aggression. Child Dev 67: Oostermeijer S, Nieuwenhuijzen M, van de Ven P, Popma A, Jansen L (2016) Social information processing problems related to reactive and proactive aggression of adolescents in residential treatment. Pers Indiv Differ 90: Dodge KA (2006) Translational science in action: hostile attributional style and the development of aggressive behavior problems. 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