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Attachment-Related Mentalization Moderates the Relationship Between

Psychopathic Traits and Proactive Aggression in Adolescence

Article in Journal of Abnormal Child Psychology · March 2013

DOI: 10.1007/s10802-013-9736-x

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Attachment-Related Mentalization
Moderates the Relationship Between
Psychopathic Traits and Proactive
Aggression in Adolescence

Svenja Taubner, Lars O. White, Johannes

Zimmermann, Peter Fonagy & Tobias
Nolte

Journal of Abnormal Child

Psychology
An official publication of the
International Society for Research in
Child and Adolescent Psychopathology

ISSN 0091-0627

J Abnorm Child Psychol

DOI 10.1007/s10802-013-9736-x

1 23
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1 23
 Author's personal copy
J Abnorm Child Psychol
DOI 10.1007/s10802-013-9736-x

Attachment-Related Mentalization Moderates

the Relationship Between Psychopathic Traits
and Proactive Aggression in Adolescence
Svenja Taubner & Lars O. White &
Johannes Zimmermann & Peter Fonagy & Tobias Nolte

# Springer Science+Business Media New York 2013

Abstract The lack of affective responsiveness to others’ men- mentalizing capacities. Effects of mentalization on reactive
tal states – one of the hallmarks of psychopathy – is thought to aggression were fully accounted for by its shared variance with
give rise to increased interpersonal aggression. Recent models proactive aggression. Psychopathic traits alone only partially
of psychopathy highlight deficits in attachment security that explain aggression in adolescence. Mentalization may serve as
may, in turn, impede the development of relating to others in a protective factor to prevent the emergence of proactive
terms of mental states (mentalization). Here, we aimed to aggression in spite of psychopathic traits and may provide a
assess whether mentalization linked to attachment relation- crucial target for intervention.
ships may serve as a moderator for the relationship between
interpersonal aggression and psychopathic traits in an adoles- Keywords Mentalization . Aggression . Adolescence .
cent community sample. Data from 104 males and females Psychopathy . Reflective functioning
with a mean age of 16.4 years were collected on mentalization
capacities using the Reflective Functioning Scale on the Adult Psychopathy is linked to chronic criminality, lifelong antiso-
Attachment Interview (AAI). Psychopathic traits and aggres- cial behaviors and recidivism in adults (Gretton et al. 2004;
sive behavior were measured via self-report. Deficits in Leistico et al. 2008; Skeem et al. 2005), and is characterized
mentalization were significantly associated with both psycho- by shallow affect, egocentricity, lack of remorse, superficial
pathic traits and proactive aggression. As predicted, charm, impulsivity, and manipulativeness (Cleckly 1941;
mentalization played a moderating role, such that individuals Hare 1991). One of the most harmful consequences of psy-
with increased psychopathic tendencies did not display in- chopathy for society is the predisposition towards excessive
creased proactive aggression when they had higher interpersonal aggression, especially cold, premeditated ag-
gression as a means to attain one’s goals at the expense of
S. Taubner : J. Zimmermann
others’ well-being (“proactive aggression”; Blair et al. 2005)
Department of Psychology, University of Kassel, Kassel, Germany
in contrast to “reactive aggression” that is defined as a defen-
S. Taubner sive strategy against a perceived hostile attack (Card and Little
International Psychoanalytic University Berlin, Berlin, Germany 2006). Of particular concern is the repeated finding of low
levels of treatment responsiveness for individuals with psy-
L. O. White
Department of Child and Adolescent Psychiatry, Psychotherapy, chopathic traits (Hawes and Dadds 2005), although some
and Psychosomatics, University of Leipzig, Leipzig, Germany recent findings have emerged for psychosocial interventions
in young children (McDonald et al. 2011). Nevertheless, given
P. Fonagy : T. Nolte
that psychopathy itself may prove somewhat intractable to
Research Department of Clinical, Educational and Health
Psychology, University College London, London, UK conventional treatments, especially later in development
(Harris and Rice 2006), an alternative approach may be to
S. Taubner (*) identify targets for intervention that buffer against the damag-
Department of Psychology, Faculty of Human Sciences,
ing consequences of psychopathy (e.g., proactive aggression).
University of Kassel, Arnold-Bode-Str. 10,
34109 Kassel, Germany One such target area for treatments might be attachment-
e-mail: [email protected] related mentalization. This concept integrates cognitive
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J Abnorm Child Psychol

theory of mind (ToM), the capacity to infer the inner psycho- impact on activation patterns in brain areas underpinning
logical state of another, and emotional empathy, the capacity to mentalizing (Nolte et al. 2013). Given that emerging
affectively respond to the emotional display of another (Blair et evidence documents links of psychopathic tendencies in
al. 2005; Blair 2008), within the framework of attachment children with disorganized attachment relationships
theory (Fonagy et al. 2002). (Pasalich et al. 2012), maladaptive interactive patterns in
While research has demonstrated that individuals with families (Dadds et al. 2012), and severe institutional depri-
psychopathic traits match or even outperform controls in vation (Sonuga-Barke et al. 2010), it is conceivable that
tests of cognitive ToM, they appear to have impairments in mentalization is similarly affected during ontogeny.
emotional empathy, potentially giving rise to a relative Accordingly, in behavioral studies, children’s inten-
deficit in a functional violence inhibition mechanism (Blair tionality – portraying characters in attachment-related
1999; Blair et al. 1996; Griffin and Gross 2004; Kosson et narratives as subjects whose behaviors are determined
al. 2002; Richell et al. 2003; Stevens et al. 2001; Sutton et by mental states – was related to cognitive empathy
al. 2000). It follows that they may represent the emotions of (ToM) under non-challenging conditions (low distress,
their victims (ToM), but fail to respond emotionally to these offline mentalizing), but this association did not hold
representations (Sharp and Venta 2012). In turn, such a during a social-emotional challenge (high distress; Hill
failure to resonate with others’ emotional states is thought et al. 2008). By contrast, low intentionality under chal-
to lower the threshold for committing aggressive acts lenging conditions predicted levels of conduct disorder
against others. Neuroscientists have attributed this to a neu- (Hill et al. 2007) and mediated the prospective link for
robiological dysfunction at the level of an underactive at-risk children between insecure attachment in infancy
amygdala and impaired fronto-limbic circuitry, for example, and increased risk of externalizing symptoms at pre-
in response to others’ distressed facial expressions (Jones et school age (Hill et al. 2008). This lends further support
al. 2009). Resonating with others’ distress is thought to put a to the relevance of attachment-related mentalizing deficits
“brake” on aggression because potential pain inflicted on to increases in aggression, although conclusive data for
the victim is also “felt” by the perpetrator (Blair 1995; adolescence are still lacking. In adults, preliminary find-
Feshbach 1987). Deficits in this domain may disinhibit in- ings demonstrate that violent offenders show reduced RF
dividuals with psychopathic traits in their use of proactive in comparison to nonviolent offenders or individuals with
aggression as a means of achieving their goals. respective personality disorders (Levinson and Fonagy
Mentalization – as indexed by reflective functioning (RF) 2004). However, despite the conceptual parallels in rela-
on the Adult Attachment Interview (AAI; Fonagy et al. tion to inhibited mentalization and psychopathy, no stud-
1998; George et al. 1996) – may serve as a protective factor ies to date have attempted to integrate these concepts. In
against the consolidation of antisocial behavior. Mentalizing conjunction with Blair and colleagues’ work on empathy
is defined as the capacity to relate to others (especially (Blair et al. 2005; Blair 2008), paradigms are needed that
attachment figures) by grasping their behaviors as the prod- measure emotional empathy under challenging condi-
uct of mental states, while bearing in mind the necessarily tions. In an attempt to fill these gaps empirically, in the
inferential nature of this process (Fonagy et al. 2007). The present cross-sectional study we set out first to assess
ability to feel others’ distress as one’s own also forms a whether deficits in attachment-related mentalization are
crucial aspect of mentalization and is thought to develop in associated with psychopathic traits and interpersonal ag-
part within the early attachment relationship through verbal gression during the transition to adulthood. Secondly,
and nonverbal channels in interactions with caregivers in given its possible role in inhibiting aggression, we inves-
infancy and childhood (Gergely and Unoka 2008; Sharp and tigated whether intact mentalization despite high levels of
Venta 2012). Previous research indicates that early attach- psychopathy would serve as a protective factor for inter-
ment relationships characterized by violence, abuse, and personal aggression.
neglect may entail an inhibition of mentalizing or only
fragmentary use of intentional attributions (Fonagy and
Moran 1991). Crucially, access to mental processes such Hypotheses
as empathizing or attributing behavior to intentional mental
states is thought to vary as a function of the concurrent We predicted that aggressive behavior and psychopathic per-
attachment-related distress (interpersonal context) as well sonality traits would be inversely associated with RF, in
as the quality of attachment of an individual (developmental keeping with the assumed deficit in empathic responding of
history) (Fonagy and Target 2005; Grienenberger et al. psychopathic individuals. Furthermore, we expected that RF
2005; Hill et al. 2007, 2008; Luyten et al. 2012; Nolte et would play a moderating role in the relationship between
al. 2011). Recent evidence suggests that the experience of psychopathy and aggressive behavior. The moderator hypoth-
attachment-related (i.e. interpersonal) stress has an adverse esis is based on the assumption that RF has an inhibitory effect
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on the expression of psychopathic personality traits in terms of migration ranged from 1 to 11 years with a mean of M=5.
aggression. More specifically, adolescents with marked psy- 3 years, SD=3.9). Regarding these, 6 participants came to
chopathic tendencies should not engage in aggressive behav- Germany being older than 6 years whereas the vast majority of
ior in the presence of higher RF. participants was born and raised in Germany. Level of educa-
tion was very homogeneous; participants in late adolescence
were attending grade 11 in vocational schools and participants
Method in middle adolescence were attending grade 10 in comprehen-
sive schools.
Participants
Measures
The sample of this study consisted of a total of 104
adolescent males and females recruited from the com- Reflective Functioning
munity in two large cities in Germany. Participants
were recruited from local schools. The recruitment The capacity to mentalize was measured using the Adult
was organized using the following procedure: After Attachment Interview (AAI; George et al. 1996). RF was
the municipal authorities had agreed, the headmasters coded according to the RF Scale (Fonagy et al. 1998) from
of 8 comprehensive schools (grades 6 to 10) and 1 AAI transcripts. The AAI consists of 20 questions asked in a
vocational school (grades 11 to 13) were asked to set order with standardized probes. Individuals are asked to
collaborate. Four headmasters of the comprehensive describe their childhood relationship with their parents,
schools and the headmaster of the vocational school choosing five adjectives to characterize each relationship
agreed to participate, reasons for declination were not and substantiating these descriptors with specific memories.
provided. After headmasters’ consent, the study was To elicit attachment-related information, they are asked how
presented by members of the research team directly their parents responded to them when they were in physical
during classes of all 10th grade pupils in the compre- or emotional distress (e.g., during times when they were
hensive schools and to all 11th grade pupils in the upset, injured, or sick as children). They are also asked
vocational school. Pupils were informed verbally and about memories of separation, loss, experiences of rejection,
provided with a short information sheet to take home and times when they might have felt threatened, including,
and to discuss with their parents. Depending on the but not limited to, those involving physical and sexual
number of questions, presentations could take up to abuse. The interview requires that participants reflect on
one school lesson (45 min). If interested in participa- their parents’ styles of parenting and that they consider
tion, the adolescents were asked to arrange appoint- how childhood experiences with their parents may have
ments with the research team individually by phone or influenced their personality. Several studies have demon-
by email. According to the schools’ information, the strated that the AAI represents a social-emotional challenge
complete population targeted comprised about 400 pu- eliciting a stress response even when individuals appear
pils; therefore with N =104 approximately 25 % of the indifferent on interview responses, as indexed by elevated
target population were recruited indicating a possible psychophysiological markers (e.g. Dozier and Kobak 1992;
bias due to self-selection. Inclusion criteria were (a) Roisman et al. 2004). Thus, the RF Scale assesses whether
male and female adolescents with (b) no neurological participants understand attachment-related experiences in
impairment, (c) no acute substance abuse and (d) suf- terms of mental states during a social-emotional challenge
ficient knowledge of German language. All assessments (Fonagy et al. 1998). Statements are coded on an 11-point
took place at the University of Bremen and the scale from anti-reflective (−1) to exceptionally reflective (9).
University of Kassel. The study was approved by the Qualitative markers of RF are the acknowledgement of
ethics committee of the University of Kassel; partici- opacity of mental states, separateness of minds, develop-
pants gave written and informed consent. If a study mental aspects, and efforts to understand behavior in terms
participant was aged below 18 years, a parent or legal of mental states. Scoring focuses on eight questions from the
guardian gave an additional written and informed con- AAI that are considered “demand questions” that explicitly
sent. All participants were paid €30 for participation. probe for RF. The global score is obtained by individually
The sample comprised 59 male and 45 female partic- weighting and aggregating the ratings of the individual
ipants aged from 15 to 24 years with a mean age of 16. questions. The RF Scale has been validated with the coher-
4 years (SD=1.8). Forty-three participants (41.3 %) were ence scale of the AAI and shows a good interrater reliability
from families with immigration backgrounds, mainly after training (Fonagy et al. 1991; Taubner et al. 2012). All
from Turkey, Russia or Arabic countries. Only 12 participants interviews were administered by trained students.
immigrated to Germany during their childhood (age of Interviews were audiotaped, transcribed verbatim, and
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coded by two trained and reliable assessors. Interrater reli- Statistical Analyses
ability for 30 % of the sample had an acceptable Spearman
correlation of r=0.82. Statistical analyses were performed using the Statistical
Package for the Social Sciences (SPSS 19.0). The data
Aggressive Behavior were analyzed in the following three steps1: First, we
computed raw correlations between key variables
Level of aggression was recorded via the Reactive– including age and immigration background. Second,
Proactive-Aggression Questionnaire (RPQ; Raine et al. we conducted two hierarchical regression analyses,
2006), which consists of 23 items that load on two predicting reactive and proactive aggression from age,
scales: reactive and proactive aggression. The question- gender, immigration status, and general intelligence in
naire assesses the frequency of aggressive behavior by the first step, psychopathic personality traits in the sec-
asking the participant to score certain acts (e.g., “Had ond step, and RF in the third step. All continuous pre-
fights with others to show who was on top” or dictors were centered to their mean prior to regression
“Damaged things because you felt mad”) between analyses (Cohen et al. 2003). We conducted these analyses
0 (never) and 2 (often). For the current analysis, sub- in order to confirm whether RF is associated with aggressive
scales were used. The proactive aggression subscale can behavior above and beyond other variables measured in this
range from 0 to 24 and the reactive aggression subscale study. Finally, we tested two moderation models using PPI-R
from 0 to 22. In the current sample, both scales showed as the independent variable, RF as the moderation variable,
good internal consistencies, with Cronbach’s alpha (α)= and RPQ scales as the dependent variable. To that end, we
0.83 for proactive aggression and α=0.80 for reactive generated a new variable by multiplying the (centered) PPI-R
aggression. and RF scores, and added this variable into the aforemen-
tioned hierarchical regression analyses in the fourth step. We
Psychopathy probed for significant interactions by depicting simple regres-
sion lines for adolescents with low (−1 SD), moderate (M),
Psychopathic tendencies were assessed with the German and high (+1 SD) RF (Hayes and Matthes 2009).
version of the Psychopathic Personality Inventory-
Revised (PPI-R; Alpers and Eisenbarth 2008; Lilienfeld
and Widows 2005). The PPI-R is an 154-item question- Results
naire, scored from 1 (never) to 4 (very often), which
yields eight subscales on a two-factor structure: (1) Means and Correlations
“Fearless dominance”, with the subscales fearlessness,
stress immunity, and social potency, and (2) “Impulsive Table 1 presents descriptive characteristics, effects of
antisociality” with the subscales impulsive nonconformi- gender, age, and immigration status, and intercorrela-
ty, blame externalization, Machiavellian egocentricity, tions of key variables. RF ranged from 1 to 7 (M=3.
carefree nonplanfulness, and coldheartedness. In contrast 99, SD=1.40), which is below an expected mean of 5
to the RPQ, the PPI-R focuses on psychopathic person- for non-clinical adult populations (Fonagy et al. 1996).
ality traits. Since the two-factor structure of the PPI-R IQ ranged from 79 to 142 (M=108.6, SD=13.5) and
has recently been called into question (Uzieblo et al. can therefore be considered to be in the normal range.
2010), we used the composite score in the current Psychopathy traits (total score of the PPI-R) ranged
analyses. The composite score can range between 154 from 279 to 451 (M=348.0, SD=29.2), which is above
and 616. In the current sample, the internal consistency mean values for nonclinical German adult populations
of the composite score was very good, with α=0.88. (Eisenbarth and Alpers 2007). Proactive aggression mea-
sured by the RPQ ranged from zero to 20 (M=3.35,
General Intelligence SD = 3.50), whereas reactive aggression had a range
from 1 to 21 (M=7.68, SD=4.08). Gender, age, and
Intelligence (IQ) was controlled in all subsequent statistical immigration status were related to key variables and
analyses. IQ was assessed with the Cultural Fair Test (CFT- therefore included as covariates in all following analyses
3; Cattell and Weiß 1971), which measures general intelli-
1
gence and yields results unaffected by verbal competence Following the recommendations by Fidell and Tabachnick (2003), we
under time-controlled conditions. CFT-3 has proven high checked for outliers prior to hypothesis testing. Two data points in
RPQ-Pro, one data point in RPQ-Re, and one data point in PPI-R were
validity in assessing fluid and general intelligence in inter-
identified as representing absolute z-values >2.5. However, we did not
national studies (Neitzke and Röhr-Sendelmeier 1996; correct for these outliers as they did not affect any of the results
Sternberg 2004). presented below.
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Table 1 Descriptive statistics and raw correlations of key variables

Descriptive Correlations

Range M SD Gender Age IS RF PPI-R Pro Re

Reflective functioning (RF) 1–7 3.99 1.40 −0.13 0.01 −0.32**

Psychopathy (PPI-R) 279–451 348.0 29.2 0.28** 0.03 −0.04 −0.22*
Proactive aggression (RPQ-Pro) 0–20 3.35 3.50 0.11 −0.13 0.08 −0.36*** 0.59***
Reactive aggression (RPQ-Re) 1–21 7.68 4.08 0.16 −0.12 0.01 −0.22* 0.40*** 0.63***
General intelligence (CFT-3) 79–142 108.6 13.5 0.12 0.24* −0.18 0.25* −0.07 −0.21* −0.18

N=104. * p<0.05. ** p<0.01. *** p<0.001. Gender was dummy-coded with 0=females and 1=males. Immigration status (IS) was dummy-coded
with 0=no and 1=yes

(see Table 1). Specifically, psychopathic traits were Moderating Effect of Reflective Functioning
higher in males, general intelligence was positively cor-
related with age, and immigrants had somewhat lower Table 2 presents the results of the interaction term of PPI-R
RF values. Correlations of key variables were in the and RF in the fourth step of the hierarchical regression
expected directions. There were negative correlations analyses. The interaction term was significant in predicting
between RF and levels of psychopathy and aggression, both proactive aggressive behavior, β=−0.35, p<0.001,
with moderate effect sizes. Whereas intelligence and RF ΔR2 =0.106, and reactive aggressive behavior, β=−0.23,
had a positive correlation, levels of proactive aggression p<0.05, ΔR2 =0.046.3 Figure 1 visualizes the interactions
correlated negatively with IQ. Psychopathy and proactive by plots of simple regression lines for adolescents with low
aggression were correlated with a higher effect size than (RF=2.59), average (RF=3.99), and high (RF=5.39) RF.
psychopathy and reactive aggression, z = 2.66, p < 0.01 As hypothesized, the relationship between psychopathy
(Steiger 1980). Both forms of aggression, proactive and reac- and aggressive behavior was strongest when RF was low
tive, were correlated strongly (see Table 1). (−1 SD), with simple slopes of β=0.86, p<0.001, for pro-
active aggression, and β=0.54, p<0.001, for reactive ag-
Incremental Association of Reflective Functioning and gression, respectively. That is, in adolescents with low RF,
Aggression psychopathy was highly predictive of aggressive behavior.
Conversely, when RF was high (+1 SD), the relationship
Table 2 summarizes the results of the two hierarchical re- between psychopathy and aggressive behavior was nonsig-
gression analyses. In the first analysis, RF remained signif- nificant, both for proactive aggression, β=0.16, p=0.15,
icant in predicting proactive aggressive behavior, β=−0.22, and for reactive aggression, β=0.09, p=0.51. This means
p < 0.05, ΔR 2 = 0.038, even when controlling for that in adolescents with high RF, psychopathy was unrelated
confounding variables in the first step and for psychopathy to aggressive behavior.
in the second step, F(6, 97)=12.10, p<0.001, R2 =0.43. In Finally, as proactive and reactive aggression were strong-
contrast, the second analysis revealed that RF was no longer ly associated, we tested whether the two significant interac-
predictive of reactive aggressive behavior, β=−0.11, p=0. tion effects actually reflect a single finding. To this end, we
26, when entered into the regression model in the third step, repeated the hierarchical regression analyses while respec-
F(6, 97)=4.49, p<0.001, R2 =0.22. 2 tively including the other aggressive type as an additional
covariate. Considering proactive aggression as the outcome,
controlling for reactive aggression did not change the re-
2 sults, i.e., the interaction effect of psychopathy and reflec-
Based upon these findings and given that the partial correlation
between RF and psychopathy was at least marginally significant, r= tive functioning remained significant, β=−0.26, p<0.001,
−0.18, p=0.08 (controlling for gender, age, immigration status, and ΔR2 =0.058. However, with reactive aggression as the out-
general intelligence), it seemed reasonable to test whether RF would come, controlling for proactive aggression cancelled out the
mediate the relationship between psychopathy and aggression or
interaction effect, β=−0.03, p=0.77. This suggests that the
whether psychopathy would mediate the relationship between RF and
aggression. For this purpose, we tested respective indirect effects interaction effect of psychopathy and reflective functioning
(controlling for covariates) using bias corrected and accelerated boot- on reactive aggression was mainly driven by the variance-
strap confidence intervals (based upon 5,000 bootstrap replicates, see
Preacher and Hayes 2008). However, none of the indirect effects were
significant, both when using proactive and reactive aggression as the
3
outcome variable. Thus, we did not find any indication for mediation in Note that omitting the four covariates in the first step did not change
our data. the results, i.e. both interaction effects remained significant.
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Table 2 Hierarchical regression analyses predicting aggressive behavior

RPQ-Proactive RPQ-Reactive

B SE β ΔR2 B SE β ΔR2

Step 1 0.088 0.089

Gender 1.392 0.726 0.20 1.990 0.846 0.24*
Age −0.300 0.205 −0.16 −0.385 0.239 −0.17
Immigration status 0.299 0.695 0.04 −0.228 0.810 −0.03
General intelligence (CFT-3) −0.050 0.026 −0.19 −0.052 0.030 −0.17
Step 2 0.303 0.118
Psychopathy (PPI-R) 0.069 0.010 0.58*** 0.050 0.013 0.36***
Step 3 0.038 0.010
Reflective functioning (RF) −0.543 0.215 −0.22* −0.332 0.294 −0.11
Step 4 0.106 0.046
PPI-R×RF −0.030 0.006 −0.35*** −0.023 0.009 −0.23*

N=104. * p<0.05. ** p<0.01. *** p<0.001. Gender was dummy-coded with 0=females and 1=males. Immigration status (IS) was dummy-coded
with 0=no and 1=yes

overlap with proactive aggression and should not be In contrast to the reported relationship between psy-
interpreted as a finding in its own right. chopathic traits and superior levels of ToM, in our
sample psychopathic traits were associated with lower
levels of RF. We attribute this result to the conceptual
Discussion differences between ToM and RF. The latter is con-
ceived as a capacity closely linked to the ability to
In sum, the results from this community adolescent sample mentalize under affectively challenging circumstances,
confirmed our hypotheses: Deficits in mentalization were as in attachment relationships, whilst the former cap-
significantly associated with both psychopathic traits and tures false-belief reasoning and strategic planning char-
aggression. Moreover, deficits in RF were associated with acterized by a much smaller emphasis on the affective
aggressive behavior over and above psychopathic personal- context. As such, our data are consistent with a growing
ity traits. Results from moderation analyses suggest that literature demonstrating links between insecure and dis-
individuals with psychopathic traits acted aggressively organized attachment with the related cascading
mainly when they had average or low levels of RF. mentalizing deficits and psychopathic traits in childhood
Conversely, high RF seemed to have an inhibitory effect (e.g. Pasalich et al. 2012). Although more evidence is
on the aggressive expression of psychopathic personality needed, it is conceivable that some of the core process-
traits. Crucially, follow-up analyses chiefly reinforced this es of psychopathy (e.g., the lack of affective empathy)
pattern for proactive rather than reactive aggression: First, are partly attributable to such a pathway. Future longi-
the incremental association only held for proactive and not tudinal studies will need to investigate individual differ-
reactive aggression when accounting for confounds. ences in the interplay between attachment insecurity,
Second, although the moderating effect of RF on the rela- compromised mentalizing and externalizing behavior or
tionship between psychopathic traits and aggression was psychopathy.
found for both proactive and reactive aggression, effect Empirical studies have repeatedly demonstrated that psy-
sizes were stronger for proactive than reactive aggres- chopathic traits have a stronger relationship with proactive
sion. Most importantly, the effect of RF on reactive than reactive aggression, with moderate effect sizes (e.g.,
aggression was abolished when controlling for the pro- Wilson et al. 2011). The selective link between RF and
active type while the effect on proactive aggression held proactive aggression supports the key role of RF in facili-
irrespective of co-variation for the reactive type. We tating attention to the mental states of others and therefore
interpret this as preliminary evidence for a selective link abstaining from the proactive use of aggression in the
of RF to aggression of the proactive rather than reactive absence of threat (in line with Blair’s violence inhibition
type – as the latter’s association with RF was almost mechanism). Once fight–flight responses are triggered in the
entirely accounted for by its shared variance with pro- context of threat cues, however, individuals may engage in
active aggression. reactive aggressive behavior, representing an evolutionary
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Fig. 1 RF moderates the 15 15

relationship between
psychopathy and aggression

Proactive aggression (RBQ)

Reactive aggression (RBQ)

Low RF
10 10
Average RF

High RF

5 5

0 0
300 350 400 300 350 400
Psychopathy (PPI-R) Psychopathy (PPI-R)

adaptive response that may be more automatic and less accounts make somewhat distinct assumptions about the
influenced by mentalizing.4 As proactive aggression is etiology of aggressive psychopathology. In the case of psy-
one of the defining hallmarks of psychopathy, we feel that chopathy, numerous twin studies in childhood and adoles-
this finding lends strong support for a non-peripheral role of cence now document that the overlap between psychopathic
mentalization in the behavioral expression of psychopathy. tendencies or callous unemotional traits and concurrent dis-
In the present sample, lower RF scores were associ- ruptive and antisocial behavior appears to be largely attrib-
ated with immigration status of participants’ families, a utable to genetic influence (Larsson et al. 2006; Taylor et al.
finding which has not been reported to date. In the 2003; Viding et al. 2005, 2007, 2008). However, Viding and
absence of cross-cultural studies of RF, however, any colleagues (2005, 2007) stress that this overlap may also
conclusions about ethnic influences would be premature. be accounted for by gene–environment interactions or
Although almost all participants were raised in Germany evocative gene–environment correlations. Moreover, approx-
(only 6 participants spent half of their childhood in their imately one-third of the variance in psychopathic tendencies
countries of origin), lower RF scores of participants in childhood can be traced to nonshared environmental
with an immigration background could in part be attrib- influences (Viding et al. 2005). Mentalization therefore,
uted to acculturation stress, i.e. being conflicted between with its ties to attachment (Fonagy et al. 1997a, b; Hill
two cultures. Because parents may represent a different et al. 2008), which itself is largely mediated by shared
culture in comparison to the culture represented by peers, this and nonshared environmental factors (Fearon et al.
cultural conflict may indeed affect attachment-related 2006; Roisman and Fraley 2008), may add to the understand-
mentalization. Additionally, rather lower levels of verbal ing of etiological factors in psychopathy.
IQ in the immigrant subsample may partly explain this This perspective on the pertinence of environmental factors
finding as preliminary evidence pointing to a link be- for psychopathy also dovetails with recent demonstrations of
tween language ability and explicit mentalizing in ado- efficacy in tackling psychopathic traits in childhood using
lescent boys (Rutherford et al. 2012). Also, in light of higher psychosocial interventions (McDonald et al. 2011; Pasalich
levels of unresolved attachment in immigrants (Van Ecke et al. 2012). Inasmuch as mentalization may help to inhibit
et al. 2005) their children may more often lack the aggression against conspecifics in the presence of psychopath-
organized attachment experiences thought to be critical ic traits, impairments in this capacity may give rise to exces-
for the development of mentalization (Fonagy et al. sive levels of aggression, especially of the proactive type. Our
2002). In any case, the effects of RF on proactive findings demonstrate that attachment-based RF – the aware-
aggression were robust to controlling for immigration ness of others’ mental states in understanding their behavior –
status, suggesting that it alone cannot explain the main may serve as a protective factor for the expression of aggres-
findings reported in this sample. sion. In turn, our findings highlight mentalization as one
This study is the first to attempt to empirically integrate potential target for treatments for psychopathy in adolescence.
the literature on the roles of psychopathy and mentalization In particular, as randomized controlled trials suggest that this
in the development of aggressive behavior (Blair 1995; social cognitive capacity may be amenable to psychosocial
Fonagy et al. 1997c). Despite conceptual links, both interventions for other disorders (Levy et al. 2006) or predict
distinct outcome pathways (Gullestad et al. 2012), such treat-
4
Nonetheless, mentalizing may potentially protect against mistaking ments may show promise, if not for reducing psychopathic
harmless but ambiguous social signals for threat cues (e.g., “hostile
traits themselves, then at least for inhibiting the associated
attribution bias”), which, in turn, trigger aggressive acts that may
appear unprovoked and proactive to an outside observer, but biologi- aggression. If an interventional focus on improving RF – as is
cally function according to reactive patterns. the case in mentalization-based treatments (Bateman and
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J Abnorm Child Psychol

Fonagy 2008, 2011) – leads to less or no aggressive behavior, References

this would be an important step in the prevention of further
aggressive crime. In addition, mentalizing capacities should Alpers, G. W., & Eisenbarth, H. (2008). Psychopathic personality
be taken into account in designs of future twin and adoption inventory-revised (PPI-R). Göttingen: Hogrefe.
studies. Bateman, A., & Fonagy, P. (2008). Comorbid antisocial and borderline
personality disorders: mentalization-based treatment. Journal of
Bearing in mind the limitations of cross-sectional anal-
Clinical Psychology, 64, 181–194.
yses, these findings extend previous evidence of deficits Bateman, A., & Fonagy, P. (2011). Handbook of mentalizing in mental
in the empathic responding of individuals with psycho- health practice. Washington, DC: American Psychiatric Association.
pathic tendencies to an ecologically valid, affectively Blair, R. J. (1995). A cognitive developmental approach to morality:
investigating the psychopath. Cognition, 57, 1–29.
charged, narrative-based attachment context. In contrast
Blair, R. J. (1999). Responsiveness to distress cues in the child with
to the majority of previous empirical investigations on the psychopathic tendencies. Personality and Individual Differences,
nature of psychopathy, the current sample comprised both 27, 135–145.
male and female participants from a community sample Blair, J. (2008). Empathic dysfunction in psychopathy. In C. Sharp,
P. Fonagy, & I. Goodyer (Eds.), Social cognition and devel-
and may therefore have wider implications for generaliz-
opmental psychopathology (pp. 175–197). Oxford: Oxford
ability. A further strength of the study lies in the design, University Press.
which combined both self-report and observer-rated Blair, R. J., Sellars, C., Strickland, I., Clark, F., Williams, A., & Smith,
instruments. M. (1996). Theory of mind in the psychopath. Journal of Forensic
Psychiatry, 7, 15–25.
Blair, R. J., Mitchell, D. G., & Blair, K. (2005). The psychopath:
Limitations Emotion and the brain. Oxford: Blackwell.
Card, N., & Little, T. (2006). Proactive and reactive aggression in
At the same time, several limitations deserve consideration. childhood and adolescence: a meta-analysis of differential rela-
tions with social adjustment. International Journal of Behavioral
First, owing to the cross-sectional nature of our data, it is
Development, 30, 466–480.
impossible to rule out reverse effects of psychopathy on RF, Cattell, R. B., & Weiß, R. H. (1971). Grundintelligenztest Skala 3
hampering the interpretation of the direction of the moder- (CFT 3). Göttingen: Hogrefe.
ation effects. Therefore, the findings of the study require Cleckly, H. (1941). The mask of sanity. St. Louis: Mosby.
replication and application to larger-scale, longitudinal de- Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied
multiple regression/correlation analysis for the behavioral sci-
signs with community and clinical populations to test the ences (3rd ed.). Mahwah: Lawrence Erlbaum.
robustness and generalizability of these preliminary results. Dadds, M.R., Allen, J.L., Oliver, B.R., Faulkner, N., Legge, K., Moul,
Furthermore, this study would have benefitted from the C., … Scott, S. (2012). Love, eye contact and the developmental
inclusion of some measure of psychopathy or aggression origins of empathy v. psychopathy. British Journal of Psychiatry,
200, 191–196.
that was not self-report, to enhance validity and to reduce Dozier, M., & Kobak, R. R. (1992). Psychophysiology in attachment
the possibility of shared method variance as well as a interviews: converging evidence for deactivating strategies. Child
measure of verbal IQ. Participation of only 25 % of the Development, 63, 1473–1480.
target population bears the possibility of a selection bias. Eisenbarth, H., & Alpers, G. (2007). Validierung der deutschen
Übersetzung des psychopathic personality inventory (PPI). Zeitschrift
Participants had to make contact with the research staff für Klinische Psychologie und Psychotherapie, 36, 216–224.
individually and had to ask their parents for permission, Fearon, P. R. M., Van Ijzendoorn, M. H., Fonagy, P., Bakermans-
too. Therefore, pupils with less organizational abilities and Kranenburg, M. J., Schuengel, C., & Bokhorst, C. L. (2006). In
current difficulties with their parents may have refrained search of shared and nonshared environmental factors in security
of attachment: a behavior-genetic study of the association be-
from participation. Still, variance of the key variables was tween sensitivity and attachment security. Developmental Psy-
in the expected range. However, notwithstanding these lim- chology, 42, 1026–1040.
itations the identified effects are in line with our a priori Feshbach, N. D. (1987). Parental empathy and child adjustment/
hypotheses, supporting mentalization as a protective factor maladjustment. In N. Eisenberg & J. Strayer (Eds.), Empathy
and its development (pp. 271–291). New York: Cambridge
for the expression of one of the core behavioral traits of University Press.
psychopathy, proactive aggression. Fidell, L. S., & Tabachnick, B. G. (2003). Preparatory data analysis. In
I. B. Weiner, I. B. Weiner, J. A. Schinka, & W. F. Velicer (Eds.),
Acknowledgments This research was conducted with the help of Handbook of psychology: Vol. 2: Research methods in psychology
funds from the German Federal Ministry of the Interior, University of (pp. 115–141). Hoboken: Wiley.
Kassel, International Psychoanalytic Association and German Psycho- Fonagy, P., & Moran, G. S. (1991). Understanding psychic change in
analytic Society. We would like to thank Fritz Hasper, Ramon child psychoanalysis. The International Journal of Psycho-
Rodriguez-Sanchez. Marie Lübs and Christian Curth for their efforts Analysis, 72, 15–22.
during data-collection. In addition, we would like to express our Fonagy, P., & Target, M. (2005). Bridging the transmission gap: an end
gratitude to cooperating institutions, namely the Victim-Offender- to an important mystery of attachment research? Attachment &
Mediation Bremen (TOA Bremen e.V.), the Association for the Pro- Human Development, 7, 333–343.
motion of Accepting Youth-Work, (VaJa e.V.) and the comprehensive Fonagy, P., Steele, M., Steele, H., Moran, G., & Higgitt, A. (1991). The
schools in Kassel, who granted us access to research participants. capacity for understanding mental states: the reflective self in
 Author's personal copy
J Abnorm Child Psychol

parent and child and its significance for security of attachment. depression. Philosophical Transactions of the Royal Society B:
Infant Mental Health Journal, 12, 201–218. Biological Sciences, 363, 2529–2541.
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., Jones, A., Laurens, K., Herba, C., Barker, G., & Viding, E. (2009).
… Gerber, A. (1996). The relation of attachment status, psychi- Amygdala hypoactivity to fearful faces in boys with conduct
atric classification, and response to psychotherapy. Journal of problems and callous-unemotional traits. The American Journal
Consulting and Clinical Psychology, 64, 22–31. of Psychiatry, 166, 95–102.
Fonagy, P., Redfern, S., & Charman, T. (1997a). The relationship Kosson, D., Suchy, Y., Mayer, A., & Libby, J. (2002). Facial affect
between belief-desire reasoning and a projective measure of at- recognition in criminal psychopaths. Emotion, 2, 398–411.
tachment security. British Journal of Developmental Psychology, Larsson, H., Andershed, H., & Lichtenstein, P. (2006). A genetic factor
15, 51–61. explains most of the variation in the psychopathic personality.
Fonagy, P., Steele, H., Steele, M., & Holder, J. (1997b). Attach- Journal of Abnormal Psychology, 115, 221–230.
ment and theory of mind: overlapping constructs? Associa- Leistico, A. M., Salekin, R. T., DeCoster, J., & Rogers, R. (2008). A
tion of Child Psychology and Psychiatry Occasional Papers, large-scale meta-analysis relating the hare measures of psychop-
14, 31–40. athy to antisocial conduct. Law and Human Behavior, 32, 28–45.
Fonagy, P., Target, M., Steele, M., & Steele, H. (1997c). The develop- Levinson, A., & Fonagy, P. (2004). Offending and attachment. The
ment of violence and crime as it relates to security of attachment. relationship between interpersonal awareness and offending in a
In J. D. Osofsky (Ed.), Children in a violent society (pp. 150– prison population with psychiatric order. Canadian Journal of
177). New York: Guilford. Psychoanaysis, 12, 225–251.
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective Levy, K.N., Meehan, K.B., Kelly, K.M., Reynoso, J.S., Weber, M.,
functioning scale manual. Unpublished manuscript, London. Clarkin, J.F., … Kernberg, O.F. (2006). Change in attachment
Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect patterns and reflective function in a randomized control trial
regulation, mentalization and the development of self. New of transference-focused psychotherapy for borderline person-
York: Other Press. ality disorder. Journal of Consulting and Clinical Psychology,
Fonagy, P., Gergely, G., & Target, M. (2007). The parent-infant dyad 74, 1027–1040.
and the construction of the subjective self. Journal of Child Lilienfeld, S. O., & Widows, M. R. (2005). Psychopathic personality
Psychology and Psychiatry, 48, 288–328. inventory revised (PPI-R). Professional manual. Lutz: Psycholog-
George, C., Kaplan, N., & Main, M. (1996). The Berkeley adult ical Assessment Resources.
attachment interview. Unpublished manuscript, Berkeley. Luyten, P., Mayes, L., Fonagy, P., & Van Houdenhove, B. (submitted
Gergely, G., & Unoka, Z. (2008). Attachment, affect-regulation, and 2012). The interpersonal regulation of stress.
mentalization: The developmental origins of the representational McDonald, R., Dodson, M., Rosenfield, D., & Jouriles, E. (2011).
self. In C. Sharp, P. Fonagy, & I. M. Goodyer (Eds.), Social Effects of a parenting intervention on features of psychopathy in
cognition and developmental psychopathology. New York: Ox- children. Journal of Abnormal Child Psychology, 39, 1013–1023.
ford University Press. Neitzke, C., & Röhr-Sendelmeier, U. (1996). Achievement motivation
Gretton, H. M., Hare, R. D., & Catchpole, R. (2004). Psychopathy and of intellectually gifted students when confronted with challenging
offending from adolescence to adulthood: a 10-year follow-up. and unchallenging tasks. In A. J. Cropley & D. Dehn (Eds.),
Journal of Consulting and Clinical Psychology, 72, 636–645. Fostering the growth of high ability: European perspectives (pp.
Grienenberger, J., Kelly, K., & Slade, A. (2005). Maternal reflective 193–202). Norwood: Ablex Publishing Corporation.
functioning, mother infant affective communication, and infant Nolte, T., Guiney, J., Fonagy, P., Mayes, L., & Luyten, P. (2011).
attachment: exploring the link between mental states and ob- Interpersonal stress regulation and the development of anxiety
served caregiving behavior in the intergenerational transmission disorders: an attachment-based developmental framework. Fron-
of attachment. Attachment & Human Development, 7, 299–311. tiers in Behavioral Neuroscience, 5, 55.
Griffin, R. S., & Gross, A. M. (2004). Childhood bullying: current Nolte, T., Bolling, D.Z., Hudac, C., Fonagy, P., Mayes, L.C., &
empirical findings and future directions for research. Aggression Pelphrey, K. (submitted 2013). Brain mechanisms underlying
and Violent Behavior, 9, 379–400. the impact of attachment-related stress on social cognition.
Gullestad, F. S., Johansen, M. S., Høglend, P., Karterud, S., & Wilberg, Pasalich, D. S., Dadds, M. R., Hawes, D. J., & Brennan, J. (2012).
T. (2012). Mentalization as a moderator of treatment effects: Attachment and callous-unemotional traits in children with early-
findings from a randomized clinical trial for personality disorders. onset conduct problems. Journal of Child Psychology and Psy-
Psychotherapy Research. doi:10.1080/10503307.2012.684103. chiatry, 41, 302–313.
Hare, R. (1990/91). The psychopathy checklist – revised manual. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling
Toronto Multi Health Systems. strategies for assessing and comparing indirect effects in multiple
Harris, G. T., & Rice, M. E. (2006). Treatment of psychopathy: A mediator models. Behavior Research Methods, 40, 879–891.
review of the empirical findings. In C. J. Patrick (Ed.), Handbook Raine, A., Dodge, K., Loeber, R., Lynam, D., Reynolds, C.,
of psychopathy (pp. 555–572). New York: Guildford Press. Stouthamer-Loeber, M., et al. (2006). The reactive-proactive
Hawes, D. J., & Dadds, M. R. (2005). The treatment of conduct aggression questionnaire: differential correlates of reactive and
problems in children with callous-unemotional traits. Journal of proactive aggression in adolescent boys. Aggressive Behavior,
Consulting and Clinical Psychology, 73, 737–741. 32, 159–171.
Hayes, F., & Matthes, J. (2009). Computational procedures for probing Richell, R., Mitchell, D., Newman, C., Leonard, A., Baron-Cohen,
interactions in OLS and logistic regression: SPSS and SAS S., & Blair, J. (2003). Theory of mind and psychopathy: can
implementations. Behavior Research Methods, 41, 924–936. psychopathic individuals read the ‘language of the eyes’?
Hill, J., Fonagy, P., Lancaster, G., & Broyden, N. (2007). Aggression Neuropsychologia, 41, 523–526.
and intentionality in narrative responses to conflict and distress Roisman, G. I., & Fraley, R. C. (2008). A behavior-genetic study of
story stems: an investigation of boys with disruptive behaviour parenting quality, infant attachment security, and their covariation
problems. Attachment & Human Development, 9, 223–237. in a nationally representative sample. Developmental Psychology,
Hill, J., Murray, L., Leidecker, V., & Sharp, H. (2008). The dynamics 44, 831–839.
of threat, fear and intentionality in the conduct disorders: longi- Roisman, G. I., Tsai, J. L., & Chiang, K. S. (2004). The emo-
tudinal findings in the children of women with post-natal tional integration of childhood experiences: physiological,
 Author's personal copy
J Abnorm Child Psychol

facial expressive, and self-reported emotional response during Taubner, S., Hörz, S., Fischer-Kern, M., Doering, S., Buchheim, A., &
the adult attachment interview. Developmental Psychology, Zimmermann, J. (2012). Internal structure of the reflective func-
40, 776–789. tioning scale. Psychological Assessment. Advance online publi-
Rutherford, H. J. V., Wareham, J. D., Vrouva, I., Mayes, L. C., Fonagy, cation. doi:10.1037/a0029138.
P., & Potenza, M. N. (2012). Sex differences moderate the rela- Taylor, J., Loney, B., Bobadilla, L., Iacono, W., & McGue, M. (2003).
tionship between adolescent language and mentalization. Person- Genetic and environmental influences on psychopathy trait di-
ality Disorders: Theory, Research, and Treatment, 3, 393–405. mensions in a community sample of male twins. Journal of
Sharp, C., & Venta, A. (2012). Mentalizing problems in children and Abnormal Child Psychology, 31, 633–645.
adolescents. In N. Midgley & I. Vrouva (Eds.), Mind the child: Uzieblo, K., Verschuere, B., Van den Bussche, E., & Crombez, G.
Mentalization-based interventions with children, young people (2010). The validity of the psychopathic personality inventory–
and their families (pp. 35–53). London: Routledge. revised in a community sample. Assessment, 17, 334–346.
Skeem, J. L., Miller, J. D., Mulvey, E., Tiemann, J., & Monahan, J. Van Ecke, Y., Chope, R. C., & Emmelkamp, P. M. G. (2005). Immi-
(2005). Using a five factor lens to explore the relation between grants and attachment status: research findings with Dutch and
personality traits and violence in psychiatric patients. Journal of Belgian immigrants in California. Social Behavior and Personal-
Consulting and Clinical Psychology, 73, 454–465. ity, 33, 657–674.
Sonuga-Barke, E. J., Schlotz, W., & Kreppner, J. (2010). Differentiat- Viding, E., Blair, R. J., Moffitt, T., & Plomin, R. (2005). Evidence for
ing developmental trajectories for conduct, emotion, and peer substancial genetic risk for psychopathy in 7-year-olds. Journal of
problems following early deprivation. Monographs of the Society Child Psychology and Psychiatry, 46, 592–597.
for Research in Child Development, 75, 102–124. Viding, E., Frick, P. J., & Plomin, R. (2007). Aetiology of the rela-
Steiger, J. H. (1980). Tests for comparing elements of a correlation tionship between callous-unemotional traits and conduct prob-
matrix. Psychological Bulletin, 87, 245–251. lems in childhood. The British Journal of Psychiatry,
Sternberg, R. J. (2004). Culture and intelligence. American Psycholo- 190(Suppl. 49), s33–s38.
gist, 59, 325–338. Viding, E., Jones, A. P., Frick, P. J., Moffitt, T. E., & Plomin, R. (2008).
Stevens, D., Charman, T., & Blair, R. (2001). Recognition of Heritability of antisocial behaviour at 9: do callous-unemotional
emotion in facial expressions and vocal tones in children traits matter? Developmental Science, 11, 17–22.
with psychopathic tendencies. Journal of Genetic Psychology, Wilson, L., Miller, J. D., Zeichner, A., Lynam, D., & Widiger, T. A.
162, 201–211. (2011). An examination of the validity of the elemental psychopathy
Sutton, J., Reeves, M., & Keogh, T. (2000). Disruptive behavior, assessment: relations with other psychopathy measures, aggression,
avoidance of responsibility and theory of mind. British Journal and externalizing behaviors. Journal of Psychopathology and Be-
of Developmental Psychology, 18, 1–11. havioral Assessment, 33, 315–322.

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