Joumal of Abnormal Psychology © 2013 American Psychological Association

2014, Vol. 123, No. 1,205-213 0021-843X/14/$12.00 DOI: 10.1037/a0035072

Examining the Relations Among Pain Tolerance, Psychopathic Traits, and

Violent and Nonviolent Antisocial Behavior
Joshua D. Miller, Steven Rausher, Courtland S. Hyatt, Jessica Maples, and Amos Zeichner
University of Georgia

Psychopathic traits are typically associated with an array of extemalizing behaviors including violent and
nonviolent crime and recidivism, substance use, aggression, and sexual coercion. In the current study, we
test the hypothesis that psychopathic traits are related to an increased tolerance for physical pain, which
may partially account for the relations between psychopathy and antisocial behavior (ASB). Using
community participants oversampled for psychopathic traits (N = 104), we found that psychopathic
traits, measured using self- and informant reports, manifested small correlations with some measures of
physical pain tolerance (tolerance of pressure and electric shock) but not others (tolerance of cold
temperature). In addition, pain tolerance, particularly tolerance of pressure, manifested small correlations
with a history of antisocial and aggressive behavior. However, there was little evidence that pain
tolerance serves as a mediator of the relations between psychopathy and violent or nonviolent ASB.
Conversely, there was evidence that the relations between pain tolerance and ASB were mediated by the
presence of certain psychopathic traits. The implications of these findings are discussed.

Keywords: pain tolerance, psychopathy, self and informant reports, antisocial behavior

Psychopathy is a personality disorder characterized by egocen- of ASB and aggression (see Jones, Miller, & Lynam, 2011, for a
tricity, callousness, a lack of remorse or empathy, manipulative- review). Another possible explanation for the link between psy-
ness, impulsivity, and irresponsibility, as well as a predisposition chopathy and antisociality places an emphasis on the role of high
toward antisocial behavior (ASB). Although often studied using trait fearlessness (Lykken, 1995), such that fearless individuals are
categorical approaches, there is a general consensus that psychop- difficult to socialize as punishment (real or anticipated) may have
athy is a dimensionally distributed construct (Guay, Ruscio, less of an aversive impact on them. A third theory suggests that
Knight, & Hare, 2007) that manifests a similar nomological net- psychopathic individuals have a deficient "violence inhibition
work irrespective of the type of sample in which it is studied (e.g., mechanism," which is thought to be a basic, primitive system that
Sellbom, 2011; Vachon, Lynam, Loeber, & Stouthamer-Loeber, encourages an aggressor to terminate his or her aggression in
2012). response to cues of distress or submission from the victim (Blair,
Despite some debate regarding whether ASB is most appropri- 1995). Blair and colleagues have demonstrated that psychopathic
ately considered a core component of psychopathy (Hare & Neu- individuals have deficits in processing others' verbal and nonver-
mann, 2008) or a correlate (Skeem & Cooke, 2010), there is httle bal expressions of fear (Blair et al., 2002, 2004) and thus may miss
question that the two are closely linked. Extant research has shown cues that would encourage the cessation of aggression. In line with
that psychopathy is related to ASBs including aggression (Wood- this theory. Caes and colleagues (2012) demonstrated that psycho-
worth & Porter, 2002), violence (Kennealy, Skeem, Walters, & pathic traits in female undergraduate students were associated with
Camp, 2010), recidivism (Walters, Knight, Grann, & Dahle, 2008), a diminished ability to perceive pain experienced by others, as well
and sexual coercion toward women (Knight & Guay, 2006). A as diminished fear in response to pain experienced by others.
variety of explanations have been put forth for the relation between Although the data suggest that psychopathic individuals are less
psychopathy and ASB. From a personality perspective, psychop- responsive to fear or pain experienced by others, there is relatively
athy is composed primarily of traits related to interpersonal antag- little recent research examining their own responses to physical
onism (e.g., callousness, egocentricity) and disinhibition (e.g., pain. One might speculate that psychopathic individuals may be
impulsivity; Miller, Lynam, Widiger, & Leukefeld, 2001)—both less responsive to self-experienced pain, which may make it more
of which are among the most prominent personality trait correlates difficult for them to perceive or appreciate others' responses to
pain. Being less responsive to self and others' experienced pain
may then make it easier for psychopathic individuals to engage in
ASB, especially those involving aggression/violence. Physical
This article was published Online First November 18, 2013. pain tolerance is associated with behaving aggressively toward
Joshua D. Miller, Steven Rausher, Courtland S. Hyatt, Jessica Maples,
others (Niel, Hunnicutt-Ferguson, Reidy, Martinez, & Zeichner,
and Amos Zeichner, Department of Psychology, University of Georgia.
Funding for this study was provided by the Owens Institute for Behav-
2007; Reidy, Dimmick, MacDonald, & Zeichner, 2009; Séguin,
ioral Research at the University of Georgia. Pihl, Boulerice, Tremblay, & Harden, 1996), as well as the ability
Correspondence concerning this article should be addressed to Joshua D. to do harm to oneself (e.g.. Franklin, Hessel, & Prinstein, 2011).
Miller, University of Georgia, Psychology Building, Athens, GA 30602- Data from a small sample (N = 12) of individuals with congenital
3013. E-mail: [email protected] insensitivity to pain suggest that these individuals can understand
205
206 MILLER, RAUSHER, HYATT, MAPLES, AND ZEICHNER

and detect pain in others, although others' pain may be "greatly included measures of tolerance of physical pressure, expostire to
underestimated" (Danziger, Prkachin, & Wilier, 2006, p. 2494). cold temperatures, and electric stimulation. Finally, we also ex-
There are also now data that indicate that the same neurological amined multiple types of ASB that could be grouped broadly into
systems are activated when experiencing pain oneself and seeing some- violent and nonviolent composites.
one else experience pain (Corradi-DeU'Acqua, Hofstetter, & Vuil- Analytically, we first examined the zero-order correlations
leumier, 2011; Lamm, Decety, & Singer, 2011); as such, difficul- among the self- and informant reports of psychopathy, ASB
ties experiencing pain oneself may serve as a proxy for difficulties scores, and pain tolerance scores. We expected that the self- and
in empathizing with others' experiences of pain. informant psychopathy scores would be generally associated with
With regard to psychopathy, the research literature suggests that extemalizing behaviors and that the psychopathy scales reflecting
psychopathic individuals may be slower to detect the presence of "meanness" (i.e., SRP-III Callous Affect; EPA Antagonism)
an electric shock but may not differ in their tolerance level for pain would be most strongly related to physical pain tolerance. We then
(see Hare, 1965, 1966, 1968; Schoenherr, 1964), although psycho- conducted two sets of mediation analyses. The first set of media-
pathic individuals may tolerate more pain in response to incentives tion models tested whether the relations between psychopathy and
(Hare & Thorvaldson, 1970). Fedora and Reddon (1993) compared ASB (conducted separately for violent and nonviolent ASB) would
psychopathic prisoners (n = 28), nonpsychopathic prisoners (n = be mediated, in pari, by higher levels of pain tolerance. We
28), and normal controls (n = 29) in relation to tolerance of predicted that this would be the case for violent but not nonviolent
electrical stimulation and found that both prisoner groups had behavior given that physical pain tolerance has previously been
substantially higher tolerances than the control group but did not linked to aggressive behavior and a difficulty estimating others'
differ from one another. The majority of these types of studies, experience of pain (Danziger et al., 2006; Reidy et al., 2009). This
however, have relied exclusively on electric stimulation as their analysis provides a critical test as to whether pain tolerance may be
means of measuring pain tolerance, studied these effects in very an associated feature of psychopathy or a central mechanism by
small samples of male offenders, and used a single psychopathy which psychopathic traits lead to ASB. The second set of media-
score rather than examining psychopathy at the facet or subscale tion analyses, which were more exploratory in nature and exam-
level, the latter approach being more consistent with modem ined multiple mediators simultaneously, tested whether the rela-
measurement approaches to psychopathy. tions between pain tolerance and ASB were mediated by
In the current study, we examined the relations between self- psychopathic traits.
and informant reporis of psychopathy, three measures of pain
tolerance, and violent and nonviolent ASB. Multiple measures and Method
source ratings of psychopathy were used so as to ensure that the
currents results would not be due to idiosyncrasies in the concep-
Procedures and Participants
tualization or assessment of psychopathy from one specific per-
spective. To that end, we chose two psychopathy treasures that Pariicipants were recruited via adveriisements placed in local
were developed from entirely different perspectives. The Self- newspapers, fliers placed around town, and word of mouth. Two
Repori Psychopathy Scale-III (SRP-III; Paulhus, Neumann, & variants of advertisements were used. To oversample for psycho-
Hare, in press) was developed to capture psychopathy as it has pathic traits, one version called for individuals who thought of
been conceived of and studied from the perspective of Psychopa- themselves as charming, aggressive, carefree, impulsive, and irre-
thy Checklist and measures derived from it (e.g.. Hare, 2003), sponsible, but good at handling people and looking after "number
whereas the Elemental Psychopathy Assessment (EPA; Lynam et one" (e.g., Widom, 1977). The other adveriisement did not include
al., 2011) was developed to assess the basic personality traits these characteristics but rather provided only generic information
associated with psychopathy as conceptualized from a five-factor regarding a study on personality.
model perspective. The SRP-III contains two factors believed to be Potential participants first completed a telephone screen to as-
related to the interpersonal and affective aspects of psychopathy sess for inclusion criteria (between ages of 18 and 65; no current
(Interpersonal Manipulation and Callous Affect), as well as two signs of psychosis; no current and regular use of analgesic medi-
factors related to disinhibited traits and behaviors associated with cations; no acute or chronic pain disorders). Pariicipants were then
psychopathy (Erratic Lifestyle and ASB). Alternatively, the EPA scheduled for a laboratory assessment that included informed
has four higher-order factors that measure trait-based components consent, completion of personality questionnaires, and the pain
of psychopathy including Antagonism, Disinhibition, Emotional tolerance assessment. All pariicipants were run through the labo-
Stability, and Narcissism (Few, Miller, & Lynam, 2013). Together, ratory protocol by a male research assistant. Participants were
these two psychopathy measures capture the core traits believed by asked to endure each of the three pain tolerance tasks for as long
many to be central to psychopathy, including those in the triarchic as they could and to indicate to the research assistant when they no
model of psychopathy (Patrick, Fowles, & Krueger, 2009), which longer wished to endure the task any longer because the stimuli
comprises meanness (e.g., SRP-III Callous Affect and Interper- were experienced as being painful.
sonal Manipulation; EPA Antagonism and Narcissism), disinhibi- Pariicipants were paid $30 for their participation. Upon com-
tion (SRP-III Erratic Lifestyle and ASB; EPA Disinhibition) and pletion of the study, individuals were asked to provide email
boldness (EPA Emotional Stability and Narcissism). In addition, addresses for up to three individuals who knew them well. Infor-
we collected self- and informant ratings of psychopathy, given mant reporis were then sought in a sequential manner (i.e., if
concerns that psychopathic individuals may be unwilling or unable informant #1 chose not to participate or did not respond to the
to provide accurate data (cf. Miller, Jones, & Lynam, 2011). email invitation, an invitation was sent to informant #2). If more
Similarly, pain tolerance was assessed in a multimodal manner and than one informant ultimately completed the assessment (n = 7),
 PSYCHOPATHY AND PAIN TOLERANCE 207

the data from both informants were combined. Informants were want to increase further. Pressure level was recorded as M (pound-
reimbursed $10 for their participation. IRB approval was obtained force). The maximum possible pressure (100) was much higher
for all aspects of this study. than the maximum tolerated pressure (41). This procedure was
Self-report data were collected from 120 individuals. Data from repeated three times (Ms 1-3; 12.4, 11.4, and 10.6, respectively;
14 individuals were excluded because they provided invalid data SDs = 6.4, 6.3, and 6.7, respectively). The scores for the third
as assessed by validity scales from the EPA or other markers (e.g., reading were nonnormal and were log transformed. An algometer
finished all self-report assessments in a time that was deemed composite was used comprising the z-scores of three values (a =
implausible). Data from two individuals are not reported here .94).
because they did not complete the pain tolerance assessment. In the Cold pressor. The cold pressor test measures pain duration by
current study, data from 104 individuals with complete and valid asking individuals to submerge their nondominant hand in cold
data were used (M age = 30.9, SD = 10.8; 71% male; 64% White, water (3°C). The water was housed in a portable cooler and chilled
22% Black, 6% biracial, 8% Hispanic). The oversampling strategy with commercially available ice cubes held in a compartment
appeared to have been successful as the mean SRP-III Total score separated by a mesh barrier. A water pump was use to circulate the
was higher in the current study (M = 169.06, SD = 28.9) than the chilled water between the compartments and a digital thermometer
levels reported in Seibert et aL (2011; M = 147.78, SD = 27.2; probe was placed in the area of hand submersion. The maximum
í(232) = 5.75, p<.O\;d= .76) and Visser, Ashton, and Pozzebon submersion time allowed was 240 s (M = 36.5 s; SD = 43.05).
(2012; M = 146.56, SD = 28.8; í(448) = 6.97, p < .01; á = .78). Cold pressor test scores manifested a nonnormal distribution and
In fact, the current mean EPA total score (M = 51.38, SD = 7.05) were log-transformed prior to use.
was similar to the mean found in the prison sample used in Lynam Electric stimulation. Participants' pain tolerance was as-
et al. (2011; M = 49.72, SD = 7.08; í(172) = 1.52, ns; d = .23). sessed by administering brief shocks (.50 s) via electrodes attached
The informants (n = 78) were primarily White (74%) and to the index and middle fingers of the participants' nondominant
female (64%), with an average age of 36.8 (SD = 17.3). With hand in an incremental stepwise intensity method. Shocks were
regard to their relationships with the participants, the most com- generated by a Coulboum Instruments, Inc. Precision Regulated
mon relationships were friendship (39%), family member (39%), Shocker interfaced with a Coulboum Instruments LabLinc device
and romantic partner (22%). On average, informants knew the controller. Shocks were administered until they reached a level at
participant for 14.9 years (SD = 15.5). Individuals with and which the participants indicated that they no longer wanted the
without informants did not differ with regard to psychopathic shocks to increase due to experiencing them as "too painful."
traits, pain tolerance, or ASB. With regard to demographic vari- Shocks were capped at 2.57 mA (M = 1.51 mA; SD = .70).
ables, the group with informants was younger (d = .47) but did not
differ in relation to gender, race, or ethnicity. ASB Measures
Crime and Analogous Behavior Scale. The Crime and Anal-
Psychopathy and Personality Trait Measures ogous Behavior Scale (CAB; Miller & Lynam, 2003) is a self-
report inventory that assesses externalizing behaviors. Violent
EPA. The EPA (Lynam et al., 2011) is a 178-item self-report
ASB (ASB-V; four items; M = .81; SD = 1.31) and nonviolent
measure of psychopathy that provides a total score as well as
ASB counts (four items; M = 1.47; SD = 1.31) were created by
scores on 18 subscales. The 18 subscales can be grouped into four
giving participants a " 1 " for every relevant antisocial act they
higher-order factors (Few, Miller, & Lynam, 2013), which were
endorsed.
used in the current study along with the total score (a = .95; mean
Reacüve-Proacdve Aggression Questionnaire. The Reactive-
interitem correlation [MIC] = .10): Antagonism (a = .93; MIC =
.24), Emotional Stability (a = .88; MIC = .21), Disinhibition Proactive Aggression Questionnaire (Raine et al., 2006) consists of
23 self-report items assessing two aggression scales: proactive
(a = .94; MIC = .23), and Narcissism (a = .87; MIC = .15).
aggression and reactive aggression (as = .81 and .85, respec-
SRP-III. The SRP-III (Paulhus, Neumann, & Hare, in press)
tively).
is a 64-item measure of psychopathy. In the current study, we
focused on the four SRP-III subscales of Interpersonal Manipula-
tion (self-report; a = .84; MIC = .25; informant report; a = .87;
Results
MIC = .29), Callous Affect (self-report; a = .78; MIC = .19; We first tested whether gender moderated the correlations re-
informant report; a = .84; MIC = .26), Erratic Lifestyle (self- ported in Tables 1 and 2 (120 tests in all). To do so, regression
report; a = .77; MIC = .18; informant report: a = .83; MIC = analyses were conducted such that the variables in the first col-
.24), and ASB (self-report; a = .80; MIC = .22; informant report: umns of these tables were first mean centered and then multiplied
a = .85; MIC = .28), as well as the total score (self-report; a = by gender (0 = males; 1 = females) to create interaction terms
.92; MIC = .15; informant report; a = .94; MIC = .21). used in the prediction of the other variables listed at the top of the
other columns. Of the 120 tests of moderation, 6 (5%) were
significant. Given the relatively small number of significant inter-
Pain Measures actions, the following results are presented using the combined
Algometer. To assess pain tolerance in response to pressure, a sample. Next, we tested whether the self- and informant reported
Wagner Instruments (Greenwich, CT) FDIX 50 algometer 1 cm^ SRP-III psychopathy scores were significantly correlated and they
rubber tip probe was applied to the supinator muscle on the were total (r = .56, p < .01), Interpersonal Manipulation (r = .44,
participants' nondominant upper arms at increasing pressure until p < .01), Callous Affect (r = .55, p < .01), Erratic Lifestyle (r =
it reached a subjective level of pain that the participant did not .49, p < .01), and ASB (r = .56, p < .01).
208 MILLER, RAUSHER, HYATT, MAPLES, AND ZEICHNER

Table 1
Relations Between Antisocial Behavior and Psychopathic Traits

Violent Nonviolent
Reactive Proactive antisocial antisocial
Psychopathy aggression aggression behavior behavior

Self-report
SRP-III Total .52" .61" .50** .51"
SRP-III Interpersonal Manipulation .37" .57** .31" .33"
SRP-III Callous Affect ,42" .38** .39** .30"
SRP-III Erratic Lifestyle .44* .43** .30** .38"
SRP-III Antisocial Behavior .43** .53" .57** .61"
EPA Total .59" .63** .52** .39**
EPA Antagonism .44** .58** .41** .32**
EPA Emotional Stability -.11 .06 .15 .09
EPA Disinhibition .51" .49** .34** .34**
EPA Narcissism .66* .49** .49** .20*
Informant report
SRP-III Total .30" .24* .51" .37"
SRP-III Interpersonal Manipulation ,25* .20 ,39** .26*
SRP-III Callous Affect ,34" .27* .46** .24*
SRP-III Erratic Lifestyle ,10 .13 .32** .26*
SRP-III Antisocial Behavior .32" .22 .55" .47"
Note. SRP-III = Self-report Psychopathy Scale -Version lu; EPA = Elemental Psychopathy Assessment.
*p < .05. "p < .01.

Psychopathy and ASB Finally, pain tolerance, as measured via the cold pressor task, was
uncorrelated (0 of 15) with psychopathy traits with correlations
As expected, both self- and informant reported psychopathy ranging from -.09 (informant reported SRP-III Interpersonal Ma-
traits were correlated with the four ASB indices (i.e., reactive nipulation) to .16 (informant reported SRP-III Erratic Lifestyle)
aggression, proactive aggression, violent ASB, nonviolent ASB) with a median of .04. The correlations manifested by the respective
(see Table 1).' The correlations between the self-report SRP-III self- and informant reports SRP-III scales with the pain tolerance
Total score and these four ASB markers ranged from .50 to ,61 tasks did not differ in any instances (zs :SL2O),
with a median of .52, whereas the self-report scores on the indi-
Mirroring the findings between pain tolerance and psychopathy,
vidual SRP-III factors manifested correlations that ranged from ,30
only the algometer scores were correlated with ASB, specifically
to .61 with a median of ,41. The correlations between the self-
violent ASB (r = ,30) and reactive aggression (r = .22). The
report EPA total scores and the four ASB indices ranged from .39
remaining correlations between the pain tolerance measures and
to .63 with a median of .56, whereas the lower-order self-report
the ASB scores were nonsignificant.
EPA factors manifested correlations that ranged from —.11 to ,66
with a median of .38. Finally, informant report SRP-III total scores
manifested correlations with ASB that ranged from .24 to .51 with Are There Indirect Effects of Pain Tolerance on the
a median of .34, whereas the informant reports on the lower-order Relations Between Psychopathy and ASB?
scales manifested correlations that ranged from .10 to .55 with a
Next, we tested whether there were significant indirect effects of
median of ,27,
pain tolerance on the relations between psychopathy and violent
and nonviolent ASB,^ To test this question, single mediator anal-
Relations Among Indices of Pain Tolerance, yses were conducted using the bootstrapping procedures described
Psychopathic Traits, and ASB by Preacher and Hayes (2004) to provide the indirect effects
The three pain indices manifested sigtiificant correlations with (product of the A and B paths), which were estimated following
one another that ranged from .30 (cold pressor—electric shock) to 5,000 replications (Hayes, 2009). Significance was determined
.57 (algometer—cold pressor) with a median of .45 (see Table 2). using 95% confidence intervals. Diverging from the classic Baron
Next, we examined the correlations between the pain tolerance and Kenny (1986) approach, we followed recent suggestions (e.g.,
indices and the self- and informant reports of psychopathy. Pain Hayes, 2009; MacKinnon, Krull, & Lockwood, 2000) that all
tolerance, as measured by the mean of three algometer ratings, relations (X -^ Y) be tested for indirect effects, not just those that
manifested mostly (11 of 15) statistically significant positive cor-
relations with both self- and informant reported psychopathy traits ' The ASB indices were all significantly correlated with one another
ranging from ,02 (informant reported SRP-III Interpersonal Ma- with correlations ranging from .26 (reactive aggression: nonviolent ASB)
nipulation) to .30 (self-reported SRP-in Callous Affect) with a to .83 (proactive aggression: violent ASB) with a median correlation of .50.
median of .24. Pain tolerance, as measured by electric shock, ^ The violent ASB composite used in these analyses was made up of the
average of the z-scored values for reactive aggression, proactive aggres-
manifested fewer (4 of 15) significant positive relations with sion, and violent ASB as assessed by the CAB. These three variables
correlations ranging from .01 (informant reported SRP-III ASB) to formed an internally consistent composite (a =.76). The nonviolent ASB
.29 (self-reported SRP-III Erratic Lifestyle) with a median of .15. scores used in these analyses are from the CAB composite.
 PSYCHOPATHY AND PAIN TOLERANCE 209

Table 2 Discussion
Relations Among Pain Tolerance, Antisocial Behavior, and
Psychopathic Traits The existing literature on the relation between psychopathy and
pain tolerance is mixed and limited (e.g.. Fedora & Reddon, 1993;
Cold Electric Hare, 1965, 1966) and based primarily on studies that used small
Pressure temperature shock samples of male offenders (psychopathic vs. nonpsychopathic) and
Pain tolerance measured pain with electrical stimulation only. Similarly, previous
Cold temperature .57** work did not differentiate between the various facets of psychop-
Electric shock .45** .30** athy, which may manifest diverging relations with measures of
Psychopathy
pain tolerance. In the current study, which used a larger commu-
Self-report
SRP-III Total .27** .05 .25*
nity sample (recruited, in part, for psychopathic traits) and a
SRP-III Interpersonal •M -.01 .08 variety of pain induction strategies, psychopathy manifested small
Manipulation positive correlations with greater pain tolerance when measured
SRP-III Callous Affect .30** .05 .27** using physical pressure via an algometer (mean across psychopa-
SRP-III Erratic Lifestyle .19 .03 .29** thy traits and self- and informant ratings: r = .22) and electric
SRP-III Antisocial Behavior .28** .08 .19
EPA Total .26** .09 .20* shock (M r = .15) and no relations when measured via tolerance
EPA Antagonism .21* .04 .15 of cold water (i.e., cold pressor: M r = .04). In general, the
EPA Emotional Stability .20* .04 .07 relations found between psychopathy and pain tolerance were
EPA Disinhibition .11 .09 .18 small but relatively consistent across types of psychopathy traits
EPA Narcissism .24* .05 .12
Informant report and data source (i.e., self- vs. informant ratings of psychopathy),
SRP-III Total .24* .03 .11 although the interpersonal factor of psychopathy (e.g., glib, charm-
SRP-III Interpersonal .02 -.09 .10 ing characteristics) manifested the smallest correlations across
Manipulation raters.
SRP-III Callous Affect .27* -.01 .16
SRP-III Erratic Lifestyle .26* .16 .10 The positive relations found between psychopathic traits and
SRP-III Antisocial Behavior .26* .04 .01 pain tolerance build on recent work by Caes et al. (2012) who
Antisocial behavior
found that psychopathic individuals are more tolerant of pain
Reactive aggression .22* .04 .17
Proactive aggression .06 -.04 .05 experienced by others. In general, it appears that physical pain may
Violent antisocial behavior .30** -.01 .12 be somewhat less aversive for psychopathic individuals, irrespec-
Nonviolent antisocial behavior .14 .04 .16 tive of whether it is the psychopathic individual or someone else
Note. SRP-IH = Self-report Psychopathy Scale—Version III; EPA who is the recipient. This is consistent with the notion that puta-
Elemental Psychopathy Assessment. tively aversive stimuli may have a less punishing effect on psy-
'p < .05. "p < .01. chopathic individuals which, in turn, may make it difficult to
socialize these individuals to behave in a prosocial manner (Lyk-
ken, 1995). It is also consistent with findings that suggest that the
same neural structures are involved in the processing of pain
manifest significant total effects. These analyses were conducted
experienced by the self and others (Lamm et al., 2011); these
using the algometer (pressure) ratings only as they demonstrated
regions include areas that are also associated with psychopathy,
the most robust relations between psychopathy and markers of particularly the affective components (e.g., Kiehl, 2006). It is
ASB.^,"* Of the 18 tests, there was only one case of a significant interesting to note that individuals with congenital insensitivity to
indirect effect, such that EPA Emotional Stability had an effect pain can perceive pain experienced by others, although the pain
on violent ASB through greater (pressure) pain tolerance (see may be substantially underestimated (Danziger et al, 2006).
Table 3).
Given these findings, we tested whether this relative immunity
to or tolerance of pain may partially explain the ASBs often
Are There Indirect Effects of Psychopathy on the associated with psychopathy, particularly acts of an aggressive or
violent nature. As is typically the case, psychopathy (measured
Relations Between Pain Tolerance and ASB?
with self- and informant reports) was substantially associated with
Finally, we tested a model in which pain tolerance, measured both violent and nonviolent ASB however, pain tolerance failed to
via the algometer composite, was related to ASB through the mediate these relations except in one (of 18) case. In general, pain
presence of psychopathic traits. For these analyses, multiple tolerance, although associated with psychopathy and ASB to some
mediators were tested simultaneously (i.e., three SRP-III fac- degree, does not appear to operate as a mechanism by which the
tors, excluding the ASB factor; four EPA factors). Using the two are related. We believe that tests of indirect effects like these
SRP-III factors, there was an indirect path between pain toler-
ance and violent ASB through SRP-III Callous Affect. Using
' SRP-III Antisocial Behaviors factor was not used in the mediation
the EPA factors, there were indirect paths between pain toler- analyses given its overlap with the antisocial behaviors used as the out-
ance and violent ASB through EPA Antagonism and Narcis- comes. Mediation analyses were run only with self-report psychopathy
sism. There were no indirect paths between pain tolerance and scores.
nonviolent ASB for the SRP-III factors, whereas there was a * Pain tolerance, as assessed with the cold pressor or electric stimulation,
did not mediate the relations between psychopathy and violent or nonvi-
significant indirect path for EPA Emotional Stability. olent behavior.
210 MILLER, RAUSHER, HYATT, MAPLES, AND ZEICHNER

Table 3
Regression Coefficients from Individual Mediator Models in Which Psychopathic Traits Predict Antisocial Behavior (ASB) Through
Pain Tolerance (Algometer)

Indirect effect (AB) Path A Path B Path C Path C

TV Mediator DV; ASB B (95% CI) SE B SE B SE B SE B SE

SRP-III total Algometer Violent 0004 (-.0008, .0023) .001 .009* .003 .050 .067 .019* .002 .018* .002
SRP-IIl IPM Algometer Violent .0017 (-.0005, .0074) .002 .011 .010 .157* .073 .045* .008 .043* .008
SRP-III CA Algometer Violent .0028 (-.0023, .0106) .003 .033* .011 .084 .079 .046* .008 .044* .009
SRP-III ELS Algometer Violent .0025 (-.0002, .0097) .002 .021 .011 .129 .076 .048* .009 .045* .009
EPA total Algometer Violent .0019 (-.0024, .0084) .003 .034* .013 .047 .063 .081* .008 .080* .008
EPA Antag. Algometer Violent .0364 (-.0045, .1340) .034 .328* .153 .102 .071 .796* .110 .762* .112
EPA ES Algometer Violent .0650 * (.0060, .1913) .044 .313* .154 .203* .086 .060 .136 -.003 .136
EPA Dis. Algometer Violent .0282 (-.0042, .1075) .027 .179 .158 .151* .071 .762* .115 .735* .114
EPA Narc. Algometer Violent .0303 (-.0238, .1408) .039 .448* .182 .068 .066 1.10* .120 1.07* .124
SRP-III total Algometer Nonviolent .0000 (-.0025, .0032) .001 .009* .003 .006 .125 .023* .004 .023* .004
SRP-III IPM Algometer Nonviolent .0016 (-.0011,.0104) .003 .011 .010 .151 .132 .046 .013 .044 .012
SRP-III CA Algometer Nonviolent .0026 (-.0072, .0150) .006 .033* .011 .083 .140 .045* .015 .042* .015
SRP-III ELS Algometer Nonviolent .0021 (-.0029, .0130) .004 .021 .011 .107 .132 .057* .015 .055* .015
EPA Total Algometer Nonviolent .0025 (-.0065, .0161) .006 .034* .012 .063 .133 .071* .017 .069* .018
EPA Antag. Algometer Nonviolent .0414 (-.0361,.2019) .057 .328* .153 .112 .135 .685* .208 .648* .213
EPA ES Algometer Nonviolent .0588 (-.0229, .2424) .062 .313' .154 .178 .141 .216 .218 .161 .222
EPA Dis. Algometer Nonviolent .0325 (-.0150, .1658) .042 .179 .158 .148 .132 .735* .209 .708* .210
EPA Narc. Algometer Nonviolent .0612 (-.0700, .2419) .076 .448* .182 .131 .139 .585* .255 .526* .262
Note. IV = independent variable; DV = dependent variable; Path A = effect of psychopathic traits on pain tolerance; Path B = effect of pain tolerance
on ASB; Path C: effect of psychopathic traits on ASB; Path C = effect of psychopathic traits on the ASB controlling for the indirect path; 95% CI = 95%
confidence interval; SRP-III = Self-Report Psychopathy Scale—Version III; IPM = Interpersonal Manipulation; CA = Callous Affect; ELS = Erratic
Lifestyle; EPA = Elemental Psychopathy Assessment; Antag. = Antagonism; ES = Emotional Stability; Dis. = Disinhibition; Narc. = Narcissism.
'p < .05.

are vital to the accumulation of a refined understanding of psy- mant reported psychopathy scores were substantially related in this
chopathy. There exists within the field of psychopathy a host of sample, with correlations ranging from .44 (SRP-III Callous Af-
fascinating correlates of psychopathy found using a multitude of fect) to .56 (SRP-III Total; ASBs). As with the previous study, the
exciting methodologies including structural (e.g., de Oliveira- current sample used informants who knew the participants for an
Souza et al., 2008) and functional brain differences (Harenski, extended period of time, which is important, as frequency of
Harenksi, Shane, & Kiehl, 2010), diminished startle response to interactions and interpersonal intimacy are known moderators of
aversive stimuli (Vaidyanathan, Hall, Patrick, & Bernât, 2011), the relations between self- and other personality ratings (Connelly
and attentional difficulties (e.g., Baskin-Sommers, Curtin, & New- & Ones, 2010). These data support the idea that psychopathic
man, in press). It is our opinion that the search for deficits that individuals can provide reliable and valid data on their own degree
characterize psychopathy should be paired with analyses that test of psychopathy in nonforensic settings in which there is no per-
whether these findings (e.g., deficient fear, enhanced pain toler- ceived cost to the participants. As noted by Miller and colleagues,
ance, attention difficulties, under or overarousal) operate as mech- "is it possible that the lack of insight that is attributed to psycho-
anisms by which psychopathy is related to ASB and other impor- pathic individuals has less to do with a lack of awareness than it
tant outcomes. does with a lack of concem for the consequences, morality, and
We also tested an altemative model by which psychopathic deviance of these traits and subsequent behaviors" (p. 763).
traits were examined as potential mediators of the relations be-
tween pain tolerance (measured via the algometer ratings) and
Limitations, Future Directions, and Conclusions
ASB. That is, one could argue that greater pain tolerance might set
the stage for the development of psychopathic traits, which in turn There are several notable limitations to the current study. First,
would lead to violent or nonviolent ASB. In this model, one can although a multimodal assessment of psychopathy was included,
conceive of pain tolerance as a more distal predictor of ASB that we did not use an interview such as the Psychopathy Checklist;
operates primarily through the more proximal effects of psycho- Screening Version (Hart, Cox, & Hare, 1995), which some con-
pathic personality traits. The current data provide very preliminary sider to be the gold standard for the assessment of psychopathy.
support for this hypothesis as there were significant indirect effects Second, the current study is unable to speak to the mechanism(s)
of pain tolerance on violent ASB through psychopathic traits, by which psychopathy is related to pain tolerance. Hare and
particularly traits related to callousness and self-centeredness. Thorvaldson (1970, p. 373) discussed several possible explana-
There was also evidence of an indirect effect of emotional stabil- tions for such a finding, however, such that psychopathic individ-
ity/resilience on the relations between pain tolerance and nonvio- uals may experience less pain due to the lower levels of emotional
lent behavior. Longitudinal data are necessary, however, to pro- arousal experienced in anticipation of the painful stimuli or may be
vide a methodologically rigorous test of this type of model. able to "tune out input with disturbing qualities" (Hare, 1970;
Finally, it is also worth noting that, mirroring the findings Lykken, 1968). Another possibility put forth by Hare (1966) and
reported by Miller, Jones, and Lynam (2011), the self- and infor- others (Séguin et al., 1996) is that psychopathic individuals may be
 PSYCHOPATHY AND PAIN TOLERANCE 211

Table 4
Regression Coefficients from Multiple Mediator Models in Which Pain Tolerance Predicts Antisocial Behavior (ASB) Through
Psychopathic Traits

Indirect effect (AB) Path A Path B Path C Path C

IV Mediator DV: ASB B (95% CI) SE B SE S SE B SE B SE

SRP-III
Algometer IPM Violent .0247 (-.0059, .1036) .025 1.06 .971 .023* .010 .203* .084 .095 .074
Callous Affect .0518 • (.0024, .1345) .033 2.72* .860 .019 .010
Erratic Lifestyle .0349 (-.0007, .1030) .026 1.65 .863 .019 .011
EPA
Algometer Antagonism Violent .0271 * (.0029, .0871) .020 .132* .062 .223 .133 .203* .084 .043 .062
Emotional Stability .0133 (-.0118, .0697) .019 .126* .062 .110 .115
Disinhibition .0254 (-.0041,.0889) .022 .070 .062 .377* .146
Narcissism .0874 * (.0378, 1741) .033 .127* .051 .712* .139
SRP-III
Algometer IPM Non-violent .0195 (-.0112, .1259) .030 1.06 .971 .018 .018 .198 .137 .086 .137
Callous Affect .0297 (-.0702, .1565) .055 2.72* .860 .012 .019
Erratic Lifestyle .0668 (.0000, .1826) .048 1.65 .863 .037 .019
EPA
Algometer Antagonism Non-violent .0162 (-.0495, 1179) .040 .132* .062 .142 .293 .198 .137 .064 .136
Emotional Stability .0608 * (.0030, .1895) .043 .126* .062 .507* .252
Disinhibition .0583 (-.0075, .1929) .048 .070 .062 .857* .320
Narcissism -.0094 (-.1109, .0697) .044 .127* .051 -.068 .305
Note. IV = independent variable; DV = dependent variable; Path A = effect of psychopathic traits on pain tolerance; Path B = effect of pain tolerance
on ASB; Path C: effect of psychopathic traits on ASB; Path C = effect of psychopathic traits on the ASB controlling for the indirect path; 95% CI = 95%
confidence interval; SRP-III = Self-Report Psychopathy Scale—Version III; IPM = Interpersonal Manipulation; CA = Callous Affect; ELS = Erratic
Lifestyle; EPA = Elemental Psychopathy Assessment.

motivated to mask their true experience of pain from experiment- deficits serve as mediators of the relations between psychopathy
ers. Altematively, it may be the case that psychopathy and pain and relevant outcomes.
tolerance are correlated due to the shared role of certain neural
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