, Volume 10, Issue 6, pp 1082–1090 | Cite as

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

  • Patrizia VelottiEmail author
  • Carlo Garofalo
  • Giancarlo Dimaggio
  • Peter Fonagy


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


Mentalizing Mindfulness Alexithymia Aggression Antisocial personality disorder Offenders 


Author Contributions

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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed Consent

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


  1. Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park: Sage.Google Scholar
  2. Allison, C., Baron-Cohen, S., Wheelwright, S. J., Stone, M. H., & Muncer, S. J. (2011). Psychometric analysis of the empathy quotient (EQ). Personality and Individual Differences, 51, 829–835. Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Google Scholar
  5. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. Scholar
  6. Bagby, R. M., & Taylor. (1997). Affect dysregulation and alexithymia. In Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: University Press.Google Scholar
  7. Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The 20-item Toronto alexithymia scale. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32.Google Scholar
  8. Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient (EQ): an investigation of adults with Asperger syndrome and high-functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34, 163–175.Google Scholar
  9. Baron-Cohen, S., Bowen, D. C., Holt, R. J., Allison, C., Auyeung, B., Lombardo, M. V., et al. (2015). The “Reading the Mind in the Eyes” test: complete absence of typical sex difference in ~400 men and women with autism. PLoS One, 10(8), e0136521. Scholar
  10. Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: mentalization-based treatment. Oxford: Oxford University Press.Google Scholar
  11. Bateman, A., & Fonagy, P. (2011). Antisocial personality disorder. In A. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 357–378). Washington DC: American Psychiatric Publishing, Inc..Google Scholar
  12. Bateman, A., Bolton, R., & Fonagy, P. (2013). Antisocial personality disorder: a mentalizing framework. Focus, 11(2), 178–186.Google Scholar
  13. Beeney, J. E., Stepp, S. D., Hallquist, M. N., Scott, L. N., Wright, A. G. C., & Ellison, W. D. (2015). Attachment and social cognition in borderline personality disorder: specificity in relation to antisocial and avoidant personality disorders. Personality Disorders: Theory, Research, and Treatment, 6, 207–215. Scholar
  14. Bertsch, K., Grothe, M., Prehn, K., Vohs, K., Berger, C., Hauenstein, K., et al. (2013). Brain volumes differ between diagnostic groups of violent criminal offenders. European Archives of Psychiatry and Clinical Neuroscience, 263(7), 593–606. Scholar
  15. Black, D. W. (2015). The natural history of antisocial personality disorder. Canadian Journal of Psychiatry, 60(7), 309–314. Scholar
  16. Black, D. W., Gunter, T., Loveless, P., Allen, J., & Sieleni, B. (2010). Antisocial personality disorder in incarcerated offenders: psychiatric comorbidity and quality of life. Annals of Clinical Psychiatry, 22, 113–120.Google Scholar
  17. Bo, S., Abu-Akel, A., & Kongerslev, M. T. (2014). Metacognition as a framework to understanding the occurrence of aggression and violence in patients with schizophrenia. In P. H. Lysaker, M. Brune, & G. Dimaggio (Eds.), Social cognition and metacognition in schizophrenia: psychopathology and treatment approaches (pp. 137–145). London: Academic Press.Google Scholar
  18. Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., et al. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of Psychosomatic Research, 41(6), 551–559.Google Scholar
  19. Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63(3), 452–459.Google Scholar
  20. Carcione, A., Nicolò, G., Pedone, R., Popolo, R., Conti, L., Fiore, D., et al. (2011). Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Research, 190, 60–71. Scholar
  21. Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165(9), 1127–1135. Scholar
  22. Compton, W. M., Conway, K. P., Stinson, F. S., & Grant, B. F. (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and specific drug use disorders in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 677–685.Google Scholar
  23. Dimaggio, G., & Lysaker, P. H. (Eds.). (2010). Metacognition and severe adult mental disorders: From basic research to treatment. London: Routledge.Google Scholar
  24. Dolan, M., & Fullam, R. (2004). Theory of mind and mentalizing ability in antisocial personality disorders with and without psychopathy. Psychological Medicine, 34(6), 1093–1102.Google Scholar
  25. Engen, H. G., & Singer, T. (2013). Empathy circuits. Current Opinion in Neurobiology, 23(2), 275–282. Scholar
  26. Fonagy, P. (1991). Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. International Journal of Psychoanalysis, 72, 639–656.Google Scholar
  27. Fonagy, P. (2003). The development of psychopathology from infancy to adulthood: the mysterious unfolding of disturbance in time. Infant Mental Health Journal, 24(3), 212–239. Scholar
  28. Fonagy, P., & Bateman, A. W. (2016). Adversity, attachment, and mentalizing. Comprehensive Psychiatry, 64, 59–66. Scholar
  29. Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21, 1355–1381.Google Scholar
  30. Fossati, A., Maffei, C., Acquarini, E., & Di Ceglie, A. (2003). Multigroup confirmatory component and factor analyses of the Italian version of the aggression questionnaire. European Journal of Psychological Assessment, 19(1), 54–65.Google Scholar
  31. Fossati, A., Vigorelli Porro, F., Maffei, C., & Borroni, S. (2012). Are the DSM-IV personality disorders related to mindfulness? An Italian study on clinical participants. Journal of Clinical Psychology, 68(6), 672–683. Scholar
  32. Garofalo, C. & Velotti, P. (2017). Negative emotionality and aggression in violent offenders: The moderating role of emotion dysregulation. Journal of Criminal Justice, 51, 9-16.
  33. Garofalo, C., Velotti, P., & Zavattini. (2018). Emotion regulation and aggression: the incremental contribution of alexithymia, impulsivity, and emotion dysregulation facets. Psychology of Violence, 8(4), 470–483. Scholar
  34. Gawda, B. (2013). The emotional lexicon of individuals diagnosed with antisocial personality disorder. Journal of Psycholinguistic Research, 42(6), 571–580. Scholar
  35. Giovannini, C., Giromini, L., Bonalume, L., Tagini, A., Lang, M., & Amadei, G. (2014). The Italian five facet mindfulness questionnaire: a contribution to its validity and reliability. Journal of Psychopathology and Behavioral Assessment, 36(3), 415–423.Google Scholar
  36. Goodwin, R. D., & Hamilton, S. P. (2003). Lifetime comorbidity of antisocial personality disorder and anxiety disorders among adults in the community. Psychiatry Research, 117(2), 159–166.Google Scholar
  37. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10, 144–156. Scholar
  38. Kooiman, C. G., Spinhoven, P., & Trijsburg, R. W. (2002). The assessment of alexithymia: a critical review of the literature and a psychometric study of the TAS-20. Journal of Psychosomatic Research, 53, 1083–1090. Scholar
  39. Lieberman, M. D. (2007). Social cognitive neuroscience: a review of core processes. Annual Review of Psychology, 58, 259–289. Scholar
  40. Lobbestael, J., Cima, M., & Arntz, A. (2013). The relationship between adult reactive and proactive aggression, hostile interpretation bias, and antisocial personality disorder. Journal of Personality Disorders, 27(1), 53–66. Scholar
  41. Lovett, B. J., & Sheffield, R. A. (2007). Affective empathy deficits in aggressive children and adolescents: a critical review. Clinical Psychology Review, 27(1), 1–13.Google Scholar
  42. Marsh, A. A., & Blair, R. J. (2008). Deficits in facial affect recognition among antisocial populations: a meta-analysis. Neuroscience and Biobehavioral Reviews, 32(3), 454–465.Google Scholar
  43. McGauley, G., Yakeley, J., Williams, A., & Bateman, A. (2011). Attachment, mentalization and antisocial personality disorder: the possible contribution of mentalization-based treatment. European Journal of Psychotherapy, Counselling and Health, 13(4), 371–393.Google Scholar
  44. Millon, T. (2006). MCMI-III manual. 3rd edition. Minneapolis: NCS Pearson. [Italian adaptation: Zennaro, A., Ferracuti, S., Lang, M., & Sanavio, E., Eds. Firenze: Giunti OS; 2008].Google Scholar
  45. Misso, D., Schweitzer, R. D., & Dimaggio, G. (2018). Metacognition: a potential mechanism of change in the psychotherapy of perpetrators of domestic violence. Journal of Psychotherapy Integration. Advance online publication.
  46. Ogloff, J. R. (2006). Psychopathy/antisocial personality disorder conundrum. Australian and New Zealand Journal of Psychiatry, 40(6–7), 519–528. Scholar
  47. Preti, A., Vellante, M., Baron-Cohen, S., Zucca, G., Petretto, D. R., & Masala, C. (2011). The empathy quotient: £a cross-cultural comparison of the Italian version. Cognitive Neuropsychiatry, 16(1), 50–70. Scholar
  48. Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M., & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10, 238–261. Scholar
  49. Semerari, A., Carcione, A., Dimaggio, G., Nicolò, G., & Procacci, M. (2007). Understanding minds, different functions and different disorders? The contribution of psychotherapeutic research. Psychiatry Research, 17, 106–119. Scholar
  50. Swann, A. C., Lijffijt, M., Lane, S. D., Steinberg, J. L., & Moeller, F. G. (2009). Trait impulsivity and response inhibition in antisocial personality disorder. Journal of Psychiatric Research, 43, 1057–1063. Scholar
  51. Taubner, S., White, L. O., Zimmermann, J., Fonagy, P., & Nolte, T. (2013). Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. Journal of Abnormal Child Psychology, 41(6), 929–938.Google Scholar
  52. Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorder of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.Google Scholar
  53. Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4), 412–426. Scholar
  54. Ullrich, S., & Coid, J. (2009). Antisocial personality disorder: co-morbid Axis I mental disorders and health service use among a national household population. Personality and Mental Health, 3, 151–164. Scholar
  55. Velotti, P., Garofalo, C., D’Aguanno, M., Popolo, R., Salvatore, G., & Dimaggio, G. (2016). Mindfulness moderates the relationship between aggression and antisocial personality disorder traits: preliminary investigation with an offender sample. Comprehensive Psychiatry, 64, 38–45. Scholar
  56. Velotti, P., Garofalo, C., Callea, A., Bucks, R., Roberton, T., & Daffern, M. (2017). Exploring anger among offenders: the role of emotion dysregulation and alexithymia. Psychiatry, Psychology and Law, 28(1), 128–138. Scholar
  57. Velotti, P., Beomonte Zobel, S., Rogier, G., Tambelli, R. (2018). Exploring relationships: a systematic review on intimate partner violence and attachment. Frontiers in Psychology, 9.
  58. Werner, K. B., Few, L. R., & Bucholz, K. K. (2015). Epidemiology, comorbidity, and behavioral genetics of antisocial personality disorder and psychopathy. Psychiatric Annals, 45(4), 195–199.
  59. Zafirakis, E. (2009). Examining empathy and perspective taking among high-risk and low-risk persistently antisocial and non antisocial young adults. International Journal of Interdisciplinary Social Sciences, 4(7), 193–204.Google Scholar
  60. Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527–543. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Educational Sciences DepartmentGenoa UniversityGenoaItaly
  2. 2.Department of Developmental PsychologyTilburg UniversityTilburgthe Netherlands
  3. 3.Center for Metacognitive Interpersonal TherapyRomeItaly
  4. 4.Psychoanalysis Unit, Research Department of ClinicalEducational and Health Psychology University College LondonLondonUK

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