SOMATIC MARKERS IN PSYCHOPATH SURVIVORS Somatic marker functioning during recovery from a romantic relationship with a psychopathic abuser: An examination of mental health, resilience, and post-traumatic growth in social decision making by Courtney Meagan Humeny A thesis submitted to the Faculty of Graduate Studies and Postdoctoral Affiars in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Cognitive Science Carleton University Ottawa, Ontario © 2017 Courtney Humeny SOMATIC MARKERS IN PSYCHOPATH SURVIVORS ii Abstract Damasio’s (1994) Somatic Marker Hypothesis (SMH) proposes a system in the brain that creates somatic markers, a mechanism which assists in integrating emotional information to aid in everyday functioning, including social decision making. Survivors of domestic abuse commonly experience mental health impairments that are associated with abnormalities in the somatic marker circuitry. These abnormalities are made apparent in deficits in facial affect processing and social impairments that contribute to the maintenance of these disorders. Whiffen and MacIntosh (2005) propose that the strategies survivors use to cope with distress can perpetuate and extend impairments to mental health by diminishing their ability to maintain supportive relationships. However, some survivors demonstrate growth or resilience despite their experiences, and utilize social support relatively well. The purpose of my research is to provide a conceptual investigation of the neuropsychological underpinnings of Whiffen and MacIntosh’s pathway by utilizing Damasio’s SMH. I examine survivors who identified as having a prior romantic relationship with a psychopathic abuser. Survivors of psychopathic abusers have received limited attention from researchers, but suggestions have been made regarding profound declines to emotional and interpersonal functioning (Pagliaro, 2009). Two studies were conducted to examine the association between abusers’ ascribed level of psychopathic traits, and survivors’ abuse experiences and recovery outcomes (e.g., mental health impairments, resilience). Participants (N = 105 and N = 392) were recruited from domestic abuse survivor support websites and completed a series of close and open- ended questionnaires, the Iowa Gambling Task (IGT), and a facial affect recognition task. A series of correlation and regression analyses revealed that abusers’ ascribed levels of SOMATIC MARKERS IN PSYCHOPATH SURVIVORS iii psychopathic traits were predicted by survivors’ experiences of abuse that was frequent, physically harmful, and versatile (i.e., physical, financial, sexual, and property abuse), and survivors diminished positive emotional experiences and elevated post-traumatic stress symptoms (Study 1a and 2). While frequent and physically harmful abuse were predictive of abusers’ ascribed Factor 1 and Factor 2 psychopathy scores, survivors’ experiences of anxiety was also predictive of their ratings of abusers’ ascribed Factor 1 psychopathy scores (Study 1a). Thematic and linguistic analysis (n = 7) suggests that psychopathic traits can enhance abusers’ ability to use various linguistic tactics to gaslight their victims; a form of emotional abuse that severely impact victims’ mental health and interpersonal relationships (Study 1b). No evidence was found for the role of somatic markers in Whiffen and MacIntosh’s feedback pathway: mixed ANOVAs revealed no differences on task performance in relation to survivors’ recovery outcomes (Study 2). Regression analyses revealed that survivors’ mental health impairments were predicted by perceiving the abusive relationship to have a greater negative impact on mental health, more recent contact with the abuser, and a greater reception of social support (Study 2). In terms of survivors’ positive outcomes, resilience was predicted by a higher reception of social support and lower levels of mental health impairments (Study 2). Post-traumatic growth was predicted by being in the abusive relationship for a longer duration, less recent contact with the abuser, higher levels of resilience and received social support, and lower levels of perceived emotional support and mental health impairments (Study 2). Discussion centers on the theoretical and practical implications of Whiffen and MacIntosh’s feedback pathway in the context of recovery from psychopathic abusers during romantic relationships. SOMATIC MARKERS IN PSYCHOPATH SURVIVORS iv Acknowledgements First, I would like to thank the survivors who participated in my studies, those who shared my recruitment announcements to spread the word of my research, who contacted me personally about their experiences, and those who continued to request updates on my research over the course of this five-year project. I would like to acknowledge the tremendous amount of support I received from my committee, who were able to provide comments from different perspectives: Dr. Adelle Forth from Psychology and her expertise in psychopathy and survivors of psychopathy, Dr. Katharine Kelly from Gender Studies and Sociology with her expertise on violence against women, and Dr. Kasia Muldner from the Institute of Cognitive Science with expertise in cognition and decision making. I would like to thank my External Examiner, Dr. Kasia Uzieblo from Thomas More University College in Antwerp, Belgium. As a fellow researcher of the emerging area of psychopath survivors, your questions and insight into my thesis meant a lot to me. All together, I will continue to use the insights from my committee as I prepare my results for journal submission. I would like to thank my supervisor Dr. John Logan for taking on a second-year doctoral student with no project and an interest in a research area that, at the time was very new to both of us. Thank you for all your work in reading various iterations of Ethics applications and thesis drafts, your openness with the project, and supporting my side interests/research projects, which facilitated my ability to carry out the first doctoral thesis on surivovrs of psychopaths. SOMATIC MARKERS IN PSYCHOPATH SURVIVORS v I would like to thank Dr. Ian Broom for introducing me to the research world of psychopathy, and for giving me an opportunity to gain experience in this area and present at my first conference, the 2011 Society for the Scientific Study of Psychopathy. It was at this conference that I met with researchers in this new area and learned of the Aftermath: Surviving Psychopathy Foundation. I would like to thank the volunteers and the Board of Directors at Aftermath for promoting the importance of this research area, and for providing me with moral and financial support in the form of a research grant in 2011 and a research award in 2016. I would also like to express thanks to other agencies that funded my research. These include the Social Sciences and Humanities Research Council, Ontario Graduate Scholarship program, and the donors for internal awards at Carleton University, particularly the New Sun Award for Aboriginal Students. I would like to thank my web developer/programmer Rufino Ansara for his loyalty and perseverance; working side-by-side with me on numerous occasions to develop, pilot, and update the website through various iterations of Ethics clearance over the years. Lastly, I would like to thank my non-academic support system. Dr. Nalini Ramlakhan, thank you for being one of the first fans of my research, being on the same page as me throughout our graduate degree, and providing an unwavering source of support and positive energy. I would like to thank my family, my brother Matthew Humeny and my Dad, Randy Humeny, who taught me the importance of work ethic, modesty, and dreaming big. I would also like to thank my fiancé Jean-Pierre Beaulieu, for providing me and my baby, Maibelle, a forever home, for taking me to the lab on weekends, making sure I was fed, and for ensuring that I talked to someone other than the person who works at the coffee shop on my writing days. SOMATIC MARKERS IN PSYCHOPATH SURVIVORS vi Dedication I dedicate this dissertation to my dad, Randy Humeny. SOMATIC MARKERS IN PSYCHOPATH SURVIVORS vii Table of Contents Abstract ............................................................................................................................... ii Acknowledgements ............................................................................................................ iii Dedication ............................................................................................................................v List of Figures ....................................................................................................................xv List of Tables ................................................................................................................... xvi List of Appendices .............................................................................................................xx List of Abbreviations ...................................................................................................... xxii Introduction ..........................................................................................................................1 Somatic Marker Hypothesis .................................................................................................9 Iowa Gambling Task ..............................................................................................11 Criticisms of the Somatic Marker Hypothesis .......................................................13 Are Somatic Markers Impaired in Survivor Populations? .................................................19 Common Reactions Associated with Domestic Abuse ..........................................22 Post-Traumatic Stress Disorder .............................................................................24 Neural correlates of cognitive and emotional difficulties ..........................25 Cognitive and emotional processes in domestic abuse survivors ..............27 Facial affect recognition ............................................................................29 Depression and Anxiety .........................................................................................32 Psychopathy .......................................................................................................................35 Factor Structure Underlying Assessments of Psychopathy ...................................37 Theories of Psychopathy ........................................................................................40 Response Modulation Hypothesis..............................................................40 SOMATIC MARKERS IN PSYCHOPATH SURVIVORS viii Violence Inhibition Mechanism Model .....................................................41 Language Use.........................................................................................................43 Psychopathy and Crime .........................................................................................47 Emotion Deficits ....................................................................................................47 Psychopathy and Domestic Abuse .........................................................................49 Facial affect recognition in psychopathic abusers .....................................52 Psychopathy and Victim Selection ........................................................................55 Survivors of Psychopathic Abusers ...................................................................................59 Positive Outcomes Following Trauma...............................................................................66 Correlates of Resilience .........................................................................................68 Emotion and resilience ...............................................................................69 Correlates of Post-Traumatic Growth ....................................................................71 Post-traumatic growth and mental health impairments .............................71 Social Support ........................................................................................................74 Overview of Studies ...........................................................................................................78 Study 1 ...........................................................................................................................79 Method ...................................................................................................................89 Participants .................................................................................................89 Procedure ...................................................................................................90 Measures ....................................................................................................91 1) Demographics ................................................................................91 2) Victimization Screening Survey ....................................................92 3) Modified Self-Report Psychopathy Scale-Short ............................93 SOMATIC MARKERS IN PSYCHOPATH SURVIVORS ix Validity of the SRP-III and SRP-SF ..................................94 Potential limitations and strengths .....................................95 4) Affect Intensity Measure................................................................97 5) Impact of Events Scale Revised .....................................................99 6) Ego Resilience Scale ....................................................................100 7) Symptom Checklist-90 Revised ...................................................100 8) Open-Ended Questions ................................................................102 Data Analysis .......................................................................................................102 Study1a ....................................................................................................102 Descriptive statistics ....................................................................102 Regression analyses .....................................................................103 Correlational analyses ..................................................................105 Study1b ....................................................................................................106 Descriptive statistics ....................................................................106 Applied linguistics .......................................................................106 Qualitative methods .....................................................................107 Thematic analysis.............................................................108 Sample size ..........................................................111 Inter-rater reliability .............................................111 Results ..........................................................................................................................112 Data Treatment.....................................................................................................112 Quantitative Data Cleaning ..................................................................................113 Missing data .............................................................................................114 SOMATIC MARKERS IN PSYCHOPATH SURVIVORS x Identification of univariate outliers ..........................................................115 Normality .................................................................................................115 Multicollinearity ......................................................................................116 Regression diagnostics .............................................................................116 Qualitative Data Cleaning. ...................................................................................117 Study 1a .......................................................................................................................118 Reliability Checks ................................................................................................118 Descriptive Statistics ............................................................................................118 Research Question One: Do survivors who experience abuse that is more versatile, physically harmful, and frequent ascribe higher levels of psychopathic traits in their abusers (Study 1a)?.........................................................................123 Research Question Two: Do survivors’ current experiences of emotional functioning influence the level of psychopathic traits they ascribe to their abusers (Study 1a)? ...........................................................................................................126 Research Question Three: Do survivors’ abuse experiences and current mental health impairments affect their ratings of specific categorizations of psychopathic traits (e.g., Factor 1, lifestyle facet, etc; Study 1a)? .............................................128 Discussion- Study 1a....................................................................................................134 Psychopathic Traits and Abuse Experiences .......................................................135 Emotional Functioning During Recovery from a Psychopathic Abuser .............138 The Factors and Facets of Psychopathy ...............................................................140 Theoretical and Practical Implications.................................................................145 Study 1b ...........................................................................................................................149