When Does a Man Become a Monster? Reassessing Empathy in Psychopathy Assessments

Featured Article

Psychology, Public Policy, and Law| 2025, Vol. 31, pp. 115- 133.

Article Title

Do Psychopathic Persons Lack Empathy? An Exploratory Systematic Review of Empathy Assessment and Emotion Recognition Studies in Psychopathy Checklist Samples

Authors

Rasmus Rosenberg Larsen - Forensic Science Program, Department of Philosophy, University of Toronto Mississauga

Sonya Anna McLaren - Department of Psychology, Carleton University

Stephanie Griffiths - Department of Psychology, Okanagan College; Werklund School of Education, University of Calgary

Jarkko Jalava - Department of Interdisciplinary Studies, Okanagan College

Abstract

Psychopathy assessments are widely used in the legal system to inform decisions about sentencing, rehabilitation, etc. Recently, these assessments have become controversial as long-held beliefs about psychopathy are contested. One common claim that has yet to be scrutinized is the assumption that psychopathic persons lack empathy. This hypothesis has been studied extensively in forensic samples, but there are few relevant systematic reviews to inform forensic practices. We conducted a systematic review of empirical studies testing empathy in persons assessed with the Hare Psychopathy Checklist (PCL) scales. Included studies ( n = 66) measured general, cognitive, and affective empathy across two different paradigms using (a) empathy assessment tools and (b) emotion recognition tests. These studies had great heterogeneity in their reporting of effects, precluding a meaningful meta-analysis. A structured overview of results showed a total of 1,672 effects were reported across 66 included studies ( N = 5,711) of which 182 effects (10.89%) were statistically significant and 1,490 effects (89.11%) were nulls. Exploratory analyses revealed that high-powered studies had a significantly larger proportion of nulls (89.29%) compared to low-powered studies (81.45%), suggesting a potential problem with false-positive discoveries in the research literature. In conclusion, we found little evidence to suggest that PCL psychopathic persons have different empathic capacities, thus challenging the common assumption that psychopathy is associated with a lack of empathy. We discuss the implication of these results for the current and future use of PCL assessment in forensic settings.

Keywords

psychopathy, empathy, systematic review, Hare Psychopathy Checklist-Revised, forensic

Summary of Research

“The most common approach to assessing psychopathy in forensic settings is to use the Hare Psychopathy Checklist-Revised (PCL-R) [which] includes 20 behavioral and interpersonal items scored on a scale from 0 to 2 points, where a score of 25 or 30 (of a maximum 40) is used as the most common conventional threshold for clinical psychopathy…

According to the PCL-R manual, there are at least three central ways that psychopathic individuals deviate from nonpsychopathic persons:

First, psychopathic individuals are described as extraordinarily dangerous, displaying substantially higher risk of institutional infraction, post-release reconviction, and instrumental violence.
Second, the PCL-R manual describes psychopathy as a chronic condition, where afflicted individuals benefit little from treatment and rehabilitation programs.
Third, the PCL-R manual describes psychopathic persons as having deficient moral and prosocial dispositions, including an impaired capacity for moral reasoning…

However, in recent years, a growing number of studies have contested the veracity of these three claims. For instance, meta-analyses have shown that the link between psychopathy and dangerousness might be overstated, as evidence suggests that a PCL score is at best moderately correlated with forensic risk outcomes… many review studies have concluded that PCL psychopathic persons benefit from rehabilitation programs in similar ways as nonpsychopathic persons, and today, the “ untreatability view ” is broadly seen as a clinical lore…” (p. 115- 116).

“...If a person is assessed with clinical levels of psychopathy, and therefore assumed to be lacking empathy, this may serve to justify more restrictive sentencing and management decisions… In this study, we aim to close this gap in the literature by systematically reviewing the empirical evidence testing empathic capacities in persons assessed with PCL psychopathy” (p. 116- 117).

“The most common type of empathy assessment tools are self-reports consisting of narrative, multiple choice, and task-based questionnaires… Overall, empathy assessment tools typically generate a total score and/or scores on subscales of affective and/or cognitive empathic capacities…” (p. 118- 119).

“Emotion recognition tests consist of performance-based tasks [that] rate a person’s ability to correctly identify emotions expressed nonverbally or nonconnotatively by other people. Emotion recognition tests usually involve viewing pictures of human faces or videos of people in different emotional states [where] participants must correctly identify each of the expressed emotions” (p. 121).

“The 66 included studies had substantial heterogeneity in terms of their statistical reporting, test design and measures, risk of bias, and overall quality…

The most pressing obstacles to performing a meta-analysis were the findings that

(a) more than one-third of all studies had incomplete reporting of statistics necessary for meta-analyzing effects,

(b) nonreported effects were extensive, making up more than one-fifth of all test [results]. Thus, performing a meta-analysis of this literature means that around 50% of results would either be missing or imputed into the analysis based on incomplete information, generating a level of bias and uncertainty that severely undermines the primary purpose of our systematic review to inform public policy and legal practices…” (p. 122- 123).

“This systematic review analyzed empathy studies on PCL samples published between 1980 and 2023. Across a total of 66 included studies, our systematic review found little evidence to support the widespread claim that PCL psychopathy is associated with a lack of empathy. The most consistently replicated effects were nulls, and significant effects were seemingly driven by the use of flexible analyses” (p. 127).

Translating Research into Practice

“Our systematic review found little evidence that high PCL scores are associated with empathy deficits… Our findings are largely inconsistent with the widely held belief among researchers and clinicians that PCL psychopathic persons lack empathy” (p. 125).

“Finally, many of the empathy assessment studies included in this review utilized tools that have varying or unknown degrees of validity. While this worry is particularly relevant for what we labeled “ ad hoc ” tools, a recent large-scale review study has raised concerns about the validity of the RMET, an established mainstream cognitive empathy assessment tool” (p. 126).

“These discoveries have implications for how psychopathy is used to inform legal decisions, suggesting that the current use of PCL assessments to infer a lack of empathy is not an evidence-based practice. Further, in recent years, the forensic use of the PCL scales has attracted criticism from researchers arguing that many of the common evidence-based justifications for using the tools might be less substantiated than previously thought” (p. 127).

Other Interesting Tidbits for Researchers and Clinicians

“What forensic practitioners arguably need is a systematic review that probes the assumed connection between a PCL assessment and a lack of empathy, thus properly reflecting the reality that forensic decision making about psychopathic individuals is almost exclusively based on the PCL assessment tools” (p. 117).

“The results from empathy research suggest that, in forensic contexts, clinicians cannot accurately ascertain whether a person lacks empathic capacities. Most (but not all) of the 66 studies included in this review involve forensic samples where participants have been deemed by a clinician to lack empathy insofar that a PCL assessment entails making such determination. So, when test participants show equal performance in validated empathy tasks, it suggests that there is a gap between clinicians ’ impression/perception of and the participant’s actual empathic capacities.

While clinicians may believe that psychopathic persons lack empathy, a range of studies suggest that they still find interpersonal traits such as lack of remorse and empathy difficult to score reliably” (p. 126).