Since its implementation in the third edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980), personality disorders have been assessed categorically, requiring individuals to present with a predetermined number of symptoms to receive a diagnosis. Though it is the prevailing classification system, the categorical model has been widely criticized for reasons including heterogeneity of disorders, high rates of comorbidity, and arbitrary boundaries with normality (Clark, 2007; Lilienfeld, Waldman, & Israel, 1994; Trull & Durrett, 2005; Widiger & Samuel, 2005; Widiger & Trull, 2007).
As a result of these concerns, the Alternative Model of Personality Disorders (AMPD) was developed. In contrast to the traditional model, the AMPD assesses maladaptive personality traits dimensionally and hierarchically. In doing so, it is able to capture a significant proportion of the variance present in the categorical model (i.e., Antagonism captures cluster B personality disorders) and eliminate the categorical model’s aforementioned limitations (Hopwood, Thomas, Wright, & Krueger, 2012; Krueger, Derringer, Markon, Watson, & Skodol, 2012; Krueger & Markon, 2014).
Another important advantage of the alternative model is that it can be integrated with normal range personality traits, thereby providing a conceptual framework for understanding other psychological constructs (Watson, Clark, Harkness, 1994). For example, when comparing the associations of the Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) and Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992) with behavioral and self-adjustment ratings, Suzuki and colleagues (2017) found the nomological networks of Antagonism and Agreeableness, Disinhibition and Conscientiousness, and Negative Affectivity and Neuroticism were highly similar.
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Similarly, factor analytic studies have found strong negative associations between Antagonism and Agreeableness and Disinhibition and Conscientiousness and strong positive associations between Negative Affectivity and Neuroticism in undergraduate (Griffin & Samuel, 2014), community, and outpatient samples (Watson, Stasik, Ro, & Clark, 2013). These findings suggest that these AMPD traits may be pathological variants of personality, with Antagonism and Disinhibition constituting the low end and Negative Affectivity the high end of their respective continua. Though there is considerable convergence of the nomological networks of these trait-pairings, they have primarily relied on self and behavioral report, making it unclear if the associations are accurate or an artifact of the research method.
Functional imaging studies may provide a more rigorous test of the integrated framework. Identifying overlapping regions of neural activity during trait-relevant tasks would provide further support for the integration of normal and pathological personality. Additionally, finding differences in activation across the continua will reveal the factors distinguishing those with normal and pathological presentations of the trait, thereby informing the development of future clinical treatments.
The overlapping neural activity of all five trait-pairings must be examined across various theoretically relevant paradigms to comprehensively test the validity of the integrated model. Beyond the scope of any individual study, such a task can only be accomplished through the accumulation of a large body of research. The present study aims to contribute to this knowledge base by testing the Antagonism-Agreeableness continuum.
The Antagonism-Agreeableness continuum is characterized by the presence or absence of prosocial behaviors. At the high end (Agreeableness), the trait is characterized by concern for the needs and rights of others, altruism, and honesty (Graziano, Habashi, Sheese, & Tobin, 2007). Conversely, the lower end of the spectrum is marked by callousness toward and unawareness of the feelings of others and manipulativeness (APA, 2013). One particularly important prosocial behavior associated with this continuum is empathy.
Empathy refers to the ability to understand and share the feelings of others, leading to numerous benefits in social environments including, improved communication and interpersonal relationships (Fan, Duncan, de Greck, & Northoff, 2011; Li et al., 2019). Empathy is widely considered a multidimensional construct containing affective and cognitive subcomponents (Di Girolamo, Giromini, Winters, Serie, & de Ruiter, 2019). Affective empathy is an automatic emotional reaction to the emotional state of another (Fan et al., 2011).
These experiences can match the observed emotion or can be an appropriate reaction to it (i.e., sympathy, compassion) (Di Girolamo et al., 2019). Conversely, cognitive empathy refers to the ability to intentionally identify, recognize, and assess the mental states of others (Georgiou, Demetriou, & Fanti, 2019). Studies have frequently examined these subcomponents using neuroimaging paradigms, which typically present participants with images depicting emotional experiences and instructing them to either passively view (affective empathy) or actively evaluate what they perceive (Fan et al., 2011).
Studies examining the neural substrates of affective empathy using passive viewing paradigms have tended to find increased neural activity in the anterior insula (AI) and anterior cingulate cortex (ACC). For example, Wicker and colleagues (2003) conducted a functional imaging study to identify the mechanisms in the brain associated with affective empathy. Their participants completed two tasks while in an fMRI. First, they observed clips of individuals expressing disgusted facial expressions. Then, the participants smelled a disgust inducing odor.
Their study revealed that observing disgusted facial expressions and feeling disgust oneself were associated with activity in the left AI and right ACC, suggesting that the aforementioned brain regions may be implicated in affective empathy. Other studies have examined the neural substrates of cognitive empathy by employing evaluative paradigms. One such study was conducted by Lamm, Baston, and Decety (2007), who examined the association between perspective taking and neural activity during an empathy paradigm. While viewing clips of individuals in pain, participants were instructed to imagine how the individual in the clip was feeling or how they would be feeling if put in the same position.
They were then asked to rate the imagined intensity and unpleasantness of the pain. The results illustrated increased activity in the bilateral AI, left middle insula, anterior medial cingulate cortex (aMCC), thalamus, and basal ganglia compared to baseline across both conditions. The described results are similar to those illustrated in a meta-analysis conducted by Fan and colleagues (2011). Across paradigms, the authors found affective empathy to be consistently associated with activation in the right AI, cognitive empathy to be associated with activation in the dorsal aMCC, and activation in the dACC, aMCC, supplementary motor area (SMA), and bilateral AI to be shared by both subcomponents.
Given empathy is a defining characteristic of the Antagonism-Agreeableness continuum, its association with Agreeableness is unsurprising. Previous studies have demonstrated a moderate to strong positive association between Agreeableness, empathy, and both of its subcomponents, which have been replicated cross-culturally (Butrus & Witenbeg, 2013; Melchers et al., 2016; Nettle, 2007). However, fewer studies have examined empathy’s associations with Antagonism. Rather, the literature has primarily examined its associations categorically, examining the presence of empathy in cluster B personality disorders. The studies have yielded mixed results.
Compared to controls, individuals diagnosed with either antisocial personality disorder or narcissistic personality disorder demonstrated lower levels of affective empathy but no differences in cognitive empathy (Kheradmand, Jalali, & Esfandabad, 2018; Ritter et al., 2011). Conversely, individuals diagnosed with borderline personality disorder displayed the opposite pattern (Dziobek et al., 2011). Although these findings are inconsistent in terms of empathy’s subcomponents, they appear to suggest cluster B personality disorders, and, therefore, possibly Antagonism, are negatively associated with empathy.
While self-report evidence appears to illustrate Agreeableness and Antagonism demonstrate opposite associations with empathy and indicate they may form a single continuum, far less is known about their patterns of neural activity.
Few studies have directly examined Antagonism’s and Agreeableness’s associations with empathy and its subcomponents. Instead, neuroimaging studies have primarily examined empathy’s associations in different, but related, constructs. For example, Li and colleagues (2019) found higher levels of trait cognitive-empathy were associated with activity in the left AI while higher levels of affective empathy were associated with increased activity in the right AI. Conversely, evidence suggests individuals higher in trait narcissism (who are lower in affective empathy) demonstrate decreased activation in the right AI (Fan et al., 2011).
While these studies provide preliminary evidence for an integrated continuum, research assessing the traits using reliable and valid self-report measures and examining their associations with both components of empathy is critical for a more accurate evaluation of the framework.
The present study aims to contribute to the knowledge base evaluating the integrated model of personality by examining the extent to which neural activity associated with Antagonism and Agreeableness overlaps during an empathy paradigm. While in an fMRI, participants will complete the Multifaceted Empathy Test (MET; Dziobek et al., 2008), a paradigm designed to assess both cognitive and affective empathy.
During the MET, participants will observe images of individuals experiencing emotions and will be asked to infer the mental states of the individuals in the stimuli and rate their personal emotional reactions to the images. Participants will also complete self-reported measures of normal range and maladaptive personality traits. I hypothesize self-reported Antagonism and Agreeableness will be associated with neural activity in the brain regions associated with cognitive empathy (dorsal aMCC), affective empathy (right AI), and regions implicated in both (dACC, aMCC, SMA and bilateral AI).
Support for this hypothesis would provide further evidence for their integration. The present study also aims to further our knowledge by examining differences in the neural activation in these regions across the continuum. I predict that activation differences between Antagonism and Agreeableness will be greatest for the regions associated with affective empathy (right AI) and that there will be no differences in activation for regions involved with cognitive empathy (dorsal aMCC).
