**10. Cognitive empathy and theory of mind: automatic perspective taking**

Blair [41] stated that "cognitive empathy or theory of mind is intact in individuals with psychopathy". These ideas have been very seriously undermined by Drayton et al. [42] in relation to automatic perspective taking. Previous research did not take the complexity of cognitive empathy into account, and this led to serious misunderstandings of cognitive empathy. Drayton et al. [42] point out that "automatic theory of mind processes are engaged when an individual unintentionally represents the perspective of another person," also called "altercentric interference". Drayton et al. [42] suggest that "psychopathic individuals have a diminished propensity to automatically think from another's perspective, which may be the cognitive root of their deficits in social functioning and moral behaviour". Drayton et al. [42] raise, for this author, the possible failure of previous research on theory of mind and psychopathy, failing "to tap into a critical component of normal theory of mind processing; or tendency to take other's perspective automatically". Drayton et al. [42] defined "automatic theory of mind processes" as an individual representing "the thoughts and feelings of another person without intending to do so". They also point out that psychopathic individuals have a previously unobserved cognitive deficit that might explain their patterns of destructive and anti-social behaviour, that is, … failure "to automatically take the perspective of others, but can deliberately (controlled), take the perspective of others". These findings suggest that psychopathic individuals have the ability to take the perspective of others but lack the propensity to do so. It seems they can pass theory of mind tasks in the research situation but fail to do so in the real world situation. This is one of the endless problems of laboratory research not translating into the "real world," that is, the clinical world. This lack of generalisation can be a serious flaw in academic psychological research. Drayton et al. [42] note that "psychopathic individuals do show deficits in their ability to understand what others are feeling but this capacity to represent other feelings appears to be distinct from capacity to represent what others see and believe". They also point out that "psychopathic individuals appear to represent other's perspective in a relatively

typical manner when doing so. It is goal-conducive and yet is able to ignore other's perspective when it is not conducive". This means that all previous theory of mind research on psychopathy missed the fundamental point of the deficit of automatic perspective of others. Drayton et al. [42] point out that "this combination of relatively intact deliberative Theory of Mind but impaired spontaneous theory of mind may allow psychopathic individuals to use information about others' mental states to achieve their own ends, while at the same avoid the, 'cost,' of automatically representing other's mental states, resulting in callous and chronic criminal behaviour". They have no empathic interest in other minds, except getting their own egocentric desires met.

In relation to psychiatry, there's a sharp difference between findings in university laboratories and the findings in clinical practice. Research groups are very rarefied and very often do not represent what is found in the general population, clinically. An example is autism defined by the Autism Diagnostic Interview or Autism Diagnostic Observational Scale which give you a very narrow definition of autism, very unlike what you find in the general population which is the broader autism phenotype [43].

Asperger originally defined persons with autism as being autistic psychopaths, which Frith [44] described as autistic psychopathy or autistic personality disorder. In actual fact, there is a lot of truth in Asperger's [27] definition of autistic psychopaths. This has been brought back now with the terms criminal autistic psychopathy [40, 45]. Indeed, the following could be seen as synonyms, autistic psychopathy, autistic personality disorder, high-functioning autism and Asperger's syndrome.

The kind of criminality seen in autism (criminal autistic psychopathy) would include arson, stalking, sex offences and strange repetitive crimes. According to the Centers for Disease Control [30], developmental disorders are characterised by problems with language, mobility, self-help and independent living. There is a myth that ASD and personality disorder and psychopathy are completely different. There is also a myth that autism and Asperger's syndrome have little or no relationship with criminality and serious murder. Patricia Howlin [46] stated "little, if any significant association between autism and criminal offending". This is clearly not supported by my reading of the literature [40]. Sipponma [47] pointed out that 27% of adult offenders in her study met criteria for autism spectrum disorder. These could be called criminal autistic psychopathy. Ashead and Sarkar [48] described correctly personality disorders as "developmental in nature", and they noted that personality regulates social relationships, arousal impulsivity and emotions, as well as self-directedness and self-soothing as well as verbal and non-verbal communication problems. What is of interest is that all of these areas are abnormal in ASD and personality disorder.

Ashead and Sarkar [48] note the following clusters of personality disorders: odd, eccentric behaviour; anti-social, borderline and narcissistic personality disorders; fearful and anxious behaviour; and avoidant, dependent and obsessive compulsive.

All these clusters, clearly at a descriptive level, overlap with ASD. Ashead and Sarkar [48] describe the following features of personality disorder:

**11**

*The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift*

*DOI: http://dx.doi.org/10.5772/intechopen.88540*

• Preoccupation and ruminations

• Major problems in in-patient units

• Failure to confirm to social norms

• Disregard for safety of self and others

• Problems with emotional processing

• Low affiliation and harm avoidance

• Emotional detection problems

• Reduced observing self

• Egocentricity

assuming we ever will.

used aliases".

• Reduced reaction to upset in other people

• Preoccupation with one or more stereotyped patterns of behaviour

All of these features also occur in autism spectrum disorders. Of course, in a way, this is not surprising since the boundaries between most psychiatric disorders are fluid and we do not have an accurate, categorical diagnosis at this point in time,

It's interesting that Wolfe [49], in her group of schizoid disorder overlapping with Asperger's syndrome, found "fraudulent behaviour and pathological lying"; in that, 5 out of 13 had "falsely reported their parents of being cruel to them" and "had

There is a myth that persons with high-functioning autism cannot lie. This is utterly false, as from a clinical perspective, many parents complain to me about their children with high-functioning autism being what they call "inveterate liars". Of course, the great majority of persons with autism are the opposite and are incredibly honest, open, moral, etc. These features of autism spectrum disorder occur in the general population, as do features of personality disorder. It's only

• Reduced self-awareness and capacity to decentre the self

• Social relationship problems

• Social reciprocity problems

• Impulsivity

• Irrationality

• Odd beliefs

• Magical thinking

• Identity confusion

• Empathy problems


*The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift DOI: http://dx.doi.org/10.5772/intechopen.88540*

• Odd beliefs

*Neurodevelopment and Neurodevelopmental Disorder*

egocentric desires met.

phenotype [43].

Asperger's syndrome.

personality disorder.

• Emotional indifference

• Brief psychotic episodes

• Anger, suspicion and fearfulness

• Fears of others attacking and threatening them

typical manner when doing so. It is goal-conducive and yet is able to ignore other's perspective when it is not conducive". This means that all previous theory of mind research on psychopathy missed the fundamental point of the deficit of automatic perspective of others. Drayton et al. [42] point out that "this combination of relatively intact deliberative Theory of Mind but impaired spontaneous theory of mind may allow psychopathic individuals to use information about others' mental states to achieve their own ends, while at the same avoid the, 'cost,' of automatically representing other's mental states, resulting in callous and chronic criminal behaviour". They have no empathic interest in other minds, except getting their own

In relation to psychiatry, there's a sharp difference between findings in university laboratories and the findings in clinical practice. Research groups are very rarefied and very often do not represent what is found in the general population, clinically. An example is autism defined by the Autism Diagnostic Interview or Autism Diagnostic Observational Scale which give you a very narrow definition of autism, very unlike what you find in the general population which is the broader autism

Asperger originally defined persons with autism as being autistic psychopaths, which Frith [44] described as autistic psychopathy or autistic personality disorder. In actual fact, there is a lot of truth in Asperger's [27] definition of autistic psychopaths. This has been brought back now with the terms criminal autistic psychopathy [40, 45]. Indeed, the following could be seen as synonyms, autistic psychopathy, autistic personality disorder, high-functioning autism and

The kind of criminality seen in autism (criminal autistic psychopathy) would include arson, stalking, sex offences and strange repetitive crimes. According to the Centers for Disease Control [30], developmental disorders are characterised by problems with language, mobility, self-help and independent living. There is a myth that ASD and personality disorder and psychopathy are completely different. There is also a myth that autism and Asperger's syndrome have little or no relationship with criminality and serious murder. Patricia Howlin [46] stated "little, if any significant association between autism and criminal offending". This is clearly not supported by my reading of the literature [40]. Sipponma [47] pointed out that 27% of adult offenders in her study met criteria for autism spectrum disorder. These could be called criminal autistic psychopathy. Ashead and Sarkar [48] described correctly personality disorders as "developmental in nature", and they noted that personality regulates social relationships, arousal impulsivity and emotions, as well as self-directedness and self-soothing as well as verbal and non-verbal communication problems. What is of interest is that all of these areas are abnormal in ASD and

Ashead and Sarkar [48] note the following clusters of personality disorders: odd, eccentric behaviour; anti-social, borderline and narcissistic personality disorders; fearful and anxious behaviour; and avoidant, dependent and obsessive compulsive. All these clusters, clearly at a descriptive level, overlap with ASD. Ashead and

Sarkar [48] describe the following features of personality disorder:

**10**


All of these features also occur in autism spectrum disorders. Of course, in a way, this is not surprising since the boundaries between most psychiatric disorders are fluid and we do not have an accurate, categorical diagnosis at this point in time, assuming we ever will.

It's interesting that Wolfe [49], in her group of schizoid disorder overlapping with Asperger's syndrome, found "fraudulent behaviour and pathological lying"; in that, 5 out of 13 had "falsely reported their parents of being cruel to them" and "had used aliases".

There is a myth that persons with high-functioning autism cannot lie. This is utterly false, as from a clinical perspective, many parents complain to me about their children with high-functioning autism being what they call "inveterate liars". Of course, the great majority of persons with autism are the opposite and are incredibly honest, open, moral, etc. These features of autism spectrum disorder occur in the general population, as do features of personality disorder. It's only

when you get to a certain threshold that you would get a diagnosis of autism or personality disorder. In truth, we need a new classification system in psychiatry again. The problem is that most of our current disorders overlap and are therefore not independent. We need to go back from a classificatory point of view, to a pre-Kraepelin period and, in a way, that is, what the NIMH is stating with their transdiagnostic research.

There are a number of phrases associated with personality disorder, which could also be associated with autism spectrum disorder:

