35 Neuroendocrinological aspects of social anxiety and aggression related disorders proximately 15–25% of the prison population. Characterization in the literature is inconsistent, but psychopathy has often been defined based on the Hare Psychopathy Checklist, which describes psychopathy along two distinct dimensions: Factor 1 (comprising lack of guilt and empathy, shallow affect, and pathological lying), and Factor 2 (including impulsivity, anti-social behavior, and sensation-seeking) (Hare & Neumann, 2008). Alternatively, a distinction between primary and secondary psychopathy has been made, with similar symptoms but a difference in anxiety levels (Anderson & Kiehl, 2012; Brazil et al., 2016; Van Honk & Schutter, 2006). Whereas primary psychopathy is characterized by low anxiety, secondary psychopathy is defined by higher anxiety levels. Both show pronounced problems in emotional processing (e.g., reduced guilt, empathy, etc.), increased goal directed behavior, instrumental aggression (i.e., goal-oriented self-serving aggression), and an increase in impulsive behavior and uncontrolled aggression after emotional provocation. Psychological and behavioral interventions give mixed results in effectiveness, depending on different types of anti-social individuals (Brazil et al., 2016). In general, psychopathic individuals are not responsive to treatment due to the specific characteristics of the disorder and a lack of motivation to seek treatment. Figure 2.1 Illustration of gaze path, correlation between Social Anxiety symptoms and first fixations on angry eyes and effects of testosterone administration on gaze avoidance in individuals with SAD. Adapted from Enter, Terburg, Harrewijn, Spinhoven, and Roelofs (2016 ). Panel A provides an illustration of a gaze path measured using eye-tracking while a patient with social anxiety disorder (SAD) and a healthy control participant (HC) were viewing an angry facial expression. Panel B: A correlation between percentage first fixations on angry eyes and LSAS social anxiety scores (Liebowitz, 1987) in the placebo condition indicated that SAD participants with stronger anxiety symptomatology showed increased gaze avoidance of angry eye contact (r = -.561, p = .046). Panel C: Testosterone administration, compared to placebo, alleviated gaze avoidance of angry eye contact by increasing the percentage first fixations towards angry eyes. 2
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