Cognitive, Emotional and Social Markers of Serial Murdering

Alessandro Angrilli1,2, Giuseppe Sartori1 and Giovanna Donzella1

Department of General Psychology, University of Padova, Via Venezia 8, 351313, Padova, Italy.
CNR-IN Institute of Neuroscience, Section of Padova, Italy.

Word count: 3361 words

Running title: Cognition and emotion in a serial murderer

Address all Correspondence to: Alessandro Angrilli , PhD

Department of General Psychology, University of Padova
Via Venezia 8, 35131 Padova, Italy
e-mail: alessandro.angrilli@unipd.it

Complete citation:
Angrilli, A., Sartori, G., Donzella, G. (2013). Cognitive, emotional and social markers of serial
murdering. The Clinical Neuropsychologist, 27, 485494.
doi: http://dx.doi.org/10.1080/13854046.2013.771215

Angrilli et al. Cognition in a serial murderer

ABSTRACT

Although criminal psychopathy is starting to be relatively well described, our knowledge of the
characteristics and scientific markers of serial murdering is still very poor. A serial killer who
murdered more than five people, KT, was administered a battery of standardized tests aimed at
measuring neuropsychological impairment and social/emotional cognition deficits. KT exhibited a
striking dissociation between a high level of emotional detachment and a low score on the antisocial
behavior scale on the Psychopathy Checklist-Revised (PCL-R). The Minnesota Multiphasic
Personality Inventory-2 showed a normal pattern with the psychotic triadic scale at borderline level.
KT had a high intelligence score and showed almost no impairment in cognitive tests sensitive to
frontal lobe dysfunction (Wisconsin Card Sorting Test, Theory of Mind, Tower of London, this
latter evidenced a mild impairment in planning performance). In the tests on moral, emotional and
social cognition, his patterns of response differed from matched controls and from past reports on
criminal psychopaths as, unlike these individuals, KT exhibited normal recognition of fear and a
relatively intact knowledge of moral rules but he was impaired in the recognition of anger,
embarrassment and conventional social rules. The overall picture of KT suggests that serial killing
may be closer to normality than psychopathy defined according to either the DSM IV or the PCL-R,
and it would be characterized by a relatively spared moral cognition and selective deficits in social
and emotional cognition domains.

Keywords: Psychopathy; Antisocial Personality Disorder; Social cognition; Frontal lobe; Serial
killer.

Angrilli et al. Cognition in a serial murderer

Introduction

Criminal psychopathy represents one of the main social and legal problems in western
countries. In recent decades, scientific literature has increased our knowledge on psychopathy by
providing structural-functional, neurological and psychophysiological correlates of this elusive
psychiatric disorder (Herpetz et al. 2001; Kiehl, 2006; Raine et al., 1998, 2000; Raine and Yang,
2006). Most literature has shown converging evidence of reduced elaboration of negative stimuli or
punishment and reduced autonomic response to aversive conditioning in psychopaths (Birbaumer et
al., 2005; Hare & Quinn, 1971; Hare et al., 1978; Herpetz et al., 2001; Patrick, 1994; Patrick, et al.,
1997). In addition, frontal lobe dysfunction has been hypothesized to explain their abnormal
behavior (Gorenstein, 1982; Raine et al., 1998, 2000). Cognitive testing indicates in psychopaths no
impairment in normal cognition (Blair et al. 1996; Hare, 1984), but rather a specific deficit in
emotional, social and moral cognition (Blair & Coles, 1991; Blair, 1995; Blair et al., 2002) In the
literature, the hypothesis that moral reasoning is related to emotional response is receiving
increasing empirical support (Greene et al., 2001) as it plays a key relevance in several psychiatric
as well as acquired neurological disorders. In this view, the described deficits of psychopaths in the
social/moral domain may be considered a consequence of a more basic disorder in emotional
responses to environmental stimuli.
One of the main scientific problems in the study of criminal behavior is the classification
and the assessment of psychopathy. At least three possible categories of subjects can be classified
under the ambiguous and generic term psychopath: the subjects affected by antisocial personality
disorder, the criminal psychopaths assessed by the PCL-R, and serial murderers. Most of scientific
literature has focussed on psychopathy (or, more properly, sociopathy) as a classified psychiatric
disorder termed Antisocial Personality Disorder (APD, American Psychological Association, 2000).
Research has been done on psychopathy classified through the most used semi-structured interview
Hares Psychopathy Checklist (PCL-R; Hare, 1991). This instrument provides a more valid and

Angrilli et al. Cognition in a serial murderer

useful classification of criminal psychopathy by including specific additional important features to

the antisocial behavior considered by the DSM-IV-TR (American Psychological Association,
2000). However, notwithstanding the increasing number of scientific reports on psychopathy, as
defined above with the two main psychiatric methods of classification available, there is still lack of
scientific data on the third specific category of criminal psychopaths (sometimes classified as
extreme psychopaths for the high number of homicides, lack of relation with victims and lack of
evident behavioural markers), which is represented by serial murderers. Indeed, despite the great
number of anecdotal reports in the media and scientific literature on extreme psychopathy, the
cognitive and psychobiological characterization of serial killers behaviour has not yet been studied
(Abbott, 2001). In general, insurmountable logistic problems arise in studying serial murderers,
usually because they are under special restrictions, and because scientific research aimed at
preventing human violence is secondary compared with the main concern of judicial institutions. In
the present study, we made both a psychiatric and a neuropsychological/cognitive assessment of a
rare case of serial killer, here named KT, to our knowledge the first case in the literature who has
been studied with a scientific quantitative approach. To this aim we used a battery of tests,
questionnaires and interviews, most of which allowed a quantitative statistical comparison with
normative data or with matched healthy subjects. These methods and instruments have been already
used in past research on psychopaths, and allowed us to examine the hypothesis that serial killers
like KT are different from APD and PCL criminal psychopaths and closer, yet clearly distinguished,
to healthy subjects.

Angrilli et al. Cognition in a serial murderer

Subjects, Method and Procedure

KT is a male, aged 41 at the time of testing (for protecting KT privacy we omitted most of
his biographical information1) and owns a masters degree with the highest rating. He murdered
more than 5 people over a period of seven years. In the nineties he was convicted to about 30 years
for partial insanity, with a psychiatric diagnosis of schizoid and paranoid personality disorder.
During adolescence he suffered from a brief psychotic episode of paranoid schizophrenia, for which
he was under brief psychiatric treatment. KT, according to Holmes classification (Holmes &
DeBurger, 1988) belongs to the missionary-organized type, as the victims were prostitutes,
homosexuals, drug addicts and priests. For K.T. all victims were sinners, and his mission was moral
cleansing of the world. His preferred mode of killing was the use of a blunt instrument and fire.
The investigation has been performed according to the Declaration of Helsinki and approved
by the Ethics Committee of the Faculty of Psychology, University of Padova. KT provided a verbal
informed consent as a part of routine psychopathological evaluation made by the third author
(G.D.), a State Prison clinical psychologist who makes inmate clinical evaluation.
KT was tested in three sessions in a quiet room of the jail in which he was imprisoned. He
was administered three groups of test (including questionnaires and semi-structured interviews)
aimed to assess psychiatric condition, cognitive frontal impairment, and emotional-social-moral
cognition. For psychiatric assessment we used the MMPI-2 (Minnesota Multiphasic Personality
Inventory, Butcher et al., 1989, Graham, 1999), the DSM-IV-TR (American Psychological
Association, 2000), and Hare Psychopathy Checklist Revised (PCL-R Hare, 1991). The
neuropsychological and cognitive tests consisted of Ravens matrices (non-verbal intelligence,
Raven, 1938), Tower of London (planning, Shallice, 1982), Wisconsin Card Sorting Test
(perseverations, Heaton et al, 1993), Theory of Mind (TOM, Happ, 1994), a test aimed to measure

We omitted most biographical information in order to protect KTs privacy. Further information
on KTs history is available from authors upon qualified request.

Angrilli et al. Cognition in a serial murderer

the capability to interpret others intention. The third group of tests was originally built up by
collecting several tests from the literature, has been adapted and developed for measuring
emotional, social and moral cognition in psychopaths (Blair, 1995; Blair & Cipolotti, 2000). It
included the Emotion Attribution Test, a test consisting of 67 short stories describing emotional
situations, in which subject is asked to attribute the emotion felt by the protagonist of each story. A
second test, the Social Situation Test, was developed for measuring social competence and contains
twenty-five short stories in which the protagonists behavior may be either normal or aberrant.
Subject has to tell whether protagonists behavior is normal or socially aberrant, and when
recognized as aberrant he has to evaluate the severity of social habits violation.
The third test was specific for the Recognition of Moral/Conventional Situations, and
included six short stories with violations of moral rules mixed with six stories of violations of
conventional social rules. Moral violations were characterized by acts against individuals or
personal objects (e.g., a boy hitting another boy), and conventional violations were acts against
social habits (e.g., a boy putting nail-polish on his hands at school). Also this test included the
subjective evaluation of the severity of violations when recognized. For further details and
examples see appendix of Blair and Cipolotti (2000).
For Ravens Matrices, Tower of London and Wisconsin Card Sorting Test we compared
KTs scores with age corrected normative data. For all other tests lacking Italian normative data,
sixty graduated matched males (mean age: 38.4 SD: 12.3) served as controls.

Results and Discussion

Psychiatric assessment
The MMPI-2 indicated a defensive profile (K = 65) with a tendency toward providing a
positive image of himself (see table 1, scales L, F, K). Clinical validity was therefore weakened by
this pattern, as KT tried to minimize psychopathological traits. The clinical profile was relatively
regular and within the average range of the normal population. However, his highest score was on

Angrilli et al. Cognition in a serial murderer

the Schizophrenia scale (at the level of clinical attention: 66), and he showed a general increase in
the psychotic triadic scale represented by paranoia, psychasthenia (a scale correlated with
obsessive-compulsive behavior) and schizophrenia (see table 1, underlined scales). This shows his
tendency toward a psychotic rather than a neurotic pattern.
________________________________
Insert Table 1 about here
________________________________

Analysis of KTs history revealed that he did not fulfil the DSM IV criteria for Antisocial
Personality Disorder (only one criterion: lack of remorse) (American Psychological Association,
2000). Only two to three criteria were fulfilled for Paranoid, Schizoid or Schizotypic Personality
Disorders. Three independent lines of evidence, that are, psychiatric court diagnosis, MMPI scores,
and DSM IV criteria, provided converging evidence for his tendency toward a schizoid/paranoid
personality disorder which did not reach the threshold for a clear-cut psychiatric classification. His
past problems of occasional psychotic events which required psychiatric assistance were considered
episodic. That KT resisted classification by standard psychiatric criteria is consistent with his
relatively good mental functioning and contact with reality.

A clinically classified

schizophrenic/schizotypic subject, with strong reality dissociation, would have not been able to
organize and plan so many independent successful serial murders.
We also used a further psychiatric instrument, the Hare Psychopathy Checklist-Revised,
which is usually adopted to classify criminal psychopaths (Hare, 1991). Psychopathy is marked by
high scores on two factors, emotional detachment and antisocial behavior. KT had an overall score
of 22/40, which is within the normal range, as it was below the critical cut-off of 30. However,
detailed analysis of the two factors revealed a normal low score (2/18, 2nd percentile) for antisocial
behaviour (Factor 2) and the maximum pathological score for emotional detachment (16/16, 100th
percentile, Factor 1; two extra-factorial items provided a rating of 2, thus the sum of all ratings is

Angrilli et al. Cognition in a serial murderer

22). Items of the Antisocial Behavior factor in PCL-R were consistent and overlapped with DSM IV
criteria for APD (Widiger et al., 1996). Therefore, KTs low score on Factor 2 was consistent with
the insufficient criteria for a diagnosis of Antisocial Personality Disorder (American Psychological
Association, 2000; Widiger et al., 1996). Indeed, subjects with high scores on Emotional
Detachment and low score on Antisocial Behavior fall within an interesting category of
psychopaths, termed detached. They are rarely studied in empirical research, are characterized by
little prior experience with the criminal justice system, do not meet the criteria for APD, and
generally have jobs unlike those of ordinary prison inmates, being military officers, managers,
politicians, salesmen, etc. (Patrick, 1994; Patrick et al., 1997) Detached criminals, compared with
antisocial ones are characterized by high scores on verbal intelligence, by high socio-economic
status (Patrick et al., 1997) and by a high rate of weapon offences instead of assault offences
(Harpur & Hare, 1991): KT conformed to this profile of detached criminals. Therefore, according to
the PCL-R, he can be classified as a detached psychopath, a category in which most serial killers
probably fall. Like detached psychopaths, many serial killers have a clean police record and no
history of previous problems with the law (Fornari & Birkhoff, 1996), and their lack of antisocial
behavior allows them to be well integrated within society and not easily detectable.

Cognitive Testing
In order to build up a thorough picture of his cognitive capacities, after his informed
consent, KT was submitted to a battery of neuropsychological, social and emotional cognition tests.
There is evidence in the literature that psychopathic offenders may have cognitive deficits, and
some studies point to a deficit in frontal lobe functioning associated with psychopathy and APD
(Gorenstein, 1982). However, frontal lobe impairment has been questioned by Robert D. Hare who,
in prisoners high on both APD and PCL-R, did not find deficits in the Wisconsin Card Sorting Test
(WCST) (Hare, 1984). Current models on psychopathy point to a consistent frontal lobe
dysfunction (Kiehl, 2006; Raine et al., 1998, 2000; Raine & Yang, 2006), mainly at the level of the

Angrilli et al. Cognition in a serial murderer

orbitofrontal cortex, which spares the main cognitive functions and involves social and emotional
cognition and affective physiological responses (Blair, 1995; Herpetz et al., 2001). Damage to the
human orbitofrontal cortex confirms a selective deficit in affective responses, in particular to
defensive responses and negative emotions, without any impairment of cognitive functions (Angrilli
et al., 1999, 2008). Raine et al. (1998) clarified this issue by distinguishing affective murderers who
exhibit reduced frontal activation and predatory murderers with normal frontal functioning. In
agreement with these results, we expected that KT, a predatory murderer, would perform normally
on tests measuring perseveration (Wisconsin Card Sorting Test) and planning (Tower of London).
Accordingly, his scores on the intelligence test (Raven IQ = 120) was normal and frontal lobe
functioning (perseveration and flexibility by the Wisconsin Card Sorting Test) was within normal
range (table 2). Tower of London fell close to the lower range of normal performance (z=-1.1), a
result pointing to a mild deficit in planning, especially when it is compared with his relatively high
intelligence.
________________________________
Insert Table 2 about here
________________________________

On a test measuring the ability to interpret other persons' mental states, the Theory Of Mind
(TOM) test (Happ, 1994), KT had a normal score (table 2). This test was developed to assess the
main social interaction deficit of autistic patients, by asking subjects to interpret the intentions of
other people. For normal subjects, TOM is a very easy test, and it is for this reason that the score
range in controls is very small (table 2). Our present results are in line with another study (Blair et
al., 1996) which, in psychopaths diagnosed by the PCL-R, did not find any deficit in the Theory of
Mind test.

Angrilli et al. Cognition in a serial murderer

10

Emotion Attribution Test and Recognition of Social/Moral situations

In the Emotion Attribution Test KT had scores within normal range for recognition of
sadness, fear, disgust, happiness and envy, but was significantly poor in identifying embarrassment
and anger (see table 3). Indeed, none of the 60 controls scored as low as KT on embarrassment and
anger. This result seems to contrast with the literature on psychopaths which mainly indicates a
deficit in the recognition of sadness and fear (Blair & Coles, 2001; Blair et al., 2002; Eisenbarth et
al., 2008). However, previous studies used different tests based either on prosody or recognition of
facial expression of emotions in pictures, methods which may make a difference and which
probably cannot be easily generalized. Instead, a study which used the same emotion tests as those
of the present study, made on a case (named J.S.) of acquired psychopathy following a right
temporofrontal lobe lesion (Blair & Cipolotti, 2000), showed an impairment similar to that of KT
on the recognition of embarrassment and anger. In addition, unlike KT, J.S. showed impairment of
the recognition of fear, a result common to other experiments on psychopaths (Blair & Coles, 2001;
Blair et al., 2002). In general, in psychopathy, there is evidence of a lack to respond to negative
emotions, which may include punishment (Hare & Quinn, 1971; Hare et al., 1978) or elaboration of
aversive stimuli and situations (Birbaumer et al., 2005; Herpetz et al., 2001; Patrick, 1994; Patrick
et al., 1997; Raine et al., 1995). From this view, KTs deficit in the recognition of embarrassment
and anger is in line with the general deficit shown by psychopaths to processing aversive situations,
but it is important to note that he had normal scores on the recognition of fear, the most common
deficit exhibited by APD offenders. Therefore, KTs intact skill to recognize fear may represent one
of the landmarks which differentiate antisocial psychopaths from serial killers, making the latter a
group closer to normality.
________________________________
Insert Table 3 about here
________________________________

Angrilli et al. Cognition in a serial murderer

11

In the Social Situation Test, KT was able to recognize normal behavior, but he showed a
mild impairment (i.e. below the 10th percentile, but within the range of controls, that is, the lowest
scores from the control group were comparable with those of KT.) in the recognition of aberrant
behavior and in the evaluation of its severity (see table 3).
In the test for distinction of moral/conventional violations prototypical psychopaths show an
altered pattern, as they tend to judge conventional violations as if they were moral violations and to
confound the two categories (Blair, 1995). Instead, KT was affected in this test in a substantially
different way. Unlike reports on psychopaths, he was able to recognize all moral violations (table
3), but underestimated their severity, although his severity score partially overlapped the lowest
scores of controls.
In striking contrast with his cognition on morality, KT was greatly impaired in the
recognition of violation of conventional social rules, as he did not recognize them as violations; also
their severity was completely underestimated (see table 3). In line with this result, there is
biographical evidence during his adolescence, of decreased compliance for conventional school
rules. Nevertheless, it is worth noting that his childhood and adolescence never moved toward overt
anti-social behavior. The overall pattern on social and emotional cognition tests was not found on
any of the 60 matched males used as controls and for score standardization. Review of the literature
(Blair, 1995) indicates that psychopaths reach a lower level of moral reasoning and competence:
therefore, in line with common sense, serial murderers, as well as psychopaths, are expected to be
impaired mainly at recognizing moral rules. Instead, KT had relatively intact moral cognition. This
fits the characteristic of a missionary-type serial killer who differentiates victims mainly as regards
the moral aspects of their lives.
However, his severe impairment in identifying social situations and violation of
conventional social rules was unexpected, and seems to represent KTs main deficit, which
involved the social cognition domain. This impairment may have lowered KTs threshold to act
violence toward others. However, his offences did not arise from the typical impulse dyscontrol

Angrilli et al. Cognition in a serial murderer

12

which characterizes APD psychopaths as his acts (like those of most serial killers) were highly
controlled and planned, and furthermore KTs impairment in social cognition was not accompanied
by an evident antisocial behavior.

Conclusions

Our results indicate that serial killers may represent a quite separate category of
psychopathy, characterized by a lack of antisocial behavior and a high level of emotional
detachment, together with selective impairment in social and emotional cognition, a deficit
relatively confined in comparison with classic APD. Quite in line with the literature on predatory
murderers who have been found to have normal frontal lobe functioning (Raine et al., 1998), KT
did not exhibit any deficit in the Wisconsin Card Sorting test, but a borderline performance in the
planning represented by the Tower of London was found. This result fits with the view that most
serial murderers are almost always captured, and therefore although they are highly functioning
criminals, at the end they are unsuccessful, possibly because some limits in planning and strategy.
The most striking result was the dissociation between the correct recognition of moral violations
and the completely impaired ability to recognize violation of social conventional rules and their
severity. Contrary to expectations, KT showed that extreme psychopathy might be associated with
relatively intact moral cognition. This provides an important issue also for forensic psychology,
since courts may base sentences on the capability of defendants for moral distinction.
The impairment in moral cognition seems to hold for psychopaths selected by means of the
PCL-R (Blair, 1995). In agreement with this, there is an increasing literature pointing to a link, in
healthy humans, between moral reasoning and capability to feel emotions, as the same brain
structures seem to subserve the two functions (Greene et al., 2001). The observation in our serial
killer of a relatively intact moral cognition in face of an emotional detachment and specific deficits
in the Emotion attribution test, raises an issue about the possibility of a dissociation between

Angrilli et al. Cognition in a serial murderer

13

emotions and morality in patients like this serial murderer, at least at the cognitive level and within
the cognitive functions investigated in the present study. Nevertheless, what is most important in the
present study is that, notwithstanding the lack of a clear psychiatric diagnosis through the use of
classic instruments, we found evidence that KT, one of the most elusive type of serial murderer,
exhibited an abnormal specific pattern on cognitive testing with affected recognition of
conventional social rule violations and embarrassment/anger emotions. This is relevant in view of
the consideration that, among all categories of serial killers, the missionary type is the most
selective with his victims and is usually well integrated within society, and therefore exhibits a
phenotype very close to that of healthy individuals.
We believe that, as standard practice in courts, psychiatric evaluation should always be
accompanied by a neuropsychological assessment focussed on cognitive and emotional functioning
of the defendant. It is necessary of course to be cautious in generalizing results from a single case,
and hopefully other serial murderers will be tested with quantitative tests comparable with those
used in the present research.

Conflict of interest
The authors report no conflicts of interest.

Abbreviations: APD, Antisocial Personality Disorder; PCL-R, Psychopathy Checklist Revised;

TOM, Theory Of Mind Test; WCST, Wisconsin Card Sorting Test; MMPI-2, Minnesota
Multiphasic Personality Inventory revised.

Angrilli et al. Cognition in a serial murderer

14

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Angrilli et al. Cognition in a serial murderer

==================================================================
Table 1. SCORES OF KT ON MINNESOTA MULTIPHASIC INVENTORY (MMPI-2)
__________________________________________________________________________
SCALE

SCORE

L
F
K
Hs
D
Hy
Pd
Mf
Pa
Pt
Sc
Ma
Si

46
51
65
60
55
55
58
43
58
59
66
36
53

Lie
Frequency
Correction
Hypocondriasis
Depression
Hysteria
Psychopathic deviance
Masculinity-Femininity
Paranoia
Psychasthenia
Schizophrenia
Hypomania
Social Introversion

17

Angrilli et al. Cognition in a serial murderer

==================================================================
Table 2. SCORES OF KT ON COGNITIVE TESTS
__________________________________________________________________________
Test

KT raw score

standard score

Ravens Matrices

43/46

IQ = 120

Tower of London

23/36

z = -1.1

Wisconsin Card Sorting Test

Errors:
Perseverative Errors:
Number of Categories:
Attempts:

11
4
6
87

z = -0.37
z = -0.55
z = 0.38
z = 0.17

Theory of Mind Test

KT score

Cut-off

12/13

< 12/13

Control
Range
11-13

Control
Mean
12.7

18

Angrilli et al. Cognition in a serial murderer

19

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Table 3. SCORES OF KT ON EMOTIONAL/SOCIAL COGNITION TESTS COMPARED WITH
NORMATIVE VALUES FROM 60 MATCHED MALES*
__________________________________________________________________________

Test

KT score

Cut-off

Control
Range

Control
Mean

6/10
9/10
5/12
2/3
10/10
5/10
1/3

<6/10
<8/10
<8/12
<2/3
<10/10
<6/10
<1/3

6-10
7-10
7-12
1-3
10-10
6-10
0-3

8.6
8.9
10.4
2.8
10.0
8.6
2.3

Recognition of normal situations

15/15

<13/15

12-15

14.3

Recognition of aberrant behavior

21/25

<22/25

21-25

24.0

Severity of aberrant behavior

43/75

<45/75

24-68

53.3

Recognition of moral violations

6/6

<6/6

5-6

5.9

Severity of moral violation

35/60

<39/60

20-60

51.9

Recognition of conventional
violations

1/6

<5/6

4-6

5.6

Severity of conventional
violations

1/60

<20/60

13-54

38.6

Emotion Attribution Test

Sadness
Fear
Embarassment
Disgust
Happiness
Anger
Envy

Social situations

Recognition of moral/conventional
violations

___________________________________________________________________________
* cut-off was computed as 10th percentile of normative data collected from a sample of 60 matched
males. Scores are numbers of correct responses out of total (e.g.: 6/10 indicates 6 correct responses
out of a total of 10). Significantly affected scores are underlined, scores also out of controls range
are underlined and bold.