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The response modulation hypothesis (sometimes called RMH or RM) is an etiological theory of which argues that psychopathy is an attention disorder. It posits that when psychopaths focus on a particular goal, they are unable to shift their attention to peripheral signals or cues that might deter them from antisocial behaviors (such as anxiety, empathy or guilt deterring someone from wanting to commit a crime).

This is in contrast to theories of psychopathy as a direct deficit of fear or empathy; instead RM argues that the particular attention modulates whether psychopaths have normal or abnormal levels of fear or empathy.

History and evolution
The theory was first proposed by Gorenstein and Newman (1980) and has since gone through changes. Initially it was proposed as theory of reward hypersensitivity in response to the Low Fear theory proposed by David T. Lykken. Gorenstein and Newman found that animals with septal and hippocampal lesions could behave in ways analogous to human psychopaths: animals with lesions did not respond to punishment conditioning when an award was offered but followed them when there was no award. Similarly, psychopaths have problems with deterrence in the presence of reward.

The theory has since changed to be more generalizable for personal behavior, shifting away from sensitivity to rewards to an attention bottleneck disorder of overly focusing on early information.

Empirical evidence
Meta-analysis have investigated RM studies for empirical validity. One such study by Smith, Lilienfeld and Scott (2015) evaluated 94 experimental samples with a total of 7,340 participants found that the relationship between attention impairment and psychopathy had a statistically significant effect size of 0.20. The authors considered this to be a "small to medium effect." The effect remained largly unchanged when adjusting for factors such as rater bias (raters evaluated how psychopathic an individual was), sample size or authors' bias. They did find however that there could be a publication bias in favor of the theory.

Another study by Hoppenbrouwers, Bulten and Brazil (2016) compared theories of "threat detection" in psychopaths (which they considered to be synonymous with RM) and theories of lower subjective fear in psychopaths. They found that RM had a significant effect size of 0.21 and that there was no significant relationship between psychopathy and lower subjective fear. Referencing Smith et al (2015), they suggested that "disturbed modulation of attention or threat processing impairments in psychopathy seem to outperform other frameworks postulating that a lack of fear experience is central to psychopathy."