Psycopathy Flashcards
Psychopathy according to different people
- Pinel (1792): “manie sans délire” (madness without delusions)→ lack of morality and impulsive and violent acts despite the absence of psychotic symptoms or deficits in intellectual functioning
- Rush (early 1800): “derangement of the moral faculties”→ irresponsibility without shame
- Pritchard (1835): “moral insanity”→ intact intellect with impaired moral qualities, no delusions
- Lombroso (1876): “born criminal”, “criminal mind” identified by deformations of skull and face
- Partridge (1930): “sociopathic personality”→ importance of environmental and cultural influences; failure to conform to societal demands, lack of socialization
- Cleckley (1941): affective (shameless, lacking empathy and remorse, fearless, callous), interpersonal (manipulative, selfish, superficially charming, lying), and behavioral (impulsive, domineering, irresponsible) features. Emotional deviation (rather than criminality) is fundamental to the clinical conception of psychopathy. Psychopathy is not restricted to individuals showing criminal or violent, antisocial behavior, but can also be found among socially well-adjusted and high-functioning individuals (e.g., corporate managers, executives, scientists, physicians)
Hare Psychopathy Checklist-Revised (PCL-R)
Hare and colleagues (1980, 1991, 2003) operationalized and transformed Cleckley’s characteristics into items on the Hare Psychopathy Checklist-Revised (PCL-R), considered as the “golden standard” instrument for the assessment of psychopathy
• Developed for use in correctional samples
• Semi-structured standardized interview covering school adjustment, employment, intimate
relationships, family, friends, criminal activity
• Assessment is performed by first reviewing the individual’s institutional records
• 20 items scored on a three-point scale (0=does not apply; 1=applies somewhat; 2=definitely applies)
• Score range = 0-40 (recommended cut-off=30; non-psychopaths < 20)
• Factor 1: “emotional detachment” (affective/interpersonal traits)
• Factor 2: “antisocial behavior” (impulsiveness, antisociality, violent behavior)
• Interview is videotaped for independent rating
• Time to complete assessment: 2-5 h
• Training is required
Psychopathy and DSM5?
• “Psychopathy” is NOT a diagnostic category in the DSM-5 or ICD 11
• Psychopathy is not the same as Antisocial Personality Disorder (DSM-5)
or Dissocial Personality Disorder (ICD)
Antisocial Personality Disorder
A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
1. failure to conform to social norms withrespect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being
indifferent to or rationalizing having hurt,
mistreated, or stolen from another
Dissocial Personality Disorder
At least three of the following must be present:
1. callous unconcern for the feelings of others;
2. gross and persistent attitude of irresponsibility and disregard for social norms, rules, and
obligations;
3. incapacity to maintain enduring relationships, though with no difficulty in establishing them;
4. very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. incapacity to experience guilt, or to profit from adverse experience, particularly punishment;
6. marked proneness to blame others, or to offer plausible rationalizations for the behaviour
that has brought the individual into conflict with society
Psychopathy prevalence
• Prevalence in the general population is 0.6-1% (less common among women)
• Early temperamental/behavioral predictors in childhood (incl. low autonomic arousal, fearlessness, sensation seeking, cruelty to animals)
• About 10-15% of substance abuse populations
• About 3.5% in the business world
• About 75% of the male and female prison population fit Antisocial Personality Disorder criteria, but inmates fitting psychopathy criteria are much fewer (men 15-25%; women ~7%)
• Recidivism within 3 years from release is higher among psychopathic offenders (60-80%) than among non-psychopathic offenders (18-25%)
Brain regions implicated in psychopathy:
Indirect evidence from “pseudopsychopathy” or “acquired sociopathic personality” following brain damage => Damage to the orbitofrontal cortex is followed by psychopathic-like characteristics and
behavior, including lack of empathy, impulsivity, irresponsibility, poor insight and socially inappropriate behavior. However, patients with OFC damage have major problems with reactive
(not with instrumental) aggression, are characterized by lack of motivation and inability to make long-term plans, and do not typically show callousness (indifference, insensitivity, active disregard)
Callousness vs lack of empathy
• Callousness does not necessarily indicate “lack of empathy”
• Empathy involves actively simulating or sharing another’s emotional experience (affective empathy) and understanding another’s perspective, representing another’s internal mental
state (cognitive empathy)
• If callousness were just lack of empathy, then it would involve deficits in emotional responding to the affective state of another, impaired ability to represent another’s mental states, and lack of
prosocial behaviors
• Instead, callous/unemotional individuals have normal cognitive empathy, but show a deficit in emotionality accompanied by active disregard (indifference, enjoyment, disdain, hostility) for others in distress (not just lack of prosocial behaviors
Beyond the OFC: other brain regions possibly implicated in psychopathy
Anterior cingulate
- lesions of the ACC → lack of empathy, hostility, irresponsibility, perseveration, difficulties in identification of emotional facial and vocal expressions, problems with error monitoring and response inhibition
Temporal lobe (amygdala, hippocampus, insula, superior temporalgyrus)
- lesions of the medial temporal lobe (TL) and amygdala in monkeys → abnormal approach behavior and fearlessness, hyperactivity, hypersexuality (Kluver-Bucy syndrome); in humans→ mild antisocial behavior (e.g., rebelliousness, disregard for social conventions, lack of
respect for authorities)
- lesions of the anterior TL, amygdala and insular cortex → impulsivity, poor behavioral control, lack of empathy
- herpes simplex viral encephalitis → aggressive and disruptive behavior
- TL epilepsy (commonly involving amygdala, hippocampus, parahippocampal gyrus, and anterior superior temporal gyrus) → psychopathy-like behaviors
The neural correlates of psychopathy
The fronto-temporo-limbic network:
The orbital cortex and adjacent prefrontal areas such as the frontal pole, the ventromedial PFC and ventral anterior cingulate
The anteromedial temporal lobe, including the amygdala, the parahippocampal gyrus, and the superior temporal gyrus
Dysfunction of brain areas within the fronto-temporo-limbic network would be related to impairment in:
Fronto polar cortex:
- attending to (and reflecting on) self-generated information and one’s own emotional states;
- representing long-term social goals and norms/values
- the ability to perform tasks related to one goal, while keeping in working memory information
related to a secondary goal (“cognitive branching”)
OFC:
- representing the reward-punishment value of a stimulus, and projecting of future outcomes based on expectations of planned near-term actions
- adapting behavior to reinforcement conditions (reversal learning)
- decision making
vmPFC/ACC
- attachment and interpersonal cooperation motivated by empathy and altruism
- using feedback signals from the body to guide complex decision-making
superior anterior temporal cortex:
- representing social conceptual knowledge (abstract representation of social concepts) → the superior temporal gyrus is part of the extended Theory of Mind circuit (ACC, temporal poles),
involved in decoding social cues, including inferences on intentionality, and empathy
hippocampus/parahippocampal gyrus:
- spatial memory
- regulating aggression through projections to PAG and hypothalamus
- contextual fear conditioning
Amygdala:
- signaling the affective salience of stimuli and events
- aversive and appetitive classical conditioning and stimulus-reinforcement learning
Insula:
- integrating representations of bodily states and higher-order associative processes
- affective and cognitive empathy
- representation of disgust to moral transgressions
The fronto-temporo-limbic network in psychopathy: structural abnormalities
- Decreased prefrontal gray matter (~ 22%)
- Decreased volume of the posterior hippocampus and exaggerated asymmetry (right > left) in the anterior hippocampus
- Reduced gray matter in the right superior temporal gyrus and bilateral amygdala
- Increased volume and length of the corpus callosum
- Gray matter decrease in the medial and lateral OFC, frontopolar cortex, anterior temporal cortex, superior temporal sulcus, and insula in individuals with high PCL:SV (screening version) scores
compared to normal healthy volunteers - The degree of structural abnormalities in the medial OFC/ventral subgenual cortex, FPC, and STS are significantly inversely related to PCL:SV Factor 1 (interpersonal/affective) scores; no significant effects were observed for Factor 2 (lifestyle/antisocial) scores
- Structural connectivity (DTI) → reduced structural integrity in the right uncinate fasciculus, the
primary white matter connection between vmPFC and anterior temporal lobe, including the
amygdala - Functional connectivity (rest-fMRI) → reduced functional connectivity between vmPFC
and amygdala as well as between vmPFC and posterior cingulate/precuneus (medial
parietal cortex)
Together, these data converge to implicate diminished vmPFC connectivity as a characteristic neurobiological feature of psychopathy→ impaired decision making, impaired regulation of emotion and social behavior, deficit in self-reflective cognition
Moral and immoral Brain
• The concept of psychopathy in the 19th century centered on how criminal behavior could be explained by “moral perversion”, “moral insanity”, or derangement of the “moral faculties”
Morality→ sets of customs and values that are embraced by a cultural group to guide social conduct
Moral transgressions are defined by their consequences for the rights and welfare of others→ hitting another, damaging another’s property, …
Conventional transgressions are defined as violations of the behavioral
uniformities that structure social interactions within social systems→
wearing pajamas in public, talking in class, …
• More recent accounts suggest that the behavior of the psychopath is a
consequence of severe impairment/lack of specific cognitive/emotional
mechanisms which are hypothesized as being crucial for the
development of the moral/conventional distinction, moral socialization,
development of moral cognition, and the control of violent behavior
Is there a “moral brain”?
Moral cognition is a part of
social cognition involving a
series of cognitive acts and
judgments associated with
norms, that result in a
conclusion, either implicit
or explicit, about what one
should do or think
Moral cognition involves a remarkably
consistent network of brain regions:
• anterior prefrontal cortex (frontal pole)
• medial and lateral OFC
• dorsolateral PFC (mostly the right
hemisphere)
• ventromedial PFC
• anterior temporal lobes
• superior temporal sulcus region
(including Temporo-parietal junction)
Moll et al., 2005
• amygdala
• ventromedial hypothalamus
• basal forebrain (especially the ventral
striatum/pallidum and extended
amygdala)
• septal area (hippocampus-
hypothalamus connection)
• walls of the third ventricle and rostral
brainstem tegmentum (from
Substantia nigra to cerebral aqueduct
Psychopathy as a disorder of the “moral brain”?
During picture viewing, incarcerated
psychopaths relative to
nonpsychopathic offenders showed
reduced moral/nonmoral picture
distinctions in the anterior temporal
cortex and in the vmPFC→ although
psychopaths recognize morally salient
stimuli, this recognition is not
instantiated in the “moral brain”
Amygdala emotional moral decision making
During emotional moral decision making, higher total psychopathy scores (all factors)
are associated with reduced left amygdala activity
The interpersonal factor is also associated with reduced activity in medial prefrontal cortex,
angular gyrus (parietal lobe; near to posterior STS), and posterior cingulate.
Amygdala dysfunction in psychopathy
• Amygdala dysfunction may be a core deficit in psychopathy
• The amygdala responds to cues or representations of distress in others (e.g., pain, fear/sadness), and is involved in the attribution of negative valence to actions and objects associated with
distress of others (via instrumental learning and classical conditioning); these aversive emotional responses guide individuals away from antisocial behavior and are crucial to moral
socialization
• Reduced amygdala functioning in psychopathic individuals may underlie reduced responsivity to the thought of causing harm to others; without such amygdala activation, individuals may be:
• impaired in moral socialization
• undeterred from conning and manipulating others
• facilitated in taking impulsive, irresponsible decisions
• facilitated in engaging in instrumental aggression (and/or antisocial behavior) without feeling guilt or remorse
Medial prefrontal cortex, posterior cingulate, and angular gyrus dysfunctions in psychopathy?
• Reduced functioning in medial prefrontal cortex, posterior cingulate, and angular gyrus in individuals high on the Interpersonal Factor of psychopathy may indicate dysfunction of complex social processes important for interpersonal interactions and moral behavior, i.e., self-
referential thinking, emotional perspective taking, recalling emotional experiences to guide behavior, and integrating emotion into social cognition
• Dysfunction in these regions may be reflected in:
• failure to represent how one’s actions affect others and the emotional perspective of the harmed other
• failure to integrate emotion into decision-making processes→ increased appropriateness of using others to achieve a goal
