Elsevier

Psychiatry Research

Volume 142, Issues 2–3, 15 June 2006, Pages 107-128
Psychiatry Research

Review article
A cognitive neuroscience perspective on psychopathy: Evidence for paralimbic system dysfunction

https://doi.org/10.1016/j.psychres.2005.09.013Get rights and content

Abstract

Psychopathy is a complex personality disorder that includes interpersonal and affective traits such as glibness, lack of empathy, guilt or remorse, shallow affect, and irresponsibility, and behavioral characteristics such as impulsivity, poor behavioral control, and promiscuity. Much is known about the assessment of psychopathy; however, relatively little is understood about the relevant brain disturbances. The present review integrates data from studies of behavioral and cognitive changes associated with focal brain lesions or insults and results from psychophysiology, cognitive psychology and cognitive and affective neuroscience in health and psychopathy. The review illustrates that the brain regions implicated in psychopathy include the orbital frontal cortex, insula, anterior and posterior cingulate, amygdala, parahippocampal gyrus, and anterior superior temporal gyrus. The relevant functional neuroanatomy of psychopathy thus includes limbic and paralimbic structures that may be collectively termed ‘the paralimbic system’. The paralimbic system dysfunction model of psychopathy is discussed as it relates to the extant literature on psychopathy.

Introduction

Psychopathy is a serious mental health disorder. Psychopathy is believed to affect approximately 1% of the general population, 15–25% of the male and female prison population (Hare, 1991, Hare, 2003), and 10–15% of substance abuse populations (Alterman and Cacciola, 1991, Alterman et al., 1993, Alterman et al., 1998). Over the last 20 years, much has been learned about the assessment and characterization of the forensic and legal aspects of psychopathy. However, compared with other psychiatric disorders of similar prevalence, relatively little is known about the neural systems implicated in psychopathy. This review will draw on information from multiple disciplines, including neurology, psychiatry, psychology, cognitive neuroscience, psychophysiology, and epileptology. The literatures will be integrated and a new model of the functional neuroanatomy underlying psychopathy will be presented. The review is offered in several parts. First, the assessment and classification of psychopathy is reviewed. The second part of the review will draw upon indirect evidence from studies of how insults or damage to regions of the brain may lead to symptoms and cognitive abnormalities consistent with those observed in psychopathy suggesting that these latter circuits may be implicated in the disorder. The third part of the review focuses on the cognitive and affective neuroscience studies of psychopathy. Finally, a new model of the functional neuroanatomy underlying psychopathy will be presented.

Section snippets

The construct and assessment of psychopathy

The modern concept of psychopathy can be traced back to the psychiatrist Pinel (1792 as cited in Cleckley, 1941), who labeled the condition ‘madness without delirium’. This term was used to denote the lack of morality and behavioral control in these individuals that occurred despite the absence of any psychotic symptoms or defects in intellectual function. In the 200 years that followed, the condition has been through an evolution in terminology, but many of the defining characteristics have

Neurology and psychopathy

One way to examine the possible neural regions implicated in psychopathic behavior is to draw from studies of behavioral changes and cognitive impairments associated with damage to specific brain circuits. It is important to recognize that this method provides only indirect evidence of the possible regions implicated in psychopathic symptomatology; nevertheless, some interesting and compelling data have accumulated. The most notable neurological case study is that of the railroad worker Phineas

Neuropsychological test findings in psychopathy

Reviews of neuropsychological function in psychopathy show no consistent relationship of standard measures of IQ, visuospatial ability, memory, selective attention, or simple motor control to psychopathy ratings on the PCL-R (Hare, 1984, Hare, 2003). Thus, it can be argued that traditional neuropsychological assessment is not particularly sensitive to those cognitive abnormalities that have been measured in psychopathy. It may be possible, however, that neuropsychological information such as IQ

Abnormalities in neurocognitive function in psychopathy

Using the PCL-R (or its predecessors) for assessment, researchers have found that psychopathy is associated with performance abnormalities in several affective and cognitive domains. The extant psychophysiological and cognitive neuroscience literature on psychopathy can be broadly classified into three general areas: 1) language, 2) attention and orienting processes, and 3) affect and emotion. Each of these areas will be reviewed with particular attention to studies that have used

Language processes and psychopathy

Early research sought to identify impairments in cognitive functioning by examining the relationship between psychopathy and hemispheric lateralization for language function (Day and Wong, 1996, Hare, 1979, Hare and Jutai, 1988, Hare and McPherson, 1984, Jutai et al., 1987, Raine et al., 1990). These studies generally found that psychopathy appeared to be related to abnormalities in the cerebral lateralization for some language stimuli, particularly for language functions of the left hemisphere.

Attention and orienting processes in psychopaths

Studies of attention and orienting can be traced back to the earliest days of psychophysiological research in psychopathy. In a classic study, Lykken (1957) found that psychopathic individuals [defined by ratings on Cleckley (1941) criteria] failed to show conditioned autonomic increases in skin conductance in an aversive conditioning paradigm using electric shock (Lykken, 1957). Dozens of studies examining the relationship between psychopathy and peripheral measures of autonomic nervous system

Affective processes in psychopathy

A variety of different methods have been used to assess affective processes in psychopaths. Previously the studies examining affective processes in psychopathy in the context of linguistic tasks were reviewed. These studies largely found that psychopaths do not differentiate the subtleties between affective and neutral stimuli in the same way that criminal nonpsychopaths and healthy individuals do. Studies using the startle–reflex methodology have shown that psychopaths do not show the normal

Psychopathy as a disorder of the paralimbic system

Studies of patients with brain damage suggest that regions of the frontal lobe, including the orbital frontal cortex and anterior cingulate, and regions of the temporal lobe, including the amygdala, parahippocampal gyrus, and anterior superior temporal gyrus, are implicated in psychopathic symptomatology. Psychophysiological studies employing ERPs have repeatedly shown that psychopaths' brain potentials elicited by salient stimuli are associated with aberrant late negativities (see Fig. 1).

Acknowledgements

The author thanks his mentors, Drs. Michael R. Levenson, George R. Mangun, Robert D. Hare, and Peter F. Liddle for their tutelage. This work was supported by NIMH grants 1 R01 MH0705539-01 (PI: Kiehl) and 1 R01 MH072681-01 (PI: Kiehl).

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