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