Attention moderates the processing of inhibitory information in primary psychopathy

Impaired Pavlovian conditioned inhibition in offenders with personality disorders

Certain types of violent offending are often accompanied by evidence of personality disorders (PDs), a range of heterogeneous conditions characterized by disinhibited behaviours that are generally described as impulsive. The tasks previously used to show impulsivity deficits experimentally (in borderline personality disorder, BPD) have required participants to inhibit previously rewarded responses. To date, no research has examined the inhibition of responding based on Pavlovian stimulus–stimulus contingencies, formally “conditioned inhibition” (CI), in PDs. The present study used a computer-based task to measure excitatory and inhibitory learning within the same CI procedure in offenders recruited from the “personality disorder” and the “dangerous and severe personality disorder” units of a high-security psychiatric hospital. These offenders showed a striking and statistically significant change in the expression of inhibitory learning in a highly controlled procedure: The contextual information provided by conditioned inhibitors had virtually no effect on their prepotent associations. Moreover, this difference was not obviously attributable to nonspecific cognitive or motivational factors. Impaired CI would reduce the ability to learn to control associative triggers and so could provide an explanation of some types of offending behaviour.

Breakdown in the brain network subserving moral judgment in criminal psychopathy

Neuroimaging research has demonstrated the involvement of a well-defined brain network in the mediation of moral judgment in normal population, and has suggested the inappropriate network use in criminal psychopathy. We used functional magnetic resonance imaging (fMRI) to prove that alterations in the brain network subserving moral judgment in criminal psychopaths are not limited to the inadequate network use during moral judgment, but that a primary network breakdown would exist with dysfunctional alterations outside moral dilemma situations. A total of 22 criminal psychopathic men and 22 control subjects were assessed and fMRI maps were generated to identify (i) brain response to moral dilemmas, (ii) task-induced deactivation of the network during a conventional cognitive task and (iii) the strength of functional connectivity within the network during resting-state. The obtained functional brain maps indeed confirmed that the network subserving moral judgment is underactive in psychopathic individuals during moral dilemma situations, but the data also provided evidence of a baseline network alteration outside moral contexts with a functional disconnection between emotional and cognitive elements that jointly construct moral judgment. The finding may have significant social implications if considering psychopathic behavior to be a result of a primary breakdown in basic brain systems.

Attention network performance and psychopathic symptoms in early adolescence: an ERP study

Reaction time (RT) and event-related potential (ERP) measures were used to examine the relationships between psychopathic symptoms and three major attention networks (alerting, orienting, and executive attention) among a community sample of youth. Antisocial Process Screening Device (APSD; Frick and Hare 2001) total and subscale scores were negatively correlated with ERP measures of attentional alerting, indicating that youth with psychopathic symptoms had difficulty using warning cues to prepare for upcoming targets. APSD total scores were not related to performance on measures of orienting or executive attention, although weaker executive attention was found among youth with higher scores on the Impulsivity subscale. These findings support attention-based models of psychopathy and provide evidence of specific deficits in attentional alerting among youth with psychopathic traits. Deficiencies in attentional alerting may be related to noradrenergic functioning and may have cascading effects on higher order cognitive and affective processing.

Investigating the neural correlates of psychopathy: a critical review

In recent years, an increasing number of neuroimaging studies have sought to identify the brain anomalies associated with psychopathy. The results of such studies could have significant implications for the clinical and legal management of psychopaths, as well as for neurobiological models of human social behavior. In this article, we provide a critical review of structural and functional neuroimaging studies of psychopathy. In particular, we emphasize the considerable variability in results across studies, and focus our discussion on three methodological issues that could contribute to the observed heterogeneity in study data: (1) the use of between-group analyses (psychopaths vs non-psychopaths) as well as correlational analyses (normal variation in 'psychopathic' traits), (2) discrepancies in the criteria used to classify subjects as psychopaths and (3) consideration of psychopathic subtypes. The available evidence suggests that each of these issues could have a substantial effect on the reliability of imaging data. We propose several strategies for resolving these methodological issues in future studies, with the goal of fostering further progress in the identification of the neural correlates of psychopathy.

Both self-report and interview-based measures of psychopathy predict attention abnormalities in criminal offenders

Historically, psychopathy has been viewed as a clinical syndrome with a unitary etiology, assessed via clinical interview. However, factor analytic studies suggest that psychopathy may also be understood as a combination of two subfactors consisting of (a) interpersonal-affective and (b) lifestyle-antisocial traits. Furthermore, evidence supports the use of self-report measures to assess psychopathy and these subfactors. This investigation employed a Stroop-like task to determine the relationship of the two psychopathy factors, as assessed by both interview-based and self-report measures, to attention-related abnormalities in psychopathy. For both instruments, the factors interacted to predict performance (i.e., interference), though the unique main effects were nonsignificant. The results suggest that the anomalous selective attention of psychopathic offenders is specific to individuals with high scores on both factors. Moreover, these results have important implications for the two-factor model of psychopathy and provide preliminary support for the functional similarity of self-report and interview-based measures of psychopathy.

Cognitive control deficits associated with antisocial personality disorder and psychopathy

Antisociality has been linked to a variety of executive functioning deficits, including poor cognitive control. Surprisingly, cognitive control deficits are rarely found in psychopathic individuals, despite their notoriously severe and persistent antisocial behavior. In fact, primary (low-anxious) psychopathic individuals display superior performance on cognitive control-type tasks under certain circumstances. To clarify these seemingly contradictory findings, we administered a response competition (i.e., flanker) task to incarcerated offenders, who were assessed for Antisocial Personality Disorder (APD) symptoms and psychopathy. As hypothesized, APD related to poorer accuracy, especially on incongruent trials. Contrary to expectation, however, the same pattern of results was found in psychopathy. Additional analyses indicated that these effects of APD and psychopathy were associated with overlapping variance. The findings suggest that psychopathy and APD symptoms are both associated with deficits in cognitive control, and that this deficit relates to general antisociality as opposed to a specific antisocial syndrome.

Specifying the attentional selection that moderates the fearlessness of psychopathic offenders

Our previous research demonstrated that psychopathy-related fear deficits involve abnormalities in attention that undermine sensitivity to peripheral information. In the present study, we specified this attention-mediated abnormality in a new sample of 87 prisoners assessed with Hare's Psychopathy Checklist-Revised (Hare, 2003). We measured fear-potentiated startle (FPS) under four conditions that crossed attentional focus (threat vs. alternative) with early versus late presentation of threat cues. The psychopathic deficit in FPS was apparent only in the early-alternative-focus condition, in which threat cues were presented after the alternative goal-directed focus was established. Furthermore, psychopathy interacted with working memory capacity in the late-alternative-focus condition, which suggests that individuals high in psychopathy and working memory capacity were able to maintain a set-related alternative focus that reduced FPS. The results not only provide new evidence that attention moderates the fearlessness of psychopathic individuals, but also implicate an early attention bottleneck as a proximal mechanism for deficient response modulation in psychopathy.

Abnormal structural correlates of response perseveration in individuals with psychopathy

Structural deficits in the frontotemporal network have been shown in individuals with psychopathy and are posited to contribute to neuropsychological impairments such as response perseveration. However, no study to date has examined structural correlates of response perseveration in individuals with psychopathy. In this structural MRI study, the authors found higher correlations between increased response perseveration and reduced cortical thickness in the orbitofrontal and anterior temporal regions in individuals with psychopathy than in healthy-comparison subjects. The findings provide preliminary evidence suggesting potential contributions of frontotemporal structural deficits in neurocognitive impairment with perseveration in individuals with psychopathy.

Economic decision-making in psychopathy: a comparison with ventromedial prefrontal lesion patients

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: "primary" (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas "secondary" (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups.

Attention moderates the fearlessness of psychopathic offenders

BACKGROUND

Psychopathic behavior is generally attributed to a fundamental, amygdala-mediated deficit in fearlessness that undermines social conformity. An alternative view is that psychopathy involves an attention-related deficit that undermines the processing of peripheral information, including fear stimuli.

METHODS

We evaluated these alternative hypotheses by measuring fear-potentiated startle (FPS) in a group of 125 prisoners under experimental conditions that 1) focused attention directly on fear-relevant information or 2) established an alternative attentional focus. Psychopathy was assessed using Hare's Psychopathy Checklist-Revised (PCL-R).

RESULTS

Psychopathic individuals displayed normal FPS under threat-focused conditions but manifested a significant deficit in FPS under alternative-focus conditions. Moreover, these findings were essentially unchanged when analyses employed the interpersonal/affective factor of the PCL-R instead of PCL-R total scores.

CONCLUSIONS

The results provide unprecedented evidence that higher-order cognitive processes moderate the fear deficits of psychopathic individuals. These findings suggest that psychopaths' diminished reactivity to fear stimuli, and emotion-related cues more generally, reflect idiosyncrasies in attention that limit their processing of peripheral information. Although psychopathic individuals are commonly described as cold-blooded predators who are unmotivated to change, the attentional dysfunction identified in this study supports an alternative interpretation of their chronic disinhibition and insensitive interpersonal style.