Antisocial Personality Disorder: Neurophysiological Mechanisms and Distinct Subtypes

Meta-analysis of associations between empathy and alcohol use and problems in clinical and non-clinical samples

AIMS

To (1) measure the aggregated effect size of empathy deficits in individuals with alcohol use disorder (AUD) compared with healthy controls, (2) measure the aggregated effect sizes for associations between lower empathy and heavier alcohol consumption and more alcohol problems in non-clinical samples and (3) identify potential moderators on the variability of effect sizes across studies in these meta-analyses.

METHOD

PsycINFO, PubMed and Google Scholar were searched following a pre-registered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We meta-analyzed (using random-effects models) mean differences in empathy between individuals with AUD compared with healthy controls and associations between empathy and alcohol consumption and alcohol problems in non-clinical samples. A total of 714 participants were included in the meta-analysis on clinical samples; 3955 were included in the meta-analyses on non-clinical samples.

RESULTS

Individuals with AUD reported significantly lower empathy than healthy controls [Hedges' g = -0.53, 95% confidence interval (CI) = -0.91, -0.16, k = 9, P < 0.01, Q = 40.09, I2  = 80.04]. Study quality [Q = 1.88, degrees of freedom (d.f.) = 1, P = 0.17] and gender (β = -0.006, Z = -0.60, P = 0.55) were not moderators. Increases in age corresponded to an increase in effect size (β = 0.095, Z = 3.34, P < 0.001). Individuals with AUD (versus healthy controls) had significantly lower cognitive (Hedges' g = -0.44, CI = -0.79, -0.10, P < 0.05), but not affective empathy (Hedges' g = -0.19, CI = -0.51, 0.14, P = 0.27), and the difference between these was significant (Z = 2.34, k = 6, P < 0.01). In non-clinical samples, individuals with lower (versus higher) empathy reported heavier alcohol consumption (r = -0.12, CI = -0.15, -0.09, k = 11, P < 0.001, Q = 9.68, I2  = 0.00) and more alcohol problems (r = -0.08, CI = -0.14, -0.01, k = 7, P = 0.021, Q = 6.55, I2  = 8.34). There was no significant heterogeneity across studies.

CONCLUSION

Individuals with alcohol use disorder appear to show deficits in empathy compared with healthy controls. Deficits are particularly pronounced for older individuals and for cognitive (versus affective) empathy. In non-clinical samples, lower empathy appears to be associated with heavier alcohol consumption and more alcohol problems.

Concurrent, Convergent, and Discriminant Validity of the DSM-5 Section III Psychopathy Specifier

Section III of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorder diagnosis that conceptualizes antisocial personality disorder as an interpersonal, rather than behavioral, construct. However, the diagnostic specifier for psychopathy has been met with recent controversy due to its conceptual and empirical overlap with triarchic boldness, which has been debated as a necessary and sufficient domain of psychopathy. This study examined the concurrent, convergent, and discriminant validity of the specifier using canonical correlation analysis in samples of undergraduate students (N = 224) and community adults with prior criminal involvement (N = 306). Findings highlight the specifier as a multidimensional construct with divergent associations across its three facets. There was limited validity evidence for two of the three facets, raising concerns regarding the clinical utility of the psychopathy specifier.

Neural response to aggressive and positive interactions in violent offenders and nonviolent individuals

BACKGROUND

Due to its severe negative consequences, human violence has been targeted by a vast number of studies. Yet, neurobiological mechanisms underlying violence are still widely unclear and it seems necessary to aim for high ecological validity to learn about mechanisms contributing to violence in real life.

METHODS

The present functional magnetic resonance imaging (fMRI) study investigated the neurofunction of individuals with a history of violent offenses compared with that of controls using a laboratory paradigm requesting individuals to empathically engage in videos depicting provocative aggressive and positive social interactions from a first-person perspective.

RESULTS

The contrast of aggressive vs. positive scenarios revealed midbrain activation patterns associated with caudal periaqueductal gray (PAG) in violent offenders; In controls, the rostral PAG was involved. Additionally, only in controls, this contrast revealed an involvement of the amygdaloidal complex. Moreover, in violent offenders the contrast of positive vs. aggressive situations revealed an involvement of areas in the insula, post-central gyrus and anterior cingulate cortex.

CONCLUSIONS

Our results support findings on the differential role of PAG subdivisions in response to threat and point to altered processing of positive social interactions in violent offenders. They further support the notion that changes in PAG recruitment might contribute to violent individuals "taking action" instead of freezing in case of threatening situations.

Superethics Instead of Superintelligence: Know Thyself, and Apply Science Accordingly

The human species is combining an increased understanding of our cognitive machinery with the development of a technology that can profoundly influence our lives and our ways of living together. Our sciences enable us to see our strengths and weaknesses, and build technology accordingly. What would future historians think of our current attempts to build increasingly smart systems, the purposes for which we employ them, the almost unstoppable goldrush toward ever more commercially relevant implementations, and the risk of superintelligence? We need a more profound reflection on what our science shows us about ourselves, what our technology allows us to do with that, and what, apparently, we aim to do with those insights and applications. As the smartest species on the planet, we don't need more intelligence. Since we appear to possess an underdeveloped capacity to act ethically and empathically, we rather require the kind of technology that enables us to act more consistently upon ethical principles. The problem is not to formulate ethical rules, it's to put them into practice. Cognitive neuroscience and AI provide the knowledge and the tools to develop the moral crutches we so clearly require. Why aren't we building them? We don't need superintelligence, we need superethics.

Individual Contribution of Youth Antisocial Symptoms to Suicide Behavior in Adults with Substance Use Disorders

This study assesses the individual contribution of youth symptoms of antisocial personality disorder (before the age of 15) in past-month suicidal behavior in adults with substance use disorders. Youth antisocial symptoms and suicidal behavior were assessed using the Mini International Neuropsychiatric Interview. Indicators of youth antisocial symptoms were significantly associated with suicide outcomes; lack of remorse (OR = 2.68 CI 95% 1.37, 5.25), and sexual assault with planning, and destruction of property to attempt (OR = 4.22 CI 95% 1.29, 15.08). Our results suggest that specific antisocial indicators during adolescence could be associated with suicide in adulthood, even after controlling for major depressive disorder. Further implications for the research of antisocial symptoms and suicide behavior from a developmental perspective are discussed.