Overactivity in Psychopathy

Individuals with psychopathic traits have deficits in their ability to experience remorse, and lack emotional empathy. Their interpersonal relationships are characterized by a pattern of manipulation of others for individual gain (Decety et al., 2013). Psychopaths make up approximately 1% of the general population, however these individuals comprise approximately 23% of prison populations (Decety et al., 2013). The discrepancy in the statistics between community and prison populations speaks to the inability of the mental health system and society in general to adequately manage, treat, and rehabilitate these individuals. Perhaps the difficulty with treatment is not only attributable to the treatment resistant nature of the disorder itself. It is possible that psychiatry and science has developed an understanding of these individuals that is incorrect. The conceptualization, description, and understanding of psychopathic individuals has long been rooted in what these individuals lack. Our understanding of these individuals has been colored by the fact that outwardly they seem to lack the very qualities that make us humans; connectedness, empathy, fear, and love.  The emphasis on what is lacking may be misguided. This may prevent a more accurate representation of these individual’s struggles, and impede successful treatment. Recent research has shed light on areas of the brain that are overactive in these individuals and ways in which this information can inform future treatment options.

Buckholtz et al. (2010) conducted a study that examined the role of the mesolimbic dopamine reward system, and how overactivity of this system in individuals with psychopathic characteristics may drive destructive behavior. Impairments in emotional empathy and social connectedness are concerning; however, impulsive, reward seeking and risky behaviors are what lead to violent crimes, recidivism, and substance abuse. In order to better understand what drives reward seeking behaviors Buckholtz et al. (2010) used positron emission tomography (PET) imaging to visualize participant’s brains and monitored dopamine release. The PET scan was done in conjunction with functional magnetic imaging (fMRI) to examine the brain’s reward system. The participants received a dose of amphetamine to induce a response from a physiologically rewarding experience. Following administration of amphetamine, brain scans were completed to measure dopamine release in response to the stimulant. Remarkably, people who had scored high on psychopathic trait tools had almost four times the amount of dopamine released in response to the pleasurable stimuli (Buckholtz et al., 2010). This finding is significant because it suggests that psychopathic behavior is not necessarily driven by a lack of empathy and a drive to harm others. This excessive dopamine response may suggest that behavior in these individuals is also driven by a need for pleasurable experience and reward response within the brain (Buckholtz et al., 2010).

Buckholtz et al. (2010) followed up by telling participants they would receive monetary rewards for completing a task. Participants’ brains were monitored with fMRI during task completion. The researchers found that the nucleus accumbens, the dopamine reward area of the brain, was more active in individuals with high psychopathic traits when anticipating the monetary reward. Again, this finding emphasizes the possibility that because of these exaggerated dopamine responses in reaction to rewards, psychopaths are not capable of considering the needs of others (Buckholtz et al., 2010). This drive for dopamine may then be translated outwardly to cold, callous affect and lack of regard for others that is seen in individuals with psychopathic traits.

In another study Decety et al. (2013) examined reactivity in response to imagined pain in the brains of their sample, which included individuals who scored high on a psychopathic trait inventory measure in addition to healthy controls. Participants who had scored high on psychopathic trait inventory imagined harm that would be severe enough to inflict physical pain being done to them. In response to this prompt, these individuals displayed an exaggerated response; regions involved in empathy including the anterior insula, the anterior midcingulate cortex, somatosensory cortex and the right amygdala all showed unusually pronounced neural activation. However, as expected, when these individuals imagined physical pain being inflicted upon others, these neural networks failed to become activated (Decety et al., 2013). This study reveals a potential possibility of using the response individuals with psychopathic traits are capable of experiencing in response to their own imagined pain to “kick start” the process of empathy for others. Further research is required to better understand how the process could be generalized however the concept of kick starting empathy with one’s own imagined pain is interesting nonetheless.

These studies by do not provide specific treatment options to implement with individuals with psychopathic traits, nor do they imply that these tendencies can be easily treated or reformed. What can be taken from these studies is that the inner workings and processes that drive psychopathic behaviors are complex in nature. These studies suggest the possibly that the symptoms that characterize antisocial personality disorder are as deeply rooted within the neurobiology as the processes of love, compassion, and need for social connectedness are in you and me. With additional research, and a better understanding of the neurobiology behind antisocial personality disorder, there is the possibility that we can be successful in reducing the rates of incarceration and improving outcomes within community settings.

References

Buckholtz, J. W., Treadway, M. T., Cowan, R. L., Woodward, N. D., Benning, S. D., Li, R., . . . Zald, D. H. (2010). Mesolimbic dopamine reward system hypersensitivity in individuals with psychopathic traits. Nature Neuroscience Nat Neurosci, 13(4), 419-421. doi:10.1038/nn.2510

Decety, J., Chen, C., Harenski, C., & Kiehl, K. A. (2013). An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy. Frontiers in human neuroscience, 7, 489.

Gregory, S., Blair, R. J., Ffytche, D., Simmons, A., Kumari, V., Hodgins, S., & Blackwood, N. (2015). Punishment and psychopathy: A case-control functional MRI investigation of    reinforcement learning in violent antisocial personality disordered men. The Lancet Psychiatry, 2(2), 153-160. doi:10.1016/s2215-0366(14)00071-6

Humphreys, K. L., Mcgoron, L., Sheridan, M. A., Mclaughlin, K. A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2015). High-Quality Foster Care Mitigates Callous-Unemotional Traits Following Early Deprivation in Boys: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 54(12), 977-983. doi:10.1016/j.jaac.2015.09.010