White matter correlates of psychopathic traits in a female community sample

Reduced structural integrity of the uncinate fasciculus in incarcerated women scoring high on psychopathy

Both men and women scoring high on psychopathy exhibit similar structural and functional neural abnormalities, including reduced volume of the orbitofrontal cortex (OFC) and reduced hemodynamic activity in the amygdala during affective processing experimental paradigms. The uncinate fasciculus (UF) is a white matter (WM) tract that connects the amygdala to the OFC. Reduced structural integrity of the UF, measured via fractional anisotropy (FA), is commonly associated with men scoring high on psychopathy. However, only one study to date has investigated the relationship between psychopathic traits and UF structural integrity in women, recruiting participants from a community sample. Here, we investigated whether Hare Psychopathy Checklist-Revised (PCL-R) facet scores (measuring interpersonal, affective, lifestyle/behavioral, and antisocial psychopathic traits, respectively) were associated with reduced FA in the left and right UF in a sample of 254 incarcerated women characterized by a wide range of psychopathy scores. We observed that PCL-R Facet 3 scores, assessing lifestyle/behavioral psychopathic traits, were associated with reduced FA in the left and right UF, even when controlling for participant's age and history of previous substance use. The results obtained in the current study help improve our understanding of structural abnormalities associated with women scoring high on psychopathy. Specifically, reduced UF structural integrity may contribute to some of the deficits commonly associated with women scoring high on psychopathy, including emotion dysregulation.

Psychopathic traits modulate functional connectivity during pain perception and perspective-taking in female inmates

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PCL-R scores are associated with altered functional connectivity in female inmates.

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PCL-R Factor 1 and Factor 2 subscores predicted opposite shifts in connectivity.

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Functional connectivity in the salience network is altered during pain perception.

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Connectivity in the social cognition network is altered during perspective-taking.

The ability to share and understand the distress of others is critical for successful social interactions and is a fundamental building block of morality. Psychopathy is a personality disorder that includes lack of empathy and concern for others. In the present study, functional MRI was used to examine neural responses and functional connectivity associated with empathy and affective perspective-taking in female inmates (N = 109) with various levels of psychopathic traits, as measured with Psychopathy Checklist-Revised (PCL-R). Participants viewed hands and feet in painful or non-painful situations while adopting a first person or third person perspective. All participants demonstrated robust neural responses in anterior insula (aINS), anterior cingulate (ACC), temporoparietal junction (TPJ) and supplementary motor area (SMA) when viewing pain, both during imagine-self and imagine-other blocks. Psychopathy shifted the functional connectivity seeded in core nodes of the salience and social cognition networks. Perceiving stimuli depicting somatic pain led to decreased functional coupling from right temporoparietal junction to superior temporal sulcus, which correlated with scores on PCL-R Factor 1 (Affective/Interpersonal). In contrast, connectivity from right insula to precuneus increased with Factor 2 (Lifestyle/Antisocial) scores. When adopting a third-person perspective, psychopathic traits modulated connectivity from the social cognition network, but not the salience network, with Factor 1 scores associated with increased connectivity to sensorimotor cortex and temporal pole, while Factor 2 scores were associated with decreased connectivity with ACC/SMA and inferior frontal gyrus. Overall, these results demonstrate that psychopathic traits in incarcerated females are associated with atypical functional connectivity within the salience network during pain-empathy processing and within the social cognition network during affective perspective-taking.

Multivariate Genetic Structure of Externalizing Behavior and Structural Brain Development in a Longitudinal Adolescent Twin Sample

Externalizing behavior in its more extreme form is often considered a problem to the individual, their families, teachers, and society as a whole. Several brain structures have been linked to externalizing behavior and such associations may arise if the (co)development of externalizing behavior and brain structures share the same genetic and/or environmental factor(s). We assessed externalizing behavior with the Child Behavior Checklist and Youth Self Report, and the brain volumes and white matter integrity (fractional anisotropy [FA] and mean diffusivity [MD]) with magnetic resonance imaging in the BrainSCALE cohort, which consisted of twins and their older siblings from 112 families measured longitudinally at ages 10, 13, and 18 years for the twins. Genetic covariance modeling based on the classical twin design, extended to also include siblings of twins, showed that genes influence externalizing behavior and changes therein (h² up to 88%). More pronounced externalizing behavior was associated with higher FA (observed correlation r_ph up to +0.20) and lower MD (r_ph up to −0.20), with sizeable genetic correlations (FA r_a up to +0.42; MD r_a up to −0.33). The cortical gray matter (CGM; r_ph up to −0.20) and cerebral white matter (CWM; r_ph up to +0.20) volume were phenotypically but not genetically associated with externalizing behavior. These results suggest a potential mediating role for global brain structures in the display of externalizing behavior during adolescence that are both partially explained by the influence of the same genetic factor.

Female Forensic Patients May Be an Atypical Sub-type of Females Presenting Aggressive and Antisocial Behavior

The percentage of forensic psychiatric patients who are female varies from 5 to 13% in Europe, rises to 18% in England and Wales, and sits at 15% in Canada. Similarly, many fewer women than men are incarcerated in correctional facilities. While these statistics supposedly reflect less antisocial and aggressive behavior (AAB) among females than males, not all findings support this supposition. Data from prospective longitudinal studies show that aggressive and antisocial behavior onsets in childhood, and in a small group of females it remains stable across the life-span. Unlike similar males, few of these females are convicted of crimes. This article begins with a review of descriptive studies of females sentenced by criminal courts to treatment in forensic psychiatric hospitals and moves on to present evidence showing that most female AAB does not lead to criminal prosecution. Next, studies of female AAB are reviewed, noting that it onsets in early childhood and, that in a small group remains stable across the life-span. Subsequent sections of the article focus on the two most common mental disorders presented by female forensic patients, schizophrenia and borderline personality disorder, highlighting what is known about the sub-groups of women with these disorders who present AAB. The article concludes with recommendations for earlier identification by psychiatric services of women presenting mental disorders and AAB, treatments to reduce both the symptoms of their mental disorders and their life-long AAB, and the research that is needed in order to improve the effectiveness of these treatments. The real possibilities of prevention of the development of AAB, and even perhaps aspects of the mental disorders that plague female forensic patients, are described.

Psychopathy

Psychopathy is a personality disorder characterized by a constellation of affective, interpersonal, lifestyle and antisocial features whose antecedents can be identified in a subgroup of young people showing severe antisocial behaviour. The prevalence of psychopathy in the general population is thought to be ~1%, but is up to 25% in prisoners. The aetiology of psychopathy is complex, with contributions of both genetic and environmental risk factors, and gene-environment interactions and correlations. Psychopathy is characterized by structural and functional brain abnormalities in cortical (such as the prefrontal and insular cortices) and subcortical (for example, the amygdala and striatum) regions leading to neurocognitive disruption in emotional responsiveness, reinforcement-based decision-making and attention. Although no effective treatment exists for adults with psychopathy, preliminary intervention studies targeting key neurocognitive disturbances have shown promising results. Given that psychopathy is often comorbid with other psychiatric disorders and increases the risk of physical health problems, educational and employment failure, accidents and criminality, the identification of children and young people at risk for this personality disorder and preventative work are important. Indeed, interventions that target the antecedents of psychopathic features in children and adolescents have been found to be effective.

Neural responses to morally laden interactions in female inmates with psychopathy

Much of social cognition requires making inferences about the mental and emotional states of others. Moreover, understanding the emotions of others is an important foundation for moral decision-making. Psychopathy is associated with both aberrant emotional understanding and atypical hemodynamic responses when viewing and evaluating morally laden social interactions. In the present functional MRI study, female inmates (N = 107) were asked to evaluate the likely emotional state of either the recipient or the initiator of harmful or helpful interactions. Psychopathy was assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R scores were not associated with differences in confidence or accuracy ratings. However, psychopathy scores were significantly related to increased hemodynamic response in right dorsolateral prefrontal cortex when viewing harmful interactions and decreased functional connectivity from right amygdala to inferior parietal cortex and insula, and from temporal parietal junction to dorsomedial prefrontal cortex. Overall, this work indicates that in females, psychopathy is associated with normal behavioral accuracy and confidence but alterations in neural network activity during moral decision-making.

Dissecting the Fornix in Basic Memory Processes and Neuropsychiatric Disease: A Review

Background: The fornix is the primary axonal tract of the hippocampus, connecting it to modulatory subcortical structures. This review reveals that fornix damage causes cognitive deficits that closely mirror those resulting from hippocampal lesions. Methods: We reviewed the literature on the fornix, spanning non-human animal lesion research, clinical case studies of human patients with fornix damage, as well as diffusion-weighted imaging (DWI) work that evaluates fornix microstructure in vivo. Results: The fornix is essential for memory formation because it serves as the conduit for theta rhythms and acetylcholine, as well as providing mnemonic representations to deep brain structures that guide motivated behavior, such as when and where to eat. In rodents and non-human primates, fornix lesions lead to deficits in conditioning, reversal learning, and navigation. In humans, damage to the fornix manifests as anterograde amnesia. DWI research reveals that the fornix plays a key role in mild cognitive impairment and Alzheimer's Disease, and can potentially predict conversion from the former to the latter. Emerging DWI findings link perturbations in this structure to schizophrenia, mood disorders, and eating disorders. Cutting-edge research has investigated how deep brain stimulation of the fornix can potentially attenuate memory loss, control epileptic seizures, and even improve mood. Conclusions: The fornix is essential to a fully functioning memory system and is implicated in nearly all neurological functions that rely on the hippocampus. Future research needs to use optimized DWI methods to study the fornix in vivo, which we discuss, given the difficult nature of fornix reconstruction. Impact Statement The fornix is a white matter tract that connects the hippocampus to several subcortical brain regions and is pivotal for episodic memory functioning. Functionally, the fornix transmits essential neurotransmitters, as well as theta rhythms, to the hippocampus. In addition, it is the conduit by which memories guide decisions. The fornix is biomedically important because lesions to this tract result in irreversible anterograde amnesia. Research using in vivo imaging methods has linked fornix pathology to cognitive aging, mild cognitive impairment, psychosis, epilepsy, and, importantly, Alzheimer's Disease.

Youth with elevated psychopathic traits exhibit structural integrity deficits in the uncinate fasciculus

Youth with elevated psychopathic traits represent a particularly severe subgroup of adolescents characterized by extreme behavioral problems and exhibit comparable neurocognitive deficits as adult offenders with psychopathic traits. A consistent finding among adults with elevated psychopathic traits is reduced white matter structural integrity of the right uncinate fasciculus (UF). The UF is a major white matter tract that connects regions of the anterior temporal lobe (i.e., the amygdala) to higher-order executive control regions, including the ventromedial prefrontal cortex. However, the relationship between youth psychopathic traits and structural integrity of the UF has been mixed, with some studies identifying a negative relationship between adolescent psychopathy scores and FA in the UF, and others identifying a positive relationship. Here, we investigated structural integrity of the left and right UF using fractional anisotropy (FA) in a large sample of n = 254 male adolescent offenders recruited from maximum-security juvenile correctional facilities. Psychopathic traits were assessed using the Hare Psychopathy Checklist: Youth Version (PCL:YV). Consistent with hypotheses, interpersonal and affective traits (i.e., PCL:YV Factor 1 and Facet 1 scores) were associated with reduced FA in the right UF. Additionally, lifestyle traits (i.e., PCL:YV Facet 3 scores) were associated with increased FA in the left UF. Results are consistent with previously published studies reporting reduced FA in the right UF in adult psychopathic offenders and increased left UF FA in youth meeting criteria for certain externalizing disorders.

Sex differences in antisocial and aggressive disorders that onset in childhood and persist into adulthood

As many as 10.7% of males and 7.5% of females display early-onset, stable, antisocial and aggressive behavior (ESAAB). Most research has focused on males. These individuals are diagnosed with conduct disorder in childhood and antisocial personality disorder in adulthood, and a very few, almost all males, present the syndrome of psychopathy. ESAAB includes three subgroups: (1) conduct problems and callousness; (2) conduct problems, callousness, and anxiety; and (3) conduct problems. Heritability of the first two subtypes is high. This high heritability derives, at least in part, from genes involved in regulating serotonergic functioning early in life and to genotypes that confer sensitivity to trauma. The first subtype is rare and characterized by difficulty in face emotion recognition, especially fear and sadness, and hypoarousal as indexed by both autonomic and neural measures, and by structural brain abnormalities. By contrast, those with conduct problems, callousness, and anxiety are more common. They include a greater proportion of females and show hypersensitivity to threat that triggers reactive aggression and that is reflected in both autonomic and neural functioning. In sum, fewer females than males present ESAAB, but many characteristics, autonomic and neural correlates, and etiology are similar. Importantly, however, females with ESAAB play a critical role in the intergenerational transfer of antisocial behavior. Despite higher prevalence of EASSB in males than females, few sex differences in neural abnormalities have been identified.

A review of psychopathy and Cluster B personality traits and their neural correlates in female offenders

Although men commit more crime and are incarcerated at higher rates than women, women represent the fastest growing segment of the justice system. Empirical work suggests that psychopathy and Cluster B disorders are implicated in antisocial behavior across gender, and that neurobiological correlates of personality may inform such behavior. This review utilizes a gendered perspective to discuss psychopathy and Cluster B disorders in relation to antisocial behavior and incorporates work on neural correlates of personality disorders. Co-morbidity across these conditions may be partly explained by similar frontal deficits, reflective of disinhibition. Affective processing abnormalities appear to be characterized by distinct deficits in limbic/paralimbic regions, reflecting differential etiological underpinnings and behavioral outcomes. This review underscores the utility in examining personality pathology together with neurobiological and environmental factors. Methodological issues and clinical implications are also discussed.

Antisocial behavior with callous-unemotional traits is associated with widespread disruptions to white matter structural connectivity among low-income, urban males

Antisocial behavior (AB), including violence, criminality, and substance abuse, is often linked to deficits in emotion processing, reward-related learning, and inhibitory control, as well as their associated neural networks. To better understand these deficits, the structural connections between brain regions implicated in AB can be examined using diffusion tensor imaging (DTI), which assesses white matter microstructure. Prior studies have identified differences in white matter microstructure of the uncinate fasciculus (UF), primarily within offender samples. However, few studies have looked beyond the UF or determined whether these relationships are present dimensionally across the range of AB and callous-unemotional (CU) traits. In the current study, we examined associations between AB and white matter microstructure from major fiber tracts, including the UF. Further, we explored whether these associations were specific to individuals high on CU traits. Within a relatively large community sample of young adult men from low-income, urban families (N = 178), we found no direct relations between dimensional, self-report measures of either AB or CU traits and white matter microstructure. However, we found significant associations between AB and white matter microstructure of several tracts only for those with high co-occurring levels of CU traits. In general, these associations did not differ according to race, socioeconomic status, or comorbid psychiatric symptoms. The current results suggest a unique neural profile of severe AB in combination with CU traits, characterized by widespread differences in white matter microstructure, which differs from either AB or CU traits in isolation and is not specific to hypothesized tracts (i.e., the UF).

A Systematic Literature Review of Neuroimaging of Psychopathic Traits

INTRODUCTION

Core psychopathy is characterized by grandiosity, callousness, manipulativeness, and lack of remorse, empathy, and guilt. It is often comorbid with conduct disorder and antisocial personality disorder (ASPD). Psychopathy is present in forensic as well as prison and general populations. In recent years, an increasing amount of neuroimaging studies has been conducted in order to elucidate the obscure neurobiological etiology of psychopathy. The studies have yielded heterogenous results, and no consensus has been reached.

AIMS

This study systematically reviewed and qualitatively summarized functional and structural neuroimaging studies conducted on individuals with psychopathic traits. Furthermore, this study aimed to evaluate whether the findings from different MRI modalities could be reconciled from a neuroanatomical perspective.

MATERIALS AND METHODS

After the search and auditing processes, 118 neuroimaging studies were included in this systematic literature review. The studies consisted of structural, functional, and diffusion tensor MRI studies.

RESULTS

Psychopathy was associated with numerous neuroanatomical abnormalities. Structurally, gray matter anomalies were seen in frontotemporal, cerebellar, limbic, and paralimbic regions. Associated gray matter volume (GMV) reductions were most pronounced particularly in most of the prefrontal cortex, and temporal gyri including the fusiform gyrus. Also decreased GMV of the amygdalae and hippocampi as well the cingulate and insular cortices were associated with psychopathy, as well as abnormal morphology of the hippocampi, amygdala, and nucleus accumbens. Functionally, psychopathy was associated with dysfunction of the default mode network, which was also linked to poor moral judgment as well as deficient metacognitive and introspective abilities. Second, reduced white matter integrity in the uncinate fasciculus and dorsal cingulum were associated with core psychopathy. Third, emotional detachment was associated with dysfunction of the posterior cerebellum, the human mirror neuron system and the Theory of Mind denoting lack of empathy and persistent failure in integrating affective information into cognition.

CONCLUSIONS

Structural and functional aberrancies involving the limbic and paralimbic systems including reduced integrity of the uncinate fasciculus appear to be associated with core psychopathic features. Furthermore, this review points towards the idea that ASPD and psychopathy might stem from divergent biological processes.

Associations of Psychopathic Traits With Local and Global Brain Network Topology in Young Adult Women

BACKGROUND

Psychopathic traits vary dimensionally in the population and are associated with multiple negative outcomes. The impaired integration theory (IIT) proposes that psychopathic traits are associated with abnormal neural network topology, such that disturbed integration of neural networks results in a self-perpetuating impairment in rapid integration and learning from multiple components of information. The IIT is based on findings from male offenders presenting high scores on all psychopathic traits. The present study investigated whether IIT predictions of topology abnormalities were associated with psychopathic traits, measured dimensionally, in young adult women with subsyndromal scores.

METHODS

Seventy-three women, with an average age of 25 years, were assessed using the Psychopathy Checklist-Revised and completed resting-state magnetic resonance imaging. Preprocessed time series from 90 anatomical regions were extracted to form connectivity matrices and used to calculate network topology based on graph theory. Correlations between total psychopathy and factor scores with both the raw connectivity matrix and global and local graph theory measures were computed.

RESULTS

Total psychopathy scores and behavioral factor scores were related to connectivity between several pairs of regions, primarily limbic/paralimbic. Psychopathic traits were not associated with global topology measures. Topology abnormalities, robust across network formation thresholds, were found in nodes of the default mode network and in hubs connecting several resting-state networks.

CONCLUSIONS

IIT predictions of abnormal topology of hubs and default mode network nodes with dimensionally measured psychopathic traits were confirmed in a sample of young women. Regional abnormalities, accompanied by preserved global topology, may underlie context-specific abnormal information processing and integration.

Amygdala-orbitofrontal structural and functional connectivity in females with anxiety disorders, with and without a history of conduct disorder

Conduct disorder (CD) and anxiety disorders (ADs) are often comorbid and both are characterized by hyper-sensitivity to threat, and reduced structural and functional connectivity between the amygdala and orbitofrontal cortex (OFC). Previous studies of CD have not taken account of ADs nor directly compared connectivity in the two disorders. We examined three groups of young women: 23 presenting CD and lifetime AD; 30 presenting lifetime AD and not CD; and 17 with neither disorder (ND). Participants completed clinical assessments and diffusion-weighted and resting-state functional MRI scans. The uncinate fasciculus was reconstructed using tractography and manual dissection, and structural measures extracted. Correlations of resting-state activity between amygdala and OFC seeds were computed. The CD + AD and AD groups showed similarly reduced structural integrity of the left uncinate compared to ND, even after adjusting for IQ, psychiatric comorbidity, and childhood maltreatment. Uncinate integrity was associated with harm avoidance traits among AD-only women, and with the interaction of poor anger control and anxiety symptoms among CD + AD women. Groups did not differ in functional connectivity. Reduced uncinate integrity observed in CD + AD and AD-only women may reflect deficient emotion regulation in response to threat, common to both disorders, while other neural mechanisms determine the behavioral response.