Functional neuroanatomy of psychopathy

Psychopathy has been characterized as a psychiatric disorder consisting of emotional deficits (shallow affect, remorselessness, and lack of shame), antisocial behaviour (impulsivity, irresponsibility, and poor behaviour controls), and interpersonal features (conning/manipulative, superficial charm, and pathological lying). In this article, structural and functional imaging findings on psychopathy are reviewed and several hypotheses are provided with regard to the neural bases of psychopathy. It is proposed that the emotional deficits are associated with impairments in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), amygdala–hippocampus complex, and the insula, whereas antisocial behaviour may be linked to deficits in the OFC, ACC, dorsolateral prefrontal cortex, and superior temporal gyrus. On the other hand, differences in the white matter of the OFC, ACC, and ventrolateral prefrontal cortex may contribute to the pathological lying behaviour often seen in psychopathic individuals. A discussion is also presented on the topic of successful vs unsuccessful psychopaths, suggesting the absence of brain abnormalities, particularly in the prefrontal cortex and the hippocampus, in successful psychopaths, and how these findings have furthered our knowledge of the neuropathology underlying psychopathy.