Abstract
Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths.
Highlights
Psychopathic individuals display antisocial personality traits including deceitfulness, impulsivity, recklessness, lack of remorse, and a general failure to conform to social norms (Cleckley, 1982; American Psychiatric Association, 2013)
In the Control group we found slightly larger differential UCS expectancy in high anxiety individuals compared to low anxiety individuals [t(17) = 2.06; p = 0.049; Cohen’s d = 0.86; Figure 2A], but there was no such trend in the Psychopath group (p > 0.1)
We investigated fear learning in psychopaths compared to well-matched control subjects
Summary
Psychopathic individuals display antisocial personality traits including deceitfulness, impulsivity, recklessness, lack of remorse, and a general failure to conform to social norms (Cleckley, 1982; American Psychiatric Association, 2013) These symptoms have long been thought to reflect an overall lack of fear resulting from abnormal functioning of the amygdala (Birbaumer et al, 2005; Raine and Yang, 2006; Moul et al, 2012). Consistent with this view, psychopathic offenders show deficits in their ability to use threat-relevant information to inhibit inappropriate approach behavior (Lykken, 1957; Newman and Kosson, 1986; Blair et al, 2004). The deficits observed in fear conditioning have provided some of the best evidence for the low-fear model of psychopathy
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