Kiehl 2: Criminal Psychopath

● Symptoms of psychopathy
○ Shallow affect
○ Lack of empathy, guilt, remorse
○ Irresponsibility
○ IMpulsivity
● 1% non-institutionalized males over 18 are psychopaths
○ 16% males in prison are psychopaths
○ 93% of adult male psychopaths are in prison, jail, parole,
probation
○ More likely to be imprisoned, and also more likely to
manipulate early release
○ More likely to reoffend
● History
○ Psychopaths have always been part of human society
○ Some psychopaths are highly unsuited for life in any
community, and others are incredibly successful
businesspeople
■ “Functioning psychopaths”
○ They are not just a cultural artifact of the demands of
modern civilization
○ Psychopathy and psychiatry
■ Not included in DSMV (instead, antisocial
personality)
● However, they are two different things
■ Sociopathy used interchangeably (to say it was a
social disease modeled by the environment)
● Psychopathy suggests a more genetic, or early
developmental predisposition (which interacts
with the environment)
● “Lacking a moral core” is a moral judgement,
not scientific
■ Psychopathy checklist
● Affective disorder (factor 1)
● Antisocial traits (factor 2)
 ●
○ ASPD doesnt capture the affective traits
of psychopathy, but does capture
antisocial traits
○ Treatment for ASPD wont help psychopaths
with affective traits

●
○ Shows how drug treatment efforts are
wasted in prison if they dont also
consider psychopathy
○ Psychopathy and the law
■ Insanity defense
● Psychopaths don't fit the technical definition
of insane
● Psychopaths are rational: the narrow sense of
being able to determine their best interest and
to navigate in the world to achieve that
interes
■ The law attributes all antisocial acts as being of
free will
● Donest recognize ppl who chronically make
antisocial choices
● Psychopaths consider only their self interests
>> is this chronic, and do they have sufficient
rationality to consider others or not
○ DO they use a deluded scale to weigh
decisions on?
 ● How does the law forgive a whole category of
criminals who breech it for their own gain 100%
of the time?
■ The law generally turns a blind eye to psychopathy,
except for crimes disproportionately committed by
psychopaths
● Modern clinical definition
○ THIS IN DETAIL >> WHO DOES SCORING, HOW IS IT SCORED, etc
etc
■ interviews, clinicians look at files and collateral
info abt patient
● look at criminal record, talk to people who
know this person well
■ Not a self-report: is an interview by a trained
clinician
■ What is the score threshold??
● 29 in US
● 25 in europe
■ Also predicts recidivism, verbal and physical
aggression, treatment success
○ Hare’s assessment includes affective and behavioral
factors
■ Requires a 0-2 likert scale score
■ Minimum score of 0, maximum score of 40
■ Ask questions designed to measure certain
characteristics
■ Two facets
● interpersonal, affective
● antisocial deviant behavior
○ Traits
■ Needing constant stimulation
■ Parasitic
■ Angry
■ Long-lasting criminal behavior (before adulthood)
■ Recidivism
○ Others say it may be useful to break criteria into 3-4
facets
● Psychopathy and criminal justice
○ 15-25x more likely to commit imprisonable crimes
○ More likely to commit sexual and nonsexual violent acts
○ More likely to be released early due to deceptive and
manipulative skills
 ○ REcidivism
■ 80% recidivism in high psychopaths, vs 15% in low
■ Violent psychopaths have a 90% recidivism rate after
20 years
■ 75% recidivism after 10 years for sexual crimes
■ Youth psychopathology shown to predict high
recidivism
○ Cost of recidivism
■ Crime’s cost in the US is $2.3 trillion per year (in
2009)
■ Adjusted for the 20% psychopaths, that is $460
billion JUST in prison costs
● Neuroscience of psychopathy
○ Unsuccessful psychopaths (those who get caught) have
reduced gray matter (neural atrophy), fewer neurons, and
increased white matter (pruning deficit) in the frontal
lobes
■ neurodevelopmental disorder (due to poorly developed
paralimbic system)
○ fMRI shows
■ decreased activity in paralimbic regions
● ATC, VMPFC, amygdala, cinglate, insula
● Involved in moral reasoning, affective memory,
inhibition
■ Decreased activation in right temporal and inc
amygdala activity when recognizing moral content
■ Less good at remembering words with emotional content
■ Prisoner psychopaths show reduced activation in
paralimbic
■ Psychopaths are much worse at inhibition tasks >>
decrease activity in inhibitory regions
○ Psychopaths show neural deficits in areas critical for
■ Recognizing moral issues
■ Inability to inhibit response pending resolution of
moral issue
■ Ability to reach decision about moral issue
○ Psychopathy is more limbic/paralimbic
○ Neurological results could help diagnose psychpathy
○ Imaging can help ID and understand development of
psychopathic traits
● Treatment
 ○ Mosttalking therapies are aimed at patients who know they
needhelp
■This is not most psychopaths; they are not distressed
■They can go through the motions, but not the critical
emotional and active component
■ Group therapy can even make criminal tendencies and
recidivism worse
○ However, past therapies have not been well designed; there
is some hope
■ Decompression treatment (long-term, one-on-one
treatment designed to rebuild social connections)
showed early promise
● Targeting juveniles can show significant
improvement
● The best predictor of recidivism was the length
of treatment (long term treatment was most
successful)
Ling: Neuroscience of Psychopathy
● PFC
○ PFC is a key region implicated in psychopathy
○ Executive functions impaired in psy individuals
○ VMPFC and OFC key
■ VMPFC is involved in decision-making and emotional
processes (for reward and punishment)
○ Structure
■ Reduced PFC volume and thickness
■ OFC gray matter reductions, and total PFC gray matter
volumes
■ Some white matter reductions (in PFC connections with
subcortical structures) >> PFC > amygdala network
disrupted
■ Reduced cortical thickness in OFC and temporal >> inc
response preservation
■ Frontotemporal structural deficits contribute to
neurocognitive impairments
■ Contradictory in psychopathic youth
○ Function
■ PFC is used in social, moral, emotional, cogntive
processes
■ Damage to VMPFC and OFC could predispose ppl to
psychopathic behavior
● More utilitarian decisions vs emotional
decisions
 ■ Shows reduced functional connectivity between VMPFC
and amyg
■ Children demonstrate abnormal PFC functioning
● Amygdala
○ Structure
■ Reduced amygdala volume in psychopathic adults
■ Not really shown in psychopathic/conduct disordered
youth
○ Function
■ Psychopathy associated with reduced amygdala function
during processing of emotional stimuli
■ Dysfunction seen in the development of callous and
unemotional traits
■ Contribute to poor affective processing, and deficits
in recognizing emotions
■ A relatively similar pattern seen in youth
● Reduced amyg activity in response to other’s
pain, empathy, and risk assessment
● Striatum
○ Structure
■ Increased striatal volume
■ Unclear for youth; sometimes show decreased striatal
volume
○ Function
■ Aberrant connectivity between striatum and other
brain areas
■ Particularly regarding dopamine and reward (during
anticipation)
■ Reduced activity found in response to negative
stimuli
■ IN youth
● Difficulties processing omission of reward
● Dysfunction of PFC-amygdala-striatum minimizes sensitivity to
punishment and maximizes sensitivity to reward >> disinhibited,
reward-driven behavior
○ Against Keihl who focuses on para Limbic system
● Forensic implications
○ The neural basis of psychopathy could be used in
courtrooms (a double edged sword)
○ Shouldnt be used as an excuse, but could provide guidance
for policies and sanctions
● Prediction
 ○ Scores on psychopathy assessment could predict violent and
nonviolent crime, and recidivism
○ Lower ACC activity increased likelihood of rearrest
■ Reduced amyg volumes associated with increase in
violence
○ Predictive power of neurobio measures is especially
prevalent with machine learning/AI
● Interventions
○ Prenatal and early childhood are key developmental periods
vulnerable to environmental influences
■ Early intervention may reduce the risk for developing
psychopathic traits
■ Prevention programs (particularly through parents)
can promote proper pre and postnatal childcare
■ Early environmental enrichment is important as well
○ Intensive treatment programs combining several approaches
may reduce psychopathic traits
○ Biological interventions are questionable
■ Drugs are iffy
■ TMS shown to alter emotional processing and moral
judgment
● Sanction and risk assessment
○ Sanctions may be ineffective since behavior > outcome link
is messed up
○ Psychopaths should still be held criminally responsible,
however the label of psychopath can lead to harsher
sentencing
○ Neurosci evidence may mitigate sanctions, but could also
be aggravating if it is interpreted at proving innate
violence
○ Understanding mechanisms contributing to behavioral
dysfunctions
Hofhansel: Morphology of Criminal Brain
● Results
○ Violent offenders had less eductionand lower verbal
intelligence, higher anger, physical/reactive/proactive
aggression
○ Aggression and psychopathy measures highly correlated
○ Global psychopathy negatively linked with gray matter
volume in prefrontal regions
■ Antisocial behavior correlated negatively in right
middle and superior temporal gyrus, right superior
frontal, left inferior parietal
 ■ Reactive aggression was negatively linked with GMV in
middle and superior temporal gyrus
■ An area in the right temporal cortex was negatively
correlated with both reactive aggression and
antisocial behavior
○ Correlates with score on PCOR
● Discussion
○ Foud inverse correlation between psychopathy and GMV >>
super PFC
○ With increasing severity of antisocial behavior >> greater
volume reductions in fronto-temporo-parietal network
○ LAcking theory of mind >> high levels of reactive
aggression
■ These areas in psychopaths were lacking GMV
○ FTP network is also involved in info processing,
particularly attention
■ Psychopaths have difficulties continuously updating
situational information
○ Diseases accompanied by aggressive behavior show
dysfunction in the temporal regions
○ GMV reductions in offenders in PFC, compared to controls
Kiehl: Inside the Mind
● So much of the world is seen through emotions
○ Psychopaths lack this empathy, and cover it up with charm
● Psychopaths lack access to their own feelings, are oblivious to
emotions cues or emotional recognition
○ Difficulties with emotional language, attention
○ Once fixed on a goal, psychopaths have tunnel processing
● The VMPFC, amygdala, OFC are likely dysfunctional
○ Particularly the connections and structure of the
paralimbic and prefrontal regions
○ Insula: social norms, anger, fear, empathy, disgust, pain
perception
■ underdeveloped/small
● Genes account for 50% variability in antisocial traits >>
environmental factors are super important
● Caldwell’s decompression treatment showed promise in treating
psychopathic patients
○ Brain and genetic research will likely further improve
these results
● Antisocial personality disorder is not the same as psychopathy
○ Psychopaths pose more threat of reoffending, and they need
to be dealt with differently