Understanding Psychopathy

Kayt Sukel
September 26, 2017

Each week, millions of people tune into their favorite police and crime scene dramas. More often than not, our favorite fictional law enforcement officers are on the trail of what they blithely call a “psychopath,” generally some kind of mass murderer or violent, predatory rapist. James Fallon, a professor of psychiatry and human behavior at the University of California, Irvine, says that thanks to these shows, most people have the wrong idea of just what it means to be a person with psychopathy.

“There are core traits—a lack of moral reasoning or sense of guilt, pathological lying, a lack of emotion, using and manipulating people—but so many people think that these traits always involve murder, rape, and sadism,” he says. “But violence or sadism is not a necessary component of psychopathy. In fact, there are plenty of psychopaths who you’ll find out in the world leading regular lives.”

Fallon would know. In the course of his research looking at the deep, underlying traits of psychopathy, he learned he himself shares many of the genetic and neurobiological traits of the criminal brains he studies. Our general misunderstanding of psychopathy may be preventing us from helping the large number of people diagnosed with this condition who are currently incarcerated for crimes big and small.

Over the past decade, neuroimaging and genetic research has offered us a new way to study this and other disorders. Research laboratories around the globe are discovering details about how those with psychopathy learn and make decisions that may one day lead to interventions to help a disorder that many previously claimed was “untreatable.”

Learning to Lie

One of the core traits of psychopathy is the ability to lie to others without remorse. Tatia Lee, a researcher at the University of Hong Kong, says it’s a key component of the manipulative and malingering behaviors that those with psychopathy exhibit. It’s long been thought that people later diagnosed with psychopathy are born with this ability to lie. She and her colleagues wondered if that was actually the case.

“Both the wider existing research and our own work show that during lying, people need to actively hold the goal of lying in mind and suppress the true information in order to generate and articulate the counterfactual statements,” she explains. “At the same time, the individual needs to regulate and suppress the negative affective response elicited by lying to others. The question was, are individuals with high-psychopathy traits ‘born to lie’ or just more capable of learning how to do so?”

To find out, Lee and colleagues tested more than 50 university students, 29 of whom showed a high level of psychopathic traits when tested with a known psychometric test. The researchers measured response time as well as observed brain activity as the students were trained to give dishonest responses during a facial recognition task. Despite there being no difference in lying performance before the training exercises, researchers saw that participants with more psychopathic traits showed significant improvement in their lying speed after the training as well as functional connectivity changes in the fronto-parietal networks that are known to govern dishonesty. The results were published in the July 25, 2017, issue of Translational Psychiatry.

“The personality trait of psychopathy actually exists in a continuum in the general population, and relatively high-psychopathic individuals can be readily found among competent, successful professionals, or, in this case, high-functioning university students,” Lee says. “This study can hopefully redirect our view from thinking of psychopathy as a constellation of static, deterministic traits and instead think of it as a dynamic, evolving condition that is potentially malleable to experiences, at least in the relatively high-functioning population.”

Flawed Cost-Benefit Analysis

Over the past few years, Joshua Buckholtz, a neuroscientist at Harvard University, and Kent Kiehl, a professor of psychology, neuroscience, and the law at the University of New Mexico, have been scanning the brains of criminals with psychopathic traits using a mobile functional magnetic resonance imaging (fMRI) unit. Their work has challenged the idea that people with psychopathic traits behave as they do because they lack appropriate emotional regulation. Instead, their results suggest that psychopaths have specific deficits in their decision-making abilities. Arielle Baskin-Sommers, director of the mechanisms of disinhibition lab at Yale University, and a frequent collaborator of Buckholtz and Kiehl’s, says that we are learning that psychopathy is fundamentally a neurodevelopmental disorder.

“These individuals have failures in integrating and noticing contextual cues when it comes time to make a decision,” she says. “And part of that seems to be an inability to do appropriate cost-benefit analysis before making a decision.”

She, Buckholtz, and Kiehl scanned the brains of 49 incarcerated people who scored high on psychopathy measures as they performed a simple task: choose between a small amount of money immediately or a larger amount of money after a delayed amount of time. They found that the connections between the striatum, a region of the brain known for reward processing, and prefrontal cortex, the brain’s executive control center, were much weaker in individuals with psychopathy. What’s more, the strength of the connection could be used to predict how many times an inmate had been convicted of a crime; the weaker the connection, the greater number of convictions. The results were published in the July 5, 2017, issue of Neuron.

“There’s a long history of people thinking that psychopaths are hypersensitive to reward. They do the things they do because they are reward-seeking,” says Baskin-Sommers. “It would be easy to boil down the high striatum activity we see to that. But in looking at these connections, it would seem the real deficit is in doing the cost-benefit analysis, upgrading and integrating information so you can make the most adaptive behavioral choice in the moment. The implication is that we need to refine how we think about these individuals and how they are making the decisions they are making.”

Changing the Conversation

Fallon, Lee, and Baskin-Sommers all hope that the continued investigations of psychopathy will help change public misconceptions about what psychopathy is, as well as further refine and specify the underlying neural mechanisms of the disorder. This, they suggest, offers the possibility of one day developing effective interventions to help more people with these traits lead more healthy, productive lives.

“Individuals with psychopathy are much more likely to have issues with substance abuse. Their onset of criminal behavior is much earlier than others, which is why psychopaths are overrepresented in prisons. They account for the vast majority of costs for treatment in prisons—despite the fact that we think of them as untreatable. We are now starting to move away from the old model that people with psychopathy are fundamentally evil people who should not be interacting with anyone in society and can’t be treated or helped,” says Baskin-Sommers. “With more studies with better experimental design and larger data sets with more representative samples, we should be able to define, refine, and specify the types of dysfunctions operating in these people. That will not only give us a clearer idea of why psychopaths do what they do. It may also help us develop better programs and treatments to help them make better decisions about what’s right and wrong.”