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Biological Standings and Implications in Psychopathy: A literature review and opinion piece
Psychopathy, a severe and dangerous personality disorder has been popularly characterized as antisocial, emotionless, and sadistic individuals often in close association with the legal justice system. While the Diagnostic and Statistical Manual of Mental Disorders has yet to include an official diagnosis for psychopathy, authors have added “psychopathy” as a specifier for a clinical disorder known as Antisocial Personality Disorder (APD), which is symptomatically very similar to what psychopathy as it is defined by Hare, 2003, with the Psychopathy Check List-Revised (PCL-R), an index commonly used to identify and classify psychopaths. PCL-R divides behaviors and attributes into four groupings: interpersonal, affective, lifestyle, and antisocial. Individuals that have traits in all four of these categories are considered to be psychopaths, though with varying scores in each section not all psychopaths will present identically. This leads to the idea that psychopathy as pathology is on a continuum, and thus, all those affected will not present in the same fashion, both to outwardly and introspectively (Lilienfeld, Watts, & Smith, 2015).
While PCL-R is commonly used to identify psychopaths, the etiology on the disorder is not clear. Many studies continue to look at both the biological and environmental factors common amongst psychopaths. Vermeij, Kempes, Cima, Mars, & Brazil, 2018,
has looked at the white matter integrity as it correlates with psychopathy and reported no significant relationships between psychopathy as a whole, but did find a nontrivial negative correlation between severity of interpersonal-affective traits, specifically, severe impulse control, and white matter integrity in areas connecting the temporal and frontal lobes as well as the amygdala. This is consistent with the findings of Craig, et al., 2009, where the micro-structural integrity abnormalities in the fractional anisotropy (an indirect measure of white matter integrity) of psychopaths, when compared to age and IQ controls, is positively correlated with antisocial social behavior severity. The areas found to have decreased white matter integrity lined the uncinated fasciculus. These deficits in connectivity seem to play a vital role in the neurobiological basis of psychopathic behavior.
Further, then just connectivity, Umbach, Berryessa, & Raine, 2015, reviews several studies that show, with few exceptions, that individuals with psychopathy demonstrated reduced function, connectivity, and volume in the amygdala and frontal cortex found through both functional and structural MRIs. These results tended to be paralleled in both adult and adolescent studies; however, the number of studies surrounding pediatric psychopathy were few and offered uncertainty due to their small numbers. Several other groups have looked at commonly occurring variance in anatomical structure and the associations it may hold with psychopathic traits. One such study looked at cavum septum pellucidum, a variant in the septum pellucidum, and its correlation with several characteristics associated with psychopathy. Crooks, et al., 2019, showed through analysis of T1-weighted structural MRI scans a significant positive correlation with the interpersonal elements, behavioral problems, and juvenile delinquency aspects of PCL-R in females where TIV, age, substance use, and IQ are controlled. These findings were not generalized to overall higher PCL-R scores or emotional elements on PCL-R.
These studies offer lots of compelling evidence showing that psychopaths may be able to be identified and classified using brain imaging and analysis. The prevalence of structural and connectivity abnormalities in psychopaths indicates that there may be applications for identification of psychopaths both for clinical and judicial systems in pediatric as well as adult populations. Umbach, Berryessa, & Raine, 2015, reports that the implications of having available physical evidence for the presence (or lack thereof) psychopathy such as MRI scans have three main sections of application including punishment, prediction, and intervention. Empirical evidence that may help to explain a defendant’s actions as a biological disposition rather than a lapse of judgment give evidence to the opinions of many scholars that psychopaths should not be held entirely responsible for their actions. Morse, 2008, argues however, that unless neuroscience advances to the point that evidence is irrefutable and conclusive that the evidence will not have a significant holding in court as the actions the defendant is being tried for are behavioral in nature, thus much more concrete procedures and absolute science would first need to be developed to be used passingly in court. It is possible, however, that these scans can be used for the lessening of punishment, rather than charge as Umbach, Berryessa, & Raine, 2015, details. Because of the “double-edged sword” nature of this data, the presentation of neurobiological reasoning for lack of empathy may mitigate the situation or attest to the dangerousness of the defendant leading to a harsher sentence. Jones and Cauffman, 2008, has shown that the presentation of psychopathy as an innate deficit in juveniles works against the psychopathic individual, often leading to longer and more severe incarceration sentences.
Further, the use of scans in the identification of abnormalities associated with psychopathic tendencies could be used in the evaluation of incarcerated individuals as they are reviewed for parole or release. Umbach, Berryessa, & Raine, 2015, concludes minimal prediction power on the current methods of screening for psychopathy in conjunction with the likelihood of recidivism in adult populations. However, Asscher, et al., 2011, reports significant prediction power for juveniles up until their 19th birthday. These results show that with current techniques, only with children would the use of scanning be reasonable, and even such should be used in conjunction with other evaluation techniques. Further, the use of brain scans for intervention seems to be a null point, as some evidence shows minimal effectiveness in adult treatment for psychopathy (Harris and Rice, 2006) with the current modes of care. Further research may lend new avenues to treatment, at which point scanning proactively for evaluation and treatment planning may be clinically appropriate for adults. For pediatric cases, however, studies report supplementation with Omega-3 fatty acids may improve callous and unemotional traits in adolescents (Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2014). These findings lend to the idea that early detection and intervention may improve some symptoms of psychopathy in children making MRI scans a reasonable evaluation aid. Additionally, studies (Lilienfeld, Watts, & Smith, 2015) have noted the different behavioral presentation of psychopathy, which lends that there are several different biological and likely environmental bedrocks that have yet to accounted for. Overall, and with few exceptions, the research and reports of the neurobiological standing of psychopathy are not conclusive enough at this point to lend itself to be a valuable tool in the implementation into clinical or judicial settings.
In conclusion, research has come a long way in identifying several possible physical differences between neuro-typical controls and psychopaths. While most of the conclusions mentioned in the aforementioned studies have been shown to be significant, the sheer number of available studies is small and variant. This inconclusively leads to findings that there are neurobiological footings in psychopathy, likely compounded with environmental risks, though much of the current research needs to be thoroughly expanded upon, both in the number of subjects as well as specificity. Throughout the literature, it is indicated that more specific traits should be looked at in correlation to physical deformation or connectivity, as it is likely that no one pathway or structure will be comprehensively responsible for many of the behaviors observed in psychopathy. While evidence for biological markers for psychopathy is increasing in sophistication and reliability, it is still very true that the limited research data still plays a very prominent role in the trustworthiness of the results. Once the science has progressed to a level that lends its self to more concrete conclusions, it is not a far jump to say that this will significantly affect the legality surrounding psychopaths and even affect the public opinion of this group of people as a whole.
- Asscher, J. J., Vugt, E. S., Stams, G. J., Deković, M., Eichelsheim, V. I., & Yousfi, S. (2011). The relationship between juvenile psychopathic traits, delinquency and (violent) recidivism: A meta-analysis. Journal of Child Psychology and Psychiatry,52(11), 1134-1143. doi:10.1111/j.1469-7610.2011.02412.x
- Craig, M. C., Catani, M., Deeley, Q., Latham, R., Daly, E., Kanaan, R., . . . Murphy, D. G. (2009). Altered connections on the road to psychopathy. Molecular Psychiatry,14(10), 946-953. doi:10.1038/mp.2009.40
- Crooks, D., Anderson, N. E., Widdows, M., Petseva, N., Decety, J., Pluto, C., & Kiehl, K. A. (2019). The relationship between cavum septum pellucidum and psychopathic traits in female offenders. Behavioural Brain Research,359, 967-972. doi:10.1016/j.bbr.2018.06.011
- Harris, G. T., & Rice, M. E. (2006). Treatment of Psychopathy: A Review of Empirical Findings. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 555-572). New York, NY, US: The Guilford Press.
- Jones, S., & Cauffman, P. E. (2008). Juvenile psychopathy and judicial decision making: An empirical analysis of an ethical dilemma. Behavioral Sciences & the Law,26(2), 151-165. doi:10.1002/bsl.792
- Lilienfeld, S. O., Watts, A. L., & Smith, S. F. (2015). Successful Psychopathy. Current Directions in Psychological Science,24(4), 298-303. doi:10.1177/0963721415580297
- Morse, S. J. (2008). Psychopathy and Criminal Responsibility. Neuroethics,1(3), 205-212. doi:10.1007/s12152-008-9021-9
- Raine, A., Portnoy, J., Liu, J., Mahoomed, T., & Hibbeln, J. R. (2014). Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: A randomized, double-blind, placebo-controlled, stratified, parallel-group trial. Journal of Child Psychology and Psychiatry,56(5), 509-520. doi:10.1111/jcpp.12314
- Umbach, R., Berryessa, C. M., & Raine, A. (2015). Brain imaging research on psychopathy: Implications for punishment, prediction, and treatment in youth and adults. Journal of Criminal Justice,43(4), 295-306. doi:10.1016/j.jcrimjus.2015.04.003
- Vermeij, A., Kempes, M. M., Cima, M. J., Mars, R. B., & Brazil, I. A. (2018). Affective traits of psychopathy are linked to white-matter abnormalities in impulsive male offenders. Neuropsychology,32(6), 735-745. doi:10.1037/neu0000448
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