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Psychopathy

An Author Correction to this article was published on 01 October 2021

A Publisher Correction to this article was published on 20 July 2021

This article has been updated

Abstract

Psychopathy is a personality disorder characterized by a constellation of affective, interpersonal, lifestyle and antisocial features whose antecedents can be identified in a subgroup of young people showing severe antisocial behaviour. The prevalence of psychopathy in the general population is thought to be ~1%, but is up to 25% in prisoners. The aetiology of psychopathy is complex, with contributions of both genetic and environmental risk factors, and gene–environment interactions and correlations. Psychopathy is characterized by structural and functional brain abnormalities in cortical (such as the prefrontal and insular cortices) and subcortical (for example, the amygdala and striatum) regions leading to neurocognitive disruption in emotional responsiveness, reinforcement-based decision-making and attention. Although no effective treatment exists for adults with psychopathy, preliminary intervention studies targeting key neurocognitive disturbances have shown promising results. Given that psychopathy is often comorbid with other psychiatric disorders and increases the risk of physical health problems, educational and employment failure, accidents and criminality, the identification of children and young people at risk for this personality disorder and preventative work are important. Indeed, interventions that target the antecedents of psychopathic features in children and adolescents have been found to be effective.

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Fig. 1: Features of psychopathy operationalized by the Hare Psychopathy Checklist–Revised.
Fig. 2: The association between psychopathy and other psychiatric disorders and maladaptive outcomes.
Fig. 3: Dispositional and environmental risk factors for psychopathy.
Fig. 4: Brain abnormalities in psychopathy and children and young people at risk of psychopathy.
Fig. 5: Quality of life and psychopathy.

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Acknowledgements

During the writing of the manuscript, S.A.D.B was hosted at the Kokoro Research Centre (Kyoto University) and supported by a short-term Invitational Fellowship from the Japanese Society for the Promotion of Science (JSPS - S19103) and an International Academic Fellowship from the Leverhulme Trust (IAF-2019-032).

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Authors and Affiliations

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Contributions

Introduction (S.A.D.B. and E.V.); Epidemiology (D.P. and E.R.K.); Mechanisms/pathophysiology (S.A.D.B., R.J.R.B., A.R.B.-S. and E.V.); Diagnosis, screening and prevention (A.E.F., P.J.F. and E.R.K.); Management (I.A.B. and A.R.B.-S.); Quality of life (A.E.F., E.V. and S.A.D.B.); Outlook (S.A.D.B., I.A.B., A.R.B.-S. and E.V.); Overview of Primer (S.A.D.B. and E.V.).

Corresponding authors

Correspondence to Stephane A. De Brito or Essi Viding.

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Competing interests

A.E.F. receives royalty payments from the sale of the Psychopathy Checklist: Youth Version, which is an instrument listed in Table 1. All other authors declare no competing interests.

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Dedication

This Primer is dedicated to the memory of our esteemed colleague S.O. Lilienfeld (PhD) for his significant contribution to the field of psychopathy as a scientist and as a mentor.

Peer review information

Nature Reviews Disease Primers thanks J. Tiihonen, who co-reviewed with M. Lähteenvuo, S. Hodgins, C. Neumann, R. Salekin, and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

Aftermath: Surviving Psychopathy Foundation: https://aftermath-surviving-psychopathy.org/

Antisocial Behavior Working Group of Enhancing Neuro Imaging and Genetics through Meta Analysis (ENIGMA) : http://enigma.ini.usc.edu/ongoing/enigma-antisocial-behaviour/

Mental Health Research Funding: https://www.mqmentalhealth.org/our-work/research-reports/

Psychiatric Genomics Consortium: https://www.med.unc.edu/pgc/

Psychopathy Is: https://psychopathyis.org/

Society for the Scientific Study of Psychopathy: https://psychopathysociety.org/

Supplementary information

Glossary

Callous–unemotional traits

Including a lack of guilt, lack of empathy, lack of concern over poor performance in important activities, and shallow/deficient affect.

Reactive aggression

Aggression, underpinned by negative affect, in response to threat, frustration or social provocation.

Social affiliation

The motivation to interact with others.

Aversive conditioning

Learning to associate negative valence with a previously neutral stimulus.

Reinforcement-based decision-making tasks

Tasks where the participant must learn which responses to make to a stimulus to gain reward/avoid punishment.

Parent management training

Training that teaches parents social learning techniques and behavioural strategies to increase children’s desirable behaviours and decrease their problematic and antisocial behaviours.

Contingency management

Rewarding youth for engagement in specified positive behaviour.

Cognitive–behavioural interventions

A family of psychological treatments that aim to alter maladaptive thinking patterns, feelings, and behaviours.

Multisystemic therapy

Synergistic interventions that involve the youth, family, school, and community systems.

Milieu therapy

Therapeutic communities to treat individual group members through setting norms and boundaries.

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De Brito, S.A., Forth, A.E., Baskin-Sommers, A.R. et al. Psychopathy. Nat Rev Dis Primers 7, 49 (2021). https://doi.org/10.1038/s41572-021-00282-1

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