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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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).
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.
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.
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- 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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