Psychophatie,Soziophatie und deren Auswirkungen.....

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Abend!

Hier mal eine kleine Linksammlung zum sehr wichtigen Thema der Psychophatie/Soziophatie und ihre Auswirkungen auf andere Menschen und die Gesellschaft.Leider ein Thema das wenig beachtet wird oder aufgrund zahlreicher Kontrollinstanzen in Wirtschaft und Bildung ziemlich unterdrückt wird.Es gibt zwar schon ein paar Bücher in deutscher Sprache,allerdings sind diese ziemlich teuer und happig von den Preisen her.Hier ein paar Seiten,wo es viele und ausführliche Informationen gibt.
Wer noch andere Links und Quellen hat,kann sie gern hier hinein posten,vielleicht gibt es ja auch englische Links,die in leichterer Sprache geschrieben sind.Diskussion ist auch erwünscht - na klar!

“Noch schwieriger wird es, wenn man die Biographien der Großen dieser Welt aus Politik, Wirtschaft und Militär, ja Kunst und Wissenschaft durchforstet. Das liest sich stellenweise wie die reine „Psychopathologie“, also die Lehre von den krankhaften Veränderungen des Seelenlebens. Sind also psychopathische Züge nur lästig, negativ, „minderwertig“? Erwachsen daraus nur missgestimmte, unbeherrschte, leicht erregbare, geltungssüchtige, gemütlose, fanatische, querulatorische oder wahnhafte Krankheitszüge? Oder sind die Psychopathen tatsächlich das „Salz der Erde“? Kurz: Ob Psychopathie oder Persönlichkeitsstörung genannt - es handelt sich zwar um ein alltägliches und doch weitgehend unbekanntes Krankheitsbild. “

Basis: Psychophatie,Soziophatie .... eine Einführung:
http://autismuskritik.twoday.net/stories/1647794/

“als-ob-Persönlichkeiten” – leben als totale Simulation (1):
http://autismuskritik.twoday.net/stories/1868194/

“als-ob-Persönlichkeiten” – leben als totale Simulation (2):

"Der amerikanische Psychiater Hervey Cleckley schreibt in seinem grundlegenden Werk The Mask of Sanity über ein Phänomen, das innerhalb der psychiatrischen Krankheitsbilder ein ungelöstes Rätsel blieb. Bei allen `orthodoxen´ Psychosen gibt es mehr oder weniger deutliche Veränderungen im Denkprozeß oder andere die Persönlichkeit verändernde Merkmale, seien es Wahnvorstellungen, Halluzinationen oder völlig alogisches Denken. Nicht so beim Psychopathen. Ist er auf irgendeine Weise auffällig geworden und unter psychologische oder psychiatrische Beobachtung gekommen, dann ergibt sich folgendes Bild:
http://autismuskritik.twoday.net/stories/1868211/

Was macht einen “echten” Psychophaten vermutlich aus?
Trotz der in der einführung zum thema angesprochenen schwer belasteten Historie des begriffs psychopath - die heute darunter verstandene realität existiert imo unbezweifelbar für sich - und deshalb jetzt zur frage der überschrift:
http://autismuskritik.twoday.net/stories/1648319/

Notiz:Psychophaten im Big Business
http://autismuskritik.twoday.net/stories/1518025/

Eine Wissenschaft von der Natur des Bösen und seiner Anwendung für politische Zwecke :
http://quantumfuture.net/gn/ponerologie/index.php

Der Psychopath - Teil 1:
Die Maske der Vernunft
http://quantumfuture.net/gn/zeichen/...sychopath1.php

Der Psychopath - Teil 2:
Psychopathen in der New Age Bewegung http://quantumfuture.net/gn/zeichen/...sychopath2.php

Der Psychopath - Teil 3:
Was ist ein Psychopath?
http://quantumfuture.net/gn/zeichen/...sychopath3.php

Der Psychopath - Teil 4:
Wie Psychopathen die Welt sehen http://quantumfuture.net/gn/zeichen/...sychopath4.php

Der Psychopath - Teil 5:
Psychopoathen und Beziehungen
http://quantumfuture.net/gn/zeichen/...sychopath5.php

Der Psychopath - Teil 6:
Wie man mit Psychopathen umgeht
http://quantumfuture.net/gn/zeichen/...sychopath6.php

Der Psychopath - Teil 7:
Symptome/Checklisten für Psychopathi
http://quantumfuture.net/gn/zeichen/...sychopath7.php

Dämmerung der Psychopathen
http://quantumfuture.net/gn/zeichen/...daemmerung.php

Buchtipp für den Einstieg,leicht zu lesen und vorallem mit alltäglichen Situationen:
Die Masken der Niedertracht
Hier eine Kritik dazu:
http://www.lebenshaus-alb.de/magazin/001483.html

Missbrauch in der Psychatrie
http://video.google.de/videoplay?doc...82293172&hl=de

The Origins of Violence:
Is Psychopathy an Adaptation? http://human-nature.com/nibbs/01/psychopathy.html

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So ,uups,kleiner Fehler unterlaufen - gleich doppelt das gute Stück ....
dies ist der offizielle Themenstrang dazu,bitte hier posten dann!

Hab auch gleich noch was:

Eine alternative Theorie,über die Herkunft der Psychophaten,sowie sie in "mystischen" oder esoterischen Kreisen seid ein paar Jahrhunderten überliefert wird. Vielleicht die Antwort,
The Organic Portal Theory:
http://www.bibliotecapleyades.net/ci...cportals06.htm

ansonsten etwas zum Narzissmus:
http://www.psychosoziale-gesundheit....arzissmus.html

"Schlussfolgerung:
Nicht alle Narzissten sind „gnadenlose Psychopathen“ im Sinne einer extremen narzisstischen Persönlichkeitsstörung. Die schicksalhafte Bandbreite des narzisstischen Alltags erstreckt sich von leicht gestört (und damit noch schwerer erkennbar, zumindest erstaunlich lange) über mittelgradig belastet bis zu jenen Extremen, die dann allerdings mit einer konsequenten Ausgrenzung durch ihr gepeinigten Umfelds rechnen müssen, spätestens wenn sich irgendwann einmal die persönlichen oder beruflichen Macht-Verhältnisse zu Lasten des Narzissten verschieben."

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Hier etwas mit Martha Stout:
How do you spot a sociopath?
http://www.bookbrowse.com/author_int...or_number=1097

http://www.dradio.de/dkultur/sendungen/kritik/533704/

Buch in englischer Sprache von Hervey Cleckley : The Mask of Sanity
http://www.cassiopaea.org/cass/sanity_1.PdF
(Habe es selbst noch net gelesen bisher,aber wird oft empfohlen )

Der Trick des Psychopathen: Uns glauben machen, dass Böses von anderswo kommt
http://quantumfuture.net/gn/ponerologie/interview.php

“Laura: Ein Weg dies zu verstehen ist zu sagen, dass es Studien gibt die zeigen, dass Psychopathen nicht nur eine höhere Anzahl an gewalttätigen Verbrechen haben, sondern auch andere Arten als nicht-psychopathische Täter begehen. Eine Studie zeigte, dass etwa ein Drittel der Opfer von Psychopathen männliche Fremde waren, während zwei Drittel der Opfer weibliche Familienmitglieder oder Bekannte waren — Verbrechen aus Leidenschaft. Normale Menschen können gewalttätige Handlungen in Zuständen extremer emotionaler Aufwühlung begehen, aber Psychopathen selektieren kaltblütig ihre Opfer aus Rache oder Vergeltung für einen gewissen Zweck. In anderen Worten, psychopathische Gewalt ist instrumental, ist ein Mittel zu einem Zweck, ist räuberisch. “

“Henry: Zweitens, in einer Gesellschaft, die von pathologischen Werten dominiert ist — wenn man man sie so nennen kann — fördert die Existenz einer kleinen Gruppe von gewissenlosen Leuten eine Kultur von Geiz und Selbstsucht und erzeugt eine Umwelt, wo das Pathologische die Norm ist. In einer solchen Gesellschaft — wie in den Vereinigten Staaten heute, wo der Präsident über Angelegenheiten, die über Leben oder Tod entscheiden, ungestraft lügen kann — wird ein pathologisches Umfeld erzeugt, wo Lügen akzeptabel wird; wo Gewalt akzeptabel wird; wo Gier akzeptabel wird. Es ist eine Nebenwirkung der Ideologie des „Amerikanischen Traums“, wo jeder Erfolg haben kann, unabhängig davon, wieviele man verletzen muss, um ihn zu erlangen. Und die Saat der Pathologie liegt in dem, was man tun muss, um etwas zu erreichen. In solch einer Umwelt nehmen Menschen mit Gewissen, die schwach und leicht zu beeinflussen sind, die Charakteristiken der [psychologisch] Pathologischen an, um zu überleben und Erfolg zu haben. Sie sehen, dass ihre Anführer lügen und betrügen, und schlussfolgern, dass sie, um voran zu kommen, dies ebenfalls tun können. “

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Ein wichtiger Text aus den Fußnoten :


“Auf der einen Seite dieser Kontroverse findet sich die traditionelle Beschreibung von Psychopathie, abgeleitet von der alten europäischen Tradition und diskutiert von Łobaczewski, kombiniert mit der nordamerikanischen Tradition von Hervey Cleckley, Robert Hare und anderen. Sie befindet sich in allgemeiner Übereinstimmung mit den Erfahrungen von praktizierenden Psychiatern, Psychologen, Strafjustizpersonal, experimentellen Psychopathologen und sogar Mitgliedern der Laien-Öffentlichkeit, die persönliche Begegnungen mit Psychopathie hatten.

Auf der anderen Seite der Streitfrage ist das, was sich die neo-Kraeplelin'sche Bewegung der Psychodiagnose (benannt nach Emil Kraepelin) nennt, die eng mit der auf der Washington Universität in St. Louis, Missouri, betriebenen Forschung verbunden ist. Diese spätere Sicht ist sehr eng an die diagnostischen Kriterien des U.S. Psychiatric Manual, bekannt als DSM-III, DSM-III-R und DSM-IV, ausgerichtet. Die grundlegende Herangehensweise dieser Schule ist, dass die Einstufung als Psychopath fast ausschließlich auf öffentlich beobachtbaren oder bekannten Verhaltensweisen beruht, was aber genau im Gegensatz zudem steht, was man über Psychopathen weiß: ihre Fähigkeit zur Maskierung ihrer wahren Natur (die Maske der Vernunft). Das Argument ist hierbei, dass ein Kliniker unfähig ist, die zwischenmenschlichen oder affektiven Charakteristiken zu erfassen. Eine weitere Annahme dieser Schule ist, dass frühmanifeste Delinquenz ein Hauptsymptom von APS (Antisoziale Persönlichkeitsstörung) ist. Dies verlagert die Betonung stark auf straffälliges und antisoziales Benehmen, d.h., öffentlich beobachtbare Verhaltensweisen, die nichts mit dem internen Make-up des Individuums zu tun haben müssen.

Wie auch immer, das DSM-III Handbuch entschied, dass Psychopathie zu der Kategorie „Antisoziale Persönlichkeitsstörung“ gehören sollte.
Die Kriterien des DSM-III Handbuches für APS wurden von einem Komitee der DSM-III Task Force der American Psychiatric Association entschieden und wurde nur gering von einem weiteren Komitee, das des DSM-III-R, überarbeitet. Die DSM-IV Kriterien wurden ebenfalls durch ein Komitee entschieden, aber ohne große Beachtung von empirischer Forschung. Diese Kriterien sind weniger fokussiert auf das Verhalten und sind deshalb den Kriterien anderer DSM-IV Persönlichkeitsstörungen sehr ähnlich.

Wegen den Problemen mit der DSM-III und DSM-III-R Diagnose von APS führte die American Psychiatric Association in Vorbereitung von DSM-IV eine Feldstudie durch, um Daten zu sammeln. Die Feldstudie war dazu entworfen, festzustellen, ob auch Persönlichkeitsmerkmale zu den Kriterien für APS (das ausschließlich auf dem öffentlich sichtbaren Verhalten beruht) gezählt werden können, ohne die Genauigkeit einer Diagnose zu reduzieren. Die Absicht jeder Kliniker, die dafür Lobbying betrieben, war, ASP zurück in die klinische Tradition zu bringen und der Verwechslung zwischen ASP und Psychopathie ein Ende zu setzen.

Die Resultate dieser Feldstudie demonstrierten, dass die meisten Persönlichkeitsmerkmale, die Symptome von Psychopathie anzeigten, genauso zuverlässig waren wie die verhaltensspezifischen DSM-III-R Elemente, und entkräfteten somit die ursprüngliche Prämisse, die Persönlichkeit von der Diagnose von ASP/Psychopathie auszuschließen. Mehr noch: die Resultate demonstrierten, dass Hares PCL-R Maßstab tatsächlich die latenten Merkmale von Psychopathie über ihren gesamten Bereich messen kann! Ähnliche Analysen der Daten des Feldversuches zeigen, dass die ASP Kriterien weniger Unterscheidungsfähigkeit von Merkmalen der Psychopathie aufwiesen, besonders bei größerem Ausmaß der Merkmale! In anderen Worten, die Kriterien für ASP, die durch das DSM-III-R Handbuch festgelegt wurden, wurden dazu ausgelegt — vorsätzlich oder nicht — die psychopathischsten Psychopathen auszuschließen!

Obwohl es nach dieser Studie eine empirische Basis gab, der die inhaltsbezogenen Kriterien für ASP im DSM-IV Handbuch vermehrte, wurde dies nicht miteinbezogen; die Kriterien, die in DSM-IV einflossen, waren nicht einmal in der Feldstudie evaluiert worden.
Die textliche Beschreibung des DSM-IV Handbuches von ASP (die laut diesem Handbuch „auch als Psychopathie bekannt“ ist) bezieht sich auf traditionelle Eigenschaften von Psychopathie, ist aber auf viele Arten nicht deckungsgleich mit den formellen Diagnosekriterien.

Eine der Konsequenzen dieser in DSM-IV inhärenten Uneindeutigkeit der Kriterien von Antisozialer Persönlichkeitsstörung (ASP) und Psychopathie ist, dass es die Tür für Gerichtsfälle offen lässt, wo ein Kliniker behaupten kann, dass der Angeklagte die DSM-IV-Definition von ASP erfüllt, und ein anderer Klinker behaupten kann, dass das nicht so ist, und beide gleichzeitig recht haben können! Der erste Kliniker kann ausschließlich die formellen Diagnosekriterien einsetzen, während der zweite Kliniker sagen kann: „Ja, der Angeklagte mag zwar die formellen Kriterien erfüllen, aber er/sie hat nicht die Persönlichkeitsmerkmale, die im Kapitel ‚Dazugehörige Eigenschaften‘ des DSM-IV Handbuchs stehen.“ In anderen Worten: Ein guter Psychopath mit einem guten Anwalt kann jegliches Verbrechen begehen und damit davonkommen. Das Versagen des DSM-IV Handbuches in der Unterscheidung zwischen Psychopathie und Antisozialer Persönlichkeitsstörung kann (und wird zweifelslos) äußerst schwere Konsequenzen auf unsere Gesellschaft haben. “

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Martha Stout, die umfangreiche Untersuchungen mit Opfern von
Psychopathen durchführte, schreibt:

"Bitte versuchen Sie, sich vorzustellen, kein Gewissen zu haben. Sie haben nicht die geringste Spur eines Gewissens und keine Gefühle von Schuld oder Reue - ganz egal, was Sie anstellen, plagen Sie keine lästigen Skrupel über das Wohlbefinden von Fremden, Freunden oder gar Verwandten. Stellen Sie sich vor, es gäbe kein lästiges Hadern mit Ihrem Schamgefühl, kein einziges Mal in Ihrem ganzen Leben, unabhängig davon, ob Sie sich egoistisch, faul, rücksichtslos oder unmoralisch verhalten.
Und stellen Sie sich darüberhinaus vor, dass der Begriff „Verantwortung“ Ihnen fremd wäre, außer vielleicht als eine Bürde, die andere Menschen offenbar wie gutmütige Trottel blind auf sich nehmen.

Und nun erweitern Sie dieses seltsame Gedankenspiel um die Fähigkeit, Ihre so überaus sonderbare psychische Disposition vor anderen Menschen zu verbergen. Da jedermann wie selbstverständlich annimmt, dass das Gewissen eine universelle menschliche Qualität ist, fällt es Ihnen leicht, zu verheimlichen, dass Sie kein Gewissen haben.

Kein Schuld- oder Schamgefühl hemmt die Erfüllung Ihrer Wünsche, und Sie werden von niemandem wegen Ihrer Gefühlskälte zur Rede gestellt. Die eisige Flüssigkeit, die in Ihren Adern fließt, ist so fremdartig, so abseits normaler menschlicher Erfahrungen, dass kaum einem Menschen der Verdacht kommt, dass mit Ihnen etwas nicht stimmen könnte.
Mit anderen Worten: Sie sind völlig frei von internen Kontrollen und Ihre ungehemmte Freiheit, ohne Skrupel alles das zu tun, was Sie wollen, ist bequemerweise für den Rest der Welt nicht erkennbar.

Sie können tun, was Sie wollen — und doch wird Ihr
geheimnisvoller Vorteil vor den meisten Ihrer Mitmenschen, die durch ihr Gewissen gelenkt werden, sehr wahrscheinlich verborgen bleiben.

Wie werden Sie Ihr Leben führen?

Wie werden Sie Ihren gewaltigen, heimlichen Vorteil nutzen, angesichts der korrespondierenden Schwäche der anderen Menschen (dem Gewissen)?

Die Antwort wird weitgehend von Ihren Neigungen und Bedürfnissen abhängen, da die Menschen unterschiedlich sind. Selbst die völlig Skrupellosen gleichen sich nicht. Einige Menschen — ob sie nun ein Gewissen haben oder nicht — neigen zur Bequemlichkeit, während andere voller Träume und ungezügeltem Ehrgeiz sind. Manche Menschen sind brillant und begabt, andere sind einfältig, und die meisten liegen irgendwo dazwischen, haben sie nun ein Gewissen oder nicht. Es gibt gewalttätige und friedfertige Menschen, blutrünstige Individuen und andere, die keine solchen Gelüste haben…
Falls Sie nicht aufgehalten werden, können Sie buchstäblich alles tun.

Wenn Sie zur passenden Zeit geboren werden, Zugang zu einem Familienvermögen haben und besonders begabt dafür sind, den Hass und das Gefühl der Benachteiligung Ihrer Mitmenschen zu schüren, können Sie es erreichen, eine große Zahl argloser Menschen ins Jenseits zu befördern. Mit genug Geld können Sie das aus der Ferne arrangieren, sich in Sicherheit wiegen und zufrieden Ihr Werk betrachten. …
Verrückt und beängstigend — und real, bei etwa vier Prozent der Bevölkerung…
Magersucht tritt bei etwa 3,4 Prozent der Bevölkerung auf, was als fast epidemisch betrachtet wird, und doch ist dieser Wert niedriger als die Verbreitung der antisozialen Persönlichkeitsstörungen. Die schweren Störungen, die man als Schizophrenie klassifiziert, treten nur bei etwa einem Prozent der Bevölkerung auf — das ist lediglich ein Viertel der Verbreitung der antisozialen Persönlichkeitsstörung. Die Gesundheitsbehörden („Centers for Disease Control and Prevention“) geben an, dass Darmkrebs in den USA bei 40 von 100.000 Personen auftritt, was als „alarmierend hoch“ eingestuft wird — und doch nur ein Hundertstel der Verbreitung der antisozialen Persönlichkeitsstörung ausmacht…

Die große Verbreitung der Soziopathie in der menschlichen Gesellschaft hat gravierende Auswirkungen auf uns andere, die wir auch auf diesem Planeten leben müssen, und zwar auch auf jene, die nicht traumatisiert worden sind. Die Individuen, aus denen diese vier Prozent bestehen, plündern unsere Beziehungen, Bankkonten und unser Selbstwertgefühl aus und stören unseren Frieden auf Erden. Und doch wissen die meisten Menschen erstaunlicherweise nichts über diese Persönlichkeitsstörung, und wenn doch, denken sie nur an gewalttätige Psychopathen, an Mörder, Serienkiller oder Massenmörder, an Individuen, die immer wieder auf spektakuläre Weise das Gesetz gebrochen haben und die, falls sie gefasst werden, durch unsere Strafjustiz eingesperrt oder gar zu Tode gebracht werden.

Für gewöhnlich sind wir uns der viel größeren Anzahl nicht-gewalttätiger Soziopathen unter uns nicht bewusst, und normalerweise erkennen wir sie nicht — Menschen, die nicht in eklatanter Weise die Gesetze brechen und vor denen unser Rechtssystem kaum einen Schutz bietet.
Die meisten Menschen würden keinen Zusammenhang erkennen zwischen der Planung eines Völkermordes und zum Beispiel dem schamlosen Anschwärzen eines Kollegen bei dessen Chef. Aber der psychologische Zusammenhang existiert nicht nur, er ist beklemmend. Die Verbindung besteht schlicht und ergreifend darin, dass der innere Mechanismus fehlt, der uns — emotional gesprochen — in die Zange nimmt, wann immer wir eine Entscheidung treffen, die wir als unmoralisch, unanständig, verantwortungslos oder egoistisch ansehen. Die meisten von uns werden einen Anflug von Schuld verspüren, wenn wir das letzte Stück Kuchen in der Küche nehmen — ganz zu schweigen von dem, was wir fühlen würden, wenn wir vorsätzlich und systematisch den Plan fassen würden, einen anderen Menschen zu verletzen.

Diejenigen, die kein Gewissen haben, sind eine Gruppe für sich, seien sie nun mörderische Tyrannen oder lediglich rücksichtslose Sozialschmarotzer. Das Vorhandensein oder Fehlen des Gewissens ist eine tiefe Kluft, die die Menschheit spaltet, wohl signifikanter als Intelligenz, Rasse oder sogar das Geschlecht.
Was einen Soziopathen, der von der Arbeit anderer lebt, von einem unterscheidet, der bei Gelegenheit einen Supermarkt ausraubt oder ein Gangsterboss ist — oder was der Unterschied zwischen einem gewöhnlichen Rowdy und einem soziopathischen Mörder ausmacht — ist nicht mehr als gesellschaftliches Ansehen, Zielstrebigkeit, Intelligenz, Mordlust oder schlichtweg die passende Gelegenheit. Was alle diese Individuen von uns anderen unterscheidet, ist das gähnende Loch an der Stelle ihrer Seele, wo sich eigentlich die am höchsten entwickelte menschliche Qualität befinden sollte.
[Martha Stout — Der Soziopath von nebenan] "

[Barack Osama bin David]

würd mich mal interessieren wie sich dieser inzest den unsere geliebte elite ja betreibt auf das hirn auswirkt

sonderlich missgestaltet sehen die ja nicht aus.. und gesundheitlich ist da wohl auch alles ok, aber das scheint sich doch irgendwie in der persönlichkeit niederzuschlagen

hat da einer mehr zu?

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Sehr interessante Bilder von Gehirnaktivitäten und vorallem bei den Unterschieden in der Gehirnaktivität zwischen nem "normalen" Menschen und nem Psychopath:
psychopath mri - general psychology
http://www.youtube.com/watch?v=oaTfd...eature=related

Robert Hare (hab leider nicht alles davon verstanden,denke aber das es für den ein oder anderen User sehr brauchbar ist,wäre cool den Clip zu übersetzen statt den Clown Jones )
http://www.youtube.com/watch?v=ui9C6xVpVf0&hl=de

"According to popular wisdom, psychopaths are crazed and bloodthirsty serial killers. The reality is not so simple. While many psychopaths do commit violent crimes, not all psychopaths are criminals and not all criminals are psychopathic. Psychopaths are found in many walks of life and are often successful in competitive professions. However they are also ruthless, manipulative and destructive. Equinox reports on techniques developed by
psychologists to work out whether a person is psychopathic and shows how brain scientists are coming close to mapping the malfunctions in the brain that cause a person to be a psychopath. "

Equinox-Psychopath
http://video.google.com/videoplay?do...54058647438214

Gary Baumgarten interviews Dr Martha Stout
http://www.youtube.com/watch?v=dhOu7x0y8qM

Nochmals der Artikel,denke er gehört definitiv auch hier rein:

Über Krieg und Feindbild
http://quantumfuture.net/gn/zeichen/...-feindbild.php

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Ein interessanter und ausführlicher Artikel zum Thema Psychopathie,der auch nochmal wichtige Infos bereit hält,da hier arge Zeichenbegrenzung ist,werdens wohl mehrere Teile:

The development of psychopathy

R.J.R. Blair, K.S. Peschardt, S. Budhani, D.G.V. Mitchell, D.S. Pine (2006)
The development of psychopathy
Journal of Child Psychology and Psychiatry 47 (3-4), 262–276.

James Blair, Unit on Affective Cognitive Neuroscience, Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Drive, Room 206, MSC 2670, Bethesda, Maryland 20892-2670, USA; Email: blairj@intra.nimh.nih.gov
Abstract

The current review focuses on the construct of psychopathy, conceptualized as a clinical entity that is fundamentally distinct from a heterogeneous collection of syndromes encompassed by the term 'conduct disorder'. We will provide an account of the development of psychopathy at multiple levels: ultimate causal (the genetic or social primary cause), molecular, neural, cognitive and behavioral. The following main claims will be made: (1) that there is a stronger genetic as opposed to social ultimate cause to this disorder. The types of social causes proposed (e.g., childhood sexual/physical abuse) should elevate emotional responsiveness, not lead to the specific form of reduced responsiveness seen in psychopathy; (2) The genetic influence leads to the emotional dysfunction that is the core of psychopathy; (3) The genetic influence at the molecular level remains unknown. However, it appears to impact the functional integrity of the amygdala and orbital/ventrolateral frontal cortex (and possibly additional systems); (4) Disruption within these two neural systems leads to impairment in the ability to form stimulus–reinforcement associations and to alter stimulus–response associations as a function of contingency change. These impairments disrupt the impact of standard socialization techniques and increase the risk for frustration-induced reactive aggression respectively.

The goal of the present paper is to provide as full an account of the development of psychopathy as possible. To explain a disorder, we need an account of the development of that disorder at multiple levels: ultimate causal (the genetic or social primary cause), molecular, neural, cognitive and behavioral. We need to be able to say how the genetic or social primary cause leads to specific receptor-level, molecular anomalies that impact on the functioning of specific neural systems such that specific cognitive functions are dysfunctional and a particular behavioral profile emerges. Of course, we have not reached that stage in understanding psychopathy. This paper will review what is currently known.

One major tenet to our argument is that psychopathy is a construct that is unique, relative to other syndromes captured in the current psychiatric nosology. The classification of psychopathy was introduced by Hare (1980, 1991). It is a developmental disorder in that it can be identified in both childhood and adulthood (Frick, O'Brien, Wootton, & McBurnett, 1994; Hare, 1980, 1991). Longitudinal studies showing that those identified as psychopathic in childhood are also identified as psychopathic in adulthood have not yet been done. However, the neuro-cognitive impairments seen in children with psychopathic tendencies are, for the most part, also seen in adults with psychopathic tendencies (see below).

The classification of psychopathy identifies a relatively homogeneous pathology (at least when compared with the diagnoses of conduct disorder [CD] and antisocial personality disorder [APD]). Unlike CD and APD, psychopathy involves a pervasive pattern of both emotional (considerably reduced empathy and guilt) and behavioral (criminal activity and, frequently, violence) symptoms (Frick et al., 1994; Hare, 1980, 1991). We argue that the emotional component is the crucial component of psychopathy. There are many developmental routes to an elevated risk for antisocial behavior (Blair, 2001; Silverthorn & Frick, 1999). The emotional dysfunction that is at the heart of psychopathy is only one such route. However, it is one that puts the individual at heightened risk for learning antisocial behaviors. Although, as will be argued, it does not necessarily mean that the individual will learn to be antisocial; whether he/she does or not will be determined by a constellation of individual and social factors.

The problem with the diagnoses of CD and APD is that because they focus on the behavioral feature of antisocial behavior, they do not differentiate between potential causes for its development. As a result, only approximately 25% of individuals classified with either of CD or APD will show psychopathic tendencies (Hart & Hare, 1996). Indeed, children with CD are a heterogeneous population. One child with CD might show the marked reduction in anxiety, empathy and guilt associated with psychopathy whilst another child with CD might show an opposite pathology – markedly elevated levels of anxiety. In contrast, we would like to believe that all appropriately identified individuals with psychopathy should share some feature of basic pathophysiology.

A core feature of the behavioral profile of children and adults with psychopathy is their excessive use of instrumental (a.k.a. proactive and planned) aggression (Cornell et al., 1996; Frick, Cornell, Barry, Bodin, & Dane, 2003). Instrumental aggression is purposeful and goal-directed aggression, used instrumentally to achieve a specific desired goal such as obtaining the victim's possessions (Berkowitz, 1993). In contrast, reactive (a.k.a. affective, impulsive, defensive) aggression is triggered by a frustrating or threatening event and is often associated with anger (Barratt, Stanford, Dowdy, Liebman, & Kent, 1999; Berkowitz, 1993; Crick & Dodge, 1996). Elevated levels of reactive aggression are found in many disorders including psychopathy (see, for a review, Blair, 2003c). However, individuals with psychopathy show particularly elevated levels of instrumental aggression, relative to individuals with other syndromes associated with behavioral dys-control.

At the anatomical level, we have followed the work of Siegel and Panksepp suggesting that reactive aggression is mediated by a basic threat system that runs from medial amygdaloidal areas down to the dorsal half of the periaqueductal gray (e.g., Gregg & Siegel, 2001; Panksepp, 199. We have suggested that this system is regulated by orbital, medial and ventrolateral frontal cortex (Blair, 2004; Grafman, Schwab, Warden, Pridgen, & Brown, 1996) and that it can become dysfunctional in two broad ways (Blair, 2004): First, the basic threat system may become elevated in its responsiveness due to endogenous (e.g., genetic) or exogenous (e.g., trauma; see below) factors. Second, the frontal systems regulating its activity may become dysfunctional. We will argue below that trauma can lead to increased responsiveness of the basic threat circuitry and therefore a greater risk for the individual expressing an extreme response (reactive aggression) to a mild threat rather than the more ecologically appropriate one (freezing or escape behavior). We will also argue below that the increased risk for reactive aggression seen in psychopathy is not to this type of dysfunction; the threat circuitry in psychopathy (at least the amygdala) is under-responsive rather than over-responsive. We will argue instead that the increased risk for reactive aggression in psychopathy is related to dysfunction in the regulatory activity of ventrolateral prefrontal cortex.

With respect to instrumental aggression, there have been suggestions that animal work on the neurobiology of predatory aggression may be informative regarding human instrumental aggression (Gregg & Siegel, 2001). However, animal predatory aggression is not displayed towards conspecifics while human instrumental aggression is almost always displayed towards conspecifics. Moreover, human instrumental aggression is goal directed and highly influenced by the individuals' learning history. Because instrumental aggression is a goal-directed motor response, we argue that it recruits the same neural regions as any other goal-directed activity; i.e., striatal and premotor cortical neurons (Passingham & Toni, 2001). We argue that the pathology leading to heightened levels of pro-active aggression relates to socialization; because of impairment in specific forms of emotional learning, the child does not learn to avoid antisocial behavior.

As noted above, children and adults with psychopathy show heightened levels of both reactive and instrumental aggression. We will argue that the explanations of the increased risk for instrumental and reactive aggression seen in psychopathy may be independent at the neural and cognitive levels though we assume, once an adequate genetic/molecular account is available, that they are fundamentally related. In other words, there may be a single genetic contribution to two, or more, functionally relatively independent neuro-cognitive dysfunctions.
Ultimate causes


By ultimate causes, we are referring to factors that are hypothesized to give rise to the basic pathology (the emotion dysfunction) that, we argue, is at the heart of the disorder. In this section, we are not considering factors (e.g., poor parenting, unemployment) that likely influence the behavioral manifestation of psychopathy but which, in our opinion, do not cause the primary emotion dysfunction seen in psychopathy. These influences will, however, be briefly discussed separately below. The ultimate causes we will consider are genes, physical/sexual abuse and brain damage (for example, from alcohol/drug abuse during pregnancy or birth complications).
Psychopathy and genes

There has been a long behavioral genetic literature examining genetic influences on aggression and antisocial behavior more generally (Miles & Carey, 1997; Rhee & Waldman, 2002). This literature has provided heritability estimates for dimensional measures of aggression ranging from 44% to 72% in adults. However, this literature is difficult to interpret. First, because any genetic impact is likely to be complex and may be expressed as a function of an interaction with environmental factors (Caspi et al., 2002). Second, because this literature typically treats aggression as a unitary construct, there is no division between reactive and instrumental aggression. Third, because the literature has, on occasion, implied a genetic basis to individual antisocial behaviors. It is extremely unlikely that there is a direct genetic contribution to these specific behaviors, or at least it is as likely as there is a direct genetic contribution to an individual using an ATM machine to gain money. An individual learns to use an ATM and under particular conditions might also learn to become a pimp.

Genetic variation is likely to play a role is in determining the probability that the individual will learn an antisocial strategy to gain money (e.g., becoming a pimp) as opposed to a strategy sanctioned by society (using an ATM machine at the end of the workday). Many have argued that the emotional dysfunction shown by individuals with psychopathy makes them more likely to learn antisocial strategies to reach goals (Blair, 1995; Eysenck, 1964; Lykken, 1995; Trasler, 1973). These strategies fundamentally involve navigation of complex situations involving multiple emotionally salient cues. As such, this suggests that there may a genetic contribution to the emotional dysfunction behind the behavior, and that it is this association with emotional dysfunction which underlies the genetic contribution to antisocial behavior. Three recent studies provide support for this suggestion. In adults, Blonigen and colleagues (Blonigen, Carlson, Krueger, & Patrick, 2003) collected data from 353 male twins using the self-report Psychopathic Personality Inventory [PPI] (Lilienfeld & Andrews, 1996) and found moderate heritability (h2 = .29 to .56) for the affect-based subscales of the measure (Blonigen et al., 2003). Blonigen and colleagues (2005) collected data from 626 pairs of 17-year-old male and female twins using the Multidimensional Personality Questionnaire and found significant heritability (h2 = .46 to .51) for the two measures of psychopathic traits indexed [Fearless dominance and Impulsive Antisociality]; (Blonigen, Hicks, Krueger, Patrick, & Iacono, 2005). In children, examining almost 3,500 twin pairs within the Twins Early Development Study (TEDS), the callous and unemotional component of psychopathic tendencies was indexed at age 7 (Viding, Blair, Moffitt, & Plomin, 2005). This study revealed a significant group heritability of h2 g = .67 and no shared environmental influence on the callous-unemotional component; i.e., genetic factors account for two-thirds of the difference between the callous-unemotional pro-bands and the population.
A social basis to psychopathy?

There is considerable belief amongst the lay population, at least, that social factors, such as abuse, might cause psychopathy. Certainly, there is considerable evidence in humans of an association between physical and sexual abuse and increased risk of aggression and impulsivity (Dodge, Pettit, Bates, & Valente, 1995; Farrington & Loeber, 2000; Widom, 1992). Similarly, considerable data indicates that exposure to violence in the home/neighborhood increases the risk for aggression (e.g., Miller, Wasserman, Neugebauer, Gorman-Smith, & Kamboukos, 1999; Schwab-Stone et al., 1999). However, our position is that abuse/exposure to other extreme traumas potentiates specific neural systems involved in the individual's response to threat and by doing so increases the risk of reactive aggression and through this, increases the probability of a diagnosis of CD (see below). In contrast, we believe that abuse is unlikely to lead to the affective 'flattening' that is core feature of psychopathy (though see Carrey, Butter, Persinger, & Bialik, 1995).

Considerable work with animals has revealed the neurobiological impact of acute and prolonged threat/stress on aggressive behavior. Stimulation of the superior colliculus, a sub-cortical region involved in the mammalian basic response to threat (Gregg & Siegel, 2001; Panksepp, 199, can potentiate the responsiveness of this system. This stimulation can increase levels of threat-relevant behavior for at least 3 months afterwards (King, 1999). In addition, the neuro-chemical response to threat can be profoundly affected throughout the lifespan by prior threat experience, particularly if this occurs early in life (Bremner & Vermetten, 2001; Charney, 2003).

The mammalian response to threat is gradated. At low levels of danger, from a distant threat, animals freeze. At higher levels, from a closer threat, they attempt to escape. At higher levels still, when the threat is very close and escape is impossible, the animal initiates reactive aggression (Blanchard, Blanchard, & Takahashi, 1977). In other words if, as appears to be the case (Bremner & Vermetten, 2001; Charney, 2003; King, 1999), prior threat exposure increases the individual's responsiveness to threat, then an individual who has been abused will be more likely to display reactive aggression to a lower-level threat than an individual who has not been so exposed. We believe that this is the origin of the association between child abuse and increased risk of aggression (Farrington & Loeber, 2000; Widom, 1992); lower-level threats, or more distal threats, can elicit reactive aggression more easily in abused individuals than in individuals not abused. However, we do not believe, on the basis of the available data, that physical/sexual abuse is a key factor in the genesis of psychopathy. A defining feature of psychopathy is the reduction, not elevation, in the individual's responsiveness to threat (Cleckley, 1976; Hare, 1970; Lykken, 1995; Patrick, 1994). Indeed, it is even possible that the neurobiological basis of psychopathy may protect the individual with psychopathic tendencies from developing mood and anxiety disorders such as depression, anxiety and post traumatic stress disorder. Thus, traumatic exposure, including exposure to violence in the home/neighborhood, increases the risk for mood and anxiety disorders in general, though not all exposed to trauma will go on to develop these disorders (Gorman-Smith & Tolan, 1998; Schwab-Stone et al., 1999). We argue that trauma increases the risk for CD/ASPD as a function of increased levels of purely reactive aggression. We hypothesize that individuals with psychopathy are protected from these risk factors. Studies examining the emotional and behavioral dimensions of psychopathy independently report that anxiety level is inversely associated with the emotional dimension but positively associated with the antisocial behavior dimension (Frick, Lilienfeld, Ellis, Loney, & Silverthorn, 1999; Patrick, 1994; Verona, Patrick, & Joiner, 2001). In short, increases in anxiety are associated with increases in antisocial behavior, particularly reactive aggression, but decreases in the emotional component of psychopathy. Similarly, depression appears to be inversely associated with psychopathy (Lovelace & Gannon, 1999).
Environmental insult

Birth complications such as anoxia and pre-eclampsia can give rise to brain damage. Babies who suffer birth complications are more likely to develop conduct disorder (CD), delinquency, and commit violence in adulthood, particularly when other psychosocial risk factors are present (Hodgins, Kratzer, & McNeil, 2001, 2002; Pine, Shaffer, Schonfeld, & Davies, 1997; Piquero & Tibbetts, 1999; Raine, 2002a; Raine et al., 1994).

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Minor physical anomalies (MPAs) are relatively minor physical abnormalities consisting of such features as low-seated ears, adherent ear lobes, and a furrowed tongue. MPAs have been associated with disorders of pregnancy and are thought to be a marker for fetal neural mal-development towards the end of the first three months of pregnancy. MPAs can be caused by environmental factors acting on the fetus such as anoxia, bleeding, and infection though they can also have a genetic basis (Guy, Majorski, Wallace, & Guy, 1983). MPAs, like obstetric complications, have also been linked to the development of CD, delinquency, and violence in adulthood, again particularly when other psychosocial risk factors are present (Brennan et al., 1997; Mednick & Kandel, 1988; Raine, 2002a). Unfortunately, the literature has not considered whether birth complications/MPAs are a risk factor for the emergence of psychopathy or syndromes linked to heightened levels of reactive aggression. Moreover, there has been little consideration of why birth complications or problems during pregnancy, as indicated by MPAs, should interact with psychosocial behavior. It has been suggested that 'the presence of a negative psychosocial factor is required to ''trigger'' the biological risk factor …' (p. 426, Raine, 2002a). It is unclear, however, how a psychosocial factor could trigger the biological risk factor. Instrumental aggression is goal-directed behavior. It is difficult to imagine how a particular state of a biological risk would inevitably trigger a specific form of instrumental behavior, i.e., instrumental aggression. A similar argument can be made for reactive aggression. Reactive aggression is a response to threat or frustration. It will not occur in the absence of environmental input. But it is not that the environmental input triggers the system into a state such that reactive aggression will be regularly displayed. Rather it is that reactive aggression will not be displayed without some form of environmental stimulus (such as an imagined threat).

Summary: We argue that there is a genetic contribution to the emotion dysfunction component of psychopathy. This, in turn, puts the individual at greater risk for the development of the full syndrome. This does not suggest that the genetic contribution is the only determinant of how the pathology manifests; it is highly likely that other factors including social factors will have an influence. However, it does suggest that the genetic contribution may be a prerequisite for the development of the disorder whilst these other factors will influence the full presentation.

Physical and sexual abuse and other environmental traumas can elevate the responsiveness of the basic threat circuitry and increase the probability that an individual might show reactive aggression (Blair, 2004). However, an elevated responsiveness of the basic threat circuitry is not seen in individuals with psychopathy but rather reduced responsiveness. This is inconsistent with suggestions that psychopathy might be due to early environmental trauma.

Birth complications are risk factors for violent antisocial behavior, particularly if they occur when other psychosocial risk factors are present (Mednick & Kandel, 1988; Raine, 2002b). Unfortunately, to our knowledge, no studies have evaluated whether birth complications and MPAs are associated with an increased risk for instrumental or reactive aggression or both. An increased risk for instrumental aggression would suggest that birth complications and MPAs are associated with dysfunction in systems responsible for emotional learning. An increased risk for reactive aggression would suggest that birth complications and MPAs are associated with dysfunction in systems responsible for the regulation of the basic threat system. We believe it is far more likely that birth complications and MPAs are associated with dysfunction in systems responsible for the regulation of the basic threat system (and thus an increased risk for reactive aggression). Indeed, work with animals shows that perinatal distress does lead to hypofunction in systems responsible the regulation of the basic threat system (Brake, Sullivan, & Gratton, 2000). We believe, on the basis of the current evidence, that it is unlikely that birth complications are associated with an increased risk for the instrumental aggression seen in individuals with psychopathy.
A molecular neuroscience account of psychopathy


Given the suggestion above of a genetic basis to the emotional disorder that is the basis of psychopathy it would be useful to be able to determine which genes give rise to what sorts of effects at the molecular level. However, we are some way off from a molecular neuroscience account of psychopathy.

Several suggestions have been made. For example, it has been suggested that there may be serotonergic abnormalities in individuals with psychopathy (Soderstrom, Blennow, Manhem, & Forsman, 2001; Soderstrom, Blennow, Sjodin, & Forsman, 2003). However, the samples in the Soderstrom et al. studies involve individuals under forensic pretrial evaluation, a non-typical sample of individuals with psychopathy. Studies with more typical samples find the usual relationship between reduced serotonergic response and increased levels of aggression (Coccaro, 1996) but no relationship with the emotional basis of psychopathy (Dolan & Anderson, 2003). We have argued elsewhere that the norepinephrine system may be implicated in the pathology of psychopathy (Blair, 2003b). Norepinephrine (NE) has a considerable role in the innervation of the neural systems involved in the basic response to threat in both animals and humans (Ferry, Roozendaal, & McGaugh, 1999; MacDonald & Scheinin, 1995). There have been provocative suggestions that NE is involved in mediating the impact of aversive cues in human choice (Rogers, Lancaster, Wakeley, & Bhagwager, submitted), and NE manipulations appear to selectively impact the processing of sad expressions (Harmer, Perrett, Cowen, & Goodwin, 2001). In addition, there have been a series of reports that high levels of antisocial behavior/conduct disorder are associated with reduced norepinephrine levels (Raine, 1993; Rogeness, Cepeda, Macedo, Fischer, & Harris, 1990). However, as yet the data with respect to psychopathy remains sparse and inconclusive.

Summary: While we believe that there is a genetic contribution to the emotion dysfunction component of psychopathy, how this contribution manifests itself at the molecular level is currently unknown.
Neural systems implicated in psychopathy

While it remains unknown how the genetic contribution to psychopathy manifests at the molecular level, it appears clear that at the neural system level it manifests in at least two main systems: the amygdala and orbital/ventrolateral frontal cortex. These will each be briefly considered in turn. As a fundamental tenet to both considerations, we view these systems as neural circuits possessing precise functions in terms of information processing. Thus, delineation of information-processing deficits in a syndrome is a fundamental prerequisite to identifying circuitry involvement in complex syndromes, such as psychopathy. Moreover, given our view of psychopathy as a neurodevelopmental disorder, delineating normal functions of these circuits, both in developing and mature organisms, is fundamental to linking circuitry-based dysfunction to information processing deficits and their associated clinical manifestations.
The amygdala and psychopathy

There are considerable indications of amygdala dysfunction in individuals with psychopathy (Blair, 2003b). Functional imaging studies have shown that adults with the disorder present with reduced amygdala activation during emotional memory (Kiehl et al., 2001) and aversive conditioning tasks (Birbaumer et al., 2005; Veit et al., 2002); though see (Muller et al., 2003). In addition, individuals with psychopathy present with impairment on a series of tasks which require the functional integrity of the amygdala. Thus, lesions of the amygdala disrupt aversive conditioning (Bechara et al., 1995; LaBar, LeDoux, Spencer, & Phelps, 1995), the augmentation of the startle reflex by visual threat primes (Angrilli et al., 1996), passive avoidance learning (Ambrogi Lorenzini, Baldi, Bucherelli, Sacchetti, & Tassoni, 1999) and fearful expression recognition (Adolphs, 2002; Blair, 2003a). Individuals with psychopathy show impairment in aversive conditioning (Flor, Birbaumer, Hermann, Ziegler, & Patrick, 2002), the augmentation of the startle reflex by visual threat primes (Levenston, Patrick, Bradley, & Lang, 2000), passive avoidance learning (Newman & Kosson, 1986) and fearful expression recognition (Blair, Colledge, Murray, & Mitchell, 2001). The functional impact of this amygdala dysfunction with respect to empathy, socialization and the development of instrumental aggression will be discussed further below.
Frontal lobe dysfunction and psychopathy

Frontal lobe/executive function dysfunction has long been related to antisocial behavior with claims that either psychopathy in particular or antisocial behavior more generally is due to frontal lobe dysfunction (Gorenstein, 1982; Moffitt, 1993; Raine, 2002a). Three main strands of data support this contention: (1) individuals with antisocial behavior show impaired performance on classic measures of executive functioning (see, for reviews of this literature, Kandel & Freed, 1989; Morgan & Lilienfield, 2000); (2) neuro-imaging data indicate that aggressive individuals are marked by reduced frontal functioning (Goyer et al., 1994; Raine et al., 1998; Volkow et al., 1995); and (3) patients with lesions of frontal cortex, whether these occur early in life or adulthood, present with a heightened risk for aggression (Anderson, Bechara, Damasio, Tranel, & Damasio, 1999; Grafman et al., 1996; Pennington & Bennetto, 1993).

We have argued elsewhere that the frontal lobe positions need greater specification (Blair, 2004). Frontal cortex corresponds to almost half of the cortex (Fuster, 1980) and has been implicated in a wide variety of putative processes (Baddeley & Della Sala, 1998; Luria, 1966; Shallice & Burgess, 1996). However, the frontal lobe positions rarely specify which regions/executive processes are thought to be dysfunctional. Moreover, the frontal lobe dysfunction positions also have not specified whether they apply to reactive or instrumental aggression or both.

Fortunately, the existent data allow some specification of the frontal lobe dysfunction positions. The neurological literature indicates that only lesions of orbital and ventrolateral frontal cortex, and not dorsolateral prefrontal cortex, are associated with increased risk of aggression (Grafman et al., 1996). Moreover, only the risk for reactive, and not instrumental, aggression is associated with such lesions (Anderson et al., 1999; Grafman et al., 1996; Pennington & Bennetto, 1993). Orbital and ventrolateral frontal cortex regulate the neural systems (the amygdala, hypothalamus and peri-aqueductal gray) that mediate the basic response to threat (including reactive aggression) (Gregg & Siegel, 2001; Panksepp, 199. When they are dysfunctional the basic threat response becomes dys-regulated, increasing the risk for reactive aggression. Psychopathy is associated with an increased risk for both reactive and instrumental aggression (Cornell et al., 1996; Frick et al., 2003; Williamson et al., 1987).

In other words, a frontal lobe dysfunction position, even if specified in detail, is unlikely to be able to account for the development of the full syndrome. However, there are indications of orbital/ventrolateral frontal cortex dysfunction in individuals with psychopathy. Animal and human lesion studies, as well as recent functional imaging studies, all strongly indicate a role of orbital/ventrolateral frontal cortex in response reversal and extinction (Cools, Clark, Owen, & Robbins, 2002; Rolls, 1997; Rolls, Hornak, Wade, & McGrath, 1994); see also below. Individuals with psychopathy show marked problems in response reversal/extinction (LaPierre, Braun, & Hodgins, 1995; Mitchell, Colledge, Leonard, & Blair, 2002; Newman, Patterson, & Kosson, 1987).
Dysfunction beyond the amygdala and orbital/ventrolateral frontal cortex

It is unlikely that the genetic contribution to psychopathy only affects the amygdala and orbital/ventrolateral frontal cortex. However, it is currently unknown whether the genetic contribution influences regions beyond these systems. On the basis of neuro-imaging data, Kiehl (in press) has argued that there is dysfunction in individuals with psychopathy within paralimbic cortex (i.e., amygdala, anterior superior temporal gyrus, rostral and caudal anterior cingulate, posterior cingulate, ventromedial frontal cortex and parahippocampal regions). However, neuro-imaging data is notoriously unable to localize deficits; impairment in any region will lead to anomalous activity in any region reliant on the dysfunctional region for input. We can only be sure that an area is dysfunctional in a population if both neuro-imaging and neuropsychological data indicate impairment. Indeed, anterior cingulate, at least, does not appear globally impaired in individuals with psychopathy. Damage to anterior cingulate is known to increase the Stroop effect; i.e., the interference by distracter information (Stuss, Gallup, & Alexander, 2001). However, individuals with psychopathy show no evidence of increases in the Stroop effect, if anything the opposite (Hiatt, Schmitt, & Newman, 2004; Peschardt et al., in press b).

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Summary: Earlier positions suggesting that frontal lobe dysfunction is a risk factor for antisocial behavior more generally or psychopathy in particular required specification. This has occurred. Orbital and ventrolateral dysfunction is a risk factor specifically for reactive aggression; in the healthy individual these regions are involved in regulating the neural systems that mediate the basic response to threat (which, at its most extreme, is reactive aggression). These regions appear dysfunctional in psychopathy and, we believe, put individuals with this disorder at heightened risk for inappropriate displays of reactive aggression. In addition, we believe that psychopathy is marked by amygdala dysfunction. We believe this dysfunction disrupts the ability of the individual to be socialized and thus puts them at greater risk of learning antisocial behaviors, including instrumental aggression, to achieve their goals (see below).
Cognitive dysfunction in psychopathy


The use of the term cognitive here refers to a functional capacity of a given neural system/neural circuit whether the circuitry involved includes 'limbic' structures or not. Thus, for example, our neural account of psychopathy above suggested amygdala dysfunction and the comparable cognitive account to be described will suggest impairment in stimulus–reinforcement association formation.
'Executive' accounts of psychopathy

We term Lynam's impulse control and Newman's response set modulation models executive accounts because they suggest the existence of general systems operating on multiple domains. These accounts do not deny the existence of emotional deficits in psychopathic individuals. However, they suggest that these emotional deficits are secondary to putative executive deficits.

Executive dysfunction in psychopathy has been linked to impulsivity (Miller, Flory, Lynam, & Leukefeld, 2003; Whiteside & Lynam, 2001), conceptualized as (lack of) premeditation and (lack of) perseverance, where lack of premeditation is likened to the 'inability to inhibit previously rewarded behavior when presented with changing contingencies' (Whiteside & Lynam, 2001) and lack of perseverance 'may be related to disorders that involve the inability to ignore distracting stimuli or to remain focused on a particular task' (Whiteside & Lynam, 2001). In addition, executive dysfunction in psychopathy has been linked to impaired response set modulation – the 'rapid and relatively automatic (i.e., non-effortful or involuntary) shift of attention from the effortful organization and implementation of goal-directed behavior to its evaluation' (Patterson & Newman, 1993; Newman, 199.

From these accounts it could be expected that individuals with psychopathy would be impaired on a broad range of tasks; many tasks can be considered to involve inhibition or response set modulation (e.g., the intra-dimensional/extra-dimensional (ID/ED) and spatial alteration/object alteration tasks). In these tasks, there are two principal measures: First, the number of response reversal errors/object reversals. Second, the number of ED errors/spatial reversals (e.g., in the ID/ED task, when the participant responds by choosing one or other shape despite the fact that the reward contingency is based on the lines which accompany the shapes). Response/object reversal, ED shifting and spatial alteration would all appear to require the inhibition of a previously rewarded behavior/response modulation. However, while inhibition or response modulation accounts can explain the response/object reversal impairment shown by individuals with psychopathy, they have more difficulty explaining the lack of an impairment in ED shifting/spatial alteration shown by the same individuals (Mitchell et al., 2002; Peschardt et al., in press b). Yet an account of these data can be provided from the perspective of cognitive neuroscience. Thus, as we argued above, individuals with psychopathy are impaired in those processes, mediated by orbital/ventrolateral frontal cortex, that allow the alternation of responding to different objects as a function of contingency change. However, they are unimpaired in those processes, mediated by dorsolateral prefrontal cortex, that allow the alternation of responding to different conceptual categories (shapes vs. lines) or spatial locations as a function of contingency change. In short, even if a characterization of the impairment in individuals with psychopathy in terms of inhibition or response modulation was correct, we argue that it would be necessary to constrain such accounts such that they were not domain general but rather specific to particular neuro-cognitive systems.
Stimulus–reinforcement associations, fear, empathy, moral socialization and instrumental antisocial behavior

The amygdala is necessary for the formation of stimulus–reinforcement associations (Baxter & Murray, 2002; Everitt, Cardinal, Parkinson, & Robbins, 2003) and, it is claimed, individuals with psychopathy are impaired in the formation of stimulus–reinforcement associations (Blair, 2004). Impairment in the formation of aversive stimulus–reinforcement associations would give rise to the observed deficits in individuals with psychopathy in aversive conditioning (Lykken, 1957), the augmentation of the startle reflex following the presentation of visual threat primes (Levenston et al., 2000) and passive avoidance learning (Newman & Kosson, 1986). In short, impairment in the formation of aversive stimulus–reinforcement associations would give rise to the deficits consistent with previous suggestions (Lykken, 1957; Patrick, 1994) that there is fear system dysfunction in psychopathy (Blair, 2004).

One class of aversive stimuli is the distress of other individuals, the expressions of fear and sadness (Blair, 2003a). The amygdala is involved in the response to these stimuli (Blair, 2003a; Morris et al., 1996). In line with suggestions of a specific form of empathy deficit, individuals with psychopathy show reduced autonomic responses to the distress cues of other individuals and impaired fearful facial and vocal expression recognition (see, for a review, Blair, 2003a).

The argument has been made that the expressions of fear and sadness serve as social reinforcers allowing conspecifics to teach the societal valence of objects and actions to the developing individual (Blair, 2003a); actions/objects associated with the sadness/fear of others acquire, in healthy developing children, negative valence. Due to their impairment in the response to the sadness and fear of other individuals and in the formation of aversive stimulus–reinforcement associations, individuals with psychopathy are less able to take advantage of this 'moral' social referencing. They should be, and are (Oxford, Cavell, & Hughes, 2003; Wootton, Frick, Shelton, & Silverthorn, 1997), more difficult to socialize through standard parenting techniques. They will not learn to avoid using instrumental antisocial behavior to achieve their goals. This is because of relative indifference to the 'punishment' of the victim's distress and impairment in learning the association between this 'punishment' and the representation of the action that caused the victim's distress. If confirmed, this observation should have fundamental implications for treatment. The nature of interventions directed to children with severe conduct problems should vary based on the degree to which the specific child exhibits the emotional features of psychopathy.

The amygdala is known to be involved in not only the processing of punishment but also reward information (Baxter & Murray, 2002; Everitt et al., 2003). Individuals with psychopathy typically show appropriate suppression of the startle reflex following the presentation of positive visual primes but reduced augmentation of the startle reflex following the presentation of negative visual primes (Levenston et al., 2000; Patrick, Bradley, & Lang, 1993), though see (Herpertz et al., 2001). This suggests that individuals with psychopathy are unimpaired in processing positive material. However, in lexical decision-making tasks where participants must identify words versus non-words, comparison individuals are faster to identify positive and negative emotional words than neutral ones, but individuals with psychopathy do not show this emotional advantage (Lorenz & Newman, 2002; Williamson et al., 1991). In addition, Verona and colleagues reported reduced skin conductance responses to both positive and negative auditory stimuli in individuals with psychopathy (Verona, Curtin, Patrick, Bradley, & Lang, 2004). Finally, in recent work within our own group, using affective priming (Peschardt, Morton, & Blair, under revision), decision-making (Peschardt et al., in press a) and emotional attention paradigms (Mitchell, Richell, Leonard, & Blair, in press), we have found impaired processing of both positive and negative material, but that this impairment is particularly severe for negative material.

Our assumption is that appetitive stimulus–reinforcement association formation is impaired, but less impaired than aversive stimulus–reinforcement association formation (Blair, 2004). Interestingly, given this claim that stimulus–reward association formation is less impaired in individuals with psychopathy than stimulus–punishment association formation, Kochanska has reported data indicating that conscience development in 'fearless' children is best achieved by socialization practices that presumably capitalize on mother–child positive orientation (secure attachment, maternal responsiveness); (Kochanska, 1997).