Psychopathy is a disorder of high public concern because it predicts violence and offense recidivism. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. No reliable pattern of altered neural activity has been disclosed so far. This study sought to identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology. First, we used activation likelihood estimation (p < 0.05, corrected) to meta-analyze brain activation changes associated with psychopathy across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 experiments. Second, we characterized the ensuing regions functionally by employing metadata of a large-scale neuroimaging database (p < 0.05, corrected). Psychopathy was consistently associated with decreased brain activity in the right laterobasal amygdala, the dorsomedial prefrontal cortex, and bilaterally in the lateral prefrontal cortex. A robust increase of activity was observed in the fronto-insular cortex on both hemispheres. Data-driven functional characterization revealed associations with semantic language processing (left lateral prefrontal and fronto-insular cortex), action execution and pain processing (right lateral prefrontal and left fronto-insular), social cognition (dorsomedial prefrontal cortex), and emotional as well as cognitive reward processing (right amygdala and fronto-insular cortex). Aberrant brain activity related to psychopathy is located in prefrontal, insular, and limbic regions. Physiological mental functions fulfilled by these brain regions correspond to disturbed behavioral patterns pathognomonic for psychopathy. Hence, aberrant brain activity may not just be an epiphenomenon of psychopathy but directly related to the psychopathology of this disorder.

Research into the neurofunctional mechanisms of psychopathy has gathered momentum over the last years. Previous neuroimaging studies have identified general changes in brain activity of psychopaths. In an exploratory meta-analysis, we here investigated the neural correlates of impaired moral cognition in psychopaths. Our analyses replicated general effects in the dorsomedial prefrontal cortex, lateral prefrontal cortex, fronto-insular cortex, and amygdala, which have been reported recently. In addition, we found aberrant brain activity in the midbrain and inferior parietal cortex.Our preliminary findings suggest that alterations in both regions may represent more specific functional brain changes related to (altered) moral cognition in psychopaths. Furthermore, future studies including a more comprehensive corpus of neuroimaging studies on moral cognition in psychopaths should re-examine this notion.

IntroductionPsychopathy is characterized by superficial charm, untruthfulness, lack of remorse, antisocial behavior, egocentricity as well as poverty in major affective reactions. This clinical profile has been empirically conceptualized and validated. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. However, no reliable pattern of altered neural activity has been disclosed so far.ObjectiveTo identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology.MethodsFirst, we used activation likelihood estimation to meta-analyze brain activation changes in psychopaths across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 analyses (P < 0.05, corrected). Second, we functionally characterized the ensuing regions employing meta-data of a large-scale neuroimaging database (P < 0.05, corrected).ResultsPsychopathy was consistently associated with decreased brain activity in the right amygdala, the dorsomedial prefrontal cortex (DMPFC), and bilaterally in the lateral prefrontal cortex (LPFC). Consistently increased activity was observed bilaterally in the fronto-insular cortex (FIC) (Fig. 1). Moreover, we found that the physiological functional role of the candidate regions related to social cognition (DMFPC), cognitive speech and semantic processing (left FIC/LPFC), emotional and cognitive reward processing (right amygdala/FIC) as well as somesthesis and executive functions (RLPFC).ConclusionPsychopathy is characterized by abnormal brain activity of bilateral prefrontal cortices and the right amygdala, which mediate psychological functions known to be impaired in psychopaths. Hence, aberrant neural activity can account for pertinent psychopathology in psychopathy.Disclosure of interestThe authors have not supplied their declaration of competing interest.