The Role of Oxytocin in Antisocial Personality Disorders: A Systematic Review of the Literature

Abstract

Background and aims: Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no reviews studying the use of oxytocin for patients with ASPD. We aim to present the first literature review on the use of oxytocin in patients with ASPD. Method: We searched relevant databases for original research on effect of oxytocin upon persons with a diagnosis of ASPD or healthy participants with symptoms seen in ASPD. Studies were included if they included healthy participants that evaluated the effect of oxytocin on symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Results: Thirty-six studies were included. There were a range of study designs, including randomized controlled trials, double blinded, single blinded, and unblinded controlled trials. The sample sizes in studies ranged from 20 to 259 participants. Studies looked at participants with a diagnosis of ASPD and participants with symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Oxytocin was found to demonstrate diversified effects, in most cases being associated with socially positive or non-criminogenic behaviors. However, some studies found opposite, and non-desirable, effects, e.g., an increase in violent inclinations to partners. The two studies looking at participants with ASPD had a number of limitations and had conflicting results on the impact that OT has on aggression in ASPD. Conclusions: This is the first systematic literature review exploring the potential use of oxytocin in managing ASPD and the symptoms of ASPD. It is apparent that there is a body of evidence addressing related symptoms in healthy individuals. There were diversified effects with oxytocin showing some benefits in promoting positive effects on symptoms of ASPD, but there were also studies showing non-desirable effects. It is difficult to draw any direct inferences from healthy control studies. Further high quality large sample studies are required to explore the effects of oxytocin in those with ASPD

Oxytocin: Narrative Expert Review of Current Perspectives on the Relationship with Other Neurotransmitters and the Impact on the Main Psychiatric Disorders

“…Overall, oxytocin had beneficial effects on socially positive and non-criminogenic behaviors, with some studies supporting the opposite fact. Probably these discrepancies had a high dependence on social context [ 92 ].…”

Links Between the Neurobiology of Oxytocin and Human Musicality

“…The need for pleasant social company is increased after a stressful event, a need that varies depending on which alleles of OXTR are present (Sicorello et al, 2020 ). Anatomically, there are subtle changes in structure and inter-connectivity of hypothalamus and parts of the limbic system, and mutations have been implicated in a range of highly maladaptive, sometimes psychopathic traits (e.g., Israel et al, 2008 ; Tost et al, 2010 ; Dadds et al, 2014 ; Aspé-Sánchez et al, 2016 ; Feldman et al, 2016 ; Gedeon et al, 2019 ; Poore and Waldman, 2020 ). A recent neuroimaging study examining the effect of OXTR alleles on resting-state networks reported that receptor genotype affected connectivity between the right hippocampus, medial prefrontal cortex, dorsal anterior cingulate cortex, amygdala, basal ganglia and thalamus (Luo et al, 2020 ).…”

“…The great majority of studies emphasize positive, prosocial behavioral outcomes after exogenous oxytocin administration; however, it is important to emphasize that not all studies describe these effects (Keech et al, 2018 ; Tabak et al, 2019 ; Erdozain and Peñagarikano, 2020 ) and some antisocial outcomes have been reported, including increased competitive and aggressive tendencies, particularly in males (Fischer-Shofty et al, 2012 ; Alcorn et al, 2015 ; Ne’eman et al, 2016 ; de Jong and Neumann, 2018 ; Gedeon et al, 2019 ). Others have also reported differential effects of exogenous oxytocin on women compared to men (e.g., Rilling et al, 2012 , 2018 ; Preckel et al, 2014 ; Feng et al, 2015 ; Chen et al, 2016 ; Bredewold and Veenema, 2018 ; Bartz et al, 2019 ; Xu et al, 2020 ).…”

“…Overall, variation in the effects of administered oxytocin is linked to: (i) gender differences; (ii) whether individuals possess intrinsic pro- or antisocial personality traits—sometimes related to polymorphisms in, or the methylation state of, OXTR; (iii) early environmental experience; and/or (iv) the social cues and psychological context when testing is undertaken (e.g., Guastella and MacLeod, 2012 ; Evans et al, 2014 ; Nishina et al, 2015 ; Chen et al, 2016 ; Feldman et al, 2016 ; Lambert et al, 2017 ; Aydogan et al, 2018 ; de Jong and Neumann, 2018 ; Wagner and Echterhoff, 2018 ; Fragkaki and Cima, 2019 ; Gedeon et al, 2019 ; Liu et al, 2019 ; Sicorello et al, 2020 ). As mentioned earlier, oxytocin and AVP can activate each other’s receptors, although the differential distribution of fibers and receptors may limit crosstalk (Rogers et al, 2018 ; Song and Albers, 2018 ).…”

Oxytocin effects on amygdala reactivity to angry faces in males and females with antisocial personality disorder

“…These findings are subsumed under the social anxiolytic effects of OT and might have clinical implications for aggression-prone individuals. Yet, it is unclear whether these findings in predominantly male, healthy, non-aggressive individuals can be transferred to aggression-prone individuals [ 28 ]. There is only one neuroimaging study which tested OT’s effect on threat-specific amygdala reactivity in a clinical sample: In women with borderline personality disorder (BPD), OT normalized increased amygdala activation in response to angry faces [ 29 ].…”