Punishment and psychopathy: a case-control functional MRI investigation of reinforcement learning in violent antisocial personality disordered men
Sarah Gregory, R. James Blair, Dominic Ffytche, Andrew Simmons, Veena Kumari, Sheilagh Hodgins & Nigel Blackwood
Lancet Psychiatry 2:153–160 (2014)
Abstract
Background
Men with antisocial personality disorder show lifelong abnormalities in adaptive decision making guided by the weighing up of reward and punishment information. Among men with antisocial personality disorder,
modifi cation of the behaviour of those with additional diagnoses of psychopathy seems particularly resistant to punishment.
Methods
We did a case-control functional MRI (fMRI) study in 50 men, of whom 12 were violent off enders with antisocial personality disorder and psychopathy, 20 were violent off enders with antisocial personality disorder but not psychopathy, and 18 were healthy non-off enders. We used fMRI to measure brain activation associated with the representation of punishment or reward information during an event-related probabilistic response-reversal task, assessed with standard general linear-model-based analysis.
Findings
Offenders with antisocial personality disorder and psychopathy displayed discrete regions of increased activation in the posterior cingulate cortex and anterior insula in response to punished errors during the task reversal
phase, and decreased activation to all correct rewarded responses in the superior temporal cortex. This finding was in
contrast to results for off enders without psychopathy and healthy non-off enders.
Interpretation
Punishment prediction error signalling in off enders with antisocial personality disorder and psychopathy was highly atypical. This finding challenges the widely held view that such men are simply characterised
by diminished neural sensitivity to punishment. Instead, this fi nding indicates altered organisation of the information processing system responsible for reinforcement learning and appropriate decision making. This difference between violent offenders with antisocial personality disorder with and without psychopathy has implications for the causes of these disorders and for treatment approaches.
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