Emotional memory and psychopathic traits in conduct disordered adolescents
Introduction
Conduct disorder (CD), antisocial personality disorder (ASPD) and psychopathy are a group of overlapping developmental disorders that are associated with significant intra and interpersonal dysfunction. While all of these disorders focus on behavioural problems such as criminality and rule breaking, psychopathy emphasises the more interpersonal and affective aspects of predatory antisocial behaviours. Prevalence studies suggest CD and ASPD are more common (by an estimated six times) than the dimensionally higher order construct of psychopathy which affects approximately 1% of the general population and approximately 15–25% of incarcerated offenders (Hare, 1991). Psychopathy as operationalised in the Psychopathy Checklist Revised (PCL-R, Hare, 1991) is characterised by distinct interpersonal, affective and behavioural traits and is thought to be particularly associated with instrumental aggression (Cornell et al., 1996). Psychopaths display arrogant, superficial, manipulative and deceitful interpersonal behaviours. Affectively, they are shallow, unable to make strong attachments and lack empathy, anxiety and guilt. Behaviourally, they are impulsive, irresponsible, sensation seeking and likely to be involved in criminal activity.
With the development of age appropriate measures of psychopathy in adolescents such as the Psychopathy Checklist: Youth Version (Forth, Kosson, & Hare, 2003) there is now an opportunity to explore the aetiology of this disorder from a neurodevelopmental perspective. It is recognised that specific facets of the antisocial personality disorders may have different neural substrates. For example, executive dysfunction may be particularly related to impulsivity and antisocial behaviour (Moffitt and Henry, 1991, Morgan and Lilienfeld, 2000) while amygdala dysfunction may be more associated with the affective components of psychopathy (Blair, 2005).
The neural systems implicated in the development and maintenance of antisocial behaviour and psychopathy include a range of interconnected circuits that encompass the orbital frontal cortex (Damasio, Tranel, & Damasio, 1990), prefrontal cortex (Raine, Lencz, Bihrle, LaCasse, & Colletti, 2000) and limbic structures such as the amygdala (Patrick, Cuthbert, & Lang, 1994). The amygdala has been the focus of study in relation to the affective (callous unemotional – CU) components of psychopathy as lesions in humans reduce the ability to acquire conditioned autonomic responses (Bechara et al., 1995) and impair emotional memory (Adolphs et al., 1997, Cahill et al., 1995, Hamann et al., 1999). Functional imaging studies also confirm the notion that the amygdala is activated in response to affectively loaded visual stimuli (Hariri et al., 2003, Morris et al., 1996).
According to the Integrated Emotions System (IES) proposed by Blair (2005) amygdala dysfunction in psychopathy disrupts the ability to form stimulus-reinforcement associations which results in impairments in the normal socialisation process. As a result, the individual is less likely to learn to avoid the use of antisocial behaviour to achieve their goals but instead may learn to use antisocial behaviour instrumentally to achieve their desires. That is, they may receive the potential rewards, e.g., financial gain, without the feelings of guilt over the victim’s distress. The IES model also makes a distinction between reactive and instrumental aggression and suggests that reactive (impulsive) aggression may be more associated with orbital/ventrolateral prefrontal cortical dysfunction, while amygdala dysfunction may be associated with instrumental aggression, which is seen as an important potentially distinguishing feature of psychopathy.
There are now a number of studies that suggest the affective (CU traits) deficits seen in psychopathy are associated with impairments in processing the emotional significance of negatively valenced stimuli (Day and Wong, 1996, Patrick et al., 1994) and with deficits in face affect recognition (Marsh & Blair, 2008) particularly for sadness, fear and disgust. Impairments in the processing of emotional words have also been reported in psychopathic populations (Day and Wong, 1996, Williamson et al., 1991). Support for the notion that amygdala dysfunction may account for the CU components of psychopathy comes from fMRI studies in both adults (Birbaumer et al., 2005, Deeley et al., 2006, Kiehl et al., 2001) and children (Marsh et al., 2008). Furthermore, there is evidence of structural alterations in the basolateral, lateral, cortical, and central nuclei of the amygdala in psychopathic populations (Yang, Raine, Narr, Colletti, & Toga, 2009).
To date, there have only been two studies examining memory for emotional material in adult antisocial samples despite evidence that emotional memory is associated with amygdala function (Cahill et al., 1995). Both reported attenuated memory for emotional material in those with psychopathic traits (Christianson et al., 1996, Dolan and Fullam, 2005). The latter studies did not specifically examine the key components of psychopathy that may have been more pertinent, e.g., CU traits or deficient affective experience (Cooke, Michie, Hart, & Clark, 2004) to the study of emotional information processing. The present study examined psychopathy related attenuation of emotional memory in a cohort of CD adolescents who were assessed on the PCL: YV. We hypothesised that if psychopathy is a developmental construct then the deficits seen in adults with psychopathic traits (particularly CU traits) should also be apparent in samples with CD who have been screened to the same degree for confounds as our original sample of ASPD adults (Dolan & Fullam, 2005).
Section snippets
Participants
Eighty-four male incarcerated adolescent offenders in secure care or prison in the North West Region of England who met criteria for DSM-IV conduct disorder, in the absence of other Axis I or II disorders and attention deficit hyperactivity disorder (ADHD), on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS, Kaufman, Birmaher, Brent, Rao, & Ryan, 1997), were assessed and accepted into the study. Exclusion criteria included: prescription medication, illicit drug use, a
Overall sample findings
In the overall sample, we found a significant effect of phase with greater recognition of phase 2 (emotional) slides than either phase 1 (Z = −4.8, df = 2, p = 0.001) or phase 3 (Z = 3.04, df = 2, p = 0.002) neutral slides. There were no significant differences between phase 1 and 3 (Z = −1.2, df = 2, p = 0.20) slides. The mean percentage correct for each phase were as follows; phase 1 = 55.9 (SD 13.2); phase 2 = 63.3 (SD 10.8) and phase 3 = 58.5 (SD 15.1).
Discussion
This is the first study to test the hypothesis that emotional memory is blunted in conduct disordered adolescents with psychopathic traits and the findings are generally in line with similar studies in antisocial adults with psychopathic traits (Dolan & Fullam, 2005). We specifically selected a highly screened group of conduct disordered offenders without ADHD as there is some evidence that ADHD as a diagnosis is associated with impairments in emotion processing (Pelc, Kornreich, Foisy, & Dan,
Acknowledgements
The work was funded by the Health Foundation and the UK National Forensic Mental Health R&D programme. Thanks to A. Povey, A. Fogg, and C. Rennie for their input on this project.
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