Review
Towards understanding atypical social affiliation in psychopathy

https://doi.org/10.1016/S2215-0366(19)30049-5Get rights and content

Summary

One distinctive feature of individuals with psychopathy is their reduced motivation and capacity to develop authentic social relationships, which are founded on an enjoyment of prosocial interactions or concern for others. Surprisingly, potential neurocognitive vulnerabilities contributing to atypical social affiliation, and lack of prosocial behaviours in psychopathy, have yet to be systematically investigated. Research efforts have largely focused on how individuals with psychopathy process negative emotions, and how this might affect their capacity to feel guilt or empathise with others' distress. Here, we propose a framework for understanding the development of atypical social affiliation and attachment in psychopathy, and outline several key processes and neural systems speculated to underpin them. We then describe present neurocognitive findings that suggest that these processes and neural systems are compromised in individuals with, or at risk of developing, psychopathy. Finally, we consider several research directions that would help with the understanding of the origin and development of social affiliation in individuals with psychopathy. This work has the potential to inform and enhance prevention and treatment strategies.

Introduction

Individuals with psychopathy are characterised by diminished empathy and remorse, manipulation of other people, the ability to engage in premeditated, cold and calculated aggression to achieve their goals, and a limited capacity to take care of their responsibilities and make good decisions.1, 2 The evidence base suggests that heritable differences account for a substantial proportion of individual variation associated with risk of developing psychopathy.3 Decades of experimental and neurocognitive research have focused on understanding why individuals with psychopathy (or those at risk of developing the disorder) do not readily empathise with other people's distress or why these individuals make poor decisions. These studies have shown atypical structure and function in a number of brain areas that are thought to facilitate emotional resonance, empathy, and decision making guided by rewards and punishments.4, 5, 6, 7 Previous studies have also shown an intact ability to take the perspective of other people in individuals with a high number of psychopathic features,8, 9 although new work suggests that they might be less likely to do so spontaneously.10 Collectively, this work has considerably advanced our understanding of the neurocognitive presentation that accompanies psychopathic features and helps explain why individuals with these features appear relatively unaffected by other people's distress, are able to manipulate and deceive others when they are motivated to do so, can commit calculated acts of aggression against other people, and often make repeated disadvantageous decisions.

By contrast, the factors that lead to atypical social affiliation and scarcity of prosocial behaviours in psychopathy have received less attention. Reduced motivation and capacity to develop social relationships founded on an enjoyment of prosocial interaction or genuine love and concern for others' wellbeing are distinctive features of psychopathy.1 Individuals with psychopathy are also characterised by putting their needs and interests before anyone else's, not fulfilling their responsibilities, and behaving in ways that violate the rights of other people—behaviours that are antithetic to the prosocial and caring behaviours that individuals without psychopathy engage in.1 Research has shown that low communion and high levels of antagonism are core features of psychopathy; moreover, individuals with these features show attenuated prosocial responses, even to those with whom they have close relationships.11, 12, 13 Yet, remarkably, little work has been done to investigate the potential underlying neurocognitive mechanisms of impaired affiliation and social connectedness in individuals who display psychopathic traits. Many of the neurocognitive mechanisms that underpin empathy when witnessing the distress of others could also be involved in processing positive affective and affiliative cues that have a known role in promoting social cohesion and bonding.14, 15 What is outstanding is a systematic investigation of how these neurocognitive mechanisms (and others) are implicated in the development of psychopathy in the context of stimuli that promote affiliation and prosocial engagement. Advancing this line of research will be of theoretical interest, because of the potential to provide a more complete characterisation of psychopathic presentation. Work in this area also has the potential to be of clinical relevance, as many clinical programmes aimed at reducing antisocial behaviour and promoting prosocial functioning rely on building relationships.16

In this Review, we propose a framework for understanding the development of atypical affiliation and attachment in individuals with psychopathy. We outline some key processes and neural systems understood to support attachment and affiliation, and describe current neurocognitive findings that suggest that these processes are compromised in individuals with, or at risk of developing, the condition. We outline how systematic research into the development of affiliation and attachment patterns that characterise psychopathy, as well as their causal origins, has the potential to inform and enhance prevention and treatment strategies.

Section snippets

Affiliation and attachment in psychopathy

All animals that live in groups have a basic drive to affiliate with members of the same species.12 Humans are not an exception. We are intrinsically social, typically forming enduring affiliative and attachment bonds with others.17, 18 We regularly meet the needs of others (and have our needs met), particularly the needs of those who are considered part of our own in-group.

Depue and Morrone-Strupinsky19 proposed that there are substantial individual differences in human trait affiliation,

Future research needs

To advance our understanding of the developmental risk for psychopathy, we suggest two broad lines of enquiry. First, what are the origins of disrupted social affiliation in psychopathy? Psychopathic features in children are moderately to strongly heritable.44 There is also tentative evidence to suggest that antisocial behaviour in the presence of psychopathic features might be more strongly heritable than antisocial behaviour in the absence of psychopathic features.55, 56 However, even a high

Translational implications

Psychopathy incurs a substantial financial and human cost to society. Current treatment approaches for adults with psychopathy have modest effectiveness.64 The evidence for efficacy of treatment for children and young people at risk of developing the condition is mixed, but more hopeful than for adults.65, 66, 67 We want to raise two important considerations in relation to prevention and treatment for children at risk of developing psychopathy. First, we propose that focusing on behaviour

Conclusion

One way to understand the atypical pattern of social behaviour observed in individuals with psychopathy is to imagine that they are essentially looking out for an extremely restricted in-group: themselves. Various affiliation-related and attachment-related cognitions are likely to have evolved to promote mutualistic social investment and collaboration within groups.71 Atypical functioning of the neurocognitive systems that give rise to these cognitions could lead to an alternative adaptive

Search strategy and selection criteria

We identified references for this Review through searches of PubMed using the terms “psychopathy” and “callous-unemotional” with one of the following terms: “affiliation”, “attachment”, “orienting', “laughter”, “mentalising”, “theory of mind”, “positive affect”, and “emotion”. We also consulted a few selected reviews and papers as recommended by reviewers or identified by ourselves. All articles included were written in English.

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