Brain Response to Empathy-Eliciting Scenarios Involving Pain in Incarcerated Individuals

edited November 2017 in Empathy FAQ Must be logged on
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Brain Response to Empathy-Eliciting Scenarios Involving Pain in Incarcerated Individuals With Psychopathy

ABSTRACT Importance A marked lack of empathy is a hallmark characteristic of individuals with psychopathy. However, neural processes associated with empathic processing have not yet been directly examined in psychopathy, especially in response to the perception of other people in pain and distress.

Objective To identify potential differences in patterns of neural activity in incarcerated individuals with psychopathy and incarcerated persons serving as controls during the perception of empathy-eliciting stimuli depicting other people experiencing pain.

Results Participants in the psychopathy group exhibited significantly less activation in the ventromedial prefrontal cortex, lateral orbitofrontal cortex, and periaqueductal gray relative to controls but showed greater activation in the insula, which was positively correlated with scores on both PCL-R factors 1 and 2.

Conclusions and Relevance In response to pain and distress cues expressed by others, individuals with psychopathy exhibit deficits in the ventromedial prefrontal cortex and orbitofrontal cortex regardless of stimulus type and display selective impairment in processing facial cues of distress in regions associated with cognitive mentalizing. A better understanding of the neural responses to empathy-eliciting stimuli in psychopathy is necessary to inform intervention programs.

Psychopathy is a personality disorder characterized by affective and interpersonal deficits as well as social deviance and poor behavioral control. As measured by the Hare Psychopathy Checklist–Revised (PCL-R),1 psychopathy comprises interpersonal, affective (factor 1), and lifestyle and antisocial (factor 2) features. The interpersonal/affective component of psychopathy is largely defined by a lack of empathy and attachment, as well as a callous lack of regard for others. Empathy, the natural capacity to share and understand the affective states of others, is at the heart of the first of the disorder's core components. The construct of empathy is complex and involves social, emotional, and motivational facets. The primary component of empathy, empathic sensitivity (or empathic arousal), refers to the automatic sharing of the affective states of others and is a crucial prerequisite to the experience of empathic concern (ie, other-oriented emotional response congruent with the perceived welfare of someone in need). Interconnected subcortical regions, including the brainstem, amygdala, and hypothalamus, and cortical regions such as the insula, orbitofrontal cortex (OFC), and ventromedial prefrontal cortex (vmPFC), form the essential neural circuit of empathy.3- 5 Empathic sensitivity is a phylogenetically ancient and basic form of intraspecies communication, and it is the first component of empathy to develop in children.4,6,7 The vicarious sharing of another's negative state provides a strong signal that can promote empathic concern, and the lack of such signals during development can impede the process of normal socialization.7,8 To be motivated to help another, one needs to be affectively, empathically aroused and anticipate the cessation of mutually experienced personal distress.9,10 Empathic sensitivity may thus serve as a catalyst in promoting empathic concern for others: the lack of this signal would make the engagement of empathic concern and prosocial behavior much less likely. The perception of others' pain or physical distress usually acts as a prosocial signal, notifying others that their conspecific is at risk, attracting their attention, and motivating helping behavior,12 and has become a fruitful avenue to investigate the neural mechanisms underpinning affective processing and empathy.<br><br>In healthy participants, functional magnetic resonance imaging (fMRI) studies 6,8,13- 19 of empathy have demonstrated reliable activation of a neural network that overlaps substantially with regions engaged when one experiences pain and when one perceives, anticipates, or even imagines pain happening to others. The activated neural network includes the anterior insular cortex (AIC), dorsal anterior cingulate cortex (dACC), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), somatosensory cortex, amygdala, periaqueductal gray, and vmPFC.20<br><br>The neural response to the distress of others, such as pain, is thought to reflect an aversive response in the observer that may act as a trigger to inhibit aggression or prompt motivation to help. Hence, examining the neural response of individuals with psychopathy as they view others being hurt or expressing pain may be an effective probe into the neural processes underlying affective and empathic deficits in psychopathy. To date, no fMRI study has investigated the neural response to empathy-eliciting stimuli in incarcerated individuals with psychopathy. Previous research21- 23 showed that these people understand the emotional state of others without “sharing” their feelings or being aroused by their emotional states. Thus, one can anticipate different hemodynamic response in the neural network involved in the perception of pain between individuals with psychopathy, especially for participants scoring high on the PCL-R. An alternative hypothesis draws on research showing that children and adolescents with callous-unemotional traits are reward-oriented, insensitive to punishment cues, lack emotional responsiveness to distress cues, and may show both reactive and instrumental aggression.24 In support of this hypothesis, one study23 found that male adolescent offenders with high callous-unemotional traits exhibited atypical neural dynamics of pain empathy processing (measured with event-related brain potentials) in the early stages of affective arousal coupled with relative insensitivity to actual pain. Another neuroimaging study25 documented strong activation of the amygdala (as well as the pain network), which correlated with a measure of sadism, in youth with aggressive conduct disorder when they observed people being hurt.<br><br>To investigate the neural mechanisms underlying empathy for pain in adults with psychopathy, 80 incarcerated male volunteers, stratified into 3 groups, were scanned using fMRI. Participants classified as having a high level of psychopathy (n = 27) were those who scored 30 or above on the PCL-R (of a possible 40), those classified as having intermediate psychopathy (n = 28) scored between 21 and 29, and volunteers scoring 20 or below (n = 25) were classified as low-psychopathy controls. Well-matched groups from the prison population are used to isolate differences due to psychopathy and eliminate confounding factors possible in the direct comparison of incarcerated people with psychopathy with community controls.<br><br>Furthermore, the inclusion of participants from across the scoring spectrum allowed us to investigate differences at a groupwise and a continuous level using both PCL-R total and factor 1 and 2 scores. The neurohemodynamic activity was measured while participants attended to visual scenarios depicting individuals being physically hurt and dynamic facial expressions of pain; these stimuli have been used in numerous fMRI studies6,8,13- 19,23,25- 30 investigating the neural underpinnings of empathy for pain in healthy children, adolescents, and adults. Moreover, having 2 sets of stimuli, ie, pain interactions (2 persons interacting without the faces of the protagonists) and facial expressions of pain may help us identify which component of empathy is dysfunctional in psychopathy. The former class of stimuli requires a cognitive understanding of a social interaction with a negative outcome, which is associated with the engagement of the network supporting mental state inference and the perception of pain in others8; the latter also induces activation in the OFC and vmPFC, which are prefrontal regions that play a pivotal role in adaptive responses to emotionally relevant situations and the production of an affective state.
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