Schultz Douglas H, Balderston Nicholas L, Baskin-Sommers Arielle R, Larson Christine L, Helmstetter Fred J
Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee WI, USA.
Department of Psychology, Yale University, New Haven CT, USA.
Front Psychol. 2016 Mar 10;7:348. doi: 10.3389/fpsyg.2016.00348. eCollection 2016.
Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into "primary" and "secondary" psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional "fearlessness," while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths.
精神病态是一种人格障碍，其特征是情感缺陷以及无法抑制冲动行为，通常可细分为“原发性”和“继发性”精神病态亚型。与原发性精神病态相关的适应不良行为被认为反映了先天性的“无畏”，而与继发性精神病态相关的问题行为则由其他因素驱动。在精神病态中观察到的无畏通常被解释为反映了杏仁核功能的根本缺陷，并且先前的研究为精神病态的低恐惧模型提供了支持。然而，这些研究中有许多未能使用适当的筛选程序，采用宽松的纳入标准，或者使用非常规方法来测定杏仁核功能。我们在巴甫洛夫恐惧条件反射过程中，使用血氧水平依赖性功能磁共振成像（BOLD成像）测量了原发性和继发性精神病态者以及非精神病态对照者的大脑活动。与低恐惧模型相反，我们在原发性精神病态者中观察到了正常的恐惧表达。精神病态者相对于匹配的对照者在杏仁核中也表现出更大的BOLD活动差异。在原发性和继发性精神病态者的前扣带回皮质（ACC）中观察到了相反的活动模式。原发性精神病态者在背侧和腹侧ACC中表现出与增强的恐惧表达一致的活动模式，而继发性精神病态者在这些区域表现出与恐惧抑制一致的活动模式。这些结果与精神病态的低恐惧模型相矛盾，并表明先前研究中观察到的精神病态者的低恐惧可能特定于继发性精神病态者。
