ABSTRACT
The objective of this paper is to describe the basis of violent psychopathology from a neuroanatomical point of view. Although there is no universally accepted neurological cause of psychopathology, there are some basic patterns of brain malfunction that are present in a majority of cases. Most notably is the compromised functioning of the orbital prefrontal cortex and associated neural circuitry. Beyond this fundamental finding are considerations of how many types of psychopaths there are, how they are characterized, and what may be the potential contributing causes. These questions are approached from multiple levels of neuroanatomical analysis, including genetic, molecular, neurotransmitter, neuronal cell cluster, and brain area levels, to entire circuit systems. These levels are then considered in light of prenatal, perinatal and postnatal development and the timing of neuronal system damage in the life of the psychopathic individual The mechanistic neuroscience approaches are discussed in terms of the relative contributions of nature (genetic/epigenetic/brain damage) and nurture (environmental).
The following conclusions are offered. First, violent psychopathology in youth is associated with structural and functional damage to the orbital cortex and strongly interconnected ventral prefrontal system structures such as the ventromedial prefrontal cortex, ventral anterior cingulate, amygdala, and associated basal ganglia and cortico-subcortical loop circuits. Second, the timing of the injury or malfunctioning of this circuit determines the type of psychopathology manifested later in development, with a) prenatal (e.g., faulty neuronal migration, in utero endocrine toxicity) and perinatal damage occurring prior to two to three years of life associated with a psychopathology where the eventual child/adolescent/adult carries out inappropriately violent acts without knowing what they are doing is wrong, b) damage occurring after the second or third year of life up to about puberty associated with a psychopathology where the eventual child/adolescent/adult carries out violent acts and knows what they are doing is wrong, but they cannot control the impulse to act, and c) damage occurring later in life where severe antisocial acts are carried out with full knowledge of the morality and consequences involved, but with a highly variable ability to inhibit the impulses at some point in time and circumstance. Third, there 396are limited treatments for some of the comorbid conditions and associated clinical findings (e.g., impulsivity, aggression, delinquency, cardiovascular anomalies, stress response), but the core violent psychopathic condition appears to still be impenetrable to intervention or prevention. Lastly, the new transdisciplinary field of imaging genetics offers a novel approach to predicting, characterizing, and treating affective, cognitive and behavioral disorders, and may offer a powerful new tool for understanding psychopathology and how it is viewed and adjudicated in the legal system.
