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Classification and Treatment of Antisocial Individuals: from Behavior to Biocognition

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Classification and Treatment of Antisocial Individuals: from Behavior to Biocognition G Model NBR-2628; No. of Pages 19 ARTICLE IN PRESS Neuroscience and Biobehavioral Reviews xxx (2016) xxx–xxx Contents lists available at ScienceDirect Neuroscience and Biobehavioral Reviews jou rnal homepage: www.elsevier.com/locate/neubiorev Review article Classification and treatment of antisocial individuals: From behavior to biocognition a,b, c a a,d,1 I.A. Brazil (PhD) ∗, J.D.M. van Dongen (PhD) , J.H.R. Maes (PhD) , R.B. Mars (PhD) , e,1 A.R. Baskin-Sommers (PhD) a Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands b Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands c Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, The Netherlands d Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom e Yale University, Psychology Department, New Haven, CT, USA a r t i c l e i n f o a b s t r a c t Article history: Antisocial behavior is a heterogeneous construct that can be divided into subtypes, such as antisocial Received 31 March 2016 personality and psychopathy. The adverse consequences of antisocial behavior produce great burden Received in revised form 11 October 2016 for the perpetrators, victims, family members, and for society at-large. The pervasiveness of antisocial Accepted 12 October 2016 behavior highlights the importance of precisely characterizing subtypes of antisocial individuals and Available online xxx identifying specific factors that are etiologically related to such behaviors to inform the development of targeted treatments. The goals of the current review are (1) to briefly summarize research on the Keywords: operationalization and assessment of antisocial personality and psychopathy; (2) to provide an overview Psychopathy of several existing treatments with the potential to influence antisocial personality and psychopathy; and Antisocial personality Treatment (3) to present an approach that integrates and uses biological and cognitive measures as starting points to Cognitive endophenotype more precisely characterize and treat these individuals. A focus on integrating factors at multiple levels Computational psychiatry of analysis can uncover person-specific characteristics and highlight potential targets for treatment to Neuroimaging alleviate the burden caused by antisocial behavior. RDoC © 2016 Elsevier Ltd. All rights reserved. Biological and cognitive fingerprinting Contents 1. Introduction . 00 2. Antisocial personality and psychopathy. .00 2.1. Early views on antisocial personality and psychopathy . 00 2.2. Differentiating between psychopathic and non-psychopathic antisocial individuals . 00 2.3. Different approaches to typifying psychopathy . 00 2.3.1. Psychopathy as a multifaceted disorder according to the PCL-R . 00 2.3.2. Primary vs. secondary psychopathy. .00 2.3.3. Other approaches to subtyping psychopathy . 00 2.4. Comorbidity . 00 2.5. Interim summary: diagnostic accounts of antisocial personality and psychopathy . 00 3. Treatment . 00 3.1. Psychological and behavioral treatment approaches . 00 3.2. Medication . 00 ∗ Corresponding author at: Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. E-mail address: [email protected] (I.A. Brazil). 1 Shared last authors. http://dx.doi.org/10.1016/j.neubiorev.2016.10.010 0149-7634/© 2016 Elsevier Ltd. All rights reserved. Please cite this article in press as: Brazil, I.A., et al., Classification and treatment of antisocial individuals: From behavior to biocognition. Neurosci. Biobehav. Rev. (2016), http://dx.doi.org/10.1016/j.neubiorev.2016.10.010 G Model NBR-2628; No. of Pages 19 ARTICLE IN PRESS 2 I.A. Brazil et al. / Neuroscience and Biobehavioral Reviews xxx (2016) xxx–xxx 3.3. Interim summary: treatment of antisocial personality and psychopathy. .00 4. A way forward: classification and treatment based on biology and cognition . 00 4.1. Current approaches . 00 4.1.1. Cognitive endophenotyping . 00 4.1.2. Computational psychiatry . 00 4.1.3. Neuroimaging . 00 4.2. An integrative approach to describing individual differences . 00 4.2.1. Stage 1: aggregation and integration of data . 00 4.2.2. Stage 2: statistical learning and biocognitive fingerprinting . 00 4.2.3. Stage 3: development of personalized treatment. .00 5. General summary and conclusion . 00 Acknowledgements. .00 References . 00 1. Introduction from biology (e.g., genetics, brain, and physiology), cognitive func- tioning, and clinical observations. Finally, we go a step further and Antisocial behavior is a heterogeneous construct that encom- propose how to combine elements from these three approaches to passes a wide range of traits and behaviors. Two subtypes of obtain profiles for classification consisting of biological and cogni- antisocial offenders, those with antisocial personality traits and tive (i.e., biocognitive) dimensions, while minimizing the reliance psychopathy, are at significantly greater risk than other offenders on behavioral observations. Ultimately, by combining information for diverse substance use disorders and elevated criminal activity. at several levels of analysis we can help improve the description of Individuals with an antisocial personality (e.g., diagnosed with anti- different types of antisocial individuals and can facilitate the devel- social personality disorder), present in about 50–80% of the prison opment of novel therapeutic interventions that are tailored to fit population, often display excessive reward seeking, intense hostil- the biological and cognitive characteristics of these individuals. ity and reactive aggression, and poor impulse control. In contrast, psychopathic individuals, who comprise of approximately 15–25% of the prison population, are characterized by difficulty estab- lishing genuine relationships, minimal and superficial affective 2. Antisocial personality and psychopathy experience, an impulsive behavioral style, and a chronic antisocial lifestyle that entails great costs to society as well as for the affected 2.1. Early views on antisocial personality and psychopathy individual (e.g., incarceration). The behaviors of these subtypes of antisocial individuals lead The existence of individuals engaging in disruptive and anti- to several adverse consequences that affect society. For exam- social acts can be found in writings dating back a few thousand ple, the financial damage resulting from psychopathic behavior is years (Yildirim and Derksen, 2015). Around the 19th century, the estimated at $400 billion in the USA alone (Kiehl and Buckholtz, high prevalence of antisocial behavior in some psychiatric popula- 2010). A similar pattern exists in European countries, such as the tions caught the attention of psychiatrists who began to attribute Netherlands, where treatment costs of a single antisocial offender the patients’ erratic behaviors to deviant mental functioning (for in forensic.
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