Individuals with psychopathy show impaired emotional and social behavior, such as lack of emotional responsiveness to others and deficient empathy. However, there are controversies regarding these individuals theory of mind (ToM) abilities and the neuroanatomical basis of their aberrant social behavior. The present study tested the hypothesis that impairment in the emotional aspects of ToM (affective ToM) rather than general ToM abilities may account for the impaired social behavior observed in psychopathy and that this pattern of performance may be associated with orbitofrontal cortex (OFC) dysfunction. To assess the emotional and cognitive aspects of ToM we used a task that examines affective versus cognitive ToM processing in separate conditions. ToM abilities of criminal offender diagnosed with antisocial personality disorder with high psychopathy features were compared to that of participants with localized lesions in the OFC or dorsolateral, participants with non-frontal lesions, and healthy control subjects. Individuals with psychopathy and those with OFC lesions were impaired on the 'affective ToM' conditions but not in cognitive ToM conditions, compared to the control groups. It was concluded that the pattern of mentalizing impairments in psychopathy resembles remarkably that seen in participants with lesions of the frontal lobe, particularly with OFC damage, providing support for the notion of amygdala-OFC dysfunction in psychopathy.
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