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. 2019 Mar;24(3):463-470.
doi: 10.1038/s41380-018-0122-5. Epub 2018 Jul 23.

A View Behind the Mask of Sanity: Meta-Analysis of Aberrant Brain Activity in Psychopaths

Free PMC article

A View Behind the Mask of Sanity: Meta-Analysis of Aberrant Brain Activity in Psychopaths

Timm B Poeppl et al. Mol Psychiatry. .
Free PMC article


Psychopathy is a disorder of high public concern because it predicts violence and offense recidivism. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. No reliable pattern of altered neural activity has been disclosed so far. This study sought to identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology. First, we used activation likelihood estimation (p < 0.05, corrected) to meta-analyze brain activation changes associated with psychopathy across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 experiments. Second, we characterized the ensuing regions functionally by employing metadata of a large-scale neuroimaging database (p < 0.05, corrected). Psychopathy was consistently associated with decreased brain activity in the right laterobasal amygdala, the dorsomedial prefrontal cortex, and bilaterally in the lateral prefrontal cortex. A robust increase of activity was observed in the fronto-insular cortex on both hemispheres. Data-driven functional characterization revealed associations with semantic language processing (left lateral prefrontal and fronto-insular cortex), action execution and pain processing (right lateral prefrontal and left fronto-insular), social cognition (dorsomedial prefrontal cortex), and emotional as well as cognitive reward processing (right amygdala and fronto-insular cortex). Aberrant brain activity related to psychopathy is located in prefrontal, insular, and limbic regions. Physiological mental functions fulfilled by these brain regions correspond to disturbed behavioral patterns pathognomonic for psychopathy. Hence, aberrant brain activity may not just be an epiphenomenon of psychopathy but directly related to the psychopathology of this disorder.

Conflict of interest statement

Conflicts of Interest

All authors declare no potential conflicts of interest.


Figure 1
Figure 1
Brain regions showing aberrant activity associated with psychopathy. Significant clusters where the ALE analysis revealed convergence of altered brain activity in corresponding experiments (p < 0.05, TFCE corrected; cf. Table 1). Orange/blue color indicates in-/decreased activity according to post-hoc analyses (cf. Table 2). ALE, activation likelihood estimation; DMPFC, dorsomedial prefonrtal cortex; FIC, fronto-insular cortex; LPFC, lateral prefrontal cortex; TFCE, threshold-free cluster enhancement.
Figure 2
Figure 2
Functional characterization of brain regions featuring aberrant activity associated with psychopathy. Significant associations with psychological terms (behavioral domains and paradigm classes) from BrainMap metadata. Reverse inference determined the above-chance probability of association with a behavioral function given observed brain activity in the respective region (p < 0.05, FDR corrected). The base rate denotes the general probability of finding BrainMap activation in the region. The x-axis indicates relative probability values. DMPFC, dorsomedial prefrontal cortex; FDR, false discovery rate; FIC, fronto-insular cortex; L, left; LPFC lateral prefrontal cortex; R, right.

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Cited by 4 articles


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