Cortical Structure in Relation to Empathy and Psychopathy in 800 Incarcerated Men

Marcin A Radecki; J Michael Maurer; Keith A Harenski; David D Stephenson; Erika Sampaolo; Giada Lettieri; Giacomo Handjaras; Emiliano Ricciardi; Samantha N Rodriguez; Craig S Neumann; Carla L Harenski; Sara Palumbo; Silvia Pellegrini; Jean Decety; Pietro Pietrini; Kent A Kiehl; Luca Cecchetti

doi:10.1016/j.bpsgos.2026.100695

Cortical Structure in Relation to Empathy and Psychopathy in 800 Incarcerated Men

Biol Psychiatry Glob Open Sci. 2026 Jan 23;6(3):100695. doi: 10.1016/j.bpsgos.2026.100695. eCollection 2026 May.

Authors

Marcin A Radecki^{1

2}, J Michael Maurer³, Keith A Harenski³, David D Stephenson³, Erika Sampaolo¹, Giada Lettieri¹, Giacomo Handjaras¹, Emiliano Ricciardi⁴, Samantha N Rodriguez^{3

5}, Craig S Neumann⁶, Carla L Harenski³, Sara Palumbo⁷, Silvia Pellegrini⁷, Jean Decety^{8

9}, Pietro Pietrini⁴, Kent A Kiehl^{3

5}, Luca Cecchetti¹

Affiliations

¹ Social and Affective Neuroscience Group, Molecular Mind Laboratory, IMT School for Advanced Studies Lucca, Lucca, Italy.
² Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
³ The Mind Research Network, Albuquerque, New Mexico.
⁴ Molecular Mind Laboratory, IMT School for Advanced Studies Lucca, Lucca, Italy.
⁵ Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
⁶ Department of Psychology, University of North Texas, Denton, Texas.
⁷ Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁸ Department of Psychology, University of Chicago, Chicago, Illinois.
⁹ Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.

Abstract

Background: Reduced empathy is a hallmark of individuals with high (i.e., clinical) levels of psychopathy, who are overrepresented among incarcerated men. However, a comprehensive, well-powered mapping of cortical structure in relation to empathy and psychopathy is still lacking.

Methods: In 804 incarcerated adult men, we administered the Perspective Taking (IRI-PT) and Empathic Concern (IRI-EC) subscales of the Interpersonal Reactivity Index (IRI), the Psychopathy Checklist-Revised (PCL-R; with interpersonal/affective [F1] and lifestyle/antisocial [F2] factors), and T1-weighted magnetic resonance imaging to quantify cortical thickness (CT), surface area (SA), and structural-covariance gradients.

Results: PCL-R F1 was uniquely negatively related to IRI-EC, while PCL-R F2 was uniquely negatively related to IRI-PT. Cortical structure was not related to the IRI subscales. In contrast, CT was related to PCL-R F1 (mostly positively), SA was related to both PCL-R factors (only positively), and both cortical indices demonstrated out-of-sample predictive utility for PCL-R F1. Compared to men with low psychopathy, men with high psychopathy had uniquely lower IRI-EC scores and increased SA (but not CT); effect sizes across the cortex were largest in the paralimbic class and somatomotor network, while spatial overlap with meta-analytic task-based activations was highest for (social-)affective/sensory clusters. Finally, the total sample revealed anterior-posterior structural-covariance gradients; in men with high psychopathy, the gradient of CT (but not SA) was globally compressed.

Conclusions: Men with high psychopathy had reduced empathic concern, increased SA, and a compressed macroscale organization of CT, indicating selective co-alterations in empathy and cortical structure. Future work should build on these novel insights in both the general and incarcerated populations to inform the treatment of psychopathy.

Keywords: Antisocial behavior; Brain structure; Cortical gradients; Empathy; Multivariate prediction; Psychopathy.

Plain language summary

Reduced empathy is a hallmark of individuals with high (i.e., clinical) levels of psychopathy. These individuals are overrepresented among incarcerated men and are at high risk for future antisocial behavior. However, relationships of cortical structure with empathy and psychopathy remain poorly understood. Here, we measured empathy and psychopathy alongside cortical thickness (CT) and surface area (SA) in ∼800 incarcerated men. Men with high psychopathy had reduced empathic concern, increased SA, and a distinct pattern of the way CT varied across the cortex. These novel insights into behavior and brain structure in a large antisocial sample aim to inform the treatment of psychopathy.