Psychopathy and medial frontal cortex: A systematic review reveals predominantly null relationships

Abstract

Theories have posited that psychopathy is caused by dysfunction in the medial frontal cortex, including ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), and dorsomedial prefrontal cortex (dmPFC). Recent reviews have questioned the reproducibility of neuroimaging findings within this field. We conducted a systematic review to describe the consistency of magnetic resonance imaging (MRI) findings according to anatomical subregion (vmPFC, ACC, dmPFC), experimental task, psychopathy assessment, study power, and peak coordinates of significant effects. Searches of PsycInfo and MEDLINE databases produced 77 functional and 24 structural MRI studies that analyzed the medial frontal cortex in relation to psychopathy in adult samples. Findings were predominantly null (85.4 % of 1573 tests across the three medial frontal regions). Studies with higher power observed null effects at marginally lower rates. Finally, peak coordinates of significant effects were widely dispersed. The evidence failed to support theories positing the medial frontal cortex as a consistent neural correlate of psychopathy. Theory and methods in the field should be revised to account for predominantly null neuroimaging findings.

Keywords: Anterior cingulate cortex; MRI; Neuroimaging; Prefrontal cortex; Psychopathy.

Fig. 1.

The medial frontal cortex consisting of ventromedial prefrontal cortex (vmPFC; teal), anterior cingulate cortex (ACC; purple), and dorsomedial prefrontal cortex (dmPFC; gold). Region of interest masks were derived from the Brainnetome Atlas (Fan et al., 2016).

Fig. 2.

PRISMA flow chart of the literature search process. Abbreviations: BOLD = blood oxygen level dependent response, GM = gray matter structure.

Fig. 3.

Summary of studies that analyzed task-based activity in the ventromedial prefrontal cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.

Fig. 4.

Peak coordinates of ventromedial prefrontal cortex clusters that were A) negatively related and B) positively related to total psychopathy. In each panel, sagittal slices are displayed from left to right at x = −14, −10, −6, −2, 2, 6, 10, 14.

Fig. 5.

Summary of studies that analyzed gray matter structure in the ventromedial prefrontal cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.

Fig. 6.

Summary of studies that analyzed task-based activity in the anterior cingulate cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.

Fig. 7.

Peak coordinates of anterior cingulate cortex clusters that were A) negatively related and B) positively related to total psychopathy. In each panel, sagittal slices are displayed from left to right at x = −14, −10, −6, −2, 2, 6, 10, 14.

Fig. 8.

Summary of studies that analyzed gray matter structure in the anterior cingulate cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.

Fig. 9.

Summary of studies that analyzed task-based activity in the dorsomedial prefrontal cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.

Fig. 10.

Peak coordinates of dorsomedial prefrontal cortex clusters that were A) negatively related and B) positively related to total psychopathy. In each panel, sagittal slices are displayed from left to right at x = −14, −10, −6, −2, 2, 6, 10, 14.

Fig. 11.

Summary of studies that analyzed gray matter structure in the dorsomedial prefrontal cortex in relation to psychopathy. Cumulative percentages may exceed 100% because many studies reported a mixture of findings (e.g., null and negative). Abbreviations: n = total number of studies included in examination.