EmpaMEG: Developing A Neurobiological Understanding Of Cognitive And Affective Empathy In Antisocial Personality Disorder And Psychopathy

Violent crime has enormous costs for society. There are 614,400 incidents of violence each year in the UK, costing the economy £29 billion. Most of this violent crime is committed by people with antisocial personality disorder (ASPD), a type of mental disorder emerging in youth and lasting throughout life. These individuals engage in violent and antisocial behaviour from childhood. Many have difficulties with empathy, that is, understanding and responding to other’s thoughts and emotions. Evidence for good treatments is poor in both groups. About one third of these people also have a more severe form of ASPD, called psychopathy. They struggle greatly to empathise with others, commit more serious and violent crime, and respond especially poorly to treatments, compared to those with ASPD without psychopathy. A better understanding of the empathy abnormalities (and their underlying biology) within these groups of violent offenders is needed to develop options for more effective treatments, including medications. There are two key types of empathy — cognitive empathy, which is the ability to understand what other people are thinking and feeling, and affective empathy, which is responding emotionally to others' emotions. Some studies suggest that problems with affective empathy drive violent offending by people with ASPD, especially in those with psychopathy. However, studies examining both cognitive and affective empathy in samples of violent offenders with ASPD, with and without psychopathy, are lacking. In this study, I will address this problem. I will compare both cognitive and affective empathy in violent offenders with ASPD with and without psychopathy to empathy in healthy non-offenders. I will measure this by having participants watch and respond to videos showing realistic social scenarios and assessing their responses to others' problems and emotions. Along with this, I will use cutting-edge technologies to further understand the brain abnormalities underlying empathy problems in people with ASPD with and without psychopathy. Firstly, I will use a new technology called OPM-MEG, which is the world's first 'wearable' brain scanning technology. This allows for measurement of brain activity, while performing tasks, like watching and responding to the video in this study, outside of a standard MRI scanner. This is especially useful in some groups, including those with ASPD, who have difficulty focusing on such tasks in a noisy MRI scanner. Secondly, I will explore the role of the neurochemicals glutamate and GABA. I will do this using a high-resolution MRI scanner, measuring glutamate and GABA in parts of the brain that are especially important in empathy. This step requires participants simply to lie still in the scanner. Finally, in a small group of adolescents who have offended, I will show that these investigations can also be used in young people. This is important for finding future interventions in young people at risk of developing ASPD in adulthood. This work could be a major stepping stone in developing treatments for ASPD and psychopathy. By linking empathy abnormalities to underlying brain biology and chemistry, we can start to develop precise, effective treatments. Such treatments would first be tailored for individuals with ASPD with psychopathy or without psychopathy. As our understanding increases, they would eventually be tailored to the specific individual. This approach, known as 'personalised medicine', is increasingly recognised as the ideal approach across both mental and physical health. The long-term benefits to society of reducing violence are enormous.