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Executive dysfunction does not appear to be a fundamental feature of psychopathy, but is instead primarily related to disinhibitory and antisocial traits. These study findings were published in Psychological Medicine.
Although executive dysfunction has previously been associated with antisocial behavior, it remains unclear what domains of and to what extent executive function is impaired in general psychopathy.
Therefore, investigators conducted a meta-analysis to evaluate if psychopathy is associated with executive function, which domains may be impaired, and how executive dysfunction may be affected by specific factors of psychopathy. The investigators first conducted a systematic literature review of publication databases in October 2022 to identify studies that evaluated the relationship between psychopathy and executive function performance among participants at least 18 years of age.
A total of 50 studies published between 1984 and 2021 from 12 were included, for a pooled sample size of 5694 participants. The investigators used multilevel random-effects models to pool effect sizes (Cohen’s d) across 5 domains of executive function, including working memory, shifting, planning, inhibition, and overall executive function. The investigators also categorized psychopathy factors into 2 overarching themes: Interpersonal/Affective (I/A) and Lifestyle/Antisocial (L/A) factors.
Overall, psychopathy was associated with small deficits in planning (Cohen d= -0.50; 95% CI, -0.79 to -0.21; P <.001), inhibition (Cohen d= -0.20; 95% CI, -0.34 to -0.06; P <.01), and general executive function (Cohen d= -0.23; 95% CI, -0.36 to -0.11; P <.001), consistent with current theories of psychopathy that emphasize symptoms of difficulty planning ahead and poor behavioral control, cultivating behaviors of violence and aggression.
When stratified by psychopathy factors, executive dysfunction was specific to L/A factors and was not significantly associated with I/A for any executive function domain. The investigators found that L/A factors were linked to impairments in working memory (Cohen d= -0.24; 95% CI, -0.40 to -0.08; P <.01), inhibition (Cohen d= -0.23; 95% CI, -0.39 to -0.08; P <.01), planning (Cohen d= -0.44; 95% CI, -0.64 to -0.25; P <.001), and overall executive function (Cohen d= -0.25; 95% CI, -0.37 to -0.12; P <.001).
The investigators noted that the proportion of women significantly moderated overall executive function, inhibition, planning, and shifting, as women with psychopathy generally experienced greater executive dysfunction than men. However, the investigators did not observe any significant moderation by participant age, sample type, publication year, or country.
“[Executive function] deficits are rather small and may not represent a central aspect of general psychopathy,” the investigators concluded. “Our findings… highlight the necessity to address psychopathy not as a single construct, but to systematically differentiate between the affective and the antisocial dimensions of this disorder.”
Meta-analysis limitations include an impurity problem (neuropsychological tasks were assigned to specific EF domains although the tasks may actually reflect performance in more than 1 domain), and the preponderance of men in the included studies affecting generalizability.
This article originally appeared on Psychiatry Advisor
