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Abstract: The complexity and consequences of psychopathy are still debated, and its relation to other mental disorders, pathological personality traits, and criminality needs to be further investigated by clinical, longitudinal studies using structured diagnostic instruments. The present study used two groups of mentally disordered offenders (N =153) investigated with in-depth clinical assessments and prospective long-term follow-up to identify the convergence between 1) the four facets of psychopathy defined by the Psychopathy Checklist—Revised (PCL-R; Interpersonal, Affective, Lifestyle, and Antisocial), 2) mental disorders according to SCID I and II interviews, 3) personality traits as measured by the Karolinska Scales of Personality, and 4) criminal recidivism. The Interpersonal facet differed substantially from the other three facets by not being significantly associated with substance use disorders, antisocial personality disorder (the other facets at P ≤0.001 level), or personality traits involving impulsive and aggressive antisocial behaviors (the other facets at P <0.01 level). Furthermore, the interpersonal facet could not predict violent recidivism better than random. The Antisocial facet outperformed not only the other facets but also the total PCL-R score in the prediction of violent recidivism, P <0.001.The findings confirm psychopathy as a heterogeneous phenomenon and have clinical implications for assessments of psychopathy and violence risk assessments in clinical and forensic contexts. [Copyright &y& Elsevier]

• Different manifestations of externalizing associated with both distinct and overlapping morphology variations. • Affected regions involved in reward processing, decision-making, inhibitory control, and regulation of anxiety and fear. • Distinct prefrontal areas may therefore be associated with different clinically relevant manifestations of externalizing. The externalizing spectrum, including traits and behaviors such as aggression, reduced inhibitiory control and substance abuse, is associated with altered prefrontal brain morphology. However, the degree to which different manifestations of the externalizing spectrum are associated with distinct or overlapping variations in individual brain morphology is unclear. Here, we therefore used structural magnetic resonance imaging, self-report assessment, and a response inhibition task in a sample of 59 young adults to examine how cortical thickness in the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex (DLPFC) relate to four different manifestations of the externalizing spectrum: disinhibition, callous aggression, substance abuse, and behavioral inhibitory control. Using Bayesian linear regression models controlling for age, gender, and years of education, we found that the different manifestations of the externalizing spectrum were associated with both distinct and overlapping morphology variations. Specifically, both callous aggression and inhibitory control was associated with increased cortical thickness of the OFC, a region involved in reward processing, decision-making, and regulation of anxiety and fear. Both disinhibition and substance abuse were associated with DLPFC thickness, although with opposite association patterns, possibly reflecting processes related to inhibitory control, working memory and attention. Moreover, disinhibition, but not callous aggression or substance abuse, was associated with behavioral inhibitory control. Our results provide further support for the link between externalizing behaviors and prefrontal brain morphology, while identifying distinct prefrontal areas associated with different clinically relevant manifestations. These findings may help guide further research aimed at developing novel treatment and intervention strategies for externalizing behaviors and disorders. [ABSTRACT FROM AUTHOR]

Forensic populations have high prevalence rates of adverse childhood experiences (ACE), but specific pathways from childhood victimization to adult victimizing behavior remain unclear. Difficulties in emotion regulation may prove to be a more proximal risk factor that functions as a pathway between ACE and aggressive antisocial behavior (AAB). In this study, we investigated concurrent associations between ACE, AAB, and difficulties in emotion regulation and tested the mediational role of emotion dysregulation. A forensic psychiatric inpatient sample (N = 97) was recruited from a maximum-security forensic psychiatric hospital in Sweden. Data were collected through file reviews and self-reports and analyzed with mediation and correlation analyses. Widespread bivariate associations among the study variables emerged, with small to moderate effect sizes. Distinct emotion regulation difficulties had unique relations to ACE and to different forms of AAB respectively. Evidence of significant indirect effects was limited and inconsistent across different types of analyses. Deficits in emotion regulation might be an important target of change in efforts to reduce AAB in forensic psychiatric patients with past ACE exposure. Attention to different dimensions of emotion regulation is crucial to deliver comprehensive interventions. • Trauma is related to aggression and antisocial behavior but not callous aggression. • No mediation found between overall emotion dysregulation and outcome measures. • Difficulties pursuing goals when distressed mediated the trauma-aggression link. [ABSTRACT FROM AUTHOR]