When most of us imagine someone in pain, we feel uncomfortable and want to help. Psychopaths do not: a callousness toward others' suffering is the central feature of a psychopathic personality. Now an imaging study finds that psychopathic inmates have deficits in a key empathy circuit in the brain, pointing to a potential therapeutic target.

Jean Decety, a psychologist at the University of Chicago, and his colleagues used functional MRI to scan the brains of 121 male prison inmates while they looked at photos of a painful moment, such as a foot stepping on a nail or a finger being smashed in a drawer. The inmates were instructed to imagine the scenario happening to themselves or to another person, a perspective-switching technique that easily elicits empathy in most people.

Inmates who scored the highest on a standard psychopathy test showed a normal response in pain perception and brain centers for emotion when imagining the pain for themselves. Yet when asked to imagine the scenario happening to others, their brains did not show typical connectivity between the amygdala, an area important for fear and emotional processing, and the ventromedial prefrontal cortex, a region vital for emotion regulation, empathy and morality. Some results even indicated that pleasure regions might have become active instead.

The brain areas that are undercommunicating in psychopathy “are key for experiencing empathetic concern and caring for one another, which is what empathy is all about and what individuals who score high on psychopathy do not have,” Decety says. Cognitive therapy may help some psychopaths; he suggests clinicians could measure changes in these faulty connections to home in on the best strategies to stimulate empathy. [For more on psychopathy, see “Inside the Mind of a Psychopath,” by Kent A. Kiehl and Joshua W. Buckholtz; Scientific American Mind, September/October 2010.]