Acquired Sociopathy

There have also been, in the last few years, some interesting suggestions about the role of the ventromesial frontal lobes in childhood. This work is based on patients injured in serious falls or car accidents —where the injury occurred under 2 years of age (Anderson et al., 1999). Unsurprisingly, because of lesions to their ventromesial frontal lobes, these individuals behave much like the adult patients described above. Thus, they consistently do badly in relationships, their general social interactions are poor, and their career progression is far from normal. This aspect of their presentation comes as no real surprise to us.

However, an additional factor appears in these neurological patients in that they fail to develop other core psychological abilities. In particular, they seem to lack empathy, and on formal tests of social and moral judgment and reasoning they do very badly. The claim has been made that these represent instances of "acquired sociopathy." Anderson et al. (1999) discuss the case of a young woman who had been run over by a vehicle at the age of 15 months. From the age of 3 she was noted to be "largely unresponsive to verbal or physical punishment" (p. 1032). By her teenage years she would have met many of the criteria for a diagnosis of conduct disorder and was stealing from her family and peers, had a conspicuous lack of friends, lied chronically, and had a history of multiple arrests. She had frequent unprotected sex and gave birth to a child, but "there was no evidence that she experienced empathy, and her maternal behavior was marked by a dangerous insensitivity to the infant's needs" (p. 1032). As in other cases of this type, the patient becomes sociopathic not by virtue of poor environmental circumstances or the nonoptimal attachment relationships that sometimes occur in dysfunctional families (see Schore, 1994, for more on the importance of the ventromesial frontal lobes for affect regulation). Rather, their behavior seems to result from an absence of the biological structures that underpin empathy. This conclusion is bolstered by functional imaging work investigating the size of the frontal lobes in psychopaths/sociopaths, which suggests that they have smaller than average frontal lobe volume (Raine et al., 2000). We should not conclude from these data that all cases of sociopathy result from brain damage or disease, but this developing literature points to the biological basis of this class of psychiatric disorder.

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