The Neurobiological Correlates of Empathy and Decision-making in Antisocial Populations - An Umbrella Review and Coordinate-based Meta-analysis.

BACKGROUND

Understanding the neural basis of antisocial behaviour is critical to developing effective treatments to reduce the enormous societal costs of violent crime. We aimed to synthesize meta-analytic evidence from neuropsychological, neurophysiological, and neuroimaging studies in antisocial populations, focussing on key neuropsychological components - empathy, decision-making, and moral reasoning.

METHODS

The review was pre-registered (PROSPERO=CRD420250502278) and followed PRISMA guidelines. MEDLINE, EMBASE and APA PsycINFO were systematically searched. Eligible meta-analyses compared antisocial populations, including: youth with clinically confirmed disruptive behaviour disorders and/or callous-unemotional traits based on clinical assessments; youth offenders; adults with clinically confirmed antisocial personality disorder and/or psychopathy; and adult offenders; with healthy controls. Metaumbrella and GingerALE were used for analyses.

RESULTS

Twenty-one meta-analyses were included. There were abnormalities in the neurobiological correlates of empathy (eG = 0.24, 95% CI: 0.17-0.31, p = <0.0001, n = 11,343) and decision-making (eG = 0.23, 95% CI: 0.11-0.35, p = 0.00013, n = 2,164) in antisocial populations, versus controls. Insufficient meta-analyses of moral reasoning were identified for analysis. Coordinate based meta-analysis revealed spatial convergence in the amygdala and inferior frontal gyrus.

CONCLUSIONS

This first umbrella review of neurobiological studies in antisocial populations supports a contributory role for small but significant abnormalities in neurobiological underpinnings of empathy and decision-making across antisocial populations, further supported by coordinate-based neuroimaging studies. This consolidates a platform for focus on these core domains in future work aimed at stratifying broad antisocial populations into more biologically homogenous groups, and eventually individualised treatment approaches.