Oxytocin Improves Distress Recognition in Individuals With Antisocial Personality Disorder

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Individuals with antisocial personality disorder are characterized by aggression, impulsivity, and reckless disregard for others feelings (American Psychiatric Association, 2013). As may be expected, these characteristics not only cause problems for the affected individual, but also for their families and peers. Antisocial personality disorder is also the most common psychiatric diagnosis amongst prison inmates, causing high costs for our societies. It is therefore not surprising that psychologists and psychiatrists have been interested in studying the reasons for aggression and impulsivity in antisocial individuals for a long time. 

One aspect which seems to be important in this context is a problem in the recognition of other people’s signals of distress or fear (Dawel et al., 2012; Marsh and Blair, 2008). Seeing another person in pain or fear normally leads to activations in the “emotional brain” (limbic system), to empathy and compassion, and a reduced tendency to act out aggressively against this person. Individuals with antisocial personality disorder have problems in recognizing fear in other people’s facial expressions, show reduced limbic activations when looking at fearful faces, and have problems empathizing with other people in pain or distress (Glenn et al., 2013). 

In the last decade, there has been an increasing research interest in the neuropeptide oxytocin. Oxytocin is commonly known as the “attachment” hormone, which is for instance secreted in high amounts during lovemaking or breastfeeding and is crucially involved in mother-child bonding, social affiliation, and approach behavior. In experimental studies, participants usually receive a nasal spray with oxytocin which leads to a short rise of oxytocin levels in the brain. Using such a procedure, several previous studies found that oxytocin improves facial emotion recognition in healthy volunteers and individuals with deficits in emotion recognition, such as those with autism spectrum disorder (Shahrestani et al., 2013). 

So, could oxytocin also be useful for individuals with antisocial personality disorder? To study this, we recruited 22 young adult men and women with antisocial personality disorder and 29 healthy young adult men and women. All participants performed an emotion recognition task twice, once after receiving oxytocin and once after placebo administration. Under placebo, antisocial individuals performed worse and showed more errors for fearful and happy faces than healthy volunteers. Most interestingly, when having received oxytocin, the groups did not differ anymore and antisocial individuals performed equally well in the recognition of fearful and happy facial expressions than healthy volunteers! 

This is a very promising finding since deficits in the recognition of other people’s distress or pain is discussed as one of the reasons for aggression in antisocial individuals. In addition, the currently available pharmacological treatment options for antisocial individuals are rather limited and unspecific. Having said this, there are still many open questions which need to be addressed by further research studies before thinking about the usage of oxytocin for treating antisocial individuals. Some of these questions concern the long-term effects of oxytocin administration as well as the development of other delivery forms than nasal sprays. Beyond this, studies with larger samples are needed to investigate potential effects of sex or the relationship to aggressive behavior. Finally, the underlying neural correlates of the described effect should be analyzed in brain imaging studies.

If you want to read more about this study, check out our recent publication:

Timmermann, M., Jeung, H., Schmitt, R., Boll, S., Freitag, C.M., Bertsch, K., & Herpertz, S.C. (2017). Oxytocin improves facial emotion recognition in young adults with antisocial personality disorder. Psychoneuroendocrinology, 85, 158–164.

The study was part of the FemNat-CD consortium funded by the European Union’s Seventh Framework Programme.

Katja Bertsch, Ph.D., is head of the work group Personality Disorders in the Department of General Psychiatry at the Center for Psychosocial Medicine at Heidelberg University in Germany.

Sabine C. Herpertz, M.D., is Chair of General Psychiatry at Heidelberg University/Medical Faculty Heidelberg and Medical Director of the Clinic for General Psychiatry at the Center for Psychosocial Medicine at Heidelberg University in Germany.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association Publishing, Arlington.

Dawel, A., O'Kearney, R., McKone, E., & Palermo, R. (2012). Not just fear and sadness: meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy. Neuroscience & Biobehavioral Reviews, 36, 2288-2304.

Glenn, A.L., Johnson, A.K., & Raine, A. (2013). Antisocial personality disorder: a current review. Current Psychiatry Reports, 15, 427. doi:10.1007/s11920-013-0427.7.

Marsh, A.A. & Blair R.J.R. (2008). Deficits in facial affect recognition among antisocial populations: a meta-analysis. Neuroscience & Biobehavioral Reviews, 32, 454-465.

Shahrestani, S., Kemp, A.H., & Guastella, A.J. (2013). The impact of a single administration of intranasal oxytocin on the recognition of basic emotions in humans: a meta-analysis. Neuropsychopharmacology, 38, 1929-1936.