<p>Kent Kiehl's work may be the closest means of determining this. According to an <a href="https://www.wired.com/2014/04/psychopath-brains-kiehl/" rel="nofollow noreferrer">interview</a>, he states "psychopaths have 5 to 10 percent reduced gray matter density in and around the limbic regions [a network deep in the brain that's important for emotional processing]." If his source(s) can be examined for 1. what percent of psychopaths exhibit such reduced gray matter like all or most or some and 2. compared to what data regarding the general population. </p>

<p>For the former, it could be twisted into finding your answer by simply combining that and the fact (which multiple sources have reported) that psychopaths make up 1% of the population (Note!: almost all sources that report this do so based on behavior, which is sampled and attempted to be detected, not based on anatomy and brain structure). </p>

<p>It is in the latter where more details on this condition can be found for the general population, if Kiehl source(s) does happen to have it.</p>

<p>If anything, enough brain scans of the general population to best ascertain this have not been conducted.  </p>

CC BY-SA 4.0
2020-04-28T10:20:20.150Z
Welcome to Psychology.SE. The insular cortex, in particular its most anterior portion, is considered a limbic-related cortex; but, as the question relates specifically to the left anterior insula, is there information in Kiehl's work on what percentage of those with reduced grey matter in the limbic regions include reduced grey matter within the left anterior insula?
Chris Rogers
CC BY-SA 4.0
2020-04-25T22:52:57.403Z
2020-04-25T23:00:20.110Z
2020-04-25T23:00:20.110Z
Holiday_Chemistry
<p>In short, the question cannot be answered as-is.  I will explain why, and then answer a broader question that you may find useful instead.</p>

<p><strong>Reverse Inference:</strong></p>

<p>As background, consider the common problem of <a href="https://www.cell.com/neuron/fulltext/S0896-6273(11)00989-5" rel="noreferrer">reverse inference</a>: Suppose we identify subjects with relatively low grey-matter volumes (GMV) in the left anterior insula (LAI).  Can we conclude that these subjects have low empathy?  Well, the <a href="https://www.sciencedirect.com/science/article/abs/pii/S002239561300157X" rel="noreferrer">source paper</a> for the referenced article already says ... not really:</p>

<blockquote>
  <p>GM volume of the left anterior  insula  was  marginally,  positively 
  correlated  with emotional empathy (... p&lt;.10 ...).</p>
</blockquote>

<p>What about NPD, can we conclude that they have NPD?  Well, subjects with low LAI GMV might have NPD, or they might just be <a href="https://www.frontiersin.org/articles/10.3389/fnins.2019.00815/full" rel="noreferrer">good singers</a>!  Or maybe they are just good at <a href="https://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&amp;Cmd=ShowDetailView&amp;TermToSearch=29061528" rel="noreferrer">learning new languages</a>!  In fact, low LAI GMV is associated with some cognitive advantages, as well as <a href="https://link.springer.com/article/10.1186/1471-244X-12-45" rel="noreferrer">many mental disorders</a>.  See, one of the problems with reverse inference is that psychological constructs simply do not line up well with gross neuroanatomical features - that is, brain regions do multiple things.</p>

<p><strong>Anatomical Abnormality:</strong></p>

<p>A second issue is with the concept of an abnormality.  Although the source paper discusses "structural abnormalities in fronto-paralimbic brain regions of patients with NPD," it does not define this abnormality.  Consider this figure from the paper:</p>

<p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; <a href="https://i.sstatic.net/UbjN0.png" rel="noreferrer"><img src="https://i.sstatic.net/UbjN0.png" alt="enter image description here"></a></p>

<p>Here, the vertical (Y) axis represents LAI GMV.  It does appear that NPD patients (green) have lower LAI GMV than healthy controls (yellow).  However, where is the abnormality?  What volume difference constitutes an identifiable condition?</p>

<p><strong>Normal Distribution:</strong></p>

<p>Technically, we should also be concerned with the low power of this paper (only 17 subjects in each group).  For example, an <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/narcissistic-self-and-its-psychological-and-neural-correlates-an-exploratory-fmri-study/33080CBD49FB388287C776198DE1D6C4" rel="noreferrer">earlier study</a> (with 11 subjects in each group) found differences in the right anterior insula rather than the left.  Hmmm...  <a href="https://en.wikipedia.org/wiki/Replication_crisis" rel="noreferrer">Replication crisis</a> anyone?  But let's put that aside for a minute, and consider the question at hand.</p>

<p>Suppose for a minute that low LAI GMV did indicate something about empathy (though it probably does not), and that there was a definable abnormality of LAI GMV (though there probably is not), what percentage of the general population would have such an abnormality?</p>

<p>Well, it's reasonable to use a normal distribution to estimate this.  For this, we need average and standard deviation values for LAI GMV.  I am not aware of a meta-analysis looking at this, but some individual studies report such values.  For example, <a href="https://link.springer.com/article/10.1186/1471-244X-12-45/tables/2" rel="noreferrer">this study</a> of 39 subjects reports LAI GMV (corrected for total brain size) mean = 2209mm<sup>3</sup> and std = 214.2mm<sup>3</sup>.  Supposing that this is representative of the general population (I wouldn't assume that, but it's a start), a normal distribution might look like this:</p>

<p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; <a href="https://i.sstatic.net/TzTj8.png" rel="noreferrer"><img src="https://i.sstatic.net/TzTj8.png" alt="enter image description here"></a></p>

<p>For this example, I just went with the cut-off being the mean for clinical patients in the study (2124mm<sup>3</sup>), resulting in about 35% of the population below the cut-off, but you can <a href="https://mathcracker.com/normal_probability" rel="noreferrer">construct your own graph</a> with whatever cut-off you deem useful for your purposes.</p>

CC BY-SA 4.0
2020-04-28T21:57:52.643Z
Might be worth pointing out explicitly that what you are showing is that 35% of the general population is below a certain threshold, and (assuming normal distributions all around) only 50% of the NPD patients are also below that threshold. So using this threshold as a diagnostic test would have about only 50% sensitivity while being extremely non-specific as well.
Bryan Krause
CC BY-SA 4.0
2020-04-29T01:24:18.857Z
This is the best answer I’ve seen on any Stack Exchange site. I very much appreciate the effort put into this and hope that many people will benefit from it as I have. Thank you.
Alex Ryan
CC BY-SA 4.0
2020-04-28T21:41:38.823Z
2020-04-28T21:41:38.823Z
Arnon Weinberg
<p>According <a href="https://www.livescience.com/37684-narcissistic-personality-disorder-brain-structure.html" rel="nofollow noreferrer">to an article on livescience.com</a>, <em>"Narcissists' Lack of Empathy Detected in Brain Scans"</em>, research seems to indicate that a low volume of grey matter in the left anterior insula is associated with an inability to exhibit empathy.</p>

<blockquote>
  <p>Researchers used magnetic resonance imaging to scan the brains of 34 people, including 17 individuals who suffer from narcissistic personality disorder, and found that pathological narcissists have less gray matter in a part of the cerebral cortex called the left anterior insula. </p>
</blockquote>

<p>What percentage of the population have this particular condition?</p>

<moral-psychology>
What percentage of the population have the brain anomaly associated with the inability to exhibit empathy?
Alex Ryan
# What percentage of the population have the brain anomaly associated with the inability to exhibit empathy?

(Asked by: username_0 on 2020-04-14)

According [to an article on livescience.com](https://www.livescience.com/37684-narcissistic-personality-disorder-brain-structure.html), *"Narcissists' Lack of Empathy Detected in Brain Scans"*, research seems to indicate that a low volume of grey matter in the left anterior insula is associated with an inability to exhibit empathy.

> Researchers used magnetic resonance imaging to scan the brains of 34 people, including 17 individuals who suffer from narcissistic personality disorder, and found that pathological narcissists have less gray matter in a part of the cerebral cortex called the left anterior insula.

What percentage of the population have this particular condition?

**Tags:** moral-psychology


---

## 2 answers

### Answer by username_3 on 2020-04-28. Score: 6 | Accepted answer

In short, the question cannot be answered as-is. I will explain why, and then answer a broader question that you may find useful instead.

**Reverse Inference:**

As background, consider the common problem of [reverse inference](https://www.cell.com/neuron/fulltext/S0896-6273(11)00989-5): Suppose we identify subjects with relatively low grey-matter volumes (GMV) in the left anterior insula (LAI). Can we conclude that these subjects have low empathy? Well, the [source paper](https://www.sciencedirect.com/science/article/abs/pii/S002239561300157X) for the referenced article already says ... not really:

> GM volume of the left anterior insula was marginally, positively
> correlated with emotional empathy (... p<.10 ...).

What about NPD, can we conclude that they have NPD? Well, subjects with low LAI GMV might have NPD, or they might just be [good singers](https://www.frontiersin.org/articles/10.3389/fnins.2019.00815/full)! Or maybe they are just good at [learning new languages](https://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=ShowDetailView&TermToSearch=29061528)! In fact, low LAI GMV is associated with some cognitive advantages, as well as [many mental disorders](https://link.springer.com/article/10.1186/1471-244X-12-45). See, one of the problems with reverse inference is that psychological constructs simply do not line up well with gross neuroanatomical features - that is, brain regions do multiple things.

**Anatomical Abnormality:**

A second issue is with the concept of an abnormality. Although the source paper discusses "structural abnormalities in fronto-paralimbic brain regions of patients with NPD," it does not define this abnormality. Consider this figure from the paper:

[![enter image description here](https://i.sstatic.net/UbjN0.png)](https://i.sstatic.net/UbjN0.png)

Here, the vertical (Y) axis represents LAI GMV. It does appear that NPD patients (green) have lower LAI GMV than healthy controls (yellow). However, where is the abnormality? What volume difference constitutes an identifiable condition?

**Normal Distribution:**

Technically, we should also be concerned with the low power of this paper (only 17 subjects in each group). For example, an [earlier study](https://www.cambridge.org/core/journals/psychological-medicine/article/narcissistic-self-and-its-psychological-and-neural-correlates-an-exploratory-fmri-study/33080CBD49FB388287C776198DE1D6C4) (with 11 subjects in each group) found differences in the right anterior insula rather than the left. Hmmm... [Replication crisis](https://en.wikipedia.org/wiki/Replication_crisis) anyone? But let's put that aside for a minute, and consider the question at hand.

Suppose for a minute that low LAI GMV did indicate something about empathy (though it probably does not), and that there was a definable abnormality of LAI GMV (though there probably is not), what percentage of the general population would have such an abnormality?

Well, it's reasonable to use a normal distribution to estimate this. For this, we need average and standard deviation values for LAI GMV. I am not aware of a meta-analysis looking at this, but some individual studies report such values. For example, [this study](https://link.springer.com/article/10.1186/1471-244X-12-45/tables/2) of 39 subjects reports LAI GMV (corrected for total brain size) mean = 2209mm3 and std = 214.2mm3. Supposing that this is representative of the general population (I wouldn't assume that, but it's a start), a normal distribution might look like this:

[![enter image description here](https://i.sstatic.net/TzTj8.png)](https://i.sstatic.net/TzTj8.png)

For this example, I just went with the cut-off being the mean for clinical patients in the study (2124mm3), resulting in about 35% of the population below the cut-off, but you can [construct your own graph](https://mathcracker.com/normal_probability) with whatever cut-off you deem useful for your purposes.

> **Comments:**
> **username_4**: Might be worth pointing out explicitly that what you are showing is that 35% of the general population is below a certain threshold, and (assuming normal distributions all around) only 50% of the NPD patients are also below that threshold. So using this threshold as a diagnostic test would have about only 50% sensitivity while being extremely non-specific as well.  
> **username_0**: This is the best answer I’ve seen on any Stack Exchange site. I very much appreciate the effort put into this and hope that many people will benefit from it as I have. Thank you.  

---

### Answer by username_1 on 2020-04-25. Score: 1

Kent Kiehl's work may be the closest means of determining this. According to an [interview](https://www.wired.com/2014/04/psychopath-brains-kiehl/), he states "psychopaths have 5 to 10 percent reduced gray matter density in and around the limbic regions [a network deep in the brain that's important for emotional processing]." If his source(s) can be examined for 1. what percent of psychopaths exhibit such reduced gray matter like all or most or some and 2. compared to what data regarding the general population.

For the former, it could be twisted into finding your answer by simply combining that and the fact (which multiple sources have reported) that psychopaths make up 1% of the population (Note!: almost all sources that report this do so based on behavior, which is sampled and attempted to be detected, not based on anatomy and brain structure).

It is in the latter where more details on this condition can be found for the general population, if Kiehl source(s) does happen to have it.

If anything, enough brain scans of the general population to best ascertain this have not been conducted.

> **Comments:**
> **username_2**: Welcome to Psychology.SE. The insular cortex, in particular its most anterior portion, is considered a limbic-related cortex; but, as the question relates specifically to the left anterior insula, is there information in Kiehl's work on what percentage of those with reduced grey matter in the limbic regions include reduced grey matter within the left anterior insula?  

---

