Neural, Cognitive, and Social–Affective Mechanisms of Psychopathy in Female Offenders: A Systematic Review

Background: Mechanistic models of psychopathy have been predominantly developed and validated in male forensic samples, leaving the neurocognitive architecture of psychopathy in female offenders insufficiently understood. This gender imbalance creates a critical theoretical gap, as the assumption that established frameworks generalize to women remains largely understudied. Objective: This systematic review synthesizes empirical evidence on the neural, cognitive, and social-affective mechanisms of psychopathy in female offenders and evaluates the extent to which dominant theoretical models Blair’s Integrated Emotion Systems, Kiehl’s Paralimbic Dysfunction Model, and Newman’s Response Modulation Hypothesis generalize to women. Methods: Following PRISMA 2020 guidelines, systematic searches were conducted in PubMed, PsycINFO, Scopus, and Web of Science. 22 empirical quantitative studies met the predefined inclusion criteria. Due to substantial methodological heterogeneity, findings were synthesized narratively. Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence was evaluated through an adapted GRADE framework. Results: Neural findings indicated abnormalities within limbic and paralimbic networks, including reduced amygdala, orbitofrontal, and anterior cingulate activity, altered resting-state connectivity, and reduced white matter integrity in the uncinate fasciculus. Cognitive results provided partial support for the Response Modulation Hypothesis. Although selective attention deficits were consistently observed, passive avoidance impairments were not reliably replicated. Abnormalities in late-stage error processing, reflected by reduced Pe amplitudes, suggested deficits in affective evaluation of errors. Social-affective findings were mixed, with reduced self-reported empathy and diminished psychophysiological reactivity to distress cues in several studies, while fear processing appeared context-dependent and emotion recognition results remained inconsistent. Conclusion: Overall, the evidence suggests that core neurobiological mechanisms proposed in dominant models of psychopathy extend to female offenders, particularly with respect to paralimbic dysfunction. However, cognitive and social-affective manifestations vary, indicating the need for gender-informed theoretical refinement. Building on these findings, this review proposes a hierarchical, gender-informed neurocognitive framework which suggests that shared paralimbic dysfunction may give rise to distinct cognitive and affective expressions in women. These findings highlight the importance of developing assessment tools and forensic interventions tailored to female-specific neurocognitive profiles.