Exploring Primary and Secondary Variants of Psychopathy in Adolescents in Detention and in the Community

Abstract

The current study aims to ascertain how different variants of callous-unemotional traits differ in their psychopathology, exposure to aggression and violence, and aggressive and violent behavior. If secondary/distressed variants (high in callous-unemotional traits and high in anxiety) and primary/traditional variants (high in callous-unemotional traits and low in anxiety) differ along these dimensions, it may speak to their different etiologies, treatment needs (e.g., trauma focused), and responsiveness to treatment. The current sample consisted of 799 adolescents from high schools (n = 419) and juvenile detention centers (n = 380). Participants were interviewed regarding their callous-unemotional traits, psychopathology, exposure to aggression and violence, and aggressive and violent behavior. Parents/guardians and teachers/staff members also reported on participants' callous-unemotional traits and aggressive and violent behavior. A model-based cluster analysis indicated that there were four clusters in the data set, based on callous-unemotional traits and anxiety: a nonvariant cluster, a primary/traditional callous-unemotional cluster, a secondary/distressed callous-unemotional cluster, and a "fearful" cluster. Secondary/distressed variants of psychopathy exhibited significantly greater symptoms of depression and psychoticism, more exposure to low level aggression and neighborhood violence, and more aggressive and violent behavior, as compared to the other clusters. Adolescents with callous-unemotional traits might not be a homogeneous group, but rather may differ in attitudes, behaviors, and exposure to risk, therefore differing in their treatment needs and responsiveness.

Anxiety and Callous-Unemotional Traits: Physiological and Behavioral Responses to Others' Distress

“…Importantly, analogous to primary and secondary variants of psychopathy in adults (Karpman, 1948;Skeem, Poythress, Edens, Lilienfeld, & Cale, 2003), whereas the majority of youth showing CU traits do not show elevated levels of anxiety, a subset of CU youth do, and elevated anxiety appears to alter the presentation of CU traits in several key ways. Among children with CU, anxiety has been associated with greater questionnaire-based reports of impulsivity and externalizing behavior problems, as well as higher reports of aggression and delinquency Rosan et al, 2015;Vaughn et al, 2009), especially reactive aggression (Fanti et al, 2013), a more extensive criminal offense record (Kimonis et al, 2011), and increased reports of depressive and psychotic symptoms (Docherty et al, 2015;Vaughn et al, 2009) relative to CU youth without anxiety. These anxiety-related differences hold true despite comparable levels of CU traits, although some studies have noted increased (Kimonis et al, 2011;Lee et al, 2010) or decreased (Euler et al, 2015) CU trait severity among youth who show anxiety symptoms relative to CU youth without anxiety.…”

“…Empirical work suggests that anxiety-related heterogeneity in youth showing CU traits may be related to meaningful differences in associated aggressive behavior, with the presence of both CU traits and anxiety associated with a specific pattern of emotional processing deficits and higher levels of aggression than children with just CU traits (Docherty, Boxer, Huesmann, O'Brien, & Bushman, 2015;Euler et al, 2015;Fanti, Demetrious, & Kimonis, 2013;Humayun, Kahn, Frick, & Viding, 2014;Kahn et al, 2013;Kimonis, Skeem, Cauffman, & Dmitrieva, 2011;Lee, Salekin, & Iselin, 2010;Rosan, Frick, Gottlieb, & Fasicaru, 2015). However, much of this research has relied exclusively on questionnaire reports of aggressive behavior rather than observed aggressive behavior (e.g., Kimonis et al, 2011;Lee et al, 2010), and has not examined how anxiety and CU traits predict child aggression in the context of experimentally manipulated distress cue salience from potential victims.…”

“…Relatedly, as CU traits are typically conceptualized in the context of child behavior problems, conducting further study in a clinical sample would allow more in-depth analysis of the CU construct. However, the practice of blending community recruitment with recruitment of youth with serious behavior problems in order to yield a CP-enhanced sample is not unprecedented in the CU and anxiety literature (e.g., Docherty et al, 2015). Third, the sample included mostly anxiety (e.g., Fanti et al, 2013), and the potential for interactive social-cognitive biases associated with both CU (e.g., Pardini, 2011) and anxiety (e.g., Taghavi et al, 2000), future research would do well to assess the role of cognition more extensively.…”

“…It is worthwhile to assess the degree to which the aggressive reactivity and internalizing symptoms (e.g., Docherty et al, 2015;Fanti et al, 2013) reported by CU youth experiencing anxiety symptoms may actually represent traumatic stress symptoms. Thus far, trauma exposure and traumatic stress symptoms have been examined as clinical correlates differentiating variants of CU youth with respect to anxiety (e.g., Humayun et al, 2013;Kimonis et al, 2012); the potential for traumatic stress to moderate the link between CU and observed aggression in the context of experimentally manipulated distress cues has not been explored.…”

“…Hypothesis: Given the growing body of literature documenting a subset of children with CU traits who show significant anxiety and increased questionnaire-based reports of aggression (e.g., Docherty et al, 2015, Rosan et al, 2015 and more extensive criminal records (Kimonis et al, 2011), it was hypothesized that child anxiety will moderate the impact of CU severity on behaviorally observed aggression (regardless of distress cue salience), such that higher levels of child anxiety would be associated with a stronger link between CU and observed aggression.…”