Callous-Unemotional Traits and Offending: An Analysis of Functional Form

Callous-unemotional (CU) traits (e.g., lack of empathy, lack of guilt, shallow affect) are associated with severe and persistent conduct problems in youth. There is evidence showing a substantial genetic correlation between CU traits and conduct problems. The etiological associations between CU traits and other psychopathological symptoms, including symptoms of hyperactivity and emotional problems (such as anxiety and depression symptoms), have been less explored. To examine the etiological associations between CU traits and symptoms of conduct problems, hyperactivity and emotional problems separately through the use of a twin design. Participants were same-sex twin pairs (n = 426 twins; 42% female; 43% MZ; age = 15) drawn from the Child and Adolescents Twin Study in Sweden, a longitudinal study of twins born in Sweden. The sample was mainly composed of children who screenpositive on neurodevelopmental problems/mental health problems or at-risk children (i.e., screen-negative children considered to be genetically at-risk siblings). We used self-report measures of CU traits, conduct problems, hyperactivity and emotional problems. Model-fitting analyses were conducted using structural equation modeling. We found a strong positive genetic correlation between CU traits and conduct problems and a moderate genetic correlation between CU traits and hyperactivity. We also found a relatively modest, but significant negative genetic correlation between CU traits and emotional problems. Using a sample of adolescent twins screened for neurodevelopmental problems, we replicated previous findings that showed a strong genetic correlation between CU traits and conduct problems and we extended research by examining further the etiological associations between CU traits and symptoms of hyperactivity and emotional problems.

Callous-unemotional (CU) traits, characterized by lack of empathy, guilt, and deficient affect, are linked to facial emotion recognition (FER) deficits in children. While anxiety is also associated with FER anomalies, these relationships are often examined in isolation despite co-occurrence. This study aims to concurrently investigate unique contributions of CU traits and anxiety on children's FER patterns. We recruited 107 children aged 6 to 11 from community settings, assessing CU traits through caregiver reports and anxiety via caregiver and child reports. FER performance was evaluated using a computer-based task. Results indicate that CU traits negatively impact overall FER accuracy, particularly when controlling for parent-reported anxiety. CU traits were inversely related to total FER accuracy for children self-reporting high anxiety levels. These findings enhance our understanding of how CU traits and anxiety interact to influence FER deficits, suggesting that interventions targeting CU traits should consider anxiety symptoms as a critical factor in emotional processing challenges among children.

While phenotypically indistinguishable with respect to callousness, individuals with primary and secondary callous-unemotional (CU) traits may show different developmental outcomes. This research predominantly comprised cross-sectional studies of male participants with a focus on maladaptive correlates. Thus, the present study examined whether youth with primary and secondary CU traits identified in Grade 7 reported distinct maladaptive outcomes (internalizing, externalizing, and substance use problems; criminal offenses; and sexual and partner experiences) and adaptive outcomes (health and wellbeing, education, and employment) in adulthood at age 25. We also examined sex differences. Participants included the high-risk control and normative samples from the Fast Track project (N = 754, male = 58%, Black = 46%). Youth with secondary CU traits reported higher levels of adult internalizing and externalizing psychopathology, a greater number of sexual partners and risky sexual behavior, and a greater number of violent offenses, compared with individuals with primary CU traits and those with low CU and anxiety symptoms. Conversely, youth with primary CU traits and low symptoms had higher wellbeing and happiness scores than those with secondary CU traits. Finally, there was differentiation on outcomes between female primary and secondary CU variants and male primary and secondary CU variants.

Youth involved in the juvenile justice system are at risk for a multitude of psychological and adjustment difficulties. Unfortunately, oftentimes these individuals do not receive the services needed. Attitudes toward mental health services contribute to whether an individual receives help; yet little is known about factors that are associated with detained youths’ attitudes regarding help. The current study advanced the literature by further examining how youth self-reports of symptoms of depression, anxiety, and aggression were related to attitudes toward mental health services among 229 detained youth (74.5% male, Mage = 15.52 years, SDage = 1.54). Additionally, the influence of callous-unemotional (CU) traits was examined. Findings suggest that while anxiety symptoms were associated with more positive attitudes toward mental health services, symptoms of depression and CU traits were associated with less positive attitudes toward mental health services. However, CU traits did not moderate associations between symptom clusters and attitudes toward mental health services. Findings suggest the need to consider internalizing symptom clusters as well as CU traits in how to approach youth regarding treatment engagement.

BackgroundNumerous studies have investigated the relevance of callous-unemotional traits in relation to externalizing psychopathology among children and adolescents. However, less research has examined the connections between callous-unemotional traits and internalizing psychopathology and findings were inconsistent. Consequently, the present study aimed to elucidate the role of callous-unemotional traits in the context of depression and anxiety while controlling for conduct problems, age, and gender.MethodsThe study utilized self-report questionnaire data from 978 adolescent psychiatric inpatients (Mage = 15.18, SD = 1.44) presenting a range of psychopathological conditions. A network analysis was conducted, incorporating callous-unemotional traits, depressive symptoms, anxiety symptoms, conduct problems, and covariates (age, gender). Additionally, comparisons were made between the networks of inpatients diagnosed with conduct disorders and those with internalizing disorders.ResultsThe findings indicated that callous-unemotional traits were relevant within the general network, as well as in both the conduct disorder and internalizing networks. In both contexts, callous-unemotional traits were predominately positively associated with depression and conduct problems. Within the conduct disorder network, callous-unemotional traits exhibited primarily negative associations with anxiety, whereas the relationships within the internalizing network were more varied.ConclusionsOur findings suggest that callous-unemotional traits hold substantial relevance for internalizing symptoms, supporting the notion that these traits should be considered potentially transdiagnostic factors.

Several studies have shown that eveningness is positively related to both depressive and anxiety symptoms. However, little is known about factors that may play a protective role against the undesirable emotional consequences of evening preference. Thus, in the present study, we explored the moderating effects of dispositional mindfulness on the relationship between morningness-eveningness and the presence of depressive symptoms, as well as between morningness-eveningness and the presence of anxiety symptoms. The study was conducted on a group of 1107 individuals (559 women and 548 men) aged 18-55 years (M=36.26, SD=9.89). Consistent with previous findings, eveningness was positively related to the presence of both depressive and anxiety symptoms. The magnitude of these effects decreased with higher dispositional mindfulness. The latter result remained significant when the analogical moderating effects of personality, established in earlier studies, were controlled for in the regression models. This leads to the conclusion that dispositional mindfulness may act as a protective factor against the elevated depressive and anxiety symptoms reported by evening-oriented individuals.

To the Editor: Mortality from cardiovascular causes, including pulmonary thromboembolism, is the second most common cause of mortality in psychiatric patients.1 Intermittent shortness of breath, chest pain, and tachycardia are the most common symptoms of pulmonary thromboembolism,2 but many of these symptoms also accompany the experience of anxiety. The diagnosis of pulmonary thromboembolism in psychiatric patients is substantially confounded by the presence of anxiety symptoms. Case report. We treated a 21-year-old woman following an overdose of 40 mg of diazepam. At presentation in 2010, apart from tachycardia (105 bpm), examination revealed no abnormalities. She gave a history of depressive and anxiety symptoms since the birth of her son 18 months before presentation and was on duloxetine 60 mg/d. During her admission, on 4 occasions she reported feeling anxious and tired and was found to be hyperventilating. On those occasions, she was tachycardic (110–123 bpm) and tachypneic (20–24 breaths/min) and had an oxygen saturation of 97%–99% on room air. On each occasion, it was explained to her that she was experiencing anxiety and was given 2.5 mg of diazepam with good effect. She was reviewed by the ward physician, and apart from tachycardia examinations, revealed no abnormalities. A few hours prior to her discharge (after a 3-day admission), she again reported similar symptoms and collapsed. All efforts to resuscitate her failed. Pulmonary thromboembolism was identified on postmortem examination as responsible for causing her death. This patient had an intermediate clinical probability of pulmonary thromboembolism as per the Revised Geneva Score for the prediction of pulmonary thromboembolism, although she had none of the risk factors or symptoms defined therein.3 However, both the presence of a psychiatric disorder and exposure to antidepressants are risk factors for pulmonary thromboembolism not considered in this risk stratification.4 Also, as clarified from her family after her death, she had never experienced hyperventilation or tiredness when anxious previously. It is important to note that most psychiatric patients with anxiety can describe the experience of anxiety that is typical for them. On the basis of the above, we suggest that even in psychiatric patients with low or intermediate clinical probabilities for pulmonary thromboembolism, the presence of atypical anxiety symptoms should lead to a high index of suspicion for pulmonary thromboembolism. In this setting, a normal enzyme-linked immunosorbent assay D-dimer result avoids further testing.5 Further studies are needed to appropriately incorporate the presence of psychiatric disorder and exposure to antidepressants and/or antipsychotics in scoring systems for pulmonary thromboembolism.

Recent research suggests that among the group of aggressive and antisocial adolescents, there are distinct variants who exhibit different levels of anxiety symptoms and callous-unemotional traits (CU traits). The purpose of the present study was to examine whether such variants are also present in male and female adolescents diagnosed with conduct disorder (CD). We used model-based cluster analysis to disaggregate data of 158 adolescents with CD (109 boys, 49 girls; mean age =15.61years) living in child welfare and juvenile justice institutions. Three variants were identified: (1) CD only, (2) CD with moderate CU traits and anxiety symptoms, and (3) CD with severe CU traits. Variants differed in external validation measures assessing anger and irritability, externalizing behavior, traumatic experiences, and substance use. The CD variant with moderate CU traits and anxiety symptoms had the most severe pattern of psychopathology. Our results also indicated distinct profiles of personality development for all three variants. Gender-specific comparisons revealed differences between girls and boys with CD on clustering and external validation measures and a gender-specific cluster affiliation. The present results extend previously published findings on variants among aggressive and antisocial adolescents to male and female adolescents diagnosed with CD.

Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders

BackgroundDisruptive behavior in children and adolescents can manifest as reactive aggression and proactive aggression and is modulated by callous-unemotional traits and other comorbidities. Neural correlates of these aggression dimensions or subtypes and comorbid symptoms remain largely unknown. This multi-center study investigated the relationship between resting state functional connectivity (rsFC) and aggression subtypes considering comorbidities. MethodsThe large sample of children and adolescents aged 8–18 years (n = 207; mean age = 13.30±2.60 years, 150 males) included 118 cases with disruptive behavior (80 with Oppositional Defiant Disorder and/or Conduct Disorder) and 89 controls. Attention-deficit/hyperactivity disorder (ADHD) and anxiety symptom scores were analyzed as covariates when assessing group differences and dimensional aggression effects on hypothesis-free global and local voxel-to-voxel whole-brain rsFC based on functional magnetic resonance imaging at 3 Tesla. ResultsCompared to controls, the cases demonstrated altered rsFC in frontal areas, when anxiety but not ADHD symptoms were controlled for. For cases, reactive and proactive aggression scores were related to global and local rsFC in the central gyrus and precuneus, regions linked to aggression-related impairments. Callous-unemotional trait severity was correlated with ICC in the inferior and middle temporal regions implicated in empathy, emotion, and reward processing. Most observed aggression subtype-specific patterns could only be identified when ADHD and anxiety were controlled for. ConclusionsThis study clarifies that hypothesis-free brain connectivity measures can disentangle distinct though overlapping dimensions of aggression in youths. Moreover, our results highlight the importance of considering comorbid symptoms to detect aggression-related rsFC alterations in youths.

Anxiety in the Behavioral and Psychological Symptoms of Dementia

The present study examined the independent contributions and the interaction effects of oppositional defiant problems (ODD), callous unemotional traits (CU) and anxiety symptoms on attentional orienting to emotional faces, in a community sample of preschoolers. Additionally, based on Rothbart's (2007) model of temperament, we analyzed whether fine-grained dimensions of reactivity (fear, anger, discomfort, sadness, activity level, approach, high intensity pleasure, impulsivity) and self-regulation (attentional shifting, attentional focusing, inhibitory control), as well as the higher order temperamental factors of negative affectivity, surgency and effortful control are associated with CU traits and ODD-related problems. Attentional orienting to emotional faces was assessed with pictorial Dot-probe task, while teachers rated CU traits and ODD-related problems. Also, parents reported on ODD-related problems, anxiety and temperament. Results indicated significant interaction effects between ODD-related problems and CU, as well as between CU and anxiety, in predicting attentional orientation patterns for angry, fearful and happy faces. Moreover, temperamental reactivity was positively associated with CU traits and ODD-related problems, whereas temperamental self-regulation was negatively related to CU traits and ODD-related problems. Results of this study have implications for early intervention and prevention approaches targeting preschool oppositional defiant problems.

A wealth of research has consistently identified two distinct callous unemotional (CU) variants that differ on etiological mechanisms. While the first variant has been posited to represent a genetically predisposed difference in lower emotional arousal, the secondary variant demonstrates overlap with trauma-related symptomatology. Limited research has examined whether these CU variants differ based on child maltreatment subtypes or whether symptom profiles for CU variants differ by male-identified and female-identified participants. We aimed to replicate findings that individuals in the secondary CU group demonstrate higher PTSS. In an undergraduate sample of youth ages 18 to 24 (N = 546; 55.5% female), the present study examined whether CU variants could be identified utilizing latent profile analysis including CU trait clusters (i.e., callousness, uncaring, unemotional), anxiety, and child maltreatment subtypes. We identified unique symptom profiles by male-identified and female-identified gender. CU variant groups were differentiated based on the severity of child maltreatment experiences and anxiety symptoms. The manifestation of CU symptoms differed by variant group and by gender. Additionally, PTSS was highest in secondary CU variant groups. The findings support the conceptualization of the secondary CU variant group as a trauma-based reaction and suggest potential differences in symptom profiles by gender.

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students.

Le rôle de l’optimisme et de l’anxiété dans la peur de l’accouchement : une étude exploratoire