Understanding heterogeneity in female psychopathy and callous-unemotional traits

Psychopathy and callous-unemotional (CU) traits, its putative developmental precursor, have proven important for designating individuals showing persistent, severe, and aggressive antisocial behavior. Empirical research supports multiple developmental pathways to psychopathy. The social and environmental adversity-based pathway to psychopathic/CU traits is termed secondary psychopathy, and is distinct from primary psychopathy that is thought to stem from biological or temperamental factors. Individuals captured by the secondary developmental pathway show a highly comorbid presentation (i.e., internalising, posttraumatic stress, borderline personality disorder symptoms) and externalising problems (e.g., conduct problems, reactive aggression); however, evidence is largely based on cross-sectional and predominantly male samples. The present research aimed to extend current understanding of psychopathy variants derived from this literature to girls and women, and uniquely contribute to the field by examining biomarkers associated with aggression and experiences of chronic stress central to theoretical accounts of secondary psychopathy. Study 1 aimed to determine whether valid, stable primary and secondary CU variants could be identified among girls, and whether they predicted poor adolescent mental and physical health outcomes using longitudinal data from the Pittsburgh Girls Study (N = 1,829). Separate trajectory analyses conducted from ages seven to 15 years using CU traits and anxiety scores indicated an optimal four class solution for CU traits (high, moderately-high, moderately-low, low) and three classes for anxiety (high, moderate, low). Classes of interest were combined to create CU variants and low CU control groups. Girls with secondary CU traits (high CU traits/high anxiety; n = 139) reported greater harsh parental punishment, depression, and less self-control at age seven, and at age 16 were distinguished by greater symptoms of depression, borderline personality and conduct disorder symptoms, compared to girls with primary CU traits (high CU traits/low anxiety; n = 59) and low CU girls (low CU traits/low-high anxiety; n = 326). Secondary CU girls also had the poorest physical health outcomes. This study makes an important contribution to the field by being the first to examine stable trajectories of CU traits, spanning eight years, with and without anxiety and associated poor mental and physical health among girls. Study 2 aimed to determine whether undergraduate women oversampled for high psychopathic traits (N = 101) and divided into primary and secondary psychopathy variants by median split on anxiety, show distinct neuroendocrine (i.e., cortisol, dehydroepiandrosterone [DHEA], testosterone) and psychophysiological (i.e., heart rate variability [HRV]) profiles to social provocation. Female secondary psychopathy variants (high psychopathic traits/high anxiety; n = 48) showed greater HRV and higher cortisol-to-DHEA ratios than primary variants (high psychopathic traits/low anxiety; n = 53). Hierarchical regression analyses indicated that the effect of testosterone on reactive aggression was moderated by low cortisol among primary psychopathy variants (dual-hormone hypothesis), whereas it moderated by high cortisol among secondary variants (reverse hypothesis). This study makes a novel contribution to the literature by being the first to examine stress-reactive psychophysiological and neuroendocrine indices among women with primary and secondary psychopathic traits. Across both studies, covering the developmental period from early childhood to adulthood, psychopathy/CU variant groups did not differ from one another on self-reported or laboratory measures of aggression. These findings suggest that girls and women with primary and secondary psychopathic traits are phenotypically indistinguishable, supporting theory, despite showing distinct and divergent patterns of psychopathology and psychophysiological and neuroendocrine biomarkers. Findings improve current understanding of female psychopathic/CU traits by supporting multiple developmental pathways, and extend the literature by identifying possible factors for targeted intervention among this understudied population