Primary and Secondary Variants of Psychopathy in a Volunteer Sample Are Associated With Different Neurocognitive Mechanisms

Abstract

Background: Recent work has indicated that there at least two distinct subtypes of psychopathy. Primary psychopathy is characterized by low anxiety and thought to result from a genetic predisposition, whereas secondary psychopathy is characterized by high anxiety and thought to develop in response to environmental adversity. Primary psychopathy is robustly associated with reduced neural activation to others' emotions and, in particular, distress. However, it has been proposed that the secondary presentation has different neurocognitive correlates.

Methods: Primary (n = 50), secondary (n = 100), and comparison (n = 82) groups were drawn from a large volunteer sample (N = 1444) using a quartile-split approach across psychopathic trait (affective-interpersonal) and anxiety measures. Participants performed a widely utilized emotional face processing task during functional magnetic resonance imaging.

Results: The primary group showed reduced amygdala and insula activity in response to fear. The secondary group did not differ from the comparison group in these regions. Instead, the secondary group showed reduced activity compared with the comparison group in other areas, including the superior temporal sulcus/inferior parietal lobe, thalamus, pallidum, and substantia nigra. Both psychopathy groups also showed reduced activity in response to fear in the anterior cingulate cortex. During anger processing, the secondary group exhibited reduced activity in the anterior cingulate cortex compared with the primary group.

Conclusions: Distinct neural correlates of fear processing characterize individuals with primary and secondary psychopathy. The reduced neural response to fear that characterizes individuals with the primary variant of psychopathic traits is not observed in individuals with the secondary presentation. The neurocognitive mechanisms underpinning secondary psychopathy warrant further systematic investigation.

Keywords: Amygdala; Anxiety; Fear; Maltreatment; Psychopathy; fMRI.

Figure 1

a) Reduced activity in the amygdala (far left), insula (middle left), ACC and PCC (middle right), and dorsolateral prefrontal cortex (far right) in the Primary group compared to the Comparison group during fear processing; b) Trendwise reduced activity in the amygdala (left) and insula (right) in the Primary compared to Secondary group during fear processing; c) Reduced activity in the superior temporal sulcus/inferior parietal lobe (far left), ACC and PCC (middle left), thalamus and globus pallidus (middle right), and susbtantia nigra (far right) in Secondary group compared to the Comparison group during fear processing.