Callous and unemotional traits
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Callous-unemotional traits (CU) are distinguished by a persistent pattern of behavior that reflects a disregard for others, and also a lack of empathy and generally deficient affect. The interplay between genetic and environmental risk factors may play a role in the expression of these traits as a conduct disorder (CD). While originally conceived as a means of measuring the affective features of psychopathy in children, measures of CU have been validated in university samples and adults.[1][2][3]
A CU specifier has been included as a feature of conduct disorder in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the International Classification of Diseases (ICD-11).[4]
Symptoms
Core features
CU traits, as measured by the Inventory of Callous-Unemotional Traits (ICU), are in three categories: callous (reflecting ruthlessness and cruel treatment or disregard for others), uncaring (passive disregard for others and lack of prosocial emotion), and unemotional (limited experience and expression of emotion).[5] Unemotional traits are uniquely elevated in cases reflecting "primary psychopathy".[3]
DSM-5's "limited prosocial emotions" specifier and attendant interview measure, the Clinical Assessment of Prosocial Emotions (CAPE), lists the following characteristics:
- Lack of remorse or guilt
- Shallow or deficient affect (unemotionality)
- Callous–lack of empathy
- Unconcerned with performance (at work or school)
- Lack of reaction to what would be a traumatic event
Associated features
Children with CU traits have distinct problems in emotional and behavioral regulation that distinguish them from other antisocial youth[6] and show more similarity to characteristics found in adult psychopathy.[7] Antisocial youth with CU traits tend to have a range of distinctive cognitive characteristics.[8] They are often less sensitive to punishment cues, particularly when they are already keen for a reward.[9] CU traits are positively related to good intellectual verbal skills.[10]
Classification
A CU specifier for conduct disorder was added to DSM-5.[4] The addition "with limited prosocial emotions" to the conduct disorder diagnosis in DSM-5 is to classify a specific subgroup of antisocial youth with distinguishing antisocial behaviors and psychopathic traits.[6] The provision of the CU specifier for CD youth is claimed to improve the diagnostic power, treatment options, and increase the understanding life-course outcomes.[6] A 2008 review concluded that CU did not have the required evidence base to be included as a new diagnosis in DSM-5.[11]
Causes and pathophysiology
Neural mechanisms
The fearlessness theory of CU traits suggests that low amounts of cortisol lead to underarousal, causing impairments in fear processing, a trait seen in CU individuals.[12] Hypoactivity in the hypothalamic-pituitary-adrenal axis in combination with CU traits seem to cause antisocial behavior even without external hardships.[12]
Genetic
A study on a large group of children found more than 60% heritability for callous-unemotional traits and that conduct problems among children with these traits had a higher heritability than among children without these traits.[13][14] The study also found slight sex differences (boys 64%, girls 49%) in the affective-interpersonal factor.[14] Similarly, the impulsive–antisocial factor was primarily influenced by genetic factors (boys 46%; girls 58%)[14]
Maltreatment and parenting play a role in the development of antisocial behavior, and studies have been shown to prove this. While callous unemotional traits are rooted in genetics, environmental triggers are an important contributing factor for the development of antisocial behaviour in children with the genetic propensity.[15]
Criticism
Diagnosis
Research has attempted to subtype youth with callous-unemotional traits by distinguishing between those with childhood-onset versus adolescent-onset conduct disorder, conduct disorder co-morbid with attention deficit hyperactivity disorder (ADHD), or by the severity and type of aggression displayed.[7] Children with CU traits have more severe conduct disorder, and respond to different management.[4] The Inventory of Callous-Unemotional Traits (ICU) assesses three independent factors in CU traits: uncaring, callous, and unemotional.[19] The severity of CD has been studied in children rated high on CU traits.[9]
Management
CU traits are relatively stable, though some studies suggest that they may decrease over time through effective treatment.[6] Early intervention is thought to be more effective because CU traits are thought to be more malleable early in life.[20]
Parenting techniques
Parenting interventions are the most commonly used treatment for treating early onset antisocial behaviors and
Prognosis
Childhood-onset CU shows a more aggressive and stable pattern of antisocial behavior with higher rates of CU traits, as well as more severe temperamental and
A systematic review found that CU traits were associated with poorer outcomes in family-based interventions for conduct problems. This suggests pre-treatment data on CU traits is clinically informative in terms of the prognostic status of children and young people with CU traits.[28]
History
Due to the potential severity of antisocial and violent traits seen in adult psychopathy, research has focused on identifying the associated traits in childhood. In adult psychopathy, individuals with primarily
Following the publication of DSM-III, these distinctions prompted research, but there were still issues with the terminology in diagnosing the core features of the undersocialized versus socialized subtype. The word undersocialized was used in order to avoid the negative connotations of psychopathy, but was commonly misinterpreted to mean that the child was not well socialized by parents or lacked a peer group. Also, the operational definition failed to include dimensions that could reliably predict the affective and interpersonal deficits in psychopathic-like youths. Due to these issues, the American Psychiatric Association removed the undersocialized and socialized distinctions from the conduct disorder description in the DSM after the third edition. The only subtypes that have been included in the manual since then relate to the time of onset: childhood-onset (before age 10), adolescent-onset (absence of antisocial traits before age 10), and unspecified-onset.[23]
See also
References
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- ^ a b c "Highlights of Changes from DSM-IV-TR to DSM-5" (PDF). DSM5.org. American Psychiatric Association. 2013. Archived from the original (PDF) on October 19, 2013. Retrieved October 23, 2013.
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- ^ Setionago, Bianca (2023-09-20). "Study of incarcerated teens identifies two factors that explain the link between childhood maltreatment and callous-unemotional traits". PsyPost. Retrieved 2023-10-01.
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- ^ Watanabe S, Hofman MA, Shimizu T, eds. (September 2017). Evolution of the Brain, Cognition, and Emotion in Vertebrates. Japan: Springer.
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Further reading
- Herpers PC, Rommelse NN, Bons DM, Buitelaar JK, Scheepers FE (December 2012). "Callous-unemotional traits as a cross-disorders construct". Social Psychiatry and Psychiatric Epidemiology. 47 (12): 2045–64. PMID 22570257.
- Viding E, McCrory EJ (August 2012). "Genetic and neurocognitive contributions to the development of psychopathy" (PDF). Development and Psychopathology. 24 (3): 969–83. S2CID 16818664.
- Waller R, Gardner F, Hyde LW (June 2013). "What are the associations between parenting, callous-unemotional traits, and antisocial behavior in youth? A systematic review of evidence". Clinical Psychology Review. 33 (4): 593–608. PMID 23583974.