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

Introduction Recent work has indicated that there at least two distinct subtypes of psychopathy. Whilst ‘primary' psychopathy is characterized by low anxiety and thought to result from a genetic predisposition, ‘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 fMRI. Results The Primary group showed reduced amygdala and insula activity to fear. The Secondary group did not differ from Comparisons in these regions. Instead, they showed reduced activity compared to Comparisons in several areas including the superior temporal sulcus/inferior parietal lobe, thalamus, pallidum, and substantia nigra. Both groups with psychopathic features also showed reduced activity in response to fear in the anterior cingulate cortex (ACC). During anger processing, the Secondary group exhibited reduced activity in the ACC in comparison with the Primary group. Conclusions Distinct neural correlates of fear processing characterize individuals with primary and secondary psychopathic features. The reduced neural response to fear that characterizes individuals with the primary variant of psychopathic traits is not observed in those with the secondary presentation. The neurocognitive mechanisms underpinning secondary psychopathy warrant further, systematic investigation.