Callous-unemotional traits and brain structure: Sex-specific effects in anterior insula of typically-developing youths

Research output: Contribution to journalArticlepeer-review


  • Nora Maria Raschle
  • Willeke Martine Menks
  • Lynn Valérie Fehlbaum
  • Martin Steppan
  • Areti Smaragdi
  • Karen Gonzalez-Madruga
  • Roberta Clanton
  • Gregor Kohls
  • Anne Martinelli
  • Anka Bernhard
  • Kerstin Konrad
  • Beate Herpertz-Dahlmann
  • Christine M. Freitag
  • Graeme Fairchild
  • Christina Stadler

External organisations

  • Psychiatric University Hospital
  • University of Southampton
  • University Hospital Aachen
  • Goethe University
  • RWTH Aachen University
  • Department of Child and Adolescent Psychiatry
  • Psychosomatics and Psychotherapy
  • University of Bath


Callous-unemotional traits are characterized by a lack of empathy, a disregard for others' feelings and shallow or deficient affect, such as a lack of remorse or guilt. Neuroanatomical correlates of callous-unemotional traits have been demonstrated in clinical samples (i.e., adolescents with disruptive behavior disorders). However, it is unknown whether callous-unemotional traits are associated with neuroanatomical correlates within normative populations without clinical levels of aggression or antisocial behavior. Here we investigated the relationship between callous-unemotional traits and gray matter volume using voxel-based morphometry in a large sample of typically-developing boys and girls (N = 189). Whole-brain multiple regression analyses controlling for site, total intracranial volume, and age were conducted in the whole sample and in boys and girls individually. Results revealed that sex and callous-unemotional traits interacted to predict gray matter volume when considering the whole sample. This interaction was driven by a significant positive correlation between callous-unemotional traits and bilateral anterior insula volume in boys, but not girls. Insula gray matter volume explained 19% of the variance in callous-unemotional traits for boys. Our results demonstrate that callous-unemotional traits are related to variations in brain structure beyond psychiatric samples. This association was observed for boys only, underlining the importance of considering sex as a factor in future research designs. Future longitudinal studies should determine whether these findings hold over childhood and adolescence, and whether the neuroanatomical correlates of callous-unemotional traits are predictive of future psychiatric vulnerability. General scientific summary This study suggests that callous-unemotional traits have a neuroanatomical correlate within typically developing boys, but not girls. Bilateral anterior insula volume explains up to 19% of the variance in callous-unemotional traits in boys.


Original languageEnglish
Pages (from-to)856-864
Number of pages9
JournalNeuroImage: Clinical
Early online date9 Dec 2017
Publication statusPublished - 2018


  • Callous-unemotional traits, Insula, Pediatric neuroimaging, Sex differences, Voxel-based morphometry