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However, the etiology of CU traits may be heterogeneous, undermining the search for effective treatments. The level of co\u2010occurring anxiety has been used to identify \u201cprimary\u201d (lower anxiety) versus \u201csecondary\u201d (higher anxiety) variants of CU traits. The primary variant has been hypothesized to emerge from strong genetic influence and secondary variants as an adaptation to adversity, such as exposure to childhood maltreatment. However, little research has tested this hypothesis directly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We examined whether anxiety moderates the etiology of CU traits to determine whether this phenotypic feature can help distinguish CU traits with stronger genetic or environmental risk. In two population\u2010based twin cohorts (initial sample:\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091,196, aged 6\u201311, oversampled for exposure to neighborhood disadvantage; follow\u2010up sample:\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200913,486, age 7), we used genotype\u2010by\u2010environment interaction twin modeling to examine if parent\u2010reported child anxiety moderated the etiology of concurrent parent\u2010reported child CU traits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Anxiety moderated the etiology of CU traits across both samples, such that nonshared environmental influences increased as anxiety increased. Additionally, in the larger sample, genetic influences decreased with increasing anxiety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings support theories suggesting that co\u2010occurring anxiety may distinguish CU traits with different origins: CU traits with higher anxiety appear more influenced by nonshared environmental factors\u2014potentially including adversity\u2014and may show weaker genetic influence. Assessing for co\u2010occurring child anxiety is likely important for diagnosing and personalizing treatments among children with CU traits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpp.70107","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:46:08Z","timestamp":1767602768000},"page":"988-997","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The nature and nurture of primary and secondary callous\u2013unemotional traits: evidence from two independent twin samples"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4349-0081","authenticated-orcid":false,"given":"Rachel C.","family":"Tomlinson","sequence":"first","affiliation":[{"name":"Department of Psychology University of Michigan  Ann Arbor MI USA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2425-5249","authenticated-orcid":false,"given":"Patrizia","family":"Pezzoli","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8468-8874","authenticated-orcid":false,"given":"Essi","family":"Viding","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9082-6185","authenticated-orcid":false,"given":"Stephane A.","family":"De Brito","sequence":"additional","affiliation":[{"name":"School of Psychology University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1790-9264","authenticated-orcid":false,"given":"Kelly L.","family":"Klump","sequence":"additional","affiliation":[{"name":"Department of Psychology Michigan State University  East Lansing MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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