New research published Comprehensive Psychoneuroendocrinology It offers insight into the moral decision-making process of psychopaths. Researchers have found that impulsive clinical psychopaths tend to make deontological choices in emotionally charged situations and avoid direct harm even at the expense of optimal outcomes.
Psychopathy is a complex personality disorder characterized by a range of emotional, interpersonal and behavioral deficits. People with this condition often show a severe lack of empathy, disregard for the rights and feelings of others, and a tendency to be manipulative and antisocial.
These traits make psychopathic individuals more likely to engage in criminal and other antisocial behavior. Although the prevalence of psychopathy in the general population is relatively low, in forensic and clinical settings, its impact is disproportionately high, especially among violent offenders and those with repeated criminal offenses.
The motivation for this study arose from the need to better understand the moral decision-making process of psychopaths. Given the high recidivism rates of psychopaths and the large social costs associated with their behavior, the researchers aimed to explore how psychopaths make moral choices in situations where they must weigh the benefits to society as a whole against harm to others.
“As I work in a forensic observation clinic in the Netherlands, where I perform psychiatric evaluations of criminal suspects, one of my main interests is psychopathy, a personality disorder that is said to be associated with impaired processing of moral issues,” said study author Ronald JP Lijnders, a Dutch forensic psychiatrist. Netherlands Institute of Forensic Psychiatry and Psychology.
The study involved two groups of male participants: 24 psychiatric patients recruited from a maximum-security forensic psychiatric hospital in the Netherlands and a non-psychopathic control group of 28 security and nursing staff from the same hospital. Psychopathy in the patients was ascertained using the Psychopathy Checklist-Revised (PCL-R) with a cut-off score of ≥26, while the control group was screened using the Psychopathic Personality Trait Inventory-Revised (PPI-R).
“What is unique about this study is that we investigated a group of clinically identified, PCL-R confirmed forensic psychiatric patients who were not receiving pharmacological treatment with selective serotonin reuptake inhibitors, selective noradrenaline reuptake inhibitors, antipsychotics or hormonal libido suppressants,” Reinders noted.
Participants were presented with a series of moral dilemmas designed to elicit either utilitarian (consequences-based) or deontological (harm-avoidance) responses. Each dilemma was displayed on a computer screen and read aloud over headphones, and participants were asked to indicate the moral permissibility of the proposed action through forced-choice questions that could be answered with “yes” or “no” (“Would you…?”).
“We have adopted an essentially utilitarian or deontological moral choice,” Reinders told PsyPost. “Utilitarians respond rationally to maximize overall happiness, that is, to promote everyone’s greater good, even if it means breaking prevailing societal rules. Deontologists, on the other hand, have an automatic emotional aversion to harming others, since the very nature of the final action determines whether it is right or wrong.”
“Moral dilemmas are classified as personal or non-personal. In personal actions, harm is caused by direct physical contact, whereas in non-personal actions, harm is brought about in an indirect, non-physical way. The utilitarian action in personal dilemmas is associated with stronger emotional value. Personal dilemmas are further divided into unavoidable and avoidable dilemmas. Inevitable harm presupposes that the person involved will ultimately be harmed regardless of whether or not and what action is taken, whereas avoidable harm does not apply if the action is abandoned.”
The researchers found that psychopathic patients who were high in impulsivity were more likely to make deontological choices in emotionally charged situations. Specifically, these patients were more likely to avoid causing harm when it involved direct physical action, even if it was not in the best interest of the overall population. This finding was particularly pronounced in personally avoidable dilemmas, where harm could be avoided by choosing not to act.
In controls, psychopathy traits such as lack of empathy and not considering consequences were associated with a greater likelihood of making utilitarian decisions, but only in scenarios where the emotional stakes were low, suggesting that while psychopathy traits can predict utilitarian choices in the general population, this tendency is influenced by the emotional context of the decision.
In contrast to some previous studies, the researchers found no evidence that psychopathy patients generally made more utilitarian choices compared to non-psychopathy controls. Rather, the severity of patients’ psychopathy was associated with more deontological choices, especially in scenarios where emotional investment was high and harm was likely to be avoided.
“We hypothesized that psychiatric patients admitted to forensic psychiatric hospitals would be more likely to make utilitarian choices than control groups,” says Reinders. “Our study found that this was not the case, as no significant differences were found between the two groups.”
“However, we found an interesting finding regarding the severity of psychopathy as measured by the Psychopathy Checklist-Revised (for patients) and the Psychopathic Personality Traits Inventory-Revised (for normal controls). Our hypothesis was that in both groups, the proportion of utilitarian choices would be positively correlated with the severity of psychopathy. This was indeed true for normal controls, but not for psychopathy patients.”
“Highly impulsive psychopathic patients were more likely to choose to avoid harm in personal, unavoidable dilemmas. We believe that the combination of lack of self-interest, strong impulsivity, and an emotional decision to harm others and have to carry it out with direct physical force may tilt responses toward deontological choices. Choosing to emotionally exploit avoidable harm may quickly be seen as ‘too much’ and impulsively rejected.”
The psychopathic patients underwent two testing sessions: in the first, they self-administered a nasal spray containing 24 IU of synthetic oxytocin, and in the second, they received a placebo nasal spray. (The normal control group did not receive the nasal spray and were tested in only one session.) The interval between the two testing sessions for the psychopathic patients was approximately 12 days, with the start time kept constant to control for the effects of circadian rhythms.
“We investigated the effects of a single intranasal dose of the neuropeptide oxytocin in a group of psychopathic patients,” Reinders told Cipost. “Contrary to our expectations, we found no effect of oxytocin on moral decision-making.”
This study sheds light on how psychopathic traits and impulsivity interact subtly with the emotional context of moral decision-making. However, as with any research, there are caveats: the study’s sample size was relatively small, and findings may not be generalizable to all psychopaths or to different cultural contexts.
Another limitation is that we relied on a single dose of oxytocin, which may be insufficient to induce significant behavioral changes. Future studies could explore the effects of repeated administrations of oxytocin over a longer period of time to assess more substantial and lasting effects on moral decision-making.
“We will continue our research into moral choice in other forensic populations,” Reinders said, “perhaps with a plan to administer multiple doses of oxytocin via the nose over a period of several weeks.”
the study, “Would you? The effects of oxytocin on moral choices in forensic psychiatric patients” is written by Ronald JP Lijnders, Sophie van den Hogen, Jacques van Honk, David Terberg and Maaike M. Kempes.
