New research published in Integral psychoneuroendocrinology This study provides insight into moral decision-making processes in psychopathic individuals. The researchers found that clinical psychopaths with high impulsivity tend to make ethical choices in highly emotional situations, thereby avoiding 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. Individuals with this disorder often exhibit a profound lack of empathy, a disregard for the rights and feelings of others, and a tendency toward manipulative and antisocial behaviors.
These traits make psychopathic individuals more likely to engage in criminal activity and other forms of antisocial behavior. The prevalence of psychopathy in the general population is relatively low, but its impact is disproportionately high in forensic and clinical settings, particularly among violent offenders and those with recidivist criminal behavior.
The study was motivated by the need to better understand the moral decision-making processes of psychopathic individuals. Given their high rates of criminal recidivism and the significant societal costs associated with their behaviors, the researchers wanted to explore how these individuals make moral choices in situations that require balancing the common good against causing harm to others.
“As I work in a Dutch forensic observation clinic for the mental assessment of suspected offenders, one of my main interests is psychopathy. This personality disorder is thought to be related to a disturbed processing of moral issues,” said study author Ronald JP Rijnders, a forensic psychiatrist at the Netherlands Institute of Forensic Psychiatry and Psychology.
The study involved two groups of male participants: 24 psychopathic patients recruited from maximum-security forensic psychiatric hospitals in the Netherlands and 28 non-psychopathic controls, consisting of security guards and nursing staff from the same hospitals. The patients’ psychopathy was confirmed using the Psychopathy Checklist-Revised (PCL-R), with a cut-off score of 26 or higher, while the controls were screened using the Psychopathic Personality Inventory-Revised (PPI-R).
“A unique point of this study is that we investigated a group of clinically identified and PCL-R-confirmed forensic psychopathic patients who were not treated with medications such as selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, antipsychotics or libido-stimulating hormone inhibitors,” Rijnders noted.
Participants were presented with a series of moral dilemmas designed to elicit either utilitarian (outcome-oriented) or deontological (harm-averse) responses. Each dilemma was displayed on a computer screen and read aloud through headphones, with participants required to indicate the moral permissibility of the proposed action via a forced-choice question (“Would you…?”) that could be answered with “yes” or “no.”
“We made moral choices that were either utilitarian or deontological in nature,” Rijnders told PsyPost. “Utilitarians have rational responses to maximize total welfare, that is, to promote the common good of all, even if it means breaking common social rules. Deontologists, on the other hand, have an automatic emotional aversion to inflicting harm on others, because the nature of the ultimate action itself determines whether that action is considered good or bad.”
“Moral dilemmas are classified into personal or impersonal dilemmas. In personal acts, harm is caused by direct physical contact, while in impersonal acts, harm is inflicted indirectly and non-physically. Utilitarian actions in personal dilemmas are associated with a stronger emotional value. Personal dilemmas are further divided into unavoidable or avoidable dilemmas. Unavoidable harm assumes that, regardless of the action taken and the nature of the action, the person concerned will eventually suffer harm, while the latter is not the case for avoidable harm if the action is abandoned.”
Among psychopathic patients, the researchers found that those with higher levels of impulsivity were more likely to make ethical choices in emotionally charged situations. Specifically, these patients were more likely to avoid causing harm when doing so involved direct physical action, even if it meant achieving less optimal outcomes overall. This finding was particularly evident in avoidable personal dilemmas, where harm could be avoided by choosing not to act.
In the control group, psychopathic traits such as lack of empathy and failure to consider consequences were associated with a higher likelihood of making utilitarian decisions, but only in low-stakes emotional scenarios. This suggests that while psychopathic traits can predict utilitarian choices in the general population, this tendency is influenced by the emotional context of the decision.
Unlike some previous studies, the researchers found no evidence that psychopathic patients, in general, made more utilitarian choices than nonpsychopathic controls. Rather, the severity of psychopathy in patients was associated with more deontological choices, particularly in scenarios involving high emotional investment and where harm might be avoidable.
“We hypothesized that psychopathic patients admitted to a forensic psychiatric hospital would have a greater propensity to make utilitarian choices than a control group,” Rijnders said. “Our study showed that this was not the case, as there were no significant differences between the two groups.”
“However, we obtained an interesting finding regarding the severity of psychopathy as measured by the Psychopathy Checklist-Revised (for patients) and the Psychopathic Personality Inventory-Revised (for normal controls). Our hypothesis was that in both groups, the percentage of utilitarian choices was positively related to the severity of psychopathy. This was indeed the case for normal controls, but not for psychopathic patients.”
“Highly impulsive psychopathic patients were more likely to make choices that do not harm the other person in the avoidable personal dilemma. We believe that the combination of absent self-interest, high impulsivity, and an emotionally charged decision that is harmful to the other person and must be carried out by direct physical force may bias the response toward a deontological choice. The choice to use the avoidable, emotionally charged harm may be immediately deemed “too hot” and then impulsively rejected.”
Psychopathic patients underwent two testing sessions, one in which they administered a nasal spray containing 24 IU of synthetic oxytocin and the other in which they received a placebo nasal spray. (Normal controls did not receive the nasal spray and were tested in a single session.) The time interval between the two testing sessions for psychopathic patients was approximately 12 days, and start times were kept consistent to control for circadian effects.
“In the group of psychopathic patients, we studied the effect of a single nasal application of oxytocin, a neuropeptide,” Rijnders told PsyPost. “Contrary to our expectations, we found no effect of oxytocin on moral decision-making.”
The study highlights the different ways in which psychopathic traits and impulsivity interact with the emotional context of moral decisions. But as with any study, there are some caveats. The study sample was relatively small, and the results cannot be generalized to all psychopathic individuals or to different cultural contexts.
Another limitation is the reliance on a single administration of oxytocin, which may not be sufficient to induce significant behavioral changes. Future research could explore the effects of repeated oxytocin administration over longer periods to assess more substantial and lasting impacts on moral decision-making.
“We will continue our research on moral choice in other forensic populations,” Rijnders said. “Perhaps a model with multiple applications of nasal oxytocin over several weeks is possible.”
The study, “Would You Do It? Effects of Oxytocin on Moral Choices in Forensic Psychopathic Patients,” was authored by Ronald JP Rijnders, Sophie van den Hoogen, Jack van Honk, David Terburg, and Maaike M. Kempes.