Morality and Antisocial Personality Disorder

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Ted Bundy, is an American serial killer who preyed on numerous
women using superficial charm to win them over and later kill them

A defining characteristic of an individual with antisocial personality disorder (ASPD) is the prevalent disregard for and violation of other people's civil rights[1]. These individuals exhibit psychopathic traits, such as callousness and lack of empathy, and are prone to committing crimes. Psychopaths (this wiki will use this term interchangeably with ASPD) have the tendency to commit acts of moral transgression despite being aware of their wrongdoing. Thus, in order to get a better understanding of ASPD, it is crucial to study the psychological and neural basis of morality. The work by Jean Piaget, later expanded by Lawrence Kohlberg, have been the most influential in the psychology of moral development[2][3]. In addition, neurobiological studies have shown that several brain structures implicated with morality. The most studied regions of the brain include the ventromedial prefrontal cortex, temporal lobe, cingulate cortex, and amygdala[4]. Studies in genetics also show that some psychopathic traits, such as aggression, can be inherited, implicating that there might be a predisposition for morality[4].

Theories of Moral Development

Piaget's Theory of Moral Development

Heinz's Dilemma
Kohlberg presented people in various age group with similar moral dilemmas and recorded
their responses to determine how individuals justify their choices and their reasoning

Piaget believed that moral development was intimately associated with one's cognitive development, which he claimed was structured into distinct stages that are innate, invariant, hierarchical, and culturally universal[3]. He argued that the progression from one stage to the next occurred through new experiences that are integrated into existing schema through assimilation and accommodation[2],[5]. Likewise, Piaget stated that moral development exists in two distinct stages in children. The first stage is referred to as the heteronomous morality, where the child bases his moral judgement based on his unilateral respect for authority [2],[3],[6]. The second stage is referred to as the autonomous morality. The child at this stage makes moral decisions beyond what was previously constraint by authority figure. The cognitive transition from equal judgement for all individuals at all situation to judgement of individuals with consideration to the situation marks the transition from the objective, heteronomous morality to the subjective autonomous morality[2],[3],[5].

Kohlberg's Theory of Moral Development

Utilizing Piaget's general theory of cognitive development as the foundation, Kohlberg developed his theory of moral judgement. Kohlberg limited his theory around the development of justice reasoning[2],[3].[5] over lifetime. His theories were based on observations of responses and evaluation that the volunteers provided for each moral dilemma2. Kohlberg proposed 3 levels of morality and 2 stages in each of the levels (for a total of 6 stages)[2],[3],[5]. Much like Piaget's stages of cognitive development, Kohlberg's stages of moral development are thought to be sequential and universal. His stages of moral development are:

Preconvential Level

  • Stage 1: Obedience and punishment orientation - Child obeys authority to avoid being punished.
  • Stage 2: Naive hedonistic orientation - Child conforms to gain rewards.

Conventional Level

  • Stage 3: Good boy orientation - Individual obeys in order to avoid disapproval.
  • Stage 4: Authority and social order orientation - One performs his own duty with respect to authority and maintains social order. These individuals follow the view point of majority to maintain that social order.

Postconventional/Autonomous Level

  • Stage 5: Social contractual orientation - One performs duties according to contract and avoid violating the will or the rights of others. It is expected that one works to promote equality of all people and to protect the minority
  • Stage 6: Conscience or principal orientation - This type of orientation have logical comphrensiveness, universality, and consistency. These individuals understand that every individuals are equal autonomous persons and the principles that guide them can be used at all time at any given situation.

Kohlberg theorized that where a person is on these six levels of morality was dependent on four factors. He believed that both genetic and environment played a role and it was the interaction between the these four factors that determined how far a person has matured. The first factor was the level of logical reasoning (cognition) as identified in Piaget's stages of cognitive development. The second factor was the individual's desire or motivation. The third factor was the opportunity to learn social roles. By learning these social roles, the individual is able to change perspective and imagine situations from other people's point of view. The last factor was the form of justice that the individual is familiar with[2]. For example, an individual who lives in a dictatorial country will not be able to voice his/her mind and is forced to live life controlled by authority. Such individual will not be able to surpass stage 4 of moral development.

False Belief Understanding
As child grows up and his ToM develops, the child is able to understand
that others may hold beliefs that are different from their own

Theory of Mind

As noted by both Piaget and Kohlberg, the maturation of morality requires one to transition from an egocentric point of view to being able to recognize and understand situations from others' perspective. The ability to recognize, understand, and appreciate the thoughts of others is referred to as the theory of mind (ToM)[7],[8],[9]. Around 3 years old, children are able understand that two people may have different desires and beliefs. At the age of 4, the children are capable of knowing that others may hold false beliefs[7]. Research has shown that a child's ToM is correlated with understanding of the psychological need of others[7]. This does not, however, mean that ToM alone is the sole factor for child's moral development. Many researches support that children with conduct disorder and high levels of psychopathic traits have a functional ToM[9] but lack emotion understanding (i.e. they have working cognitive empathy but an impaired emotional empathy[10]). It is only when an individual has developed both ToM and emotion understanding that one has societal oriented moral reasoning[7].

Neural Structures Associated with Morality

Ventromedial Prefrontal Cortex/ Orbitofrontal Cortex

The prefrontal cortex, necessary for higher level cognitive reasoning, has been a studied for its role in moral judgement. In particular, ventromedial prefrontal cortex (vmPFC) has been the most widely researched area in the study of antisocial and psychopathic individuals. It is has been shown that vmPFC plays an important role in encoding for emotional experiences and is recruited during moral decision making[4],[11] and is used for adhering to social and cultural norms[4],[12]. Neuroimaging shows that psychopaths, when compared to a normal, non-psychopathic individuals, showed decreased activation in vmPFC during moral decision making tasks[13].

Studies from individuals with vmPFC lesion showed no impairments in many aspects of non-emotional reasoning. They did, however, showed impairments in moral emotions task14. For instance, when given a moral reasoning task to an individual with lesion in the vmPFC, the individual will respond with an utilitarian response[4],[11]. Koenigs (2007) also found that psychopaths mirrors these vmPFC damaged individuals, endorsing personal harm done to others in order to maximize welfare[15]. Interestingly, when these damages to the vmPFC occur during early developmental stages, the individual will make more self-serving decisions that often violate moral rules[17]. Compared to individuals with adult onset injury, these early developmental onset individuals will make greater self-serving moral decision with almost complete disregard for the wellbeing of others[17]. Taber-Thomas (2014) suggests that vmPFC damage reduces aversion to being selfish[17], causing one to be stuck in an hedonistic, egocentric morality.

fMRI comparison of vmPFC between Non-Psychopaths vs Psychopaths
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In non-psychopaths, the vmPFC show increase in activation to moral pictures
compared to non-moral and neutral images. In psychopaths the difference is in activation is negligible,
which correlates with their inability to distinguish between moral and conventional transgressions (Fumagali, 2012)[3]

Tempolar Lobe

Areas of the temporal lobe have been studied for their role in interpreting the intentions of others. Superior Temporal Sulcus (STS) has been implicated with recognizing social stimuli like facial expressions, hand gestures, and eye gazes[18]. In healthy individuals, the superior temporal sulcus shows increase in activity during personal moral dilemma tasks[4],[19]. Along with the medial frontal cortex, STS shows strong association with emotions and social cognition[19],[20]. Especially the posterior STS (pSTS) is an important mirror circuit site that recognizes emotional contents of a behavior[18]. The right temporalparietal junction (rTPJ) is an important attention centre and plays an important role in understanding the mental states of others[21]. Study by Yoder and Decety (2014) showed increase in rTPJ response when evaluating the intentions of others' actions, especially when evaluating the harmful intentions of others[21].

Cingulate Cortex

The anterior cingulate cortex (ACC) is responsible for resolving the conflict between emotional and rational processing of moral dilemma[4],[19],[20]. During complex moral dilemma, the ACC shows increased activity and reaction time, especially in response to internal conflict that causes negative affect like guilt. The supragenual anterior cingulate cortex (supraACC) has been shown to inhibit/interrupt actions that cause individual to feel guilt about their action[22]. Guilt is a self-evaluative emotion that occurs when one feels that they have transgressed their personal moral values. The posterior cingulate cortex (PCC) is known to be active during self-reflection and making judgement about self[21]. This interplay of self reflection and behavior control acts as a self-regulatory system that inhibits one from committing moral transgression[22]. In psychopaths, the decrease in activity of the cingulate cortex, vmPFC, and the amygdala pathway during exposure to emotionally unpleasant stimuli compared to nonpsychopaths reflect their dysfunction in moral decision making[13],[20].


A defining characteristic of a psychopath is the deficiency in their emotional response to an emotional stimuli. Amygdala plays an important role in threat detection by recognizing emotionally salient cues[23]. Decrease in amygdala activity during exposure to moral violations and fearful faces is often observed in individuals with callous-unemotional traits[24]. The amygdala also plays an important role in stimulus-reinforcement learning and feeds forward to the temporal cortex and the vmPFC. The decrease in amygdala activity effectively decreases the need to pay attention to the distress (rTPJ), causing a dysfunction in emotional processing (vmPFC)[25]. This decrease in their ability to pick up on the distress of others may contribute to their inability to distinguish between moral and conventional transgression. Children with conduct problems and callous-unemotional traits also exhibit similar brain pattern to emotional stimuli. This evidence seem to implicate that abnormalities in amygdala develop at early stages in life and may contribute to development into a psychopath as an adult26. When tested with angry faces, however, psychopaths show increase in amygdala activity that mirrors impulsively aggressive individuals[26],[27]. This suggests that the amygdala may be selectively more responsive to threat and aggression in psychopaths.


Geneticists have shown through twin, family, and adoption studies that genetic factors has a significantly high contribution to antisocial personality disorder and externalizing behavior4. Researches show that traits such as fearlessness, stress immunity, impulsivity, and aggression are inheritable traits with significant variance due to genetics[28].

Monoamine Oxidase A

A lot is known about impulsive (reactive) aggression due its easily observable nature and high genetic contribution. Monoamine oxidase A (MAOA) has been a field of interest for geneticists studying aggressive antisocial behavior for being known as the "violence gene[29]." MAOA gene encodes for monoamine oxidase A enzyme which are localized in the presynaptic terminal of monoamine neuron and astrocytes to regulate the amount of dopamine, serotonin, and norepinephrine available[29],[30]. Clinical research has shown that individuals with polymorphism in the MAOA allele that causes low expression (MAOA-L) have predisposition for aggression[30].

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