The relationship between alexithymia, empathy and moral judgment in patients with multiple sclerosis
Corresponding Author
E. Gleichgerrcht
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
UDP-INECO Foundation Core on Neuroscience (UIFCoN) Diego Portales University, Santiago, Chile
Correspondence: Dr Ezequiel Gleichgerrcht, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite CSB 301, Charleston, SC, USA (tel.: +843 792 3222; fax: +843 792 8626; e-mail: [email protected]).Search for more papers by this authorB. Tomashitis
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
Search for more papers by this authorV. Sinay
Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
Favaloro University, Buenos Aires, Argentina
Search for more papers by this authorCorresponding Author
E. Gleichgerrcht
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
UDP-INECO Foundation Core on Neuroscience (UIFCoN) Diego Portales University, Santiago, Chile
Correspondence: Dr Ezequiel Gleichgerrcht, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite CSB 301, Charleston, SC, USA (tel.: +843 792 3222; fax: +843 792 8626; e-mail: [email protected]).Search for more papers by this authorB. Tomashitis
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
Search for more papers by this authorV. Sinay
Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
Favaloro University, Buenos Aires, Argentina
Search for more papers by this authorAbstract
Background and purpose
Converging research in patients with multiple sclerosis (MS) has shown increased rates of alexithymia and disturbances in social cognition, including empathy and theory of mind. Moral judgment is one of the most complex spheres of human cognition, relying on intricate neural circuits related to many other affective, social, cognitive and behavioral processes.
Methods
Relapsing−remitting MS patients (n = 38) and age-, gender- and education-matched controls (n = 38) completed a measure of alexithymia (Toronto Alexithymia Scale), a measure of empathy (Interpersonal Reactivity Index) and a series of moral dilemmas, for which measures of moral permissibility, emotional reactivity and moral relativity (the perception of how one's moral attitudes compare to the attitudes of the rest of the people) were derived.
Results
Relative to controls, patients exhibited decreased levels of other-oriented empathy [empathic concern (P < 0.01) and fantasy (P < 0.01)], increased levels of self-oriented personal distress (P < 0.01), as well as higher rates of alexithymia (P < 0.001). Moral permissibility was significantly reduced in patients with MS (P = 0.038), who also showed higher levels of emotional reactivity (P < 0.01). Additionally, a significantly higher number of patients than controls considered that respondents would deliver similar judgments to the same moral scenarios (P < 0.001).
Discussion
Understanding such complex interactions between individual dispositions and moral cognition has the potential to contribute to the development of better assessment and intervention strategies for MS patients, enhancing quality of life by achieving better social participation.
References
- 1Dahl O-P, Stordal E, Lydersen S, Midgard R. Anxiety and depression in multiple sclerosis. A comparative population-based study in Nord-Trøndelag County, Norway. Mult Scler 2009; 15: 1495–1501.
- 2Gay M-C, Vrignaud P, Garitte C, Meunier C. Predictors of depression in multiple sclerosis patients. Acta Neurol Scand 2010; 121: 161–170.
- 3Feinstein A, Feinstein K. Depression associated with multiple sclerosis. Looking beyond diagnosis to symptom expression. J Affect Disord 2001; 66: 193–198.
- 4Van Schependom J, D'hooghe MB, Cleynhens K, et al. Reduced information processing speed as primum movens for cognitive decline in MS. Mult Scler 2015; 21: 83–91.
- 5Cacioppo JT, Decety J. Social neuroscience: challenges and opportunities in the study of complex behavior. Ann N Y Acad Sci 2011; 1224: 162–173.
- 6Batson DC. These things called empathy: eight related but distinct phenomena. In: J Decety, WJ Ickes, eds. The Social Neuroscience of Empathy. Cambridge, MA: MIT Press, 2009.
- 7Decety J. Putting together phylogenetic and ontogenetic perspectives on empathy. Dev Cogn Neurosci 2012; 2: 1–24.
- 8Decety J. Dissecting the neural mechanisms mediating empathy. Emot Rev 2011; 3: 92–108.
- 9Banati M, Sandor J, Mike A, et al. Social cognition and theory of mind in patients with relapsing−remitting multiple sclerosis. Eur J Neurol 2010; 17: 426–433.
- 10Ouellet J, Scherzer PB, Rouleau I, et al. Assessment of social cognition in patients with multiple sclerosis. J Int Neuropsychol Soc 2010; 16: 287–296.
- 11Henry A, Tourbah A, Chaunu M-P, Rumbach L, Montreuil M, Bakchine S. Social cognition impairments in relapsing−remitting multiple sclerosis. J Int Neuropsychol Soc 2011; 17: 1122–1131.
- 12Pöttgen J, Dziobek I, Reh S, Heesen C, Gold SM. Impaired social cognition in multiple sclerosis. J Neurol Neurosurg Psychiatry 2013; 84: 523–528.
- 13Charvet L, Cleary R, Vazquez K, Belman A, Krupp L. Social cognition in pediatric-onset multiple sclerosis (MS). Mult Scler 2014; 20: 1478–1484.
- 14Roca M, Manes F, Gleichgerrcht E, et al. Cognitive but not affective theory of mind deficits in mild relapsing−remitting multiple sclerosis. Cogn Behav Neurol 2014; 27: 25–30.
- 15Sifneos PE. The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom 1973; 22: 255–262.
- 16Taylor GJ. Recent developments in alexithymia theory and research. Can J Psychiatry 2000; 45: 134–142.
- 17Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale – I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38: 23–32.
- 18Bodini B, Mandarelli G, Tomassini V, et al. Alexithymia in multiple sclerosis: relationship with fatigue and depression. Acta Neurol Scand 2008; 118: 18–23.
- 19Montel SR, Bungener C. Coping and quality of life in one hundred and thirty-five subjects with multiple sclerosis. Mult Scler 2007; 13: 393–401.
- 20Chahraoui K, Duchene C, Rollot F, Bonin B, Moreau T. Longitudinal study of alexithymia and multiple sclerosis. Brain Behav 2014; 4: 75–82.
- 21Ben Ari Shevil E, Johansson S, Ytterberg C, Bergström J, von Koch L. How are cognitive impairment, fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis? Disabil Rehabil 2014; 36: 2012–2018.
- 22Bird G, Cook R. Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism. Transl Psychiatry 2013; 3: e285.
- 23Prochnow D, Höing B, Kleiser R, et al. The neural correlates of affect reading: an fMRI study on faces and gestures. Behav Brain Res 2013; 237: 270–277.
- 24Prochnow D, Donell J, Schäfer R, et al. Alexithymia and impaired facial affect recognition in multiple sclerosis. J Neurol 2011; 258: 1683–1688.
- 25Bogdanov VB, Bogdanova OV, Gorlov DS, et al. Alexithymia and empathy predict changes in autonomic arousal during affective stimulation. Cogn Behav Neurol 2013; 26: 121–132.
- 26Moriguchi Y, Decety J, Ohnishi T, et al. Empathy and judging other's pain: an fMRI study of alexithymia. Cereb Cortex 2007; 17: 2223–2234.
- 27Kubota M, Miyata J, Sasamoto A, et al. Alexithymia and reduced white matter integrity in schizophrenia: a diffusion tensor imaging study on impaired emotional self-awareness. Schizophr Res 2012; 141: 137–143.
- 28Ihme K, Dannlowski U, Lichev V, et al. Alexithymia is related to differences in gray matter volume: a voxel-based morphometry study. Brain Res 2013; 1491: 60–67.
- 29Messina S, Patti F. Gray matters in multiple sclerosis: cognitive impairment and structural MRI. Mult Scler Int 2014; 2014: 609694.
- 30Charil A, Zijdenbos AP, Taylor J, et al. Statistical mapping analysis of lesion location and neurological disability in multiple sclerosis: application to 452 patient data sets. NeuroImage 2003; 19: 532–544.
- 31Pagani E, Rocca MA, Gallo A, et al. Regional brain atrophy evolves differently in patients with multiple sclerosis according to clinical phenotype. AJNR Am J Neuroradiol 2005; 26: 341–346.
- 32Sperling RA, Guttmann CRG, Hohol MJ, et al. Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis. Arch Neurol 2001; 58: 115–121.
- 33Bakshi R. Fatigue associated with multiple sclerosis: diagnosis, impact and management. Mult Scler 2003; 9: 219–227.
- 34Beatty WW. Memory and ‘frontal lobe’ dysfunction in multiple sclerosis. J Neurol Sci 1993; 115: S38–S41.
- 35Greene J, Sommerville RB, Nystrom LE, Darley JM, Cohen JD. An fMRI investigation of emotional engagement in moral judgment. Science 2001; 293: 2105.
- 36Greene J, Nystrom LE, Engell AD, Darley JM, Cohen JD. The neural bases of cognitive conflict and control in moral judgment. Neuron 2004; 44: 389–400.
- 37Greene J, Morelli SA, Lowenberg K, Nystrom LE, Cohen JD. Cognitive load selectively interferes with utilitarian moral judgment. Cognition 2008; 107: 1144–1154.
- 38Koenigs M, Young L, Adolphs R, et al. Damage to the prefrontal cortex increases utilitarian moral judgements. Nature 2007; 446: 908–911.
- 39Gleichgerrcht E, Torralva T, Rattazzi A, Marenco V, Roca M, Manes F. Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism. Soc Cogn Affect Neurosci 2013; 8: 780–788.
- 40Gleichgerrcht E, Torralva T, Roca M, Pose M, Manes F. The role of social cognition in moral judgment in frontotemporal dementia. Soc Neurosci 2011; 6: 113–122.
- 41Gleichgerrcht E, Young L. Low levels of empathic concern predict utilitarian moral judgment. PLoS One 2013; 8: e60418.
- 42Decety J, Michalska KJ, Kinzler KD. The contribution of emotion and cognition to moral sensitivity: a neurodevelopmental study. Cereb Cortex 2012; 22: 209–220.
- 43Al Aïn S, Carré A, Fantini-Hauwel C, Baudouin J-Y, Besche-Richard C. What is the emotional core of the multidimensional Machiavellian personality trait? Front Psychol 2013; 4: 454.
- 44Koven NS. Specificity of meta-emotion effects on moral decision-making. Emotion 2011; 11: 1255–1261.
- 45Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292–302.
- 46Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444–1452.
- 47Roxburgh RHSR, Seaman SR, Masterman T, et al. Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology 2005; 64: 1144–1151.
- 48Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 1983; 44: 113–126.
- 49Benedict RH, Priore RL, Miller C, Munschauer F, Jacobs L. Personality disorder in multiple sclerosis correlates with cognitive impairment. J Neuropsychiatry Clin Neurosci 2001; 13: 70–76.
- 50Kraemer M, Herold M, Uekermann J, et al. Theory of mind and empathy in patients at an early stage of relapsing remitting multiple sclerosis. Clin Neurol Neurosurg 2013; 115: 1016–1022.
- 51Lockwood PL, Bird G, Bridge M, Viding E. Dissecting empathy: high levels of psychopathic and autistic traits are characterized by difficulties in different social information processing domains. Front Hum Neurosci 2013; 7: 760.
- 52Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One 2013; 8: e61526.
- 53Bird G, Silani G, Brindley R, White S, Frith U, Singer T. Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain 2010; 133: 1515–1525.
- 54Valdesolo P, DeSteno D. Manipulations of emotional context shape moral judgment. Psychol Sci 2006; 17: 476–477.
- 55Mendez MF, Anderson E, Shapira JS. An investigation of moral judgement in frontotemporal dementia. Cogn Behav Neurol 2005; 18: 193–197.
- 56Kahane G, Shackel N. Do abnormal responses show utilitarian bias? Nature 2008; 452: E5.
- 57Lucchinetti C, Brück W, Parisi J, Scheithauer B, Rodriguez M, Lassmann H. Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 2000; 47: 707–717.
- 58Sethi V, Yousry TA, Muhlert N, et al. Lobar distribution of cortical grey matter lesions in multiple sclerosis clinical subgroups. J Neurol Neurosurg Psychiatry 2013; 84: e2.
- 59Phillips LH, Saldias A, McCarrey A, et al. Attentional lapses, emotional regulation and quality of life in multiple sclerosis. Br J Clin Psychol 2009; 48(Pt 1): 101–106.
- 60Tomasi D, Volkow ND. Gender differences in brain functional connectivity density. Hum Brain Mapp 2012; 33: 849–860.
- 61Lennon R, Eisenberg N. Gender and age differences in empathy and sympathy. In: N Eisenberg, J Strayer, eds. Empathy and its Development. Cambridge, UK: Cambridge University Press, 1987: 195–217.
- 62Comi G. Effects of disease modifying treatments on cognitive dysfunction in multiple sclerosis. Neurol Sci 2010; 31(Suppl 2): S261–S264.