Psychopathic behavior is characteristically amoral, but to date research studies have largely failed to identify any systematic differences in moral judgment capability between psychopaths and non-psychopaths. In this study, we investigate whether significant differences in moral judgment emerge when taking into account the phenotypic heterogeneity of the disorder through a well-validated distinction between psychopathic subtypes. Three groups of incarcerated participants [low-anxious psychopaths (n = 12), high-anxious psychopaths (n = 12) and non-psychopaths (n = 24)] completed a moral judgment test involving hypothetical dilemmas. The moral dilemmas featured 'personal' (i.e. involving direct physical harm) or 'impersonal' (i.e. involving indirect or remote harm) actions. Compared to non-psychopaths, both groups of psychopaths were significantly more likely to endorse the impersonal actions. However, only the low-anxious psychopaths were significantly more likely to endorse the personal harms when commission of the harm would maximize aggregate welfare-the 'utilitarian' choice. High-anxious psychopaths and non-psychopaths did not significantly differ in their personal moral judgments. These results provide novel laboratory evidence of abnormal moral judgment in psychopaths, as well as additional support for the importance of considering psychopathic subtypes.

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: "primary" (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas "secondary" (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups.

Psychopaths are notorious for their antisocial and immoral behavior, yet experimental studies have typically failed to identify deficits in their capacities for explicit moral judgment. We tested 20 criminal psychopaths and 25 criminal nonpsychopaths on a moral judgment task featuring hypothetical scenarios that systematically varied an actor’s intention and the action’s outcome. Participants were instructed to evaluate four classes of actions: accidental harms, attempted harms, intentional harms, and neutral acts. Psychopaths showed a selective difference, compared with nonpsychopaths, in judging accidents, where one person harmed another unintentionally. Specifically, psychopaths judged these actions to be more morally permissible. We suggest that this pattern reflects psychopaths’ failure to appreciate the emotional aspect of the victim’s experience of harm. These findings provide direct evidence of abnormal moral judgment in psychopathy.

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