The relationship between alexithymia, empathy and moral judgment in patients with multiple sclerosis

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.