Moral reasoning in women with posttraumatic stress disorder related to childhood abuse

BACKGROUND: Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD) show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. OBJECTIVE: To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. METHOD: Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal), social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. RESULTS: Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. CONCLUSIONS: Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood. HIGHLIGHTS OF THE ARTICLE: Moral judgment processing was found to be altered in women with PTSD related to chronic childhood trauma. In comparison to healthy women, women with PTSD were less likely to approve utilitarian actions when required to assume their agency in dilemmas involving the infliction of direct physical harm. Decreased likelihood of utilitarian action approval by the PTSD sample was driven by significantly enhanced endorsement of guilt and shame as consequences of such actions. Endorsement of guilt and shame in moral dilemmas was related to increased severity of current clinical symptoms of guilt.