How psychopathy connects alexithymia to decisions that sacrifice others

People who have difficulty identifying and expressing emotions are more likely to endorse causing harm if it benefits the greater good—especially if they also show traits linked to psychopathy. A new study published in Personality and Individual Differences sheds light on how emotional processing affects moral judgment by examining the interaction between alexithymia and psychopathy.

Alexithymia is a personality trait that affects around 10 percent of the population. It involves difficulties in recognizing and describing one’s emotions, as well as a tendency toward externally focused thinking. Researchers describe it in terms of two dimensions: the cognitive side, which affects how people identify and talk about emotions, and the affective side, which involves how people experience and feel them.

There are two competing theories about what drives this emotional difficulty. The hyper-arousal theory proposes that people with alexithymia are overwhelmed by intense emotional states they cannot regulate. In contrast, the hypo-arousal theory suggests they experience low levels of emotional activation in the first place, making it harder to feel and recognize emotions. Recent evidence, including this study, lends support to the hypo-arousal view.

Psychopathy, by contrast, is marked by a lack of empathy, superficial charm, manipulativeness, and impulsive behavior. Psychopathy exists on a continuum, and many people who score high on psychopathy traits do not meet the clinical threshold for a diagnosis. Researchers often distinguish between two subtypes: primary psychopathy, which involves callousness and low emotional responsiveness, and secondary psychopathy, which is associated with impulsivity, aggression, and emotional instability.

While previous research has shown that people with either alexithymia or psychopathic traits are more likely to make utilitarian moral decisions, little was known about how these traits might work together. Serra Şandor of İstanbul Medeniyet University aimed to investigate whether psychopathy acts as a link between alexithymia and moral decision-making.

Free daily newsletter

Drawing on dual-process theory, which suggests that moral judgments result from an interaction between fast emotional responses and slower, more deliberate reasoning, Şandor hypothesized that people with blunted emotional reactions might rely more on calculated reasoning. This could make them more likely to endorse utilitarian outcomes, especially in high-stakes, emotionally charged scenarios.

In the first part of the study, 238 university students in Turkey completed questionnaires measuring alexithymia and psychopathy. They also responded to 20 moral dilemmas, half of which involved impersonal scenarios like diverting a train, and half involving personal choices like pushing someone off a bridge to stop the train.

As expected, people with higher alexithymia scores were more likely to make utilitarian decisions in personal dilemmas—those that involve directly harming someone. There was no link between alexithymia and decisions in impersonal dilemmas. The same pattern held for psychopathy scores, especially primary psychopathy.

To understand how these traits were related, Şandor used a statistical technique called mediation analysis. The results showed that the relationship between alexithymia and utilitarian choices was fully explained by primary psychopathy. In other words, people who had difficulty recognizing and expressing emotions were more likely to score high on traits like low empathy, and those traits in turn predicted a greater tendency to make utilitarian moral judgments.

To examine the role of emotional arousal, Şandor conducted a second study with 49 participants selected from the original group. These individuals were divided into high- and low-alexithymia groups based on their earlier scores.

Participants viewed emotional images—some positive, some negative, and some neutral—while their physiological responses were measured using a method that tracks changes in skin resistance. They also rated each image in terms of how pleasant or unpleasant it was, and how emotionally arousing it felt.

People in the high-alexithymia group showed less physiological and subjective emotional reactivity to both positive and negative images. This finding supported the hypo-arousal theory: their emotional systems simply didn’t respond as strongly. They also made more utilitarian choices in the moral dilemma scenarios and scored higher on both primary and secondary psychopathy traits.

Interestingly, in this group, lower emotional arousal predicted higher levels of psychopathy—but psychopathy didn’t directly influence moral decisions in the same way it did for the low-alexithymia group. For individuals with better emotional awareness, psychopathy was a stronger predictor of utilitarian decision-making. This suggests that for people with intact emotional processing, psychopathic traits play a bigger role in how they make moral decisions, while for those with alexithymia, it’s the lack of emotional arousal itself that shapes behavior.

The study provides new insights into how different emotional traits interact to influence moral reasoning. Alexithymia appears to increase the likelihood of utilitarian decision-making by reducing emotional arousal and fostering traits associated with psychopathy. However, the route to these decisions differs depending on a person’s emotional responsiveness.

These results lend support to dual-process models of moral decision-making, which posit that emotional reactions typically steer people away from causing harm. When those reactions are weak or absent, people may rely more on abstract reasoning that prioritizes outcomes.

The findings also highlight the importance of distinguishing between personal and impersonal moral dilemmas. Emotional factors seem to matter much more when the harm is direct and personal. This aligns with previous research showing that people with damage to emotion-related brain regions, such as the ventromedial prefrontal cortex, are also more likely to endorse utilitarian solutions in personal moral dilemmas.

But the new research has some limitations. The sample was composed entirely of university students, which may limit how well the findings apply to the general population. The study also relied on self-report questionnaires to measure personality traits, which can be subject to bias.

The study’s design was also cross-sectional, meaning it captured a snapshot in time. Longitudinal studies could help to clarify whether alexithymia and psychopathy are actually related to changes in moral decision-making over time. Future research could also explore these relationships in clinical populations or use brain imaging techniques to investigate the neural pathways involved.

The study, “From emotional blunting to moral choices: The role of alexithymia in trait psychopathy and utilitarian decision-making,” was published online on March 10, 2025.