Moral Judgment: An Overlooked Deficient Domain in Multiple Sclerosis?

Alexithymia in multiple sclerosis: past, present and future

Alexithymia denotes the "absence" of "words" for "emotion" and has its roots in the Greek words "a," "lexis," and "thymos." It is sometimes referred to as "emotional blindness," "blunted feeling," or "disrupted emotional awareness." The term "alexithymia" first appeared in the 1970s in the works of Sifneos, Nemiah, and colleagues. It entails difficulties in identifying and expressing emotions and an externally oriented thinking style. It is not a psychiatric disorder but rather a multidimensional personality trait or construct, appearing to be normally distributed in the general population, with high levels of alexithymia in approximately 10% of individuals. Evidence suggests that alexithymia serves as a prognostic risk factor for health problems, a transdiagnostic risk factor for emotion-based psychopathologies, and a predictor of poor psychiatric treatment outcomes. It is frequently observed in neurological diseases. Nevertheless, its mechanisms, assessment, and management remain overlooked. In multiple sclerosis (MS), an autoimmune disease of the central nervous system, alexithymia seems to occur in up to 53% of patients. However, it remains understudied despite recent growing interest. In this mini review, we briefly reassess the prevalence, as well as the clinical, sociodemographic and neuropsychological correlates of alexithymia in MS (e.g., anxiety, depression, fatigue, socio-emotional outcomes). This is followed by an analysis of neurobiological underpinnings of alexithymia derived from neurophysiological and neuroimaging studies in this clinical population. Finally, we provide perspectives to guide future research exploring and managing alexithymia in MS.

Distinguishing the role of positivity bias, cognitive impairment and emotional reactivity in the deontological preference in multiple sclerosis during moral dilemmas: a social cognition study protocol

Background

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by a broad and unpredictable range of symptoms, including cognitive and sociocognitive dysfunction. Among these social-cognitive functions, moral judgment has been explored in persons with MS (PwMS) using moral dilemmas, where participants must decide whether to sacrifice one person to save a greater number. Opting for such a sacrifice reflects utilitarian reasoning (sacrificing one for the benefit of many is deemed acceptable), while refusing reflects deontological reasoning (such sacrifice is considered morally wrong). Compared to controls, PwMS have been shown to make greater deontological moral choices in such dilemmas.

Objectives

While PwMS have demonstrated a higher tendency for deontological moral choices in moral dilemmas compared to controls, the underlying determinants of this reasoning pattern remain unclear. In this project, we aim to investigate cognitive, emotional, and motivational factors that may explain deontological decision-making in MS.

Methods and analysis

We will recruit a sample of 45 PwMS and 45 controls aged 18-55 years. The type of response, deontological or utilitarian, to a series of 20 vignettes of moral dilemmas will constitute the primary outcomes. Global cognitive performance, positivity bias, alexithymia and empathy levels as well as emotional reactivity measured by electrodermal activity (EDA) during moral dilemmas will be secondary outcomes.

Ethics and dissemination

Ethics approval was granted by a national ethical committee (CPP Ouest III, national number 2023-A00447-38). The project is sponsored by the ARSEP Foundation. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals.

Social norms in patients with relapsing-remitting multiple sclerosis: Impairment of the moral/conventional distinction?

In multiple sclerosis, conflicting results have been reported between social impairment and relatively preserved moral judgments, mainly tested with moral dilemmas. Some results even yet suggest signs of "ultra-morality" in these patients. The objective of the present study was to test this hypothesis with the moral/conventional distinction task, investigating the knowledge of social norms and the judgment of moral versus conventional transgressions. In the first condition, the permissibility of social situations was estimated. If the participant judged the situation as wrong, he had to estimate the seriousness of the transgression, to give verbal justifications and to re-estimate the permissibility when the law authorizes the act (generalization condition) and when a social authority recommends the act (dependency condition). Forty-six multiple sclerosis patients matched to healthy controls completed this task. Contrary to our hypotheses, patients showed less permissibility for moral transgressions or a higher seriousness but, unexpectedly, for conventional transgressions. Most importantly, abnormal justifications were observed (strictly moral arguments for conventional transgressions and vice versa). This suggests a lack of distinction between conventional and moral judgment in multiple sclerosis. This confusion may explain the "ultra-morality" sometimes reported, if patients base their judgment mainly on social knowledge and not on emotional processing.