Deontological and Altruistic Guilt Feelings: A Dualistic Thesis

State of the art of the literature on definitions of self-criticism: a meta-review

Background

Several authors have developed important theoretical models on an important transdiagnostic factor in psychopathology: self-criticism (SC). Currently, there are substantial variations in the theoretical definition of SC. The lack of awareness of similarities and differences between models may in turn impact the comparison between empirical results, limiting their clinical implications.

Purpose

The purpose of this study was to identify current trends in the field of SC and to explore whether these were approached and shaped by different conceptualizations of SC.

Methods

Core components of the most influential models of SC were identified. A meta-review was conducted searching for systematic reviews and/or meta-analyses in the following databases: PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed (all years up to 28 April 2023).

Results

Contributions were heterogeneous with respect to the definition of SC and the theoretical framework. Almost all systematic reviews poorly addressed the multidimensionality of SC. In addition, discrepancies between the definitions of SC provided and their operationalizations emerged.

Conclusions

The lack of dialogue between the different theoretical perspectives emerged from key contributions in the field of SC. Potential research questions to answer to stimulate this dialogue are proposed.

Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention

Objective

Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD).

Method

DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt.

Results

DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention.

Conclusions

Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.

Exploring Guilt Differences in Grandiose Narcissism, Vulnerable Narcissism, and Malignant Self-Regard

Narcissistic personality disorder is a heterogeneous and complex pathology which manifests itself very differently in individuals. The aim of the present study was to analyze differences and similarities in morality and sensitivity to feelings of guilt among grandiose narcissism (GN), vulnerable narcissism (VN), and malignant self-regard (MSR). We expected that MSR and VN would be most sensitive to deontological and altruistic guilt, and that MSR and VN would have higher levels of moral standards than GN. A nonclinical sample of 752 participants was evaluated. Results showed a significant association among MSR, VN, and GN. According to our hypothesis, GN turned out to be the one with the lowest association values to guilt measures. Our results demonstrated that MSR is strongly associated with all types of guilt, GN is associated with a substantial lack of guilt, and VN is associated with deontological guilt and self-hate, but not altruistic guilt. Results confirm the relevance of considering and understanding guilt when differentiating GN, VN, and MSR.

The Role of Childhood Experiences in the Development of Disgust Sensitivity: A Preliminary Study on Early Moral Memories

Objective

Disgust is a basic emotion evolved to safeguard our omnivorous species from contagion. Although the factors eliciting disgust typically involve concerns related to physical contamination, physical disgust responses are also prompted by moral transgressions, (i.e. cannibalism, pedophilia, betrayal). The link between the general propensity to experience disgust (i.e. "Disgust Sensitivity") and morality, in particular in the deontological domain, is supported by an increasing amount of data on clinical and non-clinical sample. Evolutionistic explanations of this link posit that disgust evolved to indicate the presence of a threat to the integrity of the individual not only in the physical domain but also in the social and moral domain.In addition to the evolutionary point of view, this link could also be better investigated in terms of individual development. To the best of our knowledge, literature is scarce regarding which early experiences are associated to high DS. Therefore, this study aims to explore the content of early memories associated with disgust. Based on the strict link between disgust and morality, we hypothesized an association between DS and early memories of moral criticism.

Method

60 non-clinical participants filled in measures of DS. They were then presented with an auditory disgust induction, after which they recalled early memories through the technique of the "affect bridge". 10 independent raters assessed the emotional content of the memories on visual-analogical scales.

Results

Results showed a positive association between disgust sensitivity and the propensity to experience deontological guilt. There was also a significant positive association between disgust sensitivity and moral memories, in particular relating to early experiences of being the object of contempt, moral criticism, anger, and of being held responsible.

Conclusions

These data directly support the centrality of early morally-loaded interpersonal experiences in the development of DS, confirming the link between disgust and morality also at the level of individual historical development.

'I don't really know where I stand because I don't know if I took something away from her': Moral injury in South African speech-language therapists and audiologists due to patient death and dying

BACKGROUND

Speech-language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying.

AIMS

To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury.

METHODS & PROCEDURES

This article forms part of a larger qualitative study that explored SLT&As' experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying.

OUTCOMES & RESULTS

Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self-reflection and religious practices, they reported alleviation of moral injury.

CONCLUSIONS & IMPLICATIONS

In order to mitigate moral injury in South African SLT&As, they require professional education, self-care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As' biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury. WHAT THIS PAPER ADDS?: What is already known on this subject? Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs. What this article adds? This article highlights the complexity of speech-language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury. Clinical implications of this article This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self-care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying.

Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a “victim”, supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Explaining Interaction of Guilt and Obsessive-Compulsive Symptoms in Not Just Right Experiences

Objective

"Not Just Right Experiences" (NJREs) are currently considered a characteristic of Obsessive-Compulsive Disorder (OCD). Significant associations have been found between NJREs and Obsessive-Compulsive (OC) symptoms in nonclinical and clinical populations. Literature support a significant relationship between NJREs, feelings of guilt and OC features. This study aims to clarify the role of the potential interplay between guilt and OC symptomatology in NJREs and verify if high levels of guilt will predict NJREs and OC symptoms and trait guilt levels will positively interact in their prediction of NJREs.

Method

One hundred and eighty-nine adults recruited from normal population were assessed with questionnaires of NJREs and OC symptoms and proneness to experience guilt.

Results

All the variables involved in the study (NJREs severity, guilt and OCI-R scores) were positively and significantly correlated and showed that guilt and OCI-R scores significantly and positively interact in the prediction of NJREs levels. Guilt predicted NJREs only when levels of OCI-R were high.

Conclusions

These results support the association between guilt sensitivity or OC symptoms and NJREs in clinical and nonclinical participants and that a disposition toward high levels of guilt and OC symptoms have a particular sensitivity to NJREs corroborating centrality of guilt in OC symptoms.

Self-Conscious Emotions and the Right Fronto-Temporal and Right Temporal Parietal Junction

For more than two decades, research focusing on both clinical and non-clinical populations has suggested a key role for specific regions in the regulation of self-conscious emotions. It is speculated that both the expression and the interpretation of self-conscious emotions are critical in humans for action planning and response, communication, learning, parenting, and most social encounters. Empathy, Guilt, Jealousy, Shame, and Pride are all categorized as self-conscious emotions, all of which are crucial components to one’s sense of self. There has been an abundance of evidence pointing to the right Fronto-Temporal involvement in the integration of cognitive processes underlying the expression of these emotions. Numerous regions within the right hemisphere have been identified including the right temporal parietal junction (rTPJ), the orbitofrontal cortex (OFC), and the inferior parietal lobule (IPL). In this review, we aim to investigate patient cases, in addition to clinical and non-clinical studies. We also aim to highlight these specific brain regions pivotal to the right hemispheric dominance observed in the neural correlates of such self-conscious emotions and provide the potential role that self-conscious emotions play in evolution.

Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour

OBJECTIVE

Deontological Guilt (DG), and Altruistic Guilt (AG) emerge from the appraisal of violating an internalized rule or an altruistic principle, respectively. DG is strictly connected with Disgust Sensitivity and plays a key role in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Previous studies investigated how DG affects responses to hypothetical moral dilemmas, however how DG and Disgust Sensitivity interact modulating moral behavior is still unknown.

METHODS

STUDY 1. 46 healthy participants performed an ecological paradigm in which people can spontaneously decide to lie to obtain a reward (egoistic lie) or give it away (altruistic lie) after three emotional inductions: DG, AG or neutral. Furthermore, OCD traits, Morality, Guilt Propensity and Disgust Sensitivity were assessed by means of questionnaires. STUDY 2. 27 participants from the original sample were retested during the COVID-19 lockdown in Italy to ascertain whether the pandemic modified traits related to morality, disgust, guilt or OCD symptoms and whether these changes modulated moral behavior (measured by a task in which cheating was associated to higher pay-offs).

RESULTS

STUDY 1. Compared to the neutral, after the DG induction participants produced less altruistic and more egoistic lies. This effect was stronger in participants with high Disgust Sensitivity. STUDY 2. During the COVID-19 lockdown participants became more sensitive to the Authority pillar of the Moral Foundations and more sensitive to Disgust: this increment in deontological morality affected (im) moral behavior depending on changes in Disgust Sensitivity.

CONCLUSIONS

Our data suggest that people with high Disgust Sensitivity are more affected by deontological inductions which translate to higher immorality, supposedly by lowering their moral self-image. These results might have important clinical implications as they suggest that addressing Disgust Sensitivity in therapy, might also decrease the effect of guilt on patients' behavior.