Morality and Psychopathology: Tendencies to Personality Disorders and Some Other Mental Disorders Among Individuals with High and Low Moral Identity

AUTHORS

Alireza Azimpour 1 , * , Zohreh Derakhshan 1 , Susan Ghanbari 1

1 Department of Psychology, Salman Farsi University of Kazerun, Kazerun, Iran

How to Cite: Azimpour A, Derakhshan Z, Ghanbari S. Morality and Psychopathology: Tendencies to Personality Disorders and Some Other Mental Disorders Among Individuals with High and Low Moral Identity, Iran J Psychiatry Behav Sci. Online ahead of Print ; 13(1):e14966. doi: 10.5812/ijpbs.14966.

ARTICLE INFORMATION

Iranian Journal of Psychiatry and Behavioral Sciences: 13 (1); e14966
Published Online: September 30, 2018
Article Type: Original Article
Received: June 11, 2017
Revised: January 20, 2018
Accepted: April 15, 2018
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Abstract

Background: According to the criteria of personality disorders, some disorders, especially the antisocial personality disorder, can be characterized by the hypo-morality and some disorders, especially the obsessive-compulsive personality disorder, can be characterized by the hyper-morality. It seems that both the hyper-morality and the hypo-morality have linkages to different aspects of psychopathology.

Objectives: To better understand the issue, the current study aimed to compare individuals with high and low moral identity in the tendencies to all personality disorders and some other mental disorders.

Methods: From a database that had been gathered from 212 undergraduate university students, 30 students that had the highest moral identity and 24 students that had the lowest moral identity were selected to complete Millon clinical multiaxial inventory-III. The data of the two groups were compared by the multiple analysis of variance statistical method.

Results: The findings indicated that students with the highest moral identity had only higher tendency to the obsessive-compulsive personality disorder while students with the lowest moral identity had higher tendencies to the antisocial personality disorder, narcissistic personality disorders, and somatoform disorders. Nevertheless, in the tendencies to other disorders, a significant difference was not found.

Conclusions: The findings indicated that both very low and very high moral identity might be related to some psychopathological traits. It is in coordination with the emphasis of some philosophers such as Aristotle on the importance of sobriety or the doctrine of the mean for constituting the virtues and the theories of some psychiatrists such as Freud about the role of inflammation of superego in shaping some neurotic reactions. There may be some implications for preventing from both wastage and extremism in educating the moral identity.

1. Background

Studies indicate that frequently doing prosaically or moral behaviors have positive relationships with wellbeing and mental health (1-4) and vice versa, frequently doing antisocial, aggressive, or immoral behaviors have negative relationships with mental health (5, 6). Having frequently violent, immoral, or antisocial behaviors or lack of responsibility and respect to other’s right are seen in the characteristics of antisocial personality disorder (7). Charlady asserting the criteria of other disorders in cluster B of personality disorders considered all disorders in this cluster as moral disorders: criteria such as “lack of empathy” in narcissistic personality disorder, “inappropriate, intense anger” and “instability in interpersonal relationships” in borderline personality disorder, and even “excessive attention seeking” and “inappropriate sexually seductive and provocative behavior” in histrionic personality disorder (8).

Nevertheless, extravagance in morality has its own problems. According to the doctrine of the meaning of Aristotle’s ethics, the goodness such as kindness and honesty may be problematic when they practiced in the extreme and the ethical virtues can be made in mean and sobriety (9). In the perspective of Freud also swelled superego make moral anxiety and some neurotic disorders (10). Indeed, many studies confirmed the hyper-morality or hyper-responsibility in the people with obsessive-compulsive disorder (OCD) (11-13). One similarity between OCD and obsessive-compulsive personality disorder (OCPD) is the hyper-morality in both disorders (14). Indeed, being overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values is one of the criteria of OCPD (7).

2. Objectives

Many approaches in moral education intend to increase morality and moral-related variables in the people from childhood, the variables such as moral reasoning, moral emotions, and moral behaviors (15). One of the core moral variables that can be considered as a predictor of other aspects of morality is the moral identity (16, 17). Moral identity is defined as a cognitive schema that a person holds about his or her moral character (18). In searching the literature, any study was not found about the linkage between high or low moral identity and tendencies to personality disorders. The purpose of the present study is to compare the people with high and low moral identity in tendencies to personality disorders. In addition, as a marginal aim, a comparison is made in tendencies to other mental disorders. If the study reveals that individuals with the highest moral identity more have some psychopathological tendencies, it will be an implication for preventing from superfluity in the inspiration of moral identity in moral education.

3. Materials and Methods

3.1. Participants

Participants were selected from the database of a previous author’s study (in press) that had been done on the freshmen undergraduate university students (212 students; 164 females, M age: 18.99; SD: 1.16) from Salman Farsi University of Kazerun (Kazerun, Iran) in 2014, a year before administering the present study. One of the measures, which they had completed, was the measure of moral identity. The Z score of the internalization subscale of moral identity measure was used as the inclusion and exclusion criteria to find the participants. People with a Z score ≥ +1 were selected as a group with high moral identity, people with a Z score ≤ -1 were selected as a group with low moral identity, and other students (a Z score between -1 and +1) were excused from the study.

The test demanded many students from the two groups to complete the Millon clinical multiaxial inventory-III (MCMI-III) individually. 10 students with high moral identity and 9 students whit low moral identity did not participate in the test or cannot be found because of dropout from the university. Finally, 24 students were used as the low moral identity group (seven males, M age: 18.83; SD: 0.96) and 30 students were recruited as the high moral identity group (eight males, M age: 19.13, SD: 1.26). Although a higher sample size is better for such studies, considering the inclusion and exclusion criteria and the non-participation of some students, these numbers of participants were found. All students were in the 4th semester of an undergraduate course at the time of MCMI-III administration. Independent T test showed a high difference between the two groups in moral identity (t: -25.74; P < 0.0001).

3.2. Instruments

3.2.1. Millon Clinical Multiaxial Inventory-III (MCMI-III)

For the assessment of tendencies to personality and other mental disorders, MCMI-III (19) was used. Although there is an advice about not using the MCMI-III on normal people (19, 20), the present study did not intend to use the questionnaire for diagnosis. It just views the scores of MCMI-III as tendencies to personality disorders or tendencies to other disorders.

MCMI-III is a self-report scale with 175 true/false items (19). It includes the moderate personality disorder scales (1: schizoid, 2A: avoidant, 2B: depressive, 3: dependent, 4:histrionic, 5:narcissistic, 6A: antisocial, 6B: aggressive or sadistic, 7:compulsive, 8A: passive-aggressive or negativistic, and 8B: self-defeating), severe personality pathology scales (S: schizotypal, C: borderline, and P: paranoid), moderate clinical syndrome scales (A: anxiety, H: somatoform, N: bipolar or manic, D: dysthymia, B: alcohol dependence, T: drug dependence, and R: post-traumatic stress disorder), and severe syndrome scales (SS: thought disorder, CC: major depression, and PP: delusional disorder). It also has some modifying indices (X: disclosure, Y: desirability, Z: debasement, and V: validity). The validity scale must not reach three and the raw scores of other scales change to the base rate (BR) scores (20).

MCMI-III was validated on an Iranian population and its validity and reliability were confirmed. The internal consistency reliability was desirable (schizoid: 0.94, avoidant: 0.96, depressive: 077, dependent: 0.92, histrionic: 0.94, narcissistic: 0.95, antisocial: 0.95, aggressive or sadistic: 0.96, compulsive: 0.90, passive-aggressive or negativistic: 0.94, self-defeating: 0.93, schizotypal: 0.93, borderline: 0.95, paranoid: 0.94, anxiety: 0.92, somatoform: 0.95, bipolar or manic: 0.95, dysthymia: 0.95, alcohol dependence: 0.85, drug dependence: 0.91, post-traumatic stress disorder: 0.97, thought disorder: 0.90, major depression: 0.88, delusional disorder: 0.93, desirability: 0.93, and debasement:0.95) (21).

3.2.2. The Self-Importance of Moral Identity

For administering “The self-importance of moral identity” (22), first, some moral traits were represented to the respondents (caring, compassionate, fair, friendly, and so on) and then, they responded to 10 questions on a scale from 1 (strongly disagree) to 7 (strongly agree) about the traits. The measure has two subscales: internalization (the degree to which the moral traits are central to the self-concept) and symbolization (the degree to which the traits are reflected in the respondent’s actions in the world). Due to more relationships between the internalization subscale and other moral-related variables (17, 22) and considering the definition of internalization of moral identity, the present study used internalization of moral identity (as moral identity) for grouping the sample. The measure had been translated into Persian and validated on Iranian university students. The validity and reliability of this measure by different methods were desirable and the internal consistency coefficients for internalization and symbolization were 0.79 and 0.78, respectively (23).

3.3. Statistical Analysis

For statistical analysis, multiple analysis of variance (MANOVA) was used to compare the psychopathological variables between the two groups.

3.4. Ethical Considerations

All participants voluntarily participated or did not participate in the study. In addition, the examiners plighted that the individual’s data remain confidential and any participant knows just about his/her data if he/she wants to.

4. Results

No validity (V) scores of MCMI-III reached three, so no questionnaire was omitted from the analysis. Table 1 represents the descriptive indices (mean and standard deviation) of the variables in the two groups and in total.

Table 1. Descriptive Indicesa,b
Group 1Group 2Total
X68.04 ± 6.4469.41 ± 5.7468.79 ± 6.05
Y66.25 ± 15.5569.67 ± 22.2068.15 ± 19.46
Z35.29 ± 23.8145.83 ± 23.9041.15 ± 24.21
140.75 ± 19.6336.26 ± 22.2038.26 ± 21.03
2A36 ± 18.7038 ± 29.2937.11 ± 24.94
2B40.58 ± 26.8145.96 ± 30.3643.57 ± 28.69
336 ± 18.7038 ± 29.2937.11 ± 24.94
473.83 ± 17.8472.53 ± 27.173.11 ± 23.25
561.92 ± 15.4153.53 ± 18.8557.26 ± 17.75
6A40.58 ± 20.5330.1 ± 19.6234.75 ± 20.53
6B37.50 ± 20.2338.86 ± 17.7338.26 ± 18.71
743.58 ± 24.0858.43 ± 23.2551.83 ± 24.55
8A41.42 ± 26.946.56 ± 23.8644.27 ± 25.14
8B28.08 ± 21.5334.7 ± 22.8531.76 ± 22.45
S33.58 ± 20.9838.43 ± 23.1436.28 ± 22.13
C39.37 ± 20.1338.96 ± 24.8439.15 ± 22.66
P41.29 ± 22.1246.77 ± 15.5844.33 ± 18.90
A38.83 ± 21.5343.70 ± 26.5143.54 ± 24.32
H53.96 ± 2338.90 ± 29.1923.14 ± 27.16
N38.17 ± 24.2542.50 ± 29.2142.80 ± 26.87
D26.66 ± 21.1532.37 ± 25.0729.83 ± 23.37
B21.96 ± 13.2918.93 ± 14.4720.28 ± 13.91
T30.91 ± 19.3326.07 ± 16.7528.22 ± 17.93
R26.21 ± 38.3130.57 ± 29.9028.63 ± 29.01
SS50.45 ± 17.4748.63 ± 26.6849.44 ± 22.86
CC27.25 ± 21.9935.43 ± 25.6031.80 ± 24.19
PP30.66 ± 19.9439.17 ± 22.6835.39 ± 21.73

aValues are expressed as mean ± SD.

bGroup 1: low moral identity group, group 2: high moral identity group, X: disclosure, Y: desirability, Z: debasement, 1: schizoid, 2A: avoidant, 2B: depressive, 3: dependent, 4: histrionic, 5: narcissistic, 6A: antisocial, 6B: aggressive or sadistic, 7:compulsive, 8A: passive-aggressive or negativistic, 8B: self-defeating, S: schizotypal, C: borderline, P: paranoid, A: anxiety, H: somatoform, N: bipolar or manic, D: dysthymia, B: alcohol dependence, T: drug dependence, R: post-traumatic stress disorder, SS: thought disorder, CC: major depression, PP: delusional disorder.

Non-significant Levene’s test confirms the equality of variances as one of the presuppositions for the analysis of variance (24). Table 2 shows the results of Levene’s test for any variables. This is better to have variables with non-significant Levene’s tests of equality. Except for X, 2A, 4, H, and SS, other variables had no significant F (P > 0.05); so, their variances were equal.

Table 2. The Result of Levene’s Test for Equal Variancea
VariablesFP Value
X0.0160.901
Y3.5550.065
Z0.0060.938
10.9090.345
2A6.5990.013
2B0.0570.812
30.0070.934
47.2110.010
51.5310.222
6A0.0270.869
6B0.8140.371
70.1810.673
8A1.5160.224
8B0.1120.739
S0.0400.842
C0.0150.905
P2.1800.146
A2.2340.141
H7.7250.008
N1.3190.256
D1.5340.221
B0.6480.425
T1.3230.2555
R0.0001.000
SS4.9280.031
CC2.6590.109
PP1.6780.2

aGroup 1: low moral identity group, group 2: high moral identity group, X: disclosure, Y: desirability, Z: debasement, 1: schizoid, 2A: avoidant, 2B: depressive, 3: dependent, 4: histrionic, 5: narcissistic, 6A: antisocial, 6B: aggressive or sadistic, 7:compulsive, 8A: passive-aggressive or negativistic, 8B: self-defeating, S: schizotypal, C: borderline, P: paranoid, A: anxiety, H: somatoform, N: bipolar or manic, D: dysthymia, B: alcohol dependence, T: drug dependence, R: post-traumatic stress disorder, SS: thought disorder, CC: major depression, PP: delusional disorder.

Table 3 represents the overall effect of groups on the variables by the different indices of MANOVA. The effect’s significance was low and borderline (F: 1.632; P: 0.11) but the effect size indices were plausible. The observed power was more than 0.80 (0.815) and partial Eta squared was 0.638; so, it can be told that 81% of the individual’s variances are explained by the between-group variance. Perhaps, a low significance of F can be attributed to the low sample size besides many numbers of the dependent variables.

Table 3. The Result of the Overall Effect of Groups with High and Low Moral Identity on Tendencies to Personality and Clinical Disorders
EffectValueFHypothesis dfError of dfP ValuePartial Eta SquaredObserved Power
Group
Pillai’s trace0.6381.63227.0025.000.1110.6380. 815
Wilks’ lambda0.6321.63227.0025.000.1110.6380. 815
Hoteling trace1.7621.63227.0025.000.1110.6380. 815
Roy’s largest root1.7621.63227.0025.000.1110.6380. 815

Although the total effect of the groups on tendencies to disorders had a low significance, there were some significant differences in some variables. Table 4 represents the results of MANOVA on the variables separately. Because of the small sample size in the two groups [24 and 30], the borderline significances (P < 0.1) were considered (25, 26).

Table 4. The Differences of Tendencies to Disorders in the High and Low Moral Identity Groupsa
VariablesFP ValuePartial Eta SquaredObserved Power
X0.6720.4160.0130.127
Y0.4480.5060.0090.101
Z2.870.0960.0530.383
11.0330.3140.0200.169
2A0.0250.8740.0000.053
2B0.3990.530.0080.095
30.7190.4010.0140.132
40.0070.9360.0000.051
53.2700.0760.060.426
6A3.5250.0660.0650.453
6B0.0280.8670.0010.053
74.8260.0330.0860.577
8A0.760.3870.0150.137
8B1.3120.2570.0250.203
S0.520.4740.0100.109
C0.0120.9120.0000.051
P0.8640.3570.0170.149
A0.4540.5040.0090.101
H3.6370.0620.0670.465
N0.0000.9920.0000.05
D0.8140.3710.0160.144
B0.6340.4300.0120.122
T0.9820.3260.0190.163
R0.2620.6070.0050.080
SS0.120.7310.0020.63
CC1.8660.1780.0350.268
PP1.7120.1960.0330.251

aGroup 1: low moral identity group, group 2: high moral identity group, X: disclosure, Y: desirability, Z: debasement, 1: schizoid, 2A: avoidant, 2B: depressive, 3: dependent, 4: histrionic, 5: narcissistic, 6A: antisocial, 6B: aggressive or sadistic, 7:compulsive, 8A: passive-aggressive or negativistic, 8B: self-defeating, S: schizotypal, C: borderline, P: paranoid, A: anxiety, H: somatoform, N: bipolar or manic, D: dysthymia, B: alcohol dependence, T: drug dependence, R: post-traumatic stress disorder, SS: thought disorder, CC: major depression, PP: delusional disorder.

As Table 4 represents, tendencies to the obsessive-compulsive personality disorder (P < 0.05), antisocial personality disorder (P < 0.1), narcissistic personality disorder (P < 0.1), and somatoform disorders (P < 0.1) were significantly different between the groups. There were no significant differences between the groups in the other variables. Inasmuch as the total effect of the groups had a low significance (Table 3), we must be scrupulous to interpret the significant differences. In order to have robust findings, only variables with significant differences in Table 4 (obsessive-compulsive personality disorder, antisocial personality disorder, narcissistic personality disorder, and somatoform disorders) were considered for reanalyzing by another MANOVA. Table 5 represents that the overall effect of this analysis was significant (F: 1.632; P > 0.05).

Table 5. The Results of the Overall Effect of Groups with High and Low Moral Identity on Obsessive-Compulsive Personality Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder, and Somatoform Disorders
EffectValueFHypothesis dfError of dfP ValuePartial Eta SquaredObserved Power
Group
Pillai’s trace0.1982.9844490.0280.1960.755
Wilks’ lambda0.8042.9844490.0280.1960.755
Hoteling trace0.2442.9844490.0280.1960.755
Roy’s largest root0.2442.9844490.0280.1960.755

Table 6 shows the differences in tendencies to the obsessive-compulsive personality disorder, antisocial personality disorder, narcissistic personality disorder, and somatoform disorders in the high and low moral identity groups. The table shows that there were significant differences between the two groups in obsessive-compulsive personality disorder (P > 0.05), antisocial personality disorder (P > 0.1), narcissistic personality disorder (P > 0.1), and somatoform disorders (P > 0.1). By referring to Table 1, it was shown that groups with higher moral identity had a higher tendency to the obsessive-compulsive personality disorder and lower tendencies to the antisocial personality disorder, narcissistic personality disorder, and somatoform disorders.

Table 6. The Differences in Tendencies to the Obsessive-Compulsive Personality Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder, and Somatoform Disorders in the High and Low Moral Identity Groups
VariablesFP ValuePartial Eta SquaredObserved Power
Obsessive compulsive personality disorder5.2710.0260.0920.615
Antisocial personality disorder3.6520.0620.0660.466
Narcissistic personality disorder3.3090.0850.0560.407
Somatoform disorders3.1490.0820.0570.414

5. Discussion

The higher tendency to antisocial personality disorder in the people with less moral identity was highly predictable because of the definition and criteria of antisocial personality disorder as “a pervasive pattern of disregard for and violation of the rights of others” (7). The higher tendency to the narcissistic personality disorder in the people with less moral identity is comprehensible by viewing the lack of empathy as one of the criteria of narcissistic personality disorder (7). Indeed, many studies confirmed the importance of empathy in making morality and prosaically behavior (16, 27, 28) or in preventing from aggressive and antisocial behavior (28, 29).

Nevertheless, the present study did not show any difference between people with high and low moral identity in other personality disorders in cluster B (borderline and histrionic personality disorders). This is not in line with Charland claims (8) that considered all disorders in cluster B as moral disorders. Perhaps, the criteria that Charland had addressed to as moral problems are related to other aspects of morality (moral behaviors, moral reasoning, or moral emotions) rather than to moral identity.

The higher tendency to somatoform disorders in the people with less moral identity was somewhat unpredictable. One of the disorders that may have comorbidity with an antisocial personality disorder is the somatic syndrome disorder (7) that is similar to the somatoform disorders in MCMI-III. Perhaps, this comorbidity can explain the finding. However, the finding did not repeat for other pathological tendencies that have some similarity and comorbidity with an antisocial personality disorder (aggressive or sadistic, passive-aggressive, borderline, alcohol dependence, and drug dependence). It is likely doing similar studies in the patient population or using more number of participants would reveal more clear findings.

One of the other findings was a higher tendency to the obsessive-compulsive personality disorder in the people with a higher moral identity. This is in coordination with some previous studies (14) and the criteria of obsessive-compulsive personality disorder (7). If the causality linkage between moral identity and obsessive-compulsive personality disorder is supposed, the finding can have some implications for a correct moral education to prevent from extravagance for infusion of moral identity in the people. The finding can indicate, like the wastage in shaping and educating moral identity, superfluity in it can be harmful and pathological. It can be in coordination with Aristotle’s doctrine of the mean in the moral philosophy and Freud’s view about the linkage of some neurosis with inflammation of superego.

5.1. Conclusion

The study showed that extremity at both high and low amount of morality in the identity of individuals could be problematic. Indeed, the tendencies to the antisocial personality disorder, narcissistic personality disorder, and even a clinical disorder such as somatoform symptoms are related to the hypo-morality and obsessive-compulsive personality disorder is related to the hyper-morality. It has some implications for moral education and moral philosophy to prevent the extremism or wastage and considering the doctrine of the mean in the emphasis on moral values.

According to some limitations to the present study, such as the type and size of the sample, further studies on abnormal and larger samples are needed for more clear findings. In addition, due to the cross-sectional and comparative characterization of the research, still, we cannot be sure about the casual linkage between hypo or hyper-morality as the cause and psychopathological tendencies as the effect. Perhaps a longitude research or studying the relationship between moral education styles of families and psychopathology of children in the future can give the researchers more secure information.

Acknowledgements

Footnotes

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