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Published February 18, 2009 | Supplemental Material + Published
Journal Article Open

Economic Games Quantify Diminished Sense of Guilt in Patients with Damage to the Prefrontal Cortex


Damage to the ventromedial prefrontal cortex (VMPFC) impairs concern for other people, as reflected in the dysfunctional real-life social behavior of patients with such damage, as well as their abnormal performances on tasks ranging from moral judgment to economic games. Despite these convergent data, we lack a formal model of how, and to what degree, VMPFC lesions affect an individual's social decision-making. Here we provide a quantification of these effects using a formal economic model of choice that incorporates terms for the disutility of unequal payoffs, with parameters that index behaviors normally evoked by guilt and envy. Six patients with focal VMPFC lesions participated in a battery of economic games that measured concern about payoffs to themselves and to others: dictator, ultimatum, and trust games. We analyzed each task individually, but also derived estimates of the guilt and envy parameters from aggregate behavior across all of the tasks. Compared with control subjects, the patients donated significantly less and were less trustworthy, and overall our model found a significant insensitivity to guilt. Despite these abnormalities, the patients had normal expectations about what other people would do, and they also did not simply generate behavior that was more noisy. Instead, the findings argue for a specific insensitivity to guilt, an abnormality that we suggest characterizes a key contribution made by the VMPFC to social behavior.

Additional Information

© 2009 Society for Neuroscience. Received Oct. 21, 2008; revised Dec. 22, 2008; accepted Jan. 8, 2009. This work was supported by a program project grant to A. R. Damasio from the National Institute of Neurological Disorders and Stroke and by grants from the National Institute of Mental Health (R.A.), the National Institute on Drug Abuse (D.T.), the National Science Foundation (R.A. and C.F.C.), and the Gordon and Betty Moore Foundation (R.A. and C.F.C.). Hanna Damasio and Jessica Wisnowski (Dornsife Cognitive Neuroscience Imaging Center, University of Southern California) conducted the neuroanatomical analysis of the patients and provided the illustration of the VMPFC group. We thank all participants for their participation in the experiments, Amanda Hornaday, Kodi Scheer, and Ruth Henson for help with scheduling and testing the subjects, Ming Hsu for suggestions with analysis and comments on this manuscript, Michael Koenigs for comments on this manuscript, and Jonathan Leland for general comments. The authors declare no competing financial interests.

Attached Files

Published - Krajbich2009p10610.1523JNEUROSCI.5086-08.2009.pdf

Supplemental Material - Krajbich1.pdf


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