Low cortisol levels and the balance between punishment sensitivity and reward dependency

Neuroreport. 2003 Oct 27;14(15):1993-6. doi: 10.1097/00001756-200310270-00023.


The neuro-endocrinological basis of psychopathy, a disorder characterized by lack of fear, is relatively unknown. However, low levels of cortisol may result in fearlessness and have been observed in individuals with psychopathic tendencies. Low fear models state that psychopaths are not motivated to avoid punishment, especially when reward is pending. In agreement, disadvantageous decision making on the IOWA gambling task in psychopaths and psychopathic analogous, indicates low punishment sensitivity and high reward dependency. Here, it was investigated whether low basal cortisol levels predicted the balance between punishment sensitivity and reward dependency in the same manner. As hypothesized, the most disadvantageous pattern of decision making was found in the subjects with the lowest cortisol levels. These findings suggest that low levels of cortisol may set the balance between the sensitivity for punishment and reward dependency towards a pre-disposition for psychopathy.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Circadian Rhythm / physiology
  • Conditioning, Operant / physiology*
  • Decision Making / physiology
  • Female
  • Gambling / psychology
  • Humans
  • Hydrocortisone / physiology*
  • Male
  • Motivation
  • Psychopathology
  • Punishment*
  • Reward*


  • Hydrocortisone