Empathy Deficits Research Articles

Impairments in Cognitive and Emotional Empathy as Markers of General versus Specific Personality Pathology

Introduction: The alternative model for personality disorders (AMPD) of the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5) considers impairments in empathy a basic feature of personality disorders (PDs). In contrast, the AMPD pathological personality trait model and the categorical DSM-5 Section II PD model associate deficits in empathy to specific forms of personality pathology. The present study investigated to what extent impairments in cognitive and emotional empathy are markers of general versus specific personality pathology. Methods: In a clinical sample (n = 119), the Multifaceted Empathy Test was used to assess cognitive empathy, emotional empathy for positive emotions, and emotional empathy for negative emotions. Personality functioning, pathological personality traits, and DSM-5 Section II PDs were assessed via interviews and self-reports. Confirmatory factor analyses were applied to associate the three empathy facets with the three personality pathology approaches, each modeled with general personality pathology (common factor) and specific personality pathology (residuals of indicators). Results: Impairments in cognitive empathy and emotional empathy for positive emotions were significantly correlated with general personality pathology. All three empathy facets were also correlated to specific personality pathology when controlling for general personality pathology, respectively. Impairments in cognitive empathy were incrementally associated with identity and empathy (personality functioning), psychoticism (pathological personality traits), and paranoid and dependent PD (DSM-5 Section II PDs). Deficits in emotional empathy for positive emotions were incrementally associated with self-direction and intimacy (personality functioning) and detachment (pathological personality traits). Impairments in emotional empathy for negative emotions were incrementally associated with antagonism (pathological personality traits) and antisocial PD (DSM-5 Section II PDs). Conclusion: The results suggest that impairments in cognitive empathy and emotional empathy for positive emotions, but not for negative emotions, are markers of general personality pathology, while deficits in the three empathy facets are also markers for specific personality pathology.

Conectividad cerebral, empatía, insensibilidad emocional y toma de decisiones en el trastorno de la conducta: Una revisión sistemática.

The deficits in empathy, emotional insensitivity, and decision-making constitute the core of symptoms defining conduct disorder. Although several studies have established some correlates between brain connectivity and symptoms separately, there has been little effort to systematize such information. The current systematic review aimed to describe the findings obtained through analyzing brain connectivity networks by functional magnetic resonance imaging associated with alterations in empathy, emotional insensitivity, and decision-making in subjects with conduct disorder. A systematic search was carried out for original studies published in Medline (PubMed), Scopus, Scielo, Google Scholar, Scopus, and Nature. Articles published between 2000 and 2022 were included; a qualitative synthesis was obtained with the six selected articles at the end of the process. The findings show altered brain connectivity patterns in brain regions associated with empathy and insensitivity in subjects with conduct disorder.

Autistic People's Experience of Empathy and the Autistic Empathy Deficit Narrative.

There is a dominant discourse, both in clinical texts and throughout the academic literature, that autistic people lack empathy; however, over the past decade, both clinicians and academics have increasingly rejected deficit-based descriptions of autism in favor of more nuanced explanations of the experience of autistic individuals in a social world. This study asked 76 autistic individuals about their own experience of empathy and the oft-cited empathy deficit. Data were thematically analyzed and revealed a wide array of empathic self-concepts among respondents. Notably, there was a high proportion of hyper-empathic experiences. Many respondents reported their empathic responses to be overwhelming, or even distressing. These different experiences of empathy contrast with societal expectations of empathy, which often result in additional labor for autistic people as they navigate the non-autistic centered world. Although the academic literature is, in some areas, slowly moving away from a deficit perspective, more broadly there is still a negative impact from misconceptions around autistic people and empathy. Further work needs to be done to not only explore this misconception at a societal (rather than academic) level, but also better bridge the gap around the changing ideas of empathy and real-world understanding of autistic empathy.

The measure of empathy in early childhood: Testing the reliability, validity, and clinical utility of scores in early childhood.

Empathy is a critical socioemotional skill that motivates prosocial behavior and supports the ability to respond to the emotions of others. Although accurate measurement of empathy in young children is critical for identifying and remediating empathy deficits, currently available parent-report measures of childhood empathy have several psychometric limitations. The present study tested the reliability, validity, and clinical utility of scores on the Measure of Empathy in Early Childhood (MEEC), a new multidimensional, parent-report empathy scale, in 4- to 7-year-old children. The psychometric properties of MEEC scores were assessed by examining their associations with criterion, construct, discriminant, and clinical validity measures. A sample of 129 parents of community and clinic-referred children (Mage = 5.62 years, SD = 1.01, 65.9% boys) completed the MEEC and other relevant parent-report questionnaires. Internal consistencies (α = .79-.93) of MEEC scores were good. Correlations between MEEC scores and parent-report measures, sex, and age robustly supported their validity in 4- to 7-year-old children. Logistic regression analyses demonstrated that MEEC scores significantly predicted membership into clinical subgroups characterized by empathy deficits. Linear regression analyses indicated that prosocial behavior and sympathy MEEC subscales, but not affective empathy, statistically predicted parent-reported callous-unemotional traits. Theoretical and clinical implications of these findings for developmental models of empathy and empathy-related disorders are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Empathy deficits, callous-unemotional traits and structural underpinnings in autism spectrum disorder and conduct disorder youth.

Distinct empathy deficits are often described in patients with conduct disorder (CD) and autism spectrum disorder (ASD) yet their neural underpinnings and the influence of comorbid Callous-Unemotional (CU) traits are unclear. This study compares the cognitive (CE) and affective empathy (AE) abilities of youth with CD and ASD, their potential neuroanatomical correlates, and the influence of CU traits on empathy. Adolescents and parents/caregivers completed empathy questionnaires (N = 148 adolescents, mean age = 15.16 years) and T1 weighted images were obtained from a subsample (N = 130). Group differences in empathy and the influence of CU traits were investigated using Bayesian analyses and Voxel-Based Morphometry with Threshold-Free Cluster Enhancement focusing on regions involved in AE (insula, amygdala, inferior frontal gyrus and cingulate cortex) and CE processes (ventromedial prefrontal cortex, temporoparietal junction, superior temporal gyrus, and precuneus). The ASD group showed lower parent-reported AE and CE scores and lower self-reported CE scores while the CD group showed lower parent-reported CE scores than controls. When accounting for the influence of CU traits no AE deficits in ASD and CE deficits in CD were found, but CE deficits in ASD remained. Across all participants, CU traits were negatively associated with gray matter volumes in anterior cingulate which extends into the mid cingulate, ventromedial prefrontal cortex, and precuneus. Thus, although co-occurring CU traits have been linked to global empathy deficits in reports and underlying brain structures, its influence on empathy aspects might be disorder-specific. Investigating the subdimensions of empathy may therefore help to identify disorder-specific empathy deficits.

Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence.

To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence. One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression. Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA. SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.

Empathic disequilibrium as a new framework for understanding individual differences in psychopathology.

Empathy is part of basic social cognition and is central to everyday interactions. Indeed, emotional and cognitive empathy deficits are related to various psychopathologies, yet the links reported have been inconsistent. Thus, the mechanism underlying these inconsistent links is poorly understood. At least a partial answer may lie in that the dependency between cognitive and emotional empathy has been overlooked. Here, we examined the (dis)equilibrium between emotional and cognitive empathy and how it relates to individual differences in clinical traits. We further examined a possible mediator of these links-emotional reactivity. Participants (N = 425) from the general population reported on their empathy, emotional reactivity, autistic traits, psychopathic tendencies, and symptoms of depression and anxiety. Beyond empathy, both extremes of empathic disequilibrium were associated with various features of clinical conditions; Higher emotional relative to cognitive empathy was related to the social domain of autism and anxiety, while higher cognitive relative to emotional empathy was related to the non-social domain of autism, depression symptoms, and psychopathic tendencies. The associations with autistic traits, anxiety, and psychopathic tendencies were mediated by emotional reactivity. Our findings suggest a new framework for understanding how individual variability in empathy is expressed in various psychopathologies.

Alternation in functional connectivity within default mode network after psychodynamic psychotherapy in borderline personality disorder

BackgroundBorderline personality disorder (BPD) is characterized by impairments in emotion regulation, impulse control, and interpersonal and social functioning along with a deficit in emotional awareness and empathy. In this study, we investigated whether functional connectivity (FC) within the default mode network (DMN) is affected by 1-year psychodynamic psychotherapy in patients with BPD.MethodsNine BPD patients filled out the demography, Interpersonal Reactive Index (IRI), Toronto Alexithymia Scale 20 (TAS 20), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Borderline Evaluation Severity over Time (BEST) questionnaire. The BPD group (9F) and the control group (9F) had a mean ± SD age of 28.2 ± 5.3 years and 30.4 ± 6.1 years, respectively. BPD subjects underwent longitudinal resting-state fMRI before psychodynamic psychotherapy and then every 4 months for a year after initiating psychotherapy. FC in DMN was characterized by calculating the nodal degree, a measure of centrality in the graph theory.ResultsThe results indicated that patients with BPD present with aberrant DMN connectivity compared to healthy controls. Over a year of psychotherapy, the patients with BPD showed both FC changes (decreasing nodal degree in the dorsal anterior cingulate cortex and increasing in other cingulate cortex regions) and behavioral improvement in their symptoms and substance use. There was also a significant positive association between the decreased nodal degree in regions of the dorsal cingulate cortex and a decrease in the score of the TAS-20 indicating difficulty in identifying feelings after psychotherapy.ConclusionIn BPD, there is altered FC within the DMN and disruption in self-processing and emotion regulation. Psychotherapy may modify the DMN connectivity and that modification is associated with positive changes in BPD emotional symptoms.

Social cognition and apathy between two cognitive subtypes of schizophrenia: Are there the same or different profiles?

ObjectiveCognitive impairment is an essential feature of schizophrenia, and it involves a broad array of nonsocial and social cognitive domains. This study aimed to examine whether there are the same or different social cognition profiles between two cognitive subtypes of schizophrenia. MethodThere were one hundred and two chronic and institutionalized patients with schizophrenia from two referral tracks. One group is “Cognitively Normal Range” (CNR) (N = 52), and another group is “Below Normal Range” (BNR) (N = 50). We assessed or collected their apathy, emotional perception judgment, facial expression judgment, and empathy by the Apathy Evaluation Scale, the International Affective Picture System, the Japanese and Caucasian Facial Expression of Emotion, and the Interpersonal Reactivity Index, respectively. ResultsWe found different impairment profiles depending on the cognitive subtypes of the patient with schizophrenia. Surprisingly, the CNR presented impairments in apathy, emotional perception judgment, facial expression judgment, and empathy and feature impairment in empathy and affective apathy. In contrast, even though the BNR had significant neurocognition impairments, they had almost intact empathy with significantly impaired cognitive apathy. Both groups' global deficit scores (GDSs) were comparable, and all reached at least a mild impairment level. ConclusionsThe CNR and the BNR had similar abilities in emotional perception judgment and facial emotion recognition. They also had differentiable deficits in apathy and empathy. Our findings provide important clinical implications for neuropsychological pathology and treatment in schizophrenia.

Beyond impairment of language: empathy deficit in logopenic variant of Primary Progressive Aphasia (P5-6.002)

<h3>Objective:</h3> The aim of this study is to assess possible empathy deficits and their neural basis in lv-PPA compared to amnesic AD. <h3>Background:</h3> Empathy is the ability to understand (cognitive empathy) and to feel (affective empathy) what others feel. Evidence about empathy in logopenic variant of Primary Progressive Aphasia (lv-PPA) are rare and not conclusive. <h3>Design/Methods:</h3> We included 18 lv-PPA and 38 amnesic AD patients. Informer-rated Interpersonal Reactivity Index (IRI) was used to explore cognitive (Perspective Taking-PT and Fantasy-F subscales) and affective (Empathic Concern-EC and Personal Distress-PD subscales) empathy, before (T0) and after (T1) cognitive symptoms’ onset. Emotion recognition was tested through Ekman-60 Faces Test. Eighteen lv-PPA and 30 amnesic AD patients underwent Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and amyloid biomarker analysis. SPM analysis on FDG-PET was performed in 16 lv-PPA and 26 amnesic AD patients. <h3>Results:</h3> From T0 to T1, PT scores decreased, and PD scores increased in both lv-PPA (PT z=−3.43, <i>p</i>=0.001; PD z=−3.62, <i>p</i>&lt;0.001) and in amnesic AD (PT z=−4.57, <i>p</i>&lt;0.001; PD z=−5.20, <i>p</i>&lt;0.001). Lv-PPA performed poorer than amnesic AD in happiness recognition (7.54±2.18 vs 8.94±1.04, <i>p</i>=0.001). Delta-PT(T0–T1) negatively correlated with metabolic disfunction of left superior and middle frontal gyri, inferior parietal lobule and insula in lv-PPA, and of right superior temporal gyrus and middle frontal gyrus in amnesic AD (<i>p</i>&lt;0.005). Delta-PD(T0–T1) positively correlated with metabolic disfunction of left insula, inferior parietal lobule and superior frontal gyrus in lv-PPA (<i>p</i>&lt;0.005) and of right inferior frontal gyrus in amnesic AD (<i>p</i>&lt;0.001). <h3>Conclusions:</h3> Beyond language impairment, lv-PPA patients seems to present empathy changes and difficulties in emotion recognition. Lv-PPA and amnesic AD share the same empathic changes, with a damage of cognitive empathy and a heightening of person distress along time. Differences of neural correlates of empathy impairment might be due to the different vulnerability of specific brain regions in the two AD phenotypes. <b>Disclosure:</b> Ms. Giacomucci has nothing to disclose. Cristina Polito has nothing to disclose. Valentina Berti has nothing to disclose. Sonia Padiglioni has nothing to disclose. Dr. Galdo has nothing to disclose. Mr. Mazzeo has nothing to disclose. Dr. Bergamin has nothing to disclose. Miss Moschini has nothing to disclose. Miss Morinelli has nothing to disclose. Miss Nuti has nothing to disclose. Dr. De Cristofaro has nothing to disclose. Dr. Bagnoli has nothing to disclose. Benedetta Nacmias has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Sandro Sorbi has nothing to disclose. Valentina Bessi has nothing to disclose.

Teaching Literature during a Pandemic-Induced Empathy Deficit

Abstract These notes from the field describe one instructor's experience with adopting a narrative medicine-informed pedagogy in the literature classroom during the COVID-19 outbreak. It examines how the chronic stress of surviving through a pandemic can contribute to an international “empathy deficit” and how an attitude of receptivity and co-intentionality—paired with reading fictional stories about health and illness—can buoy the empathy reserves of both students and teachers.

The relationship between autistic traits and empathy in adolescents: An ERP study

Based on the mind-blindness hypothesis, a large number of studies have shown that individuals with autism-spectrum disorder (ASD) and autistic traits have empathy deficits. However, the recent double empathy theory contradicts the mind-blindness hypothesis and suggests that individuals with ASD and autistic traits do not necessarily lack empathy. Thus, the presence of empathy deficits in individuals with ASD and autistic traits is still controversial. We recruited 56 adolescents (28 high autistic traits, 28 low autistic traits, 14–17 years old) in this study to explore the relationship between empathy and autistic traits. The study participants were required to undertake the pain empathy task, during which the electroencephalograph (EEG) activities were recorded. Our results show that empathy was negatively associated with autistic traits at the questionnaire, behavioral, and EEG levels. Our results also suggested that empathy deficits in adolescents with autistic traits may be manifested mainly in the late stages of cognitive control processing.

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.

A physiological cause to empathy deficits in a mouse model of FTD

Loss of empathy is a core behavioral symptom of frontotemporal dementia (FTD). In this issue of Neuron, a study by Phillips etal.1 reveals that hypoactivity of dorsomedial prefrontal cortex is causally linked to empathy deficits in a mouse model of FTD.

Adolescent substance use outcomes in response to social consequences of use: the role of empathy.

Evidence suggests empathy deficits have a temporal relationship with substance use severity by late adolescence theorized to decrease use via recognition of social consequences. However, this has yet to be tested empirically along with differences in cognitive and affective empathy. Adolescents admitted to substance use treatment (n= 3,382) were followed through treatment and 12 months after treatment. Variable trajectories were fit using growth curve models; and cross-lagged effects of cognitive and affective empathy on response to social consequences of use were tested along with how response to social consequences affected the mean trajectory of substance use. Results indicate higher cognitive empathy predicted greater response to social consequences of use and response to these consequences at the end of treatment predicted a steeper decrease in substance use. This evidence highlights the importance of cognitive empathy for responding to social consequences of use for motivating less substance use in adolescents.

The Relationship between Empathic Deficits and Risk of Antisocial Personality Disorder

Individuals with antisocial personality disorder (ASPD) account for 2-3% of the overall population, jeopardizing society by violating the laws, mistreating others with disregard, and even more severe attacks. Though with abundant research investigating the etiology of ASPD, empathy, as a critical feature of people with ASPD, has been neglected. Empathy, broadly referring to the ability to perceive others’ feelings and thoughts, plays a vital role in social interactions. Lack of empathy might lead to less prosocial functions and reinforce antisocial behaviors. Hence, the present review sorted the previous studies regarding the relationship between empathetic traits and the development of antisocial personality disorder from the aspects of different dimensions of empathy, direct causation, and neural activity. In general, one dimension of empathy—empathetic concern was found related to the formation of ASPD. Prosociality and parental behaviors are indirectly related to ASPD by affecting empathetic abilities. Innate empathy deficit in toddlerhood also accounts for the ASPD. From the neural aspect, activities in the amygdala, anterior insula, and connectivity between the bilateral amygdala and PCC and precuneus are found to correlate with ASPD while processing emotional cues. Though the relationship between empathy and ASPD is determined, future investigation should focus on other empathy dimensions, detailed findings for different levels of CU traits, and better reliability through assessment. In general, this review might contribute to the prevention and intervention of ASPD by attaching more importance to empathetic traits and parental guidance.

Differences and Similarities in Empathy Deficit and Its Neural Basis between Logopenic and Amnesic Alzheimer's Disease.

The aims of the study were to assess empathy deficit and neuronal correlates in logopenic primary progressive aphasia (lv-PPA) and compare these data with those deriving from amnesic Alzheimer's disease (AD). Eighteen lv-PPA and thirty-eight amnesic AD patients were included. Empathy in both cognitive and affective domains was assessed by Informer-rated Interpersonal Reactivity Index (perspective taking, PT, and fantasy, FT, for cognitive empathy; empathic concern, EC, and personal distress, PD, for affective empathy) before (T0) and after (T1) cognitive symptoms' onset. Emotion recognition was explored through the Ekman 60 Faces Test. Cerebral FDG-PET was used to explore neural correlates underlying empathy deficits. From T0 to T1, PT scores decreased, and PD scores increased in both lv-PPA (PT z = -3.43, p = 0.001; PD z = -3.62, p < 0.001) and in amnesic AD (PT z = -4.57, p < 0.001; PD z = -5.20, p < 0.001). Delta PT (T0-T1) negatively correlated with metabolic disfunction of the right superior temporal gyrus, fusiform gyrus, and middle frontal gyrus (MFG) in amnesic AD and of the left inferior parietal lobule (IPL), insula, MFG, and bilateral superior frontal gyrus (SFG) in lv-PPA (p < 0.005). Delta PD (T0-T1) positively correlated with metabolic disfunction of the right inferior frontal gyrus in amnesic AD (p < 0.001) and of the left IPL, insula, and bilateral SFG in lv-PPA (p < 0.005). Lv-PPA and amnesic AD share the same empathic changes, with a damage of cognitive empathy and a heightening of personal distress over time. The differences in metabolic disfunctions correlated with empathy deficits might be due to a different vulnerability of specific brain regions in the two AD clinical presentations.

Neural empathic response to disability: An ERP study of prejudice

While social neuroscience has already provided evidence for a deficit of affective empathy in racial prejudice, little is known about other less visible social categories when considered as an outgroup. We studied the process of empathy through event-related brain potentials (ERPs). We focused on the group "people with disabilities" as they are the target of a large amount of prejudice. Twenty-six participants performed a pain decision task. The mean amplitudes of N1, P2, N2–N3 and P3 components were recorded. Our results are consistent with previous work on prejudice, showing that the pain detection is modulated by group membership (with disabilities vs. without disabilities) on N2–N3, suggesting a better neural decoding of pain vs. non-pain in the without-disability condition. Critically, no effect of early sensory components (N1, P2) was found, and P3 was not moderated by disability. These findings indicate a different time course of empathic responses depending on the condition, suggesting that people with disabilities trigger specific empathic responses. Our results contribute to disentangling perceptual processes from affective empathy reactions.

Dorsomedial prefrontal hypoexcitability underlies lost empathy in frontotemporal dementia

Empathic function is essential for the well-being of social species. Empathy loss is associated with various brain disorders and represents arguably the most distressing feature of frontotemporal dementia (FTD), a leading form of presenile dementia. The neural mechanisms are unknown. We established an FTD mouse model deficient in empathy and observed that aged somatic transgenic mice expressing GGGGCC repeat expansions in C9orf72, a common genetic cause of FTD, exhibited blunted affect sharing and failed to console distressed conspecifics by affiliative contact. Distress-induced consoling behavior activated the dorsomedial prefrontal cortex (dmPFC), which developed profound pyramidal neuron hypoexcitability in aged mutant mice. Optogenetic dmPFC inhibition attenuated affect sharing and other-directed consolation in wild-type mice, whereas chemogenetically enhancing dmPFC excitability rescued empathy deficits in mutant mice, even at advanced ages when substantial cortical atrophy had occurred. These results establish cortical hypoexcitability as a pathophysiological basis of empathy loss in FTD and suggest a therapeutic strategy.

Not Ideal, But Still Acknowledged: A 10-Country Survey on Empathy for Victims of Anti-LGBT Violence.

Using data from a cross-national survey conducted on representative samples of populations from 10 European countries (n = 10,766), the present study is the first one to empirically measure the validity of Christie's influential ideal victim model. We use a range of scenarios built around common types of anti-LGBT violence to verify the extent to which the public's empathy for victims is contingent on the victim's identity and the circumstances of the crime. The results provide strong evidence that, when applied to this group of victims, the rules of the ideal victim work, adequately moderating the public's emotional reactions. We found that all victims receive relatively high levels of empathy, but the further the victim is from the ideal, the less support they can count on. Thus, even though no victim is "rejected," a clear hierarchy of victimization emerges. As a group, LGBT people suffer from an empathy deficit, but there also are considerable variations within this group, with a lesbian attacked by extremists receiving the most, and a drunk transgender person receiving the least empathy from the public. The study contributes to the development of theory by embedding the ideal victim model in a broader sociological paradigm of dramaturgical analysis. Since our research shows that the victim's LGBT status decreases the levels of empathy (being seen as a type of stigma), we call for more attention to be paid to the actor's identity in Goffman's framework. Implications for practice and further research are offered.