Elsevier

Psychiatry Research

Volume 160, Issue 1, 15 July 2008, Pages 23-29
Psychiatry Research

Empathic abilities in people with schizophrenia

https://doi.org/10.1016/j.psychres.2007.05.017Get rights and content

Abstract

Although the existence of empathy deficits in schizophrenia is generally accepted, very few studies have directly investigated the issue. The nature of empathy deficits in healthy subjects and psychiatric patients is an understudied subject. The performances of the 30 outpatients with schizophrenia on a psychometric measure, the Empathy Quotient (EQ), were compared with those of 30 control subjects matched for age, duration of education and gender. The relatives or spouses of the patients also filled out the EQ. A neuropsychological battery, including emotion recognition, emotional reasoning and theory of mind tasks, was also administered. Schizophrenia patients had severe empathy dysfunction based on their relative EQ ratings. There was a serious discrepancy between the self and relative/spouse assessments of the empathic skills of schizophrenia patients. Consistent with the previous findings schizophrenia patients were impaired in nearly all cognitive tasks. The empathy deficits of schizophrenia patients were associated with their impairments in other social cognitive tasks. Studies focusing on dysfunctional brain networks underlying empathy deficits and studies using more experimental measures of empathy should be helpful to unravel the true nature of the empathic failure in patients with schizophrenia.

Introduction

Empathy is a fundamental human ability that is critically important for establishing bonds with the significant and valued individuals in one's social environment. This social cognitive process can be defined as the capacity to enter into another's feelings and have an appropriate emotional response to another's situation. The capacity to have an empathic response supports long-term social relationships and is one of the most important abilities required for higher social functioning.

The psychological models of empathy suggest that it has both cognitive and emotional components (Davis, 1994, Rankin et al., 2005). Cognitive empathy is conceptually very similar to theory of mind (ToM). In fact, cognitive empathy can be viewed as an emotion-specific mentalizing (ToM) ability. Recent theories suggested that ToM ability consists of two components; mental state decoding (social–perceptual) and mental state reasoning (social–cognitive) (Tager-Flusberg and Sullivan, 2000, Sabbagh, 2004). Those same components may also be applicable to cognitive empathy. Social–perceptual abilities are important to interpret the emotions of others based on observable information like facial expressions or gestures. Social–cognitive ability requires integrating the contextual and historical information about a person for understanding the feelings of others. Other cognitive abilities like working memory and attention may also be required for cognitive empathy. Emotional empathy is a different construct; it is the emotional reaction and emotional concern experienced upon observing someone in distress. While the first step to have an empathic reaction with another person's feeling is to perceive or infer the other's emotion (cognitive empathy), for a true empathic response, a physiological and autonomic response is essential.

Several groups of psychiatric and neurological patients have deficits in empathic responding. Empathy deficits are among the core features of autistic disorder and Asperger disorder (Baron-Cohen and Wheelwright, 2004). Psychopathy (Blair, 2005) and frontotemporal lobar degeneration (Rankin et al., 2005) have also been associated with empathy deficits. Different components of empathic process may be dysfunctional in different disorders. While autism was associated with deficits of cognitive empathy, psychopaths seem to have intact cognitive empathy but dysfunctional emotional empathy (Blair, 2005).

Although the existence of empathy dysfunction in schizophrenia is generally accepted, there is very limited direct evidence (Lee et al., 2004, Shamay-Tsoory et al., 2007). Since deficits in social functioning are among the most disabling clinical features of schizophrenia, empathy deficits, similar to other social cognitive deficits (Brüne, 2005, Bora et al., 2006), may contribute to poor functional outcome in patients with schizophrenia. The nature of possible empathy deficits in schizophrenia should be carefully studied. Patients with schizophrenia have many deficits in different cognitive domains that may contribute to their deficits in empathic responding.

There are several psychometric instruments that are designed to measure empathy (Davis, 1983, Baron-Cohen and Wheelwright, 2004). These instruments can be self administered. One example is the self-reported Empathy Quotient (EQ). This instrument was used to assess empathy deficits in patients with Asperger syndrome or high-functioning autism (Baron-Cohen and Wheelwright, 2004). However, these instruments measure individuals' beliefs about their own empathic skills, and the ratings of people with deficits in awareness or knowledge of their cognitive abilities (meta-cognition) could be unreliable. For these reasons, several studies have measured empathy in frontotemporal dementia from caregiver ratings rather than individual ratings (Rankin et al., 2005, Lough et al., 2006). Since metacognition deficits have been reported in patients with schizophrenia (Moritz et al., 2006), caregiver ratings may be also useful in schizophrenia.

The goals of this study were as follows: (1) To compare the empathic abilities of schizophrenia patients with those of healthy subjects using a psychometric measure. Our hypothesis was that there would be deficits in the empathic abilities of patients with schizophrenia. (2) To investigate the relationship between empathy deficits and cognitive dysfunction. We hypothesized that empathy dysfunction would be associated with cognitive deficits (especially social cognition) in schizophrenia patients.

Section snippets

Participants

Thirty patients (15 males and 15 females) with schizophrenia (according to DSM-IV criteria) participated in the present study. All of the patients were recruited from the outpatient clinic of the Psychotic Disorders Unit at Ege University School of Medicine, Ýzmir, Turkey. Patients who had a previous diagnosis of schizophrenia, who had no history of acute psychotic exacerbation for at least 4 months and who attended their appointments with relatives or spouses (which is very common in Turkish

Demographic and clinical variables

None of the demographic variables of the two groups were significantly different. The clinical variables and PANSS ratings of the schizophrenia group are reported in Table 1.

Empathy dysfunction in schizophrenia (Table 1)

The patients had a significant deficit in empathy based on the assessment by their relatives. Between-group differences were highly significant and the effect size was large. However, when the subjects rated themselves, the between-group difference was relatively small (Cohen d = 0.37) and the difference did not reach

Discussion

The main findings of this study, which investigated empathic abilities in schizophrenia, were a severe empathy deficit and serious discrepancy between the self and relative assessments of the empathic skills in schizophrenia. The findings of this study also demonstrated that social cognitive dysfunction may partly explain empathic failure in individuals with schizophrenia.

Acknowledgements

Development of the MacBrain Face Stimulus Set was overseen by Nim Tottenham and supported by the John D. and Catherine T. MacArthur Foundation Research Network on Early Experience and Brain Development. Please contact Nim Tottenham at [email protected] for more information concerning the stimulus set.

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