Empathy and symptoms dimensions of patients with obsessive-compulsive disorder

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

Introduction

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.

Methods

Participants (N = 425) from the general population reported on their empathy, emotional reactivity, autistic traits, psychopathic tendencies, and symptoms of depression and anxiety.

Results

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.

Discussion

Our findings suggest a new framework for understanding how individual variability in empathy is expressed in various psychopathologies.

Social cognition and empathy in adults with obsessive compulsive disorder: A meta-analysis

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts (obsessions) and compulsions and has been associated with psychosocial impairment. Indeed, a number of studies have highlighted impairments in both social cognitive functions and empathic skills in OCD, despite several inconsistencies. This study aimed to investigate social cognitive dysfunction and empathy deficits in patients with OCD using a meta-analytic approach. A literature search was conducted using the databases Pubmed, PsycINFO, ProQuest and Scopus to identify the relevant studies (January 1980 to March 2020). Following the systematic review of relevant OCD studies, a random-effects meta-analysis was conducted. The current meta-analysis included 25 studies consisting of 1161 patients with OCD and 1329 healthy controls. OCD was associated with decreased performance in theory of mind (ToM). In the facial emotion recognition domain, patients with OCD significantly underperformed healthy controls only in their recognition of disgust. OCD was significantly related to reduced cognitive empathy. OCD was associated with medium-sized impairments in ToM and cognitive empathy, which can likely contribute to psychosocial impairment in this disorder. Further studies are needed to investigate state and trait-related factors using experimental measures of empathy.

Empathy, compassion, and theory of mind in obsessive-compulsive disorder

OBJECTIVES

Individuals with obsessive-compulsive disorder (OCD) often suffer from impairments in social functioning. This study investigates differences in empathy, compassion, and Theory of Mind (ToM) in individuals with OCD as a possible cause for social functioning deficits.

DESIGN

Sixty-four individuals diagnosed with OCD and 62 healthy individuals completed a naturalistic behavioural task (EmpaToM) and a self-report measure (Interpersonal Reactivity Index, IRI).

METHODS

Three preregistered repeated measures analyses of variance (ANOVAs).

RESULTS

People with OCD exhibited higher empathy levels - namely increased sharing of others' suffering - in the EmpaToM task and reported more distress (IRI) compared with healthy individuals. Furthermore, no differences in compassion (EmpaToM) between both groups emerged, although people with OCD reported more concern for others (IRI) compared with healthy individuals. Concerning the ToM, no group differences were detected, neither in the behavioural task, nor self-report.

CONCLUSION

By investigating OCD with diverse scientific practices we shed light on the higher levels of empathy exhibited by individuals with OCD, which are relevant for clinical practice and our understanding of OCD symptomatology.

PRACTITIONER POINTS

●People with obsessive-compulsive disorder show higher levels of empathy, that is the increased sharing of others' suffering, compared with healthy individuals in both a traditional self-report and a naturalistic task. ●Regarding compassion, that is caring for others, their self-reported compassion was higher in people with OCD. ●In Theory of Mind, that is cognitively understanding the situation of another person, no differences have been found neither at self-report nor in a naturalistic task compared with healthy individuals. ●Independent of traditional interventions, it could prove useful to improve emotion regulation skills so people with OCD learn to cope with empathic distress. Furthermore, it might strengthen the treatment gains and lower dropout rates if the social mind and consequently social relationships become a topic in the treatment and prevention of OCD.

Direct Gaze Holds Attention, but Not in Individuals with Obsessive-Compulsive Disorder

The attentional response to eye-gaze stimuli is still largely unexplored in individuals with obsessive-compulsive disorder (OCD). Here, we focused on an attentional phenomenon according to which a direct-gaze face can hold attention in a perceiver. Individuals with OCD and a group of matched healthy controls were asked to discriminate, through a speeded manual response, a peripheral target. Meanwhile, a task-irrelevant face displaying either direct gaze (in the eye-contact condition) or averted gaze (in the no-eye-contact condition) was also presented at the centre of the screen. Overall, the latencies were slower for faces with direct gaze than for faces with averted gaze; however, this difference was reliable in the healthy control group but not in the OCD group. This suggests the presence of an unusual attentional response to direct gaze in this clinical population.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.

Excessive Object Attachment in Hoarding Disorder: Examining the Role of Interpersonal Functioning

Excessive attachment towards possessions can be maladaptive because it can lead individuals to excessively acquire and save objects. Little is known about how attachment to objects develops and changes over time; however, interpersonal factors have been theorized to play a role. The current study examined whether interpersonal factors, specifically interpersonal attachment style and empathy, moderate changes in object attachment over time. A total of 145 participants with excessive acquiring and discarding difficulties rated their level of attachment to a novel object just after receiving it, and 1 week later. Participants also completed measures of interpersonal anxious attachment and interpersonal functioning. We found that changes in object attachment over time were moderated by interpersonal anxious attachment. Also, our findings suggested that individuals with hoarding problems are likely not impaired in their ability to empathize with others, but rather have difficulty displaying empathy in tense social situations and also have more empathy for fictional characters. Further, greater discomfort in tense social situations and greater empathy for fictional characters interacted to predict greater object attachment. Taken together, these findings indicate that individuals with an interpersonal anxious attachment style may be those at risk of forming greater attachments to objects over time. A learning history that includes inconsistent support from caregivers may result in individuals experiencing more empathy for fictional characters and discomfort in tense social situations, which may produce a vulnerability for becoming excessively attached to objects. Our results are in line with theories of hoarding which propose that individuals use objects to compensate for unmet interpersonal needs and suggest that treatment may need to target interpersonal functioning to reduce hoarding symptoms.

Affective empathy and prosocial behavior in rodents

Empathy is an essential function for humans as social animals. Emotional contagion, the basic form of afffective empathy, comprises the cognitive process of perceiving and sharing the affective state of others. The observational fear assay, an animal model of emotional contagion, has enabled researchers to undertake molecular, cellular, and circuit mechanism of this behavior. Such studies have revealed that observational fear is mediated through neural circuits involved in processing the affective dimension of direct pain experiences. A mouse can also respond to milder social stimuli induced by either positive or negative emotional changes in another mouse, which seems not dependent on the affective pain circuits. Further studies should explore how different neural circuits contribute to integrating different dimensions of affective empathy.

Investigating associations between hoarding symptoms and affective and cognitive empathy

OBJECTIVES

Hoarding is associated with poor interpersonal functioning, such as social isolation and difficulties in forming relationships, but the reasons for these social problems are not well understood. Previous studies have identified empathy as an important precursor to social functioning, particularly for clinical disorders characterized by social deficits. The aim of the current study was therefore to investigate associations between measures of cognitive and emotional empathy and hoarding symptoms.

METHOD

A total of 278 participants recruited via MTurk completed online self-report questionnaires on hoarding, empathy (including cognitive and affective components), and depression. All participants subsequently completed The Awareness of Social Inference Test-Short version (TASIT-S), a behavioural measure of theory of mind, a concept used interchangeably with cognitive empathy.

RESULTS

Hoarding symptoms were associated with greater self-reported emotional empathy, specifically emotional contagion, and less self-reported cognitive empathy. Emotional empathy predicted hoarding even after controlling for depression symptoms. Hoarding symptoms were also associated with poorer performance on the TASIT-S with respect to both emotion recognition and theory of mind, with theory of mind remaining a unique predictor of hoarding symptoms after controlling for depression. Participants who reported clinically significant hoarding symptoms were impaired in emotion recognition and theory of mind according to TASIT-S norms.

CONCLUSIONS

Hoarding symptoms are associated with increased emotional contagion and decreased cognitive empathy. Empathy may be an avenue for understanding and treating interpersonal difficulties in hoarding disorder.

PRACTITIONER POINTS

As hoarding increased, self-reported emotional contagion increased As hoarding increased, self-reported and behavioural cognitive empathy decreased Self-reported emotional empathy and behavioural cognitive empathy predicted hoarding even after controlling for depression Empathy may be an avenue for understanding social difficulties in hoarding disorder.

Alexithymia Is a Key Mediator of the Relationship Between Magical Thinking and Empathy

Thought action fusion (TAF), whereby internal thoughts are perceived to exert equivalent effects to external actions, is a form of magical thinking. Psychiatric disorders associated with TAF (e.g. schizophrenia; obsessive compulsive disorder) can feature atypical social cognition. We explored relationships between TAF and empathy in 273 healthy young adults. TAF was directly correlated with higher personal distress, but not perspective taking, fantasy or empathic concern. TAF moral (the belief that thinking about an action/behaviour is morally equivalent to actually performing that behaviour) was predicted by emotion contagion, alexithymia and need for closure. TAF likelihood (the belief that simply having a thought about an event makes that event more likely to occur) was predicted by personal distress, sense of agency and alexithymia. Both cognitive (TAF and negative sense of agency) and emotional (emotion contagion, alexithymia) factors contributed to personal distress. TAF, negative sense of agency and personal distress mediated the effect of emotion contagion on alexithymia. Our findings reveal complex relationships between emotional processes and TAF, shedding further light on the social cognitive profile of disorders associated with magical thinking. Furthermore, they emphasise the potential importance of alexithymia and emotion contagion as mediators or potential risk factors in the development of psychiatric symptoms linked to TAF, such as intrusive thoughts about harm to others.

Empathic disequilibrium in two different measures of empathy predicts autism traits in neurotypical population

Background

Features of autism spectrum conditions (ASC) are normally distributed within the population, giving rise to the notion of the autism spectrum. One of the hallmark features of ASC is difficulties in social communication, which relies heavily on our ability to empathize with others. Empathy comprises of both cognitive (CE) and emotional (EE) components that, together, allow us to understand another’s emotions and be affected by them appropriately, while maintaining a self-other distinction. Although CE and EE depend on distinct neural and developmental trajectories, it was suggested that the two empathic capacities can influence, balance, and regulate each other. Previous findings regarding the role of emotional and cognitive empathy in ASC have been mixed. Therefore, our study aimed to investigate whether the intra-personal empathy imbalance between the cognitive and emotional components, a measure we termed empathic disequilibrium (ED), can be associated with autism traits at the neurotypical range.

Methods

Participants were 671 young-adults at the neurotypical range who self-reported their empathy, assessed using two highly validated questionnaires—the Interpersonal Reactivity Index and the Empathy Quotient, autism traits using the Autism-Spectrum Quotient, and the related traits, alexithymia, and systemizing.

Results

Controlling for the total empathy score, greater ED was found to be positively correlated with autism traits. Specifically, autism traits were found to be elevated in groups of individuals with relatively higher EE than CE, underscoring their imbalance.

Conclusions

Our study offers a novel perspective on the understanding of the social difficulties associated with autism tendencies in the general population and has potentially important clinical implications for understanding of ASC. We also propose a novel characterization of autism tendencies based on the imbalance between EE and CE, which we term ED, as opposed to examining EE and CE separately.

Development and psychometric evaluation of the Hospital Nurse Interpersonal Empathy Questionnaire

Objective

This study aimed to develop the Hospital Nurse Interpersonal Empathy Questionnaire (HNIEQ) and evaluate its psychometric properties.

Methods

The primary version of HNIEQ was deductively developed through reviewing the literature, and then, its face and content validity were assessed. For construct validity assessment, 250 hospital nurses were randomly selected from hospitals of Kashan, Iran. Their data were used for exploratory factor analysis. Internal consistency was assessed through Cronbach’s α coefficient and questionnaire stability was assessed through test-retest intraclass correlation coefficient. Ceiling and floor effects were also assessed. Data analysis was done via the SPSS program (v. 16.0).

Results

The final version of HNIEQ contained 45 items. Exploratory factor analysis revealed a six-factor structure (empathetic and ethical attention, perspective adoption, emotional affectability, altruism, emotion identification and responsivity, and reflection forecasting) for the questionnaire which explained 52.7% of the total variance of its total score. The Cronbach’s α coefficient and the intraclass correlation coefficient of HNIEQ were 0.953 and 0.972, respectively.

Conclusion

HNIEQ is a valid and reliable instrument for empathy assessment among nurses.

The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms

Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.

Social Cognition and Obsessive-Compulsive Disorder: A Review of Subdomains of Social Functioning

Disturbances in social cognitive processes such as the ability to infer others' mental states importantly contribute to social and functional impairments in psychiatric disorders. Yet, despite established social, emotional, and cognitive problems, the role of social cognition in obsessive-compulsive disorder is largely overlooked. The current review provides a first comprehensive overview of social (neuro)cognitive disturbances in adult patients with obsessive-compulsive disorder. Results of our review indicate various social cognitive alterations. Patients with obsessive-compulsive disorder show deficits in the recognition of affective social cues, specifically facial expressions of disgust, and more general deficits in theory of mind/mentalizing. Additionally, patients show heightened affective reactions and altered neural responding to emotions of self and others, as well as poor emotion regulation skills, which may contribute to poor social functioning of patients. However, the discrepancies in findings and scarcity of studies make it difficult to draw firm conclusions with regard to the specificity of social cognitive disturbances. The review offers directions for future research and highlights the need to investigate obsessive-compulsive disorder from an interactive social neurocognitive perspective in addition to the prevalent passive spectator perspective to advance our understanding of this intricate and burdensome disorder.

Empathy, compassion fatigue, guilt and secondary traumatic stress in nurses

Background:

Nurses are often faced with many stressful situations in life, including personal life challenges, the nature of work that requires standing long and being focused, commitment to patient care, and dealing with patients who need help.

Research objective:

The aim of this study was to investigate the relationship between empathy and compassion fatigue in nurses due to the mediating role of feeling guilty and secondary traumatic stress.

Research design:

This is a descriptive-correlation study.

Participants:

The statistical population consisted of all the nurses in Kerman hospitals in 2017. Five hospitals were randomly selected from among the private and public hospitals in Kerman. The sample size was considered 360, but after the deletion of misleading questionnaires, the final sample of study consisted of 300 nurses.

Ethical considerations:

Approval from the researcher’s university Institutional Review Board for ethical review was obtained.

Findings:

The data analysis in this study was done through the path analysis method using the Amos software. The results showed the mediating role of omnipotent guilt between empathy and compassion fatigue in the nurses, the mediating role of survivor guilt between empathy and compassion fatigue in the nurses, and the mediating role of secondary traumatic stress between empathy and compassion fatigue in the nurses. Also, empathy could explain 77% of the nurses’ compassion fatigue through feelings of guilt and secondary traumatic stress.

Discussion:

Pathogenic empathy-based guilt and secondary traumatic stress may help explain some of the links between clinical empathy and symptoms of compassion fatigue.

Conclusion:

Interventions and training programs targeting pathogenic empathy-based guilt and empathic secondary traumatic stress may be particularly important to help reduce compassion fatigue.

Emotional Processing and Personality as Predictors of Obsessive-compulsive Symptoms in College Students

The categorical definition of obsessive-compulsive disorder, and exclusive focus on thoughts and behaviors, have constrained the study and treatment of its symptoms. The present study's aim was to search for relationships among emotional processing dimensions, five major personality dimensions, and self-perceived obsessive-compulsive symptoms. The participants were 100 college students, and the questionnaires used were a selection of images from the International Affective Picture System (IAPS), the Self-assessment Manikin (SAM), the Dimensional Obsessive-Compulsive Scale (DOCS), and the NEO-FFI. We found differences in emotional processing dimensions between participants with high and low DOCS scores, grouped according to sex (d = .56); and evidence that the neuroticism and agreeableness dimensions predict self-perceived obsessive-compulsive symptoms. Emotional processing dimensions and personality are considered useful to comprehending obsessive-compulsive symptoms, which lends support to dimensional models of OC symptomatology, as well as planning and developing psychological interventions.

Exploring the Neural Correlates in Adopting a Realistic View: A Neural Structural and Functional Connectivity Study With Female Nurses

Empathizing leads to positive and negative consequences. To avoid empathy-induced distress, adopting a realistic view (dealing with a situation practically and efficiently independent of one's emotional state) is important. We hypothesized that empathy-demanding professions (e.g., nursing) may require individuals to adopt a realistic view, which may demonstrate modulated neural structure and functional connectivity. We confirmed that female nurses showed a higher tendency, compared to controls, to adopt a realistic view, using the Fantasy subscale of the Interpersonal Reactivity Index (IRI; inverse scale of the realistic view). We then employed voxel-based morphometry (VBM) and resting-state functional magnetic resonance imaging (rs-fMRI) to explore the neural underpinnings related to realistic view adoption. Nurses exhibited significantly lower gray-matter volume (GMV) in the right striatum. In multiple regression analysis, only the Fantasy subscale score showed a significant positive correlation with GMV within the striatum cluster. Moreover, nurses exhibited lower functional connectivity between the right striatum and the right lateral prefrontal cortex (PFC), representing emotional regulation. These findings show that structural differences in the striatum correlated with the realistic view. Furthermore, lower functional connectivity between the striatum and lateral PFC suggests that nurses may use efficient coping strategies that may lessen the recruitment of effortful emotional regulation.

A bidimensional measure of empathy: Empathic Experience Scale

Empathy is a key notion in the study of sociality. A phenomenological perspective on empathy as intersubjective understanding offers a common ground for multiple dimensions. Corresponding to the dichotomy between perceptual and cognitive levels, two constructs can be distinguished: vicariously experiencing and intuitively understanding others’ emotions. We developed and validated a new questionnaire for the assessment of individual differences in empathy. In a first study (N = 921), we created a questionnaire measuring empathy consisting of a pool of 75 items. Exploratory factor analysis suggested to retain two factors (“Intuitive Understanding” and “Vicarious Experience”), whereas a 30-item version of the questionnaire had satisfactory psychometric properties. In a second study (N = 504), we administered the 30-items questionnaire and several concurrent/divergent measures. Confirmatory factor analysis indicated that a two-factor structure best represented its latent factor structure. The results show that our questionnaire could be considered a reliable and valid measure of empathy with internal consistencies of 0.93 and 0.95 for Vicarious Experience and Intuitive Intuitive Understanding, respectively. Whereas our questionnaire mostly showed the expected convergence with existing scales of empathy, the correlations also suggest that it adds valuable new information to the assessment of empathy. The two-factor structure suggests that the perceptual (vicarious) experience and the basic (non-effortful) cognitive awareness of others’ emotions can be assessed as distinct constructs. This bidimensional structure that distinguishes between the perceptual experience and the basic cognitive awareness of others’ emotional states connects theoretical, empirical, and clinical data from psychology and neuroscience.

Association between glutamate transporter gene polymorphisms and obsessive-compulsive disorder/trait empathy in a Korean population

Accumulating evidence suggests that the glutamatergic system plays a major role in the pathophysiology of obsessive compulsive disorder (OCD) and empathic processing. Particularly, genetic influence of glutamate transporter gene (SLC1A1) on OCD has been frequently replicated in previous studies, but several studies did not replicate the result. Therefore, we aimed to replicate the associations between the SLC1A1 and OCD in a Korean population. In addition, we investigated the influence of SLC1A1 on trait empathy, impairments in which are characteristic of OCD. Six single-nucleotide polymorphisms (SNP) of SLC1A1 were genotyped in 615 patients with OCD and 508 healthy controls. The interpersonal reactivity index (IRI)—which consists of four subscales (perspective taking, PT; fantasy seeking, FS; empathic concern, EC; personal distress, PD)—was assessed from 277 patients with OCD and 395 controls. There were no significant associations between OCD and SNPs or haplotypes of SLC1A1. Patients with OCD exhibited significantly lower PT and higher PD scores than controls. The C-T-G haplotype at rs301430-rs301434-rs3087879 of SLC1A1 was significantly associated with higher PD scores after adjusted for age, sex, and OCD status. Our results suggest that six common SNPs of SLC1A1 may not contribute to the development of OCD, but may contribute to certain aspect of trait empathy such as personal distress. However, insufficient sample size and limited number of SLC1A1 SNPs may have reduced the likelihood of detecting significant associations. Therefore, further studies with larger sample size and more tag SNPs of the SLC1A1 gene were warranted.

The Use of "Literary Fiction" to Promote Mentalizing Ability

Empathy is a multidimensional process that incorporates both mentalizing and emotional sharing dimensions. Empathic competencies are important for creating interpersonal relationships with other people and developing adequate social behaviour. The lack of these social components also leads to isolation and exclusion in healthy populations. However, few studies have investigated how to improve these social skills. In a recent study, Kidd and Castano (2013) found that reading literary fiction increases mentalizing ability and may change how people think about other people’s emotions and mental states. The aim of our study was to evaluate the effects of reading literary fiction, compared to nonfiction and science fiction, on empathic abilities. Compared to previous studies, we used a larger variety of empathy measures and utilized a pre and post-test design. In all, 214 healthy participants were randomly assigned to read a book representative of one of three literary genres (literary fiction, nonfiction, science fiction). Participants were assessed before and after the reading phase using mentalizing and emotional sharing tests, according to Zaki and Ochsner’ s (2012) model. Comparisons of sociodemographic, mentalizing, and emotional sharing variables across conditions were conducted using ANOVA. Our results showed that after the reading phase, the literary fiction group showed improvement in mentalizing abilities, but there was no discernible effect on emotional sharing abilities. Our study showed that the reading processes can promote mentalizing abilities. These results may set important goals for future low-cost rehabilitation protocols for several disorders in which the mentalizing deficit is considered central to the disease, such as Autism Spectrum Disorders and Schizophrenia.

Two systems for empathy in obsessive-compulsive disorder: mentalizing and experience sharing

Objective:

To investigate empathic abilities in patients with obsessive-compulsive disorder (OCD) compared to control subjects. OCD is characterized by persistent obsessions and compulsions. Previous studies have proposed specific emotion recognition deficits in patients with OCD. The ability to recognize emotion is part of the broad construct of empathy that incorporates mentalizing and experience-sharing dimensions.

Methods:

Twenty-four subjects with a diagnosis of OCD and 23 control subjects underwent empathic measures.

Results:

Patients with OCD compared to control subjects showed deficits in all mentalizing measures. They were incapable of understanding the mental and emotional states of other people. On the other hand, in the sharing experience measures, the OCD group was able to empathize with the emotional experience of other people when they expressed emotions with positive valence, but were not able to do when the emotional valence was negative.

Conclusion:

Our results suggest that patients with OCD show a difficulty in mentalizing ability, whereas the deficit in sharing ability is specific for the negative emotional valence.

Interpersonal reactivity differences in Tourette syndrome

Tourette syndrome (TS) frequently involves complex tics with social significance, including imitation or socially inappropriate behaviour. This study explored every-day perspective taking and empathic tendencies in 95 patients with TS and 60 healthy controls. Analyses indicated that both males and females with TS exhibited a different interpersonal reactivity profile to controls, characterised by a reduced tendency to take other people's perspectives, and elevated personal distress in response to intense emotional situations (e.g. people experiencing crises).

Inter-individual relationships in empathic traits and feedback-related fronto-central brain activity: an event-related potential study

BACKGROUND

Neuroimaging studies continue to indicate the major role the anterior cingulate cortex (ACC) plays in processing empathic responses. Error-related negativity (ERN), an event-related potential (ERP) thought to arise from the ACC, has been found to correlate with scores for individual empathic personality. This study investigated the relationship between empathic personality traits and the amplitude of feedback-related negativity (FRN), an ERP sourced from the ACC and similar to the ERN, using a task involving feedback of monetary gains or losses.

METHODS

Sixteen healthy participants answered an empathy trait questionnaire and performed a gambling task to elicit FRN. Because FRN amplitude is thought to be associated with attention, motivation, emotional state, and anxiety trait, we performed a partial correlation analysis between the empathic trait score and FRN amplitude while controlling for variables.

RESULTS

In partial correlation analysis, FRN amplitude was significantly inversely correlated with scores for personal distress and marginally correlated with scores for empathic concern and with total average score.

DISCUSSION

The study revealed for the first time an association between FRN and emotional empathic traits, after controlling for variables that can affect FRN amplitude. However, we also found a reversed directional correlation contrary to our expectations. This fronto-central brain activity may be associated with empathic properties via dopaminergic neuronal function. Future study using these electric potentials as experimental tools is expected to help elucidate the neurological mechanism of empathy.

Interaction between valence of empathy and familiarity: is it difficult to empathize with the positive events of a stranger?

BACKGROUND

Empathy in humans is thought to have evolved via social interactions caused by the formation of social groups. Considering the role of empathy within a social group, there might be a difference between emotional empathy for strangers and familiar others belonging to the same social group. In this study, we used the global field power (GFP) index to investigate empathic brain activity during observation of a cue indicating either a negative or positive image viewed by a stranger or close friend.

METHODS

Sixteen healthy participants observed a partner performing an emotional gambling task displayed on a monitor. After the partner's choice-response, a frowning or smiling face symbol was simultaneously presented to the participant's monitor while a negative or positive emotional image was presented to the partner's monitor. All participants observed a control condition (CT) showing a computer trial, a stranger-observation condition (SO) showing the trial of a stranger, and a friend-observation condition (FO) to observe the trial of a close friend. During these observations, participants' event-related potentials (ERPs) were recorded to calculate GFP, and after the task, a subjective assessment of their feelings was measured.

RESULTS

Positive emotion was significantly larger under the FO compared to the CT and the SO. Significantly larger negative emotion was found under the SO and FO compared to the CT. In response to a positive cue, significantly larger GFP during 300 to 600 ms was observed under the FO compared to the CT and SO. In response to a negative cue, significantly larger GFP was observed under the FO and SO compared to the CT. A significantly larger GFP under the SO was found in response to only a negative cue. Topographic map analysis suggested that these differences were related to frontal-occipital dynamics. GFP was significantly correlated with empathic trait.

CONCLUSION

These results revealed that familiarity with another person has different effects depending on the valence of empathy. Negative empathy, including the danger perception function, might easily occur even among strangers, whereas positive empathy related to nursing and supporting an inner group does not happen easily with strangers.

Interpersonal functioning in obsessive-compulsive personality disorder

The core symptoms of obsessive-compulsive personality disorder (OCPD) often lead to interpersonal difficulties. However, little research has explored interpersonal functioning in OCPD. This study examined interpersonal problems, interpersonal sensitivities, empathy, and systemizing, the drive to analyze and derive underlying rules for systems, in a sample of 25 OCPD individuals, 25 individuals with comorbid OCPD and obsessive-compulsive disorder (OCD), and 25 healthy controls. We found that OCPD individuals reported hostile-dominant interpersonal problems and sensitivities with warm-dominant behavior by others, whereas OCPD+OCD individuals reported submissive interpersonal problems and sensitivities with warm-submissive behavior by others. Individuals with OCPD, with and without OCD, reported less empathic perspective taking relative to healthy controls. Finally, we found that OCPD males reported a higher drive to analyze and derive rules for systems than OCPD females. Overall, results suggest that there are interpersonal deficits associated with OCPD and the clinical implications of these deficits are discussed.

Patient-reported outcomes in obsessive-compulsive disorder

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.

Can hoarding be a symptom of social anxiety disorder? A case study

BACKGROUND

Hoarding is defined as the excessive collection and failure to discard possessions of apparently little value, leading to clutter, distress, and disability. Although patients with hoarding typically may feel ludicrous for not discarding useless, and sometimes bizarre, possessions, we are not aware of any previous description of patients displaying hoarding as a result of social anxiety.

METHOD

Single case report.

RESULTS

In this article, we describe a patient with severe social anxiety disorder who displayed hoarding as a direct consequence of social anxiety-related beliefs and atypical safety behaviors.

CONCLUSIONS

This case is of particular interest to current debates concerning the status of hoarding in new versions of classificatory systems. It also indicates that social anxiety disorder should be included in the list of conditions that needs to be excluded in order to diagnose "primary" hoarding disorder.

Involuntary social cue integration in patients with obsessive compulsive disorder

OBJECTIVE

Patients with obsessive compulsive disorder (OCD) have inferior social functioning compared to healthy controls, but the exact nature of these social deficits, and the underpinning mechanisms, are unknown. We sought to investigate social functioning in patients with OCD by measuring their involuntary/spontaneous processing of social cues using a specifically designed test, which might reveal deficits in these patients that explicit voluntary tasks do not detect.

METHODS

The sample of the study consisted of an OCD group (n = 25) and a control group (n = 26). Both groups performed an adaptation of the Social Distance Judgment Task (SDJT; Jellema et al., 2009), in which participants have to judge the geometrical distance between two human cartoon figures presented on a computer screen. Head/gaze direction and body direction were manipulated to be either compatible, i.e. both directed to the left or to the right (Compatible condition) or incompatible, i.e. body directed toward the observer (frontal view) and head/gaze directed to the left or right (Incompatible condition).

RESULTS

In the Compatible condition, controls nor OCD patients were influenced by the social cues in their judgments of the geometrical distances. However, in the Incompatible condition, where the attentional cue was more conspicuous, both groups were influenced by the cues, but the controls to a significantly larger extent than the OCD patients.

CONCLUSIONS

This study showed that patients with OCD are less likely, compared to controls, to automatically/spontaneously integrate the other's direction of attention into their visual percept. This may have resulted in their judgments of the geometrical distances between the agents to be more accurate than those of controls. The suggested impairment in automatically integrating social cues may have important repercussions for the social functioning of OCD patients.

Left prefrontal activity reflects the ability of vicarious fear learning: a functional near-infrared spectroscopy study

Fear could be acquired indirectly via social observation. However, it remains unclear which cortical substrate activities are involved in vicarious fear transmission. The present study was to examine empathy-related processes during fear learning by-proxy and to examine the activation of prefrontal cortex by using functional near-infrared spectroscopy. We simultaneously measured participants' hemodynamic responses and skin conductance responses when they were exposed to a movie. In this movie, a demonstrator (i.e., another human being) was receiving a classical fear conditioning. A neutral colored square paired with shocks (CS_shock) and another colored square paired with no shocks (CS_no-shock) were randomly presented in front of the demonstrator. Results showed that increased concentration of oxygenated hemoglobin in left prefrontal cortex was observed when participants watched a demonstrator seeing CS_shock compared with that exposed to CS_no-shock. In addition, enhanced skin conductance responses showing a demonstrator's aversive experience during learning object-fear association were observed. The present study suggests that left prefrontal cortex, which may reflect speculation of others' mental state, is associated with social fear transmission.

Abnormalities of emotional awareness and perception in patients with obsessive-compulsive disorder

BACKGROUND

Emotional awareness deficit may play a critical role in the production and maintenance of obsessive-compulsive symptoms and social dysfunction in patients with obsessive-compulsive disorder (OCD). The aim of this study was to investigate characteristics of emotional awareness such as empathy and alexithymia in OCD patients. In addition, we examined whether impaired emotional awareness measured by self-assessment questionnaires was associated with emotional facial recognition ability in OCD patients.

METHODS

Study participants included 107 patients with OCD and 130 healthy age- and sex-matched volunteers. The Interpersonal Reactivity Index (IRI) and Toronto Alexithymia Scale-20 were applied as measures of empathy and alexithymia. A subset of 56 patients with OCD additionally performed the emotional perception task of face expression.

RESULTS

Patients with OCD scored significantly lower for perspective taking, and significantly higher for personal distress of IRI, and significantly higher for alexithymia compared to normal controls. Impaired emotional awareness such as lower perspective taking and fantasy seeking had a perception bias towards disgust in response to ambiguous facial expressions in OCD patients.

LIMITATIONS

The OCD group consisted of patients in different stages of the illness and with different degrees of severity.

CONCLUSIONS

OCD involves the impairment of emotional awareness and perception and it may relate to social dysfunction and to impairments in the ability to shift naturally from obsessive thoughts to other thoughts in response to social situations in patients with OCD.

Rodent empathy and affective neuroscience

In the past few years, several experimental studies have suggested that empathy occurs in the social lives of rodents. Thus, rodent behavioral models can now be developed to elucidate the mechanistic substrates of empathy at levels that have heretofore been unavailable. For example, the finding that mice from certain inbred strains express behavioral and physiological responses to conspecific distress, while others do not, underscores that the genetic underpinnings of empathy are specifiable and that they could be harnessed to develop new therapies for human psychosocial impairments. However, the advent of rodent models of empathy is met at the outset with a number of theoretical and semantic problems that are similar to those previously confronted by studies of empathy in humans. The distinct underlying components of empathy must be differentiated from one another and from lay usage of the term. The primary goal of this paper is to review a set of seminal studies that are directly relevant to developing a concept of empathy in rodents. We first consider some of the psychological phenomena that have been associated with empathy, and within this context, we consider the component processes, or endophenotypes of rodent empathy. We then review a series of recent experimental studies that demonstrate the capability of rodents to detect and respond to the affective state of their social partners. We focus primarily on experiments that examine how rodents share affective experiences of fear, but we also highlight how similar types of experimental paradigms can be utilized to evaluate the possibility that rodents share positive affective experiences. Taken together, these studies were inspired by Jaak Panksepp's theory that all mammals are capable of felt affective experiences.

Fear conditioning by-proxy: social transmission of fear during memory retrieval

After fear conditioning (e.g., by pairing a tone to a shock), memory retrieval typically leads to fear expression (e.g., freezing to the tone). Here, we examined the effect of a conditioned rat's fear memory retrieval on a naïve cage-mate's behavior to the conditioned stimulus. We show that rats exposed to a novel tone in the presence of a cage-mate previously conditioned to that same tone selectively showed increased freezing to the stimulus the next day (fear conditioning by-proxy). In addition, fear conditioning by-proxy experienced prior to pairing the tone to a mild shock increased freezing during presentation of that tone the next day. Our results suggest that, during memory retrieval, fear of a stimulus can be socially transmitted to a cage-mate. These findings may have implications for models of phobias.