Sex and age differences in "theory of mind" across 57 countries using the English version of the "Reading the Mind in the Eyes" Test.

The "Reading the Mind in the Eyes" Test (Eyes Test) is a widely used assessment of "theory of mind." The NIMH Research Domain Criteria recommends it as one of two tests for "understanding mental states." Previous studies have demonstrated an on-average female advantage on the Eyes Test. However, it is unknown whether this female advantage exists across the lifespan and across a large number of countries. Thus, we tested sex and age differences using the English version of the Eyes Test in adolescents and adults across 57 countries. We also tested for associations with sociodemographic and cognitive/personality factors. We leveraged one discovery dataset (N = 305,726) and three validation datasets (Ns = 642; 5,284; and 1,087). The results show that: i) there is a replicable on-average female advantage in performance on the Eyes Test; ii) performance increases through adolescence and shallowly declines across adulthood; iii) the on-average female advantage is evident across the lifespan; iv) there is a significant on-average female advantage in 36 out of 57 countries; v) there is a significant on-average female advantage on translated (non-English) versions of the Eyes Test in 12 out of 16 countries, as confirmed by a systematic review; vi) D-scores, or empathizing-systemizing, predict Eyes Test performance above and beyond sex differences; and vii) the female advantage is negatively linked to "prosperity" and "autonomy," and positively linked to "collectivism," as confirmed by exploratory country-level analyses. We conclude that the on-average female advantage on the Eyes Test is observed across ages and most countries.

Empathy-related differences in the anterior cingulate functional connectivity of regular cannabis users when compared to controls.

It has been reported that cannabis consumption affects the anterior cingulate cortex (ACC), a structure with a central role in mediating the empathic response. In this study, we compared psychometric scores of empathy subscales, between a group of regular cannabis users (85, users) and a group of non-consumers (51, controls). We found that users have a greater Emotional Comprehension, a cognitive empathy trait involving the understanding of the "other" emotional state. Resting state functional MRI in a smaller sample (users = 46, controls = 34) allowed to identify greater functional connectivity (FC) of the ACC with the left somatomotor cortex (SMC), in users when compared to controls. These differences were also evident within the empathy core network, where users showed greater within network FC. The greater FC showed by the users is associated with emotional representational areas and empathy-related regions. In addition, the differences in psychometric scores suggest that users have more empathic comprehension. These findings suggest a potential association between cannabis use, a greater comprehension of the other's affective state and the functional brain organization of the users. However, further research is needed to explore such association, since many other factors may be at play.

Lower affective empathy in oral contraceptive users: a cross-sectional fMRI study.

Evidence accumulates that oral contraceptive (OC) use modulates various socio-affective behaviors, including empathic abilities. Endogenous and synthetic sex hormones, such as estrogens and progestogens, bind to receptor sites in brain regions (i.e. frontal, limbic, and cerebellar) involved in socio-affective processing. Therefore, the aim of this study was to investigate the role of OC use in empathy. In a cross-sectional functional magnetic resonance imaging study, women in different hormonal states, including OC use (n = 46) or being naturally cycling in the early follicular (fNC: n = 37) or peri-ovulatory phase (oNC: n = 28), performed a visual, sentence-based empathy task. Behaviorally, OC users had lower empathy ratings than oNC women. Congruently, whole-brain analysis revealed significantly larger task-related activation of several brain regions, including the left dorsomedial prefrontal gyrus (dmPFG), left precentral gyrus, and left temporoparietal junction in oNC compared to OC women. In OC users, the activity of the left dmPFG and precentral gyrus was negatively associated with behavioral and self-reported affective empathy. Furthermore, empathy-related region-of-interest analysis indicated negative associations of brain activation with synthetic hormone levels in OC women. Overall, this multimodal, cross-sectional investigation of empathy suggests a role of OC intake in especially affective empathy and highlights the importance of including synthetic hormone levels in OC-related analyses.

Effects of emotional valence and intensity on cognitive and affective empathy after insula lesions.

The insula plays a central role in empathy. However, the complex structure of cognitive (CE) and affective empathy (AE) deficits following insular damage is not fully understood. In the present study, patients with insular lesions (n = 20) and demographically matched healthy controls (n = 24) viewed ecologically valid videos that varied in terms of valence and emotional intensity. The videos showed a person (target) narrating a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions, they continuously rated their own affect. Mean squared error (MSE) assessed deviations between subject and target ratings. Patients differed from controls only in negative, low-intensity AE, rating their own affective state less negative than the target. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty pointing to a threshold role of the insula in online ratings of AE.

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.

Cognitive and affective perspective taking amongst adolescent offenders with variants of callous-unemotional traits.

Evidence suggests that associations between antisocial behaviour, callous-unemotional (CU) traits and cognitive empathy (e.g. perspective taking) vary depending on more fine-grained dimensions of these constructs. This study examined associations between adolescent antisocial behaviour and individual differences in cognitive and affective perspective taking ability. Based on current theory regarding distinct variants of CU traits, we further tested whether the correlates of CU traits differed amongst youth with high versus low levels of anxiety. Participants were 130 male adolescents (81 youth offenders; 49 non-offenders) aged 13-20 years, of predominantly Caucasian and Aboriginal Australian ethnicity. Perspective taking skills were indexed using performance-based testing, and self-report data was collected on CU traits and anxiety in a cross-sectional design. Offender status was associated with poorer cognitive and affective perspective taking. In addition, associations between CU traits and perspective taking skills were moderated by anxiety. Specifically, CU traits were associated with poorer skills for second-order cognitive perspective taking amongst high-anxiety youth, whereas CU traits were associated with better cognitive and affective perspective taking skills amongst low-anxiety youth. More fine-grained assessment of such factors stands to enhance understanding of, and effective intervention for, antisocial youth.

Remember walking in their shoes? The relation of self-referential source memory and emotion recognition.

Deficits in the ability to read the emotions of others have been demonstrated in mental disorders, such as dissociation and schizophrenia, which involve a distorted sense of self. This study examined whether weakened self-referential source memory, being unable to remember whether a piece of information has been processed with reference to oneself, is linked to ineffective emotion recognition. In two samples from a college and community, we quantified the participants' ability to remember the self-generated versus non-self-generated origins of sentences they had previously read or partially generated. We also measured their ability to read others' emotions accurately when viewing photos of people in affect-charged situations. Multinomial processing tree modelling was applied to obtain a measure of self-referential source memory that was not biased by non-mnemonic factors. Our first experiment with college participants revealed a positive correlation between correctly remembering the origins of sentences and accurately recognising the emotions of others. This correlation was successfully replicated in the second experiment with community participants. The current study offers evidence of a link between self-referential source memory and emotion recognition.

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.

Measuring dispositional empathy in South African children.

OBJECTIVE: Empathy is a key factor to examine in development, because of its predictive associations with both aggression and successful prosocial behaviour. However, established measures of empathy for Low-to-Middle Income Countries, including South Africa, are lacking. In children, parent-report measures are key. However, a local study examining empathy and aggression (Malcolm-Smith et al., 2015) found poor psychometric performance for a widely used parent-report measure of dispositional empathy, the Griffith Empathy Measure (GEM). We thus investigated which of two questionnaires measuring dispositional cognitive and affective empathy perform better in this context. METHOD: We contrasted internal consistency reliability of a simplified version of the GEM (SGEM; n = 160) and a parent-report version of the Questionnaire of Cognitive and Affective Empathy (QCAE; n = 440) in a low-mid socio-economic status sample. Convergence between the measures and factor structure were also assessed. RESULTS: The parent-report version of the QCAE performed well as a measure of child dispositional cognitive and affective empathy, with good reliability (overall α = 0.90 vs. SGEM α = .63), and confirmatory factor analysis supporting the two-factor structure. The SGEM's reliability and failure to correlate with QCAE indicated poor psychometric performance. CONCLUSION: This is the first psychometric evaluation of the QCAE as a parent-report measure, and our results indicate that it should prove useful for future assessments of dispositional empathy in children across a variety of contexts.

Validation of the Basic Empathy Scale in an Arabic-speaking population: The BES-Ar.

PURPOSE: The aim of this work was to test the psychometric properties of the Arabic version of the BES (Basic Empathy Scale) by establishing its factor structure, its internal consistency and construct validity in the general population. DESIGN AND METHODS: The BES was tested among 526 Tunisian adults. FINDINGS: The two-factor structure of the BES-20 was confirmed. Internal consistency and concurrent validity were very satisfactory. DISCUSSION: This scale will be useful for clinicians in various fields (mental health, psychiatry) in Arabic countries.

Does our cognitive empathy diminish with age? The moderator role of educational level.

INTRODUCTION: The literature has demonstrated how the relationship between cognitive or emotional intelligence and age exhibits an inverted-U-shape and that this decline can be mitigated by an individual's cognitive reserve (CR). Rather less is known, however, about the pattern of changes in cognitive empathy or the ability to recognize the thoughts or feelings of others. OBJECTIVES: The aim of the present study was firstly to analyze the effect of age, gender, and CR (measured through educational level), on the capacity to show cognitive empathy. Secondly, we aimed to evaluate what type of relationship-linear or quadratic-exists between age and cognitive empathy. We finally aimed to analyze the moderator role of educational level on the relationship between age and cognitive empathy. PARTICIPANTS: Totally, 902 Spanish adults aged between 18 and 79 years (M = 43.53, SD = 11.86; 57% women). MEASUREMENTS: Participants were asked to indicate their educational level (primary, high school, or college education) and their cognitive empathy was assessed using the Eyes test. RESULTS: Women scored higher than men on cognitive empathy. Participants with a college education had higher scores on cognitive empathy than those with a lower educational level. Additionally, the relationship between age and cognitive empathy fit an inverted-U-shaped curve, consistent with the data found for cognitive and emotional intelligence. Finally, the age-related decrease in cognitive empathy appeared to be mitigated by a higher educational level, but only in those individuals aged 35 years and above. Limitations and clinical implications are discussed.

Agreeableness and adolescents' cyberbullying perpetration: A longitudinal moderated mediation model of moral disengagement and empathy.

OBJECTIVE: The current study explored whether agreeableness predicted cyberbullying perpetration across 3 years and extended previous studies by exploring the mediating effect of moral disengagement and the moderating effects of empathy and gender. METHOD: The participants included 2407 adolescents from 7 middle schools in China. They were recruited to complete the Big Five Personality Inventory, Bullying Scale and Empathy Scale at Time 1, Moral Disengagement Scale at Time 1 and Time 2, and Cyberbullying Perpetration Scale at Time 1, Time 2, and Time 3. RESULTS: Agreeableness at Time 1 predicted cyberbullying perpetration at Time 3 and moral disengagement at Time 2 mediated this relationship. The relationship between moral disengagement at Time 2 and cyberbullying perpetration at Time 3 was stronger for low cognitive empathy adolescents than high cognitive empathy adolescents at Time 1. The relationship between agreeableness at Time 1 and cyberbullying perpetration adolescents at Time 3 was stronger for low affective empathy than high affective empathy adolescents at Time 1. The link between moral disengagement at Time 2 and cyberbullying perpetration at Time 3 was weaker for females than males. CONCLUSIONS: Low agreeableness adolescents are more likely to use moral disengagement, which in turn leads to more cyberbullying perpetration.

Emotional and socio-cognitive processing in young children with symptoms of anxiety.

Many children with anxiety disorders exhibit significant and persistent impairments in their social and interpersonal functioning. Two components essential for successful social interaction are empathy and theory of mind (ToM). Both constructs develop rapidly in childhood, but no study has simultaneously examined these skills in young children with emerging mental health problems, including those with symptoms of anxiety. This study investigated empathy and ToM in children with anxiety symptomatology and examined their relationship with anxiety severity. A cross-sectional study was carried out with 174 children aged 4-8 years with emerging mental health difficulties who were referred by school teachers for an assessment because of emotional, cognitive, or behavioural problems at school. Participants completed empathy and ToM tasks. Parents were interviewed and rated children's emotional and behavioural problems. Correlational analyses indicated that elevated anxiety was associated with better cognitive ToM and worse affective empathy; there were no associations between anxiety and either cognitive empathy or affective ToM. Subsequent regression analyses demonstrated that whilst enhanced cognitive ToM was explained by age and verbal IQ, anxiety symptoms uniquely predicted impaired affective empathy. These results indicate that children with symptoms of anxiety have difficulty in sharing in other people's emotions. As a result, they may find it difficult to behave in socially adequate ways in interactions with others that involve affective sharing. These findings encourage the use of early and targeted interventions that improve affective empathy development in children with anxiety symptoms.

Multisite ALLFTD study modeling progressive empathy loss from the earliest stages of behavioral variant frontotemporal dementia.

INTRODUCTION: Empathy relies on fronto-cingular and temporal networks that are selectively vulnerable in behavioral variant frontotemporal dementia (bvFTD). This study modeled when in the disease process empathy changes begin, and how they progress. METHODS: Four hundred thirty-one individuals with asymptomatic genetic FTD (n = 114), genetic and sporadic bvFTD (n = 317), and 163 asymptomatic non-carrier controls were enrolled. In sub-samples, we investigated empathy measured by the informant-based Interpersonal Reactivity Index (IRI) at each disease stage and over time (n = 91), and its correspondence to underlying atrophy (n = 51). RESULTS: Empathic concern (estimate = 4.38, 95% confidence interval [CI] = 2.79, 5.97; p < 0.001) and perspective taking (estimate = 5.64, 95% CI = 3.81, 7.48; p < 0.001) scores declined between the asymptomatic and very mild symptomatic stages regardless of pathogenic variant status. More rapid loss of empathy corresponded with subcortical atrophy. DISCUSSION: Loss of empathy is an early and progressive symptom of bvFTD that is measurable by IRI informant ratings and can be used to monitor behavior in neuropsychiatry practice and treatment trials.

Cognitive and Affective Empathy as Indirect Paths Between Heterogeneous Depression Symptoms on Default Mode and Salience Network Connectivity in Adolescents.

Depression amongst adolescents is a prevalent disorder consisting of heterogeneous emotional and functional symptoms-often involving impairments in social domains such as empathy. Cognitive and affective components of empathy as well as their associated neural networks (default mode network for cognitive empathy and salience network for affective empathy) are affected by depression. Depression commonly onsets during adolescence, a critical period for brain development underlying empathy. However, the available research in this area conceptualizes depression as a homogenous construct, and thereby miss to represent the full spectrum of symptoms. The present study aims to extend previous literature by testing whether cognitive and affective empathy indirectly account for associations between brain network connectivity and heterogeneous depression symptoms in adolescents. Heterogeneous functional and emotional symptoms of depression were measured using the child depression inventory. Our results indicate that cognitive empathy mediates the association between default mode network functional connectivity and emotional symptoms of depression. More specifically, that adolescents with a stronger positive association between the default mode network and cognitive empathy show lower emotional depression symptoms. This finding highlights the importance of cognitive empathy in the relationship between brain function and depression symptoms, which may be an important consideration for existing models of depression in adolescents.

Association Between Children's Empathy and Depression: The Moderating Role of Social Preference.

Although empathy is typically an adaptive characteristic of children, extreme empathy alone or in combination with a negative environment may contribute to a risk of depression. The present study comprehensively investigated the associations between the three constructs of empathy and depression in children, as well as the potential moderating effect of peer relationships (i.e., social preference) on this association. A total of 1223 children (mean age = 10.50 ± .93 years) completed questionnaires on empathy and depression, and social preference was nominated by their peers. Cognitive empathy and positive empathy exerted a positive quadratic effect on depression, while negative empathy had a positive linear association with depression. For children with a low social preference, all three empathy constructs were positively quadratically correlated with depression, extremely high and low empathy were associated with increased depression, and moderate empathy was associated with the lowest level of depression. For children with a high social preference, higher positive empathy was associated with lower depression.

Can a virtual learning module foster empathy in dental undergraduate students?

BACKGROUND: Empathy is an essential part of patient-centred health care, which positively benefits both patients and clinicians. There is little agreement regarding how best to design and deliver training for healthcare trainees to impart the skills and behaviours of clinical empathy. The study aimed to inform the field by sharing an educational intervention where we aimed to improve empathy amongst dental undergraduate students in Trinity College Dublin using a virtual learning module. METHODS: Adopting pre-post-repeat pre-experimental design, dental professional students completed the Jefferson Scale of Empathy (JSE) for Health Professional Students immediately prior to and after a three-week virtual programme designed to increase clinical empathy. Using a three-factor model described for the JSE in the literature, scores were evaluated for internal consistency and paired tests were performed on scores appropriate to their distributions. Seven-point Likert scales were scored to record student experience of training and technology, which are reported descriptively. RESULTS: Most of the 37 participants were female (76%) and represented dental science (N = 27) and dental hygiene roles (N = 7). Results revealed a mean JSE-HPS scale score rise from 110.0 (SD = 10.4) to 116.4 (SD = 11.1), which represented a rise of 5.8% (t (36) = 3.6, p = 0.001). The three factors associated with cognitive empathy, namely perspective-taking (T(36) = 3.931, p < 0.001; walking in the patient's shoes T(36) = 2.093, p = 0.043); and compassionate care (Z = 2.469, p = 0.014) were all found to have increased after the intervention. Students reported a positive experience of discipline-specific and generic videos as part of the module. CONCLUSION: The study demonstrated that a virtual educational module was associated with an increase in empathy amongst dental undergraduate students. The design of a blended module incorporating the Massive Open Online Course (MOOC) and virtual learning are beneficial and have a promising future.

Individual differences in brain structure and self-reported empathy in children.

Empathy refers to the understanding and sharing of others' emotions and comprises cognitive and affective components. Empathy is important for social functioning, and alterations in empathy have been demonstrated in many developmental or psychiatric disorders. While several studies have examined associations between empathy and brain structure in adults, few have investigated this relationship in children. Investigating associations between empathy and brain structure during childhood will help us to develop a deeper understanding of the neural correlates of empathy across the lifespan. A total of 125 children (66 females, mean age 10 years) underwent magnetic resonance imaging brain scans. Grey matter volume and cortical thickness from structural images were examined using the Computational Anatomy Toolbox (CAT12) within Statistical Parametric Mapping (SPM12) software. Children completed questionnaire measures of empathy (cognitive empathy, affective empathy: affective sharing, empathic concern, and empathic distress). In hypothesised region of interest analyses, individual differences in affective and cognitive empathy were related to grey matter volume in the insula and the precuneus. Although these relationships were of similar strength to those found in previous research, they did not survive correction for the total number of models computed. While no significant findings were detected between grey matter volume and empathy in exploratory whole-brain analysis, associations were found between cortical thickness and empathic concern in the right precentral gyrus. This study provides preliminary evidence that individual differences in self-reported empathy in children may be related to aspects of brain structure. Findings highlight the need for more research investigating the neurobiological correlates of empathy in children.

Altered empathy-related resting-state functional connectivity in patients with bipolar disorder.

Empathy is the ability to generate emotional responses (i.e., cognitive empathy) and to make cognitive inferences (i.e., affective empathy) to other people's emotions. Empirical evidence suggests that patients with bipolar disorder (BD) exhibit impairment in cognitive empathy, but findings on affective empathy are inconsistent. Few studies have examined the neural mechanisms of cognitive and affective empathy in patients with BD. In this study, we examined the empathy-related resting-state functional connectivity (rsFC) in BD patients. Thirty-seven patients with BD and 42 healthy controls completed the self-report Questionnaires of Cognitive and Affective Empathy (QCAE), the Yoni behavioural task, and resting-sate fMRI brain scans. Group comparison of empathic ability was conducted. The interactions between group and empathic ability on seed-based whole brain rsFC were examined. BD patients scored lower on the Online Simulation subscale of the QCAE and showed positive correlations between cognitive empathy and the rsFC of the dorsal Medial Prefrontal Cortex (dmPFC) with the lingual gyrus. The correlations between cognitive empathy and the rsFC of the temporal-parietal junction (TPJ) with the fusiform gyrus, the cerebellum and the parahippocampus were weaker in BD patients than that in healthy controls. These findings highlight the underlying neural mechanisms of empathy impairments in BD patients.

The link between cognitive and affective empathy and interpersonal emotion regulation direction and strategies.

Interpersonal emotion regulation (ER) refers to the different processes aimed at changing the emotional states of others. Some authors have speculated about the pivotal role of empathy for interpersonal ER to happen. However, the very limited empirical evidence suggests that only cognitive empathy as opposed to affective empathy may be a necessary antecedent. As previous research only considered interpersonal affect improvement and showed mixed evidence for the regulation strategies, we aimed to address this gap in the current research. To that aim, 374 adults (M = 30.3 years, 249 female) reported their tendency to engage in cognitive (perspective-taking) and affective empathy (empathic concern and personal distress) as well as their tendency to improve and worsen others' mood, and to use different regulation strategies (situation modification, attention deployment, cognitive change, and modulation of the emotional response) to change others' feelings. Results of the regression analyses showed that while affect improvement was not significantly predicted by any of the empathy variables, affect worsening was positively predicted by personal distress. Concerning the regulation strategies, while cognitive change and situation modification were positively predicted by personal distress, attention deployment was positively predicted by perspective-taking. Overall, the obtained results highlight the need to further investigate the link between empathy and ER and to carefully consider the methods selected for that purpose.