People with schizophrenia have decreased cognitive empathy that contributes to poor social functioning, according to a study using a contemporary self-report model of empathy.

Past research indicates that people with schizophrenia self-report diminished cognitive empathy – the ability to understand the emotional states of others as well as distinguish between one’s own and someone else’s emotional states. Findings have been mixed for affective empathy – the vicarious sharing of emotions experienced by others that are automatically mirrored through social cues. These inconsistent findings might be attributable to the use of suboptimal assessment tools that fail to recognize empathy as a multidimensional construct, reported Tania M. Michaels and her colleagues at Northwestern University in Chicago (Psychiatry Res. 2014 [ ])

The Interpersonal Reactivity Index ( IRI), developed more than 3 decades ago, has been used in many studies. However, concerns have been raised about the compatibility of its subscales with updated models of empathy. In 2011, the Questionnaire of Cognitive and Affective Empathy ( QCAE ) was developed as a more comprehensive measure of cognitive and affective empathy.

To assess the reliability of the QCAE subscales and how they compare to the IRI, 52 people with schizophrenia and 37 healthy controls completed both self-report questionnaires.

After accounting for symptoms and neurocognitive functioning, the researchers then examined whether cognitive and affective empathy had an effect on social functioning. The results showed that people with schizophrenia had significantly lower total QCAE cognitive empathy scores than did healthy controls.

This finding primarily was driven by a significantly lower online simulation subscale score, which focused more on others’ in-the-moment emotions. A higher total cognitive empathy score significantly correlated with better social attainment. Higher online simulation correlated with better social competence and social attainment, as well as fewer disorganized symptoms.

For affective empathy, the researchers observed a variable pattern of intact and abnormal scores. According to the authors, the findings bolster support for the presence and functional significance of decreased cognitive empathy in schizophrenia.

The findings also contribute to emerging evidence that in people with schizophrenia, some processes related to affective empathy might be intact or hyperresponsive.

“Efforts to target cognitive empathy in social cognitive training programs for schizophrenia may be a useful way to enhance the generalizability of these interventions,” they concluded.

The authors declared no relevant financial conflicts.


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