Cited by 497Action Observation and SynchronizationEmpathy and Medical EducationPsychopathy, Forensic Psychiatry, Sexual Offending

The DOI matches its Crossref record; 184 of the 188 references it cites were found in a registry or an index; none of the 145 sources its claims cite is checked for support yet.

The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions

Open access
Decety, Jean, Moriguchi, Yoshiya·2007·BioPsychoSocial Medicine

Abstract

Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

The paper proposes a multidimensional model of empathy involving bottom-up affective sharing and top-down self-awareness, mental flexibility, and emotion regulation, and applies it to psychiatric conditions with empathy deficits. It argues that empathy disorders reflect selective disruption of these dissociable components and that future clinical work must combine behavioral, dispositional, and biological levels.

Key findings

  • Empathy is framed as four interacting macro-components: affective sharing, self/other awareness, mental flexibility/perspective taking, and emotion regulation; these rely on parallel and distributed neural systems including the anterior insula, anterior cingulate cortex, prefrontal cortex, inferior parietal cortex, and temporo-parietal junction.
  • The model predicts different empathy dysfunctions: psychopathy/antisocial personality disorder is linked more to disrupted affective processing and amygdala dysfunction with intact theory of mind; borderline personality disorder to limbic hyperreactivity and prefrontal hypofunction; autistic spectrum disorders to possible deficits in both motor/affective resonance and meta-cognitive self-regulation; and alexithymia to deficits in perspective taking and regulatory processes.
  • Cited meta-analytic evidence includes Decety and Lamm’s quantitative meta-analysis of 70 functional neuroimaging studies, which found substantial overlap in brain activation between low-level processes such as reorienting attention or sense of agency and higher-level social-cognitive abilities such as empathy or theory of mind.
  • A cited meta-analysis of 39 studies yielding 4,589 participants found a robust and statistically significant relation between executive functions and antisocial behavior.
  • Neuroimaging of pain empathy shows shared activation in the anterior cingulate cortex and anterior insula for self and other pain, but also non-overlapping regions for self versus other, supporting both shared representations and self-other distinction.

Methods

  • Narrative/theoretical review integrating social psychology, cognitive neuroscience, and clinical neuropsychology; no new primary data are reported.
  • Proposes a model of empathy with bottom-up and top-down processing and reviews selected psychiatric conditions: psychopathy/antisocial personality disorder, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia.
  • Synthesizes cited neuroimaging, lesion, TMS, electrophysiological, behavioral, and comparative studies, including two cited meta-analyses: 70 functional neuroimaging studies and 39 studies with 4,589 participants.

Limitations

  • The paper states that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional, and biological factors are combined, and that self-report measures alone are not valid.
  • The paper states that social neuroscience experiments often require intra-individual comparisons, repeated-measures designs, and small samples, limiting opportunities to study potentially important situational variables.
  • Evident from the text: this is a narrative review with a limited selection of disorders, and the authors note scarce neuroscientific evidence in narcissistic personality disorder and that the dysfunctional aspect of empathy in autistic spectrum disorders is not clear and needs clarification/replication.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1751-0759-1-22

Cites

184 of 184 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Schematic representation of the bottom-up (i.e., direct matching between perception and action), and top-down (i.e., regulation and control) information processes involved in empathy. These two levels of processing are interrelated. The lower level, which is automatically activated (unless inhibited) by perceptual input, accounts for emotion sharing which leads to the implicit recognition that others are like us. Executive functions, implemented in the prefrontal cortex, serve to regulate both cognition and emotion, notably through selective attention and self-regulation. This meta-level is continuously updated by bottom-up information, and in return controls the lower level by providing top-down input. Thus, top-down regulation, through executive functions, modulates low levels and adds flexibility, making the individual less dependent on external cues. The meta-cognitive feedback plays a crucial role in taking into account one's own mental competence in order to react (or not) to the affective states of others. However, subcortical systems do not lose their basic function, they may give up some of their autonomy in terms of the degree to which higher cortical systems can modulate their functions or regulate the emotional experience (adapted from [168–170]).
Figure 1 Schematic representation of the bottom-up (i.e., direct matching between perception and action), and top-down (i.e., regulation and control) information processes involved in empathy. These two levels of processing are interrelated. The lower level, which is automatically activated (unless inhibited) by perceptual input, accounts for emotion sharing which leads to the implicit recognition that others are like us. Executive functions, implemented in the prefrontal cortex, serve to regulate both cognition and emotion, notably through selective attention and self-regulation. This meta-level is continuously updated by bottom-up information, and in return controls the lower level by providing top-down input. Thus, top-down regulation, through executive functions, modulates low levels and adds flexibility, making the individual less dependent on external cues. The meta-cognitive feedback plays a crucial role in taking into account one's own mental competence in order to react (or not) to the affective states of others. However, subcortical systems do not lose their basic function, they may give up some of their autonomy in terms of the degree to which higher cortical systems can modulate their functions or regulate the emotional experience (adapted from [168–170]).CC BY · PubMed Central
Figure 2 When individuals attend to the pain of others (like in b), activation is detected in the anterior ACC and SMA (a, b) and anterior insula (c). Adapted from [57]. Neurophysiological research on pain points out a distinction between the sensory-discriminative aspect of pain processing and the affective-subjective one. These two aspects are underpinned by discrete yet interacting neural networks.
Figure 2 When individuals attend to the pain of others (like in b), activation is detected in the anterior ACC and SMA (a, b) and anterior insula (c). Adapted from [57]. Neurophysiological research on pain points out a distinction between the sensory-discriminative aspect of pain processing and the affective-subjective one. These two aspects are underpinned by discrete yet interacting neural networks.CC BY · PubMed Central
Figure 3 Overlap of activation between reorienting, empathy and theory of mind, projected on a partially inflated lateral view of the PALS-B12 brain atlas. The yellow to orange colors code the probability of activation, with brighter yellow indicating higher activation probability (Adapted from [83]).
Figure 3 Overlap of activation between reorienting, empathy and theory of mind, projected on a partially inflated lateral view of the PALS-B12 brain atlas. The yellow to orange colors code the probability of activation, with brighter yellow indicating higher activation probability (Adapted from [83]).CC BY · PubMed Central

Verification

Claims the paper makes

124 Not checked yet · 91 Own interpretation · 8 No basis given

Verify all 145 references — free account

Show all 114 claims

  • Probably not a substantial claim. 42
  • It may state two separate claims as one. 80
  • The quote only partly states this claim. 1
109 of 109
  • The paper relies on this without support.

    Empathic deficits constitute a primary source of the autistic syndrome.

    “Empathic deficits constitute a primary source of the autistic syndrome.”
  • The paper relies on this without support.

    Antisocial individuals lack concern for others.

    “For instance it is well documented that antisocial individuals lack concern for others.”
  • The paper relies on this without support.

    The limbic system is primarily responsible for emotion processing.

    “The limbic system, which includes the hypothalamus, the parahippocampal cortex, the amygdala, and several interconnected areas (septum, basal ganglia, nucleus accumbens, insula, retrospenial cingulate cortex and prefrontal cortex) is primarily responsible for emotion processing.”
  • The paper relies on this without support.

    In humans and other mammals, an impulse to care for offspring is almost certainly genetically hard-wired.

    “In humans and other mammals, an impulse to care for offspring is almost certainly genetically hard-wired.”
  • The paper relies on this without support.

    The anterior insula and anterior cingulate cortex are involved in affective processing in general and empathy in particular.

    “Interestingly two key regions, the anterior insula and anterior cingulate cortex (ACC), involved in affective processing in general and empathy in particular have singularly evolved in apes and humans.”
  • The paper relies on this without support.

    The expression of pain provides a crucial signal that can motivate caring behaviors in others.

    “The expression of pain provides a crucial signal, which can motivate caring behaviors in others.”
  • The paper relies on this without support.

    Pain processing has a sensory-discriminative aspect and an affective-subjective aspect that are underpinned by discrete yet interacting neural networks.

    “Neurophysiological research on pain points out a distinction between the sensory-discriminative aspect of pain processing and the affective-subjective one. These two aspects are underpinned by discrete yet interacting neural networks.”
  • The paper relies on this without support.

    The capacity to regulate one's own emotions has a clear adaptive function for social interaction, both for the individual and the species.

    “The capacity to regulate one's own emotions has a clear adaptive function for social interaction, both for the individual and the species.”
  • The paper relies on this without support.

    Without regulation, the mere activation of the perception-action mechanism, including associated autonomic and somatic responses, could lead to emotional contagion or emotional distress.

    “Indeed, without such control, the mere activation of the perception-action mechanism, including the associated autonomic and somatic responses, could lead to emotional contagion or emotional distress.”
  • The paper relies on this without support.

    Such regulation is important in modulating one's own vicarious emotion so that it is not experienced as aversive.

    “Such regulation is also important in modulating one's own vicarious emotion so that it is not experienced as aversive.”
  • The authors state this as an assumption.

    Abnormalities of brain function in areas associated with cognition, affect, emotion regulation, and impulsivity, particularly in the prefrontal cortex and the temporal lobe including the amygdala and/or hippocampus, are present in borderline personality disorder.

    “Abnormalities of brain function have been assumed in the areas associated with cognition, affect, emotion regulation, and impulsivity, particularly in the prefrontal cortex and the temporal lobe, including the amygdala and/or hippocampus.”
  • The authors state this as an assumption.

    Patients with narcissistic personality disorder might have a reduced affective neural component of empathy.

    “It is assumed that patients with NPD might have reduced affective neural component of empathy.”
  • The paper relies on this without support.

    People with narcissistic personality disorder have difficulty recognizing the needs and feelings of others.

    “People with narcissistic personality disorder (NPD) also have difficulty recognizing the needs and feelings of others, and are dismissive, contemptuous and impatient when others share or discuss their concerns or problems.”
  • The paper relies on this without support.

    Children with autistic spectrum disorders display a broad range of social communication deficits, and a lack of empathy prominently figures amongst them.

    “Children with ASD display a broad range of social communication deficits, and most scholars agree that a lack of empathy (taken in a very broad sense) prominently figures amongst them.”
  • The paper relies on this without support.

    Many psychiatric disorders are associated with deficits or even lack of empathy.

    “Many psychiatric disorders are associated with deficits or even lack of empathy.”
  • The authors state this as an assumption.

    Empathy relies on dissociable information processing components.

    “because this model assumes that empathy relies on dissociable information processing components”
  • The paper relies on this without support.

    Lack of empathy leads to profound disturbance and dysfunction in social interaction.

    “The lack of empathy leads to profound disturbance and dysfunction in social interaction, and hence is important to study in the domain of psychopathology.”
  • The paper relies on this without support.

    Self-report measures alone are not valid for assessing empathy in healthy and psychiatric populations.

    “Too often, the assessment of empathy in both healthy and psychiatric populations relies on self-report measures that alone are not valid.”
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Citations

Cites

Show all 188 references

Research works printed but not linked: 5

  1. Ickes W Empathic Accuracy 1997 New York: The Guilford Press
  2. Schulkin J Bodily Sensibility 2004 New York: Oxford University Press
  3. Hatfield E Cacioppo J Rapson R Emotional Contagion 1994 New York: Cambridge University Press
  4. Russell J Agency and its Role in Mental Development 1996 Hove: Psychology Press
  5. Decety J Human empathy The Japanese Journal of Neuropsychology 2006 22 11 33

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Metadata

Authors
Decety, J., & Moriguchi, Y.
Affiliations
National Center of Neurology and Psychiatry (JP)
Venue
BioPsychoSocial Medicine
Published
2007
Volume
1
Issue
1
Pages
22
ISSN
1751-0759 (ISSN-L)
OpenAlex
W2148026136
Cited by
497
References
188
Citations by year
2026: 14 · 2025: 19 · 2024: 25 · 2023: 29 · 2022: 39 · 2021: 34 · 2020: 80 · 2019: 22 · 2018: 27 · 2017: 28 · 2016: 21 · 2015: 29 · 2014: 32 · 2013: 22 · 2012: 22
FWCI
14.24
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BioPsychoSocial Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Science Foundation (0718480)
Topics
  • Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
empathy, empathy deficits, top-down and bottom-up processing, psychopathy, antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, autism spectrum disorder, alexithymia, mental illness

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