Reduced Empathy Following Traumatic Brain Injury

Empathy is the ability and quality that allows humans to feel and understand what others are experiencing. It literally means “with [em-] suffering [-pathos]” as in suffering along with someone else. Empathy is not just emotionally suffering; it is also cognitively understanding what another person is going through; walking in their shoes, per se. Empathy connects people with each other and helps bind societies together.

In one recent study in the Journal of the International Neuropsychological Society the authors found that 31% of normal adults exhibited low emotional empathy scores on the Balanced Emotional Empathy Scale (BEES). This number is not particularly surprising because it represents a fairly normal distribution of empathy scores (i.e., about 2/3 of people have average to high empathy scores). What is surprising is that among patients with traumatic brain injury (TBI), 61% had low scores on the BEES, meaning they had a lower ability to empathize with others. Further, the authors did not find a relationship between how severe the TBI was and ability to empathize. They also found no relationship between empathy scores and performance on neuropsychological tests. This again, supports the finding of no relationship between TBI severity and empathy score. Further, low empathy scores in TBI patients could not be predicted by scores on measures of emotion, such as the Beck Depression Inventory.

BrainThese results are interesting on a couple of levels. It appears that TBI, regardless of severity, disrupts the normal functioning of the brain such that there is a disruption of frontal and limbic areas and circuitry that are involved in empathy. This makes sense because the frontal lobes are commonly damaged in TBI. This partially explains why many TBI patients with frontal lobe injuries appear emotionally blunted or apathetic. Many TBI patients with frontal damage also have a harder time interacting appropriately with others. Thus TBI interrupts general social cognition.

Another interpretation is that those with low empathy to begin with are more likely to experience TBIs. This means that there could be personality or other differences that lead to risky behaviors that in turn result in TBIs. The authors did exclude TBI patients under the age of 22 (when brains and emotional regulation are still developing) to help reduce the number of TBIs resulting risky behaviors. However, without having pre- and post-TBI measures of empathy, this interpretation cannot be ruled out. In any case, researchers are finding more and more evidence that even mild traumatic brain injury can have varied and lasting effects on a person.


RODGER LL. WOOD, CLAIRE WILLIAMS (2008). Inability to empathize following traumatic brain injury Journal of the International Neuropsychological Society, 14 (02) DOI: 10.1017/S1355617708080326

Jared Tanner, PhD

Jared Tanner has a Ph.D. in clinical psychology with an emphasis in neuropsychology. His interests are mainly neuroimaging and neuroanatomy. He spends his research time looking at the structure of gray and white matter in the brains of people with Alzheimer's disease and Parkinson's disease. With a focus on neuropsychology, he is also interested in how normal and abnormal brain structure relates to cognitive and behavioral functioning.
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