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

  • canadian

    Hello,This may be true for most with frontal lobe injury but for many with other damage i.e. temporal lobe , we have more empathy. I even notice right sided injurys have more empathy. Does this study take into consideration that each injury unique? So pile it all into generalizations? What about predispositions? I wonder how they figure this without personally having this experience to draw from.
    As many have told me ” you can’t understand you don’t have tbi.”

  • Jared Tanner

    To answer your questions: No, the authors did not really consider the “uniqueness” of each TBI because as with any aggregate statistical analysis, you lose much of the individuality by talking about groups. You can go back and look at individuals later but it is difficult to understand the big picture by focusing only on individuals, as interesting and personally meaningful as that might be. So yes, the authors do “pile it all into generalizations” as is common practice in most statistical analyses. However, any one who uses statistics honestly will be the first to tell you that just because we know that 61% of a group of TBI patients had low empathy scores (39% did not), tells you nothing about the individual. The world of statistics can be cold and harsh but it’s one of the foundational methods of science.

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  • Suzanne

    I am not familiar with this study or with the BEE, but is it possible that the people who have had a TBI are not sympathetic because of their emotional state after surviving a TBI. What are the limitations they put on the people surveyed? Are these people completely healed or was there significant and un-repairable damage to some people surveyed? How does the specific severity relate to the amount of empathy?

  • meredith

    As a TBI survivor for 17 years now, I wonder if the lack of empathy we may have (my painful experience would confirm that lack) also is upon ourselves. I have had to struggle with sorrow for my difficulty in empathizing with 2 of the people I love the most (my 10yr.old son and 8 yr.old daughter whom I home school) and I battle that someone who gives so much of her life for her children can be so non-empathetic to these same children. As for the severity of my ABI, I was in a coma for 8 days and hospitalized for 4 1/2 months as I learned how to re encultrate with my, then new, personality-now it’s just who I am. My husband of 12 years and children don’t know me any different. The struggles I have we struggle with as a family.

  • Laura

    If someone has suffered a TBI and loss of empathy, is there any hope for them to regain or develop empathy through therapy? Or, once happened, must it just be accepted as a permanent condition?

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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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