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. 2019 Mar 4:10:102.
doi: 10.3389/fpsyt.2019.00102. eCollection 2019.

Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis

Jess Kerr-Gaffney  1 , Amy Harrison  2   3 , Kate Tchanturia  1   3   4
Affiliations

Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis

Jess Kerr-Gaffney et al. Front Psychiatry. .

Abstract

Background: Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Methods: Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Results: Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). Conclusions: The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.

Keywords: anorexia nervosa; autism; eating disorders; empathy; insight; self-report.

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Figures

Figure 1
Figure 1
Systematic review search process.
Figure 2
Figure 2
Studies included in the review and meta-analyses.
Figure 3
Figure 3
Forest plot of standardized mean effect size for differences (SMD) between anorexia nervosa (AN) and healthy controls (HC) on total empathy scores. Negative effect sizes indicate lower empathy scores in the AN group. BES, Basic Empathy Scale; CI, confidence interval; EQ, empathy quotient; I7, Impulsiveness, Venturesomeness, and Empathy questionnaire; IRI, interpersonal reactivity index; SEQ, Socio-Emotional Questionnaire.
Figure 4
Figure 4
Forest plot of standardized mean effect size for differences (SMD) between anorexia nervosa (AN) and healthy controls (HC) on cognitive empathy scores. Negative effect sizes indicate lower empathy scores in the AN group. BES, Basic Empathy Scale; CI, confidence interval; EQ, empathy quotient; IRI, interpersonal reactivity index.
Figure 5
Figure 5
Forest plot of standardized mean effect size for differences (SMD) between anorexia nervosa (AN) and healthy controls (HC) on affective empathy scores. Negative effect sizes indicate lower empathy scores in the AN group. BES, Basic Empathy Scale; CI, confidence interval; EQ, empathy quotient; IRI, interpersonal reactivity index.
Figure 6
Figure 6
Funnel plot of studies included in the total empathy meta-analysis.
Figure 7
Figure 7
Funnel plot of studies included in the cognitive empathy meta-analysis.
Figure 8
Figure 8
Funnel plot of studies included in the total affective meta-analysis.
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