Empathic Accuracy in Clinical Populations

Abstract

Empathy, broadly defined as the ability to understand the other and to share others' emotions, motivates prosocial behavior and underlies successful interpersonal relations. Dysfunctions in this ability may cause fundamental difficulties in social communication. Empathy has been measured in various ways, from self-report questionnaires to laboratory objective performance tests. Empathic accuracy (EA), i.e., the ability to accurately empathize, is measured using more complex and ecological paradigms, such as asking participants to infer filmed interactions, or having people narrate personal emotional stories then assessing the correspondence between the perceiver and the target of empathy as the criteria for empathic ability. This measure is particularly useful in the study of clinical populations, where deconstructing the multifaceted concept of empathy may contribute to a more complete understanding of specific clinical profiles. This paper presents a scoping review of the literature on EA in clinical populations, and on EA and clinical traits and states in nonclinical or high-risk populations. Following an exhaustive literature search, 34 studies were found eligible to be included in this review. The largest category was studies focused on EA in people with schizophrenia (31%; 11 papers), followed by studies focused on EA in autism spectrum disorders (ASD) and autistic traits in a nonclinical population (22%; 8 papers). Studies were also found on EA and depression tendencies, psychopathy, social anxiety, behavior disorders, and personality disorders, and a few other clinical conditions. The included studies varied on research aims, designs, sample sizes, and male:female ratios. The overall synthesized results suggest that EA is reduced in schizophrenia and ASD. In other clinical populations, the number of studies was very limited. We urge researchers to further examine EA in these less-studied populations. The review reveals a general underrepresentation of female participants in studies on EA in clinical populations. We suggest that future research address understudied clinical populations, such as those diagnosed with psychopathy. Subject, target, and situational variables should also be considered, with special attention to gender differences (and similarities), the association between EA abilities and adaptive functioning, and the study of individuals with clinical conditions as targets, not just observers, in EA tasks.

Keywords: anxiety; autism; behavior disorders; depression; empathic accuracy; personality disorders; psychopathy; schizophrenia.

Figure 1

Studies search flow diagram.

Figure 2

Distribution of studies by clinical population category. Percentages refer to the percentage of papers on that population out of all papers in the current review, and colors refer to the male:female ratio. In blue, categories with overall more males than females among all participants (in all studies together). In yellow, categories with overall more females than males among all participants. The darker the color, the more pronounced the underrepresentation for females, with darker blue = 0 females, lighter blue = a ratio of more than 3:1, lightest blue = a ratio of more than 2:1, and gray = a ratio of less than 2:1. Specific male:female ratios for each category are reported under “Specific Results per Clinical Population”.