Increased affective empathy in bipolar patients during a manic episode

Abstract

Objective: To assess both cognitive and affective empathy in patients with bipolar disorder (BD) during an acute manic or depressive episode. Methods: The study included 25 patients with BD (aged 35614 years) during an acute manic episode, 25 bipolar patients (aged 41614 years) during a depressive episode, and 25 healthy control subjects (aged 36611 years). Cognitive and affective empathy were assessed using the Multifaceted Empathy Test. Results: In both manic and depressive patients, a significant deficit in cognitive empathy was demonstrated. However, indices of affective empathy were significantly higher in the manic group than in depressed and control subjects. In the depressed patients, indices did not differ from those of healthy controls. For affective empathy, a significant positive correlation was found with intensity of manic symptoms and a negative correlation was found with intensity of depressive symptoms. No such correlations were observed with cognitive empathy. Conclusion: We found evidence of increased affective empathy (overempathizing) during a manic episode in bipolar patients. This phenomenon may be connected with disturbances in emotion inhibition related to anastrophic thinking and associated with increased activity of mirror neurons, all of which occur during a manic episode.

Mentalization deficit in bipolar patients during an acute depressive and manic episode: association with cognitive functions

“…This may be connected with the fact that manic patients perceive social stimuli from strangers as more positive and directed at them and not as random behavior (Piff et al 2012 ). Increased perception of intentionality in manic patients could also correspond with the increased affective empathy (overempathising) we reported in bipolar patients during a manic episode (Bodnar and Rybakowski 2017 ).…”

The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms

“…Moreover, empirical studies using the Interpersonal Reactive Index [IRI; (139)], i.e., a self-report questionnaire evaluating empathy, or the Multifaceted Empathy Test [MET; (203)] reported that manic and depressive episodes are associated with deficits in the cognitive processes of empathy (204)(205)(206). In contrast, manic BD patients had higher affective empathy than depressives and controls (204)(205)(206). This effect was interpreted as reflecting excessive affective empathic reactions due to disturbances in emotion inhibition and persistence of positive emotions (207).…”

“…This effect was interpreted as reflecting excessive affective empathic reactions due to disturbances in emotion inhibition and persistence of positive emotions (207). This way of perceiving social stimuli as more positive than these really are leads patients to the conviction to fully understand other individuals (206).…”

Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study

“…If these findings are replicated, TMS‐measured putative MNS‐activity could potentially be used as a neuromarker to differentiate clinical states of mania from schizophrenia. Whether this excessive putative MNS‐activity is related to the earlier described heightened affective empathy in bipolar disorder patients remains to be examined. More importantly, the findings of an exaggerated MNS response in mania add incrementally to the MNS dysfunction model of psychosis which suggests an inherent MNS deficit underlying the persistent negative and cognitive symptoms and a pathological excessive MNS‐activity supporting the phasic affective and catatonic symptoms.…”

“…In fact, it has been proposed that a loss of this prefrontal inhibitory control over the MNS may result in abnormal hyper‐imitative or hyper‐empathetic behaviors. While there is limited empirical data to support the presence of these behaviors in mania, given the shared biological mechanisms (frontal disinhibition), it is possible that these behaviors are relevant to the expression of manic symptoms like increased goal‐directed activities, social disinhibition, and overfamiliarity.…”