Altered brain activity during emotional empathy in somatoform disorder

Abstract

Somatoform disorder patients suffer from impaired emotion recognition and other emotional deficits. Emotional empathy refers to the understanding and sharing of emotions of others in social contexts. It is likely that the emotional deficits of somatoform disorder patients are linked to disturbed empathic abilities; however, little is known so far about empathic deficits of somatoform patients and the underlying neural mechanisms. We used fMRI and an empathy paradigm to investigate 20 somatoform disorder patients and 20 healthy controls. The empathy paradigm contained facial pictures expressing anger, joy, disgust, and a neutral emotional state; a control condition contained unrecognizable stimuli. In addition, questionnaires testing for somatization, alexithymia, depression, empathy, and emotion recognition were applied. Behavioral results confirmed impaired emotion recognition in somatoform disorder and indicated a rather distinct pattern of empathic deficits of somatoform patients with specific difficulties in "empathic distress." In addition, somatoform patients revealed brain areas with diminished activity in the contrasts "all emotions"-"control," "anger"-"control," and "joy"-"control," whereas we did not find brain areas with altered activity in the contrasts "disgust"-"control" and "neutral"-"control." Significant clusters with less activity in somatoform patients included the bilateral parahippocampal gyrus, the left amygdala, the left postcentral gyrus, the left superior temporal gyrus, the left posterior insula, and the bilateral cerebellum. These findings indicate that disturbed emotional empathy of somatoform disorder patients is linked to impaired emotion recognition and abnormal activity of brain regions responsible for emotional evaluation, emotional memory, and emotion generation.

White matter diffusion abnormalities in patients with psychogenic non-epileptic seizures

“…These authors compared an average response to multiple types of emotional stimuli (angry, fearful, and happy) to neutral stimuli and found greater activation to emotional stimuli in the bilateral anterior STG. These and other studies (de Greck et al, 2012;Pehrs et al, 2013) suggest that STG responds differently to auditory, audiovisual, and visual-only stimuli based on the emotional content of the stimulus. Finally, our results are in agreement with the study by Ding et al (2013), who observed decreased regional structural nodal connectivity strength in STG bilaterally along with several other brain regions as well as globally decreased structural connectivity strength in PNES patients compared to controls.…”

“…There is a growing body of evidence that the STG is also involved in perception of emotions (de Greck et al, 2012;Husain et al, 2014;Pehrs et al, 2013;Robins et al, 2009). In one fMRI study increased activation in the bilateral STG was observed in response to pleasant or unpleasant sounds when compared to neutral sounds (Husain et al, 2014); HCs showed increased activation in the left STG specifically while listening to pleasant or unpleasant sounds, compared to neutral sounds.…”

Functional network connectivity of pain-related resting state networks in somatoform pain disorder: an exploratory fMRI study

“…58 Reduced insula and amygdala activity was observed during emotional empathy, indicating disturbed emotional processing. 59 However, fibromyalgia, which most closely resembles somatoform pain disorders in many aspects, displays a characteristic connectivity pattern during rest, as recently shown by Cifre and colleagues. 60 They found that functional connectivity of the anterior cingulate, insula and somatosensory regions with amygdala and basal ganglia was enhanced, whereas the interplay between somatosensory and default mode regions was reduced.…”

The alexithymic brain: the neural pathways linking alexithymia to physical disorders

“…On the other hand, recent study has shown less activity in somatoform patients in the emotional brain circuit, including the bilateral parahippocampal gyrus, the left amygdala, the left superior temporal gyrus, and the insula, during facial emotion recognition. Somatoform patients exhibited increased alexithymia scores (TAS-20) and elevated depression scores (BDI) [97]. Therefore, their neurobiological features to emotional stimuli were more similar to alexithymia.…”