Empathy as a “risky strength”: A multilevel examination of empathy and risk for internalizing disorders

Abstract

Learning to respond to others’ distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements. However, this important interpersonal skill set may also, paradoxically, confer risk for depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts. The purpose of this review is to describe an empirically-grounded theoretical rationale for the hypothesis that empathic tendencies can be “risky strengths”. We propose a model in which typical development of affective and cognitive empathy can be influenced by complex interplay among intraindividual and interindividual moderators that increase risk for empathic personal distress and excessive interpersonal guilt. These intermediate states, in turn, precipitate internalizing problems that map onto empirically-derived fear/arousal and anhedonia/misery subfactors of internalizing disorders. The intraindividual moderators include a genetically-influenced propensity toward physiological hyperarousal, which is proposed to interact with genetic propensity to empathic sensitivity to contribute to neurobiological processes that underlie personal distress responses others’ pain or unhappiness. This empathic personal distress then increases risk for internalizing problems, particularly fear/arousal symptoms. Similarly, interactions between genetic propensities toward negative thinking processes and empathic sensitivity are hypothesized to contribute to excess interpersonal guilt in response to others’ distress. In turn, this interpersonal guilt increases risk for internalizing problems, especially anhedonia/misery symptoms. Interindividual moderators, such as maladaptive parenting or chronic exposure to parents’ negative affect, further interact with these genetic liabilities to amplify risk for personal distress and interpersonal guilt, as well as for consequent internalizing problems. Age-related increases in the heritability of depression, anxiety, and empathy-related constructs are consistent with developmental shifts toward greater influence of intraindividual moderators throughout childhood and adolescence, with interindividual moderators exerting their greatest influence during early childhood. Efforts to modulate neurobiological and behavioral expressions of genetic dysregulation liabilities and to promote adaptive empathic skills must thus begin early in development.

When Does Co-Rumination Facilitate Depression Contagion in Adolescent Friendships? Investigating Intrapersonal and Interpersonal Factors

“…Personal distress is a maladaptive form of empathy characterized by aversive emotional overarousal in response to the pain or discomfort of others (Davis, 1980). Proclivity to personal distress is theorized to arise from genetic vulnerability to emotion dysregulation and has been empirically linked to internalizing symptoms (see Tone & Tully, 2014 for a review). Excessively talking about problems with friends may be an especially powerful affective trigger for personal distress.…”

Effects of mineralocorticoid receptor blockade on empathy in patients with major depressive disorder

“…Empathy is traditionally thought to be a protective factor for mental health. However, Bexcessive^em-pathy has been linked to the development of internalizing disorder and interpersonal guilt has been proposed to be a maladaptive form of cognitive empathy (Tone & Tully, 2014). Interestingly, Wolkenstein et al found better performance in the BReading the Mind in the Eyes test^in depressed patients compared to controls (Wolkenstein et al, 2011).…”

“…One has to keep in mind though, that cognitive and emotional empathy are related but distinct constructs which can function independently: The ability to take another person's perspective does not predict the ability of emotional empathy (Tone & Tully, 2014). Furthermore, different neural correlates -though interacting -underlie these two empathy constructs.…”

“…Furthermore, different neural correlates -though interacting -underlie these two empathy constructs. Cognitive empathy is linked to the prefrontal cortex while emotional empathy is strongly associated with the limbic system, especially hippocampus, amygdale, and hypothalamus (Tone & Tully, 2014). Thus, the role of the MR in the context of empathy and other aspects of social cognition needs to be further investigated in different populations of health and disease.…”

Behavioural Neurology of Personality Disorders: A Bi-dimensional Model

“…A conflict might arise between internal empathy and external empathy or the emotional and cognitive components of it [205,206]. This can lead to the development of unbalanced and distorted empathy.…”