Empathy, Emotion Recognition, and Paranoia in the General Population

Abstract

BackgroundParanoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition – a very early component of empathic processing – are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia.MethodsParanoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults (n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition.ResultsParanoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia (p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear (p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition (p = 0.002). All indirect paths through emotion recognition were non-significant.DiscussionThese results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations.

Socially Distanced: An Exploratory Study of the Relationships Between Delusional Ideation and Social Imagery Under the Lens of the COVID-19 Pandemic

“…Finally, our results indicate that empathy is a predictor of delusional ideation, especially facets of empathy measured by Empathic Concern and Fantasy Scale of the IRI. It has been emphasized that imaginative perspective-taking may be in uential to both subclinical delusion-prone populations and patients with schizophrenia [53]. Additionally, the Fantasy Scale is the only subscale of the IRI that captured both paranoia and fear recognition in Beals and colleagues' sample of non-clinical participants.…”

“…Explanations for this relationship from Buck and colleagues are grounded in the idea that the Fantasy Scale closely re ects the capacity for theory of mind; the ability to recognize and understand others' mental states. One hypothesis is that ctional characters provide a safe social relationship for those suffering with delusions [53]. Another explanation proposed by Sass and Parnas acknowledges that imaginative perspective-taking may be a manifestation of a dysfunctional boundary between oneself and others.…”

The effect of psilocybin on empathy and prosocial behavior: a proposed mechanism for enduring antidepressant effects

“…Importantly, psilocybin may induce increased empathy in the context of depression. For example, in participants with treatment-resistant depression, psilocybin ingestion has been shown to increase emotional facial processing, which is positively correlated with empathy [65][66][67] . While there is limited research available on the length of effect, some evidence suggests that increased emotional empathy may persist beyond the acute effects of psilocybin.…”

Emotion regulation and delusion-proneness relate to empathetic tendencies in a transdiagnostic sample

“…A community sample was recruited for NKI-RS, meaning participants were not excluded based on physical or mental health. A Structured Clinical Interview of the DSM-IV-TR was conducted, and a total of 62 participants met or had previously met criteria for a mood or anxiety disorder (27), substance use disorder (11), post-traumatic stress disorder (1) or more than one of the previous diagnostic categories (23); but none met criteria for a psychotic or bipolar disorder. Thus 48% of this community sample met or had previously met criteria for a clinical disorder.…”

“…While mental health symptoms of anxiety and depression are more common in the general population (20), unique interpersonal difficulties have been observed for individuals living with psychosis e.g., (21,22). Across the psychosis spectrum, there is ample evidence of deficits in cognitive and affective empathy (8,(23)(24)(25). However, it remains unclear if such deficits are specifically linked to psychotic-like symptoms, or if instead the deficits can be accounted for by symptoms of anxiety and depression which tend to co-occur with psychosis (4,5,26).…”