Relationships between alexithymia, interoception, and emotional empathy in autism spectrum disorder

Abstract

Some studies suggest that individuals with autism spectrum disorder have reduced emotional empathy while others do not. The presence of co-occurring alexithymia in autism spectrum disorder and differences in interoception have been associated with reductions in empathic ability. To fully explore the relationships between interoception, alexithymia, and emotional empathy, we collected self-report and interview data in 35 youth with autism spectrum disorder and 40 typically developing controls (ages 8–17 years). The autism spectrum disorder sample had increased alexithymia and physiological hyperarousal compared to typically developing controls, but there were no group differences in interoception or emotional empathy. Alexithymia severity correlated with higher personal distress in both groups and with lower empathic concern in the autism spectrum disorder group. Within the autism spectrum disorder group, higher incidence of reports of bodily sensation when describing emotional experience correlated with lower personal distress and lower alexithymia. In addition, although empathic concern was negatively correlated with alexithymia in the autism spectrum disorder group, across groups, the alexithymia hypothesis was supported in only the personal distress domain of emotional empathy. These results suggest emotional empathy; personal distress, in particular, is not intrinsically impaired in autism spectrum disorder. Lay abstract Empathy, the ability to understand and share the emotions of others, is a necessary skill for social functioning and can be categorized into cognitive and emotional empathy. There is evidence to suggest that individuals with autism spectrum disorder have difficulties with cognitive empathy, the ability to imagine how another person is thinking or feeling. However, it is unclear if individuals with autism spectrum disorder struggle with emotional empathy, the ability to share and feel emotions others are experiencing. Self-report and interview data were collected to explore the relationships between interoception (individuals’ self-reported awareness of sensation from their body such as thirst, heartbeat, etc.), alexithymia (an individual’s ability to describe and distinguish between their own emotions), and emotional empathy in 35 youth with autism spectrum disorder and 40 typically developing youth. Greater personal distress to others’ emotions and greater difficulty describing and recognizing self-emotions were associated with reporting fewer physical sensations in the body when experiencing emotion in the autism spectrum disorder group. The results of this study suggest that while autism spectrum disorder youth with concomitant alexithymia may experience emotional empathy differently, it should not be characterized as an absence of a capacity for emotional empathy.

Sensory Modulation in Children with Developmental Coordination Disorder Compared to Autism Spectrum Disorder and Typically Developing Children

“…Personal distress is often considered a maladaptive empathy response associated with depression, rumination, and negative self-image [ 73 , 129 ], and increased personal distress in ASD is consistent with a prior study from our group with lower sample sizes [ 73 ]. As we have already discussed the nuances of empathy in ASD in our previous paper (interactions with alexithymia and interoceptive processing being key modulators to empathy in ASD) [ 73 ], we do not expand on this finding here, only noting that our results here do not show support for cognitive or emotional empathy differences in the DCD group.…”

“…The DCD and TD groups did not differ in alexithymia; however, the ASD group scored significantly higher on alexithymia than both groups, consistent with our prior research and that of others [ 68 , 73 ]. To our knowledge, this is the first study to report that children with DCD have scores on alexithymia comparable to those of their TD peers.…”

“…Recent studies have explored a connection between sensory processing and empathy [ 23 , 73 ]. Researchers have also identified links between interoceptive abilities and empathy in typically developing [ 74 , 75 ] and autistic individuals [ 73 , 76 , 77 ], though few have examined empathy and sensory processing (exteroception).…”

“…Recent studies have explored a connection between sensory processing and empathy [ 23 , 73 ]. Researchers have also identified links between interoceptive abilities and empathy in typically developing [ 74 , 75 ] and autistic individuals [ 73 , 76 , 77 ], though few have examined empathy and sensory processing (exteroception). It has been suggested that individuals who have high sensory responsivity experience higher emotional reactivity, display more empathy, and more activation in brain regions associated with empathy (i.e., cingulate and insula) than those with lower sensory sensitivities [ 78 , 79 ]; however, Schaefer et al [ 80 ] did not find correlations with high sensory sensitivity and empathy in TD adults.…”

Alexithymia in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates, and relationship with neurocognition and empathy

“…Empathy is an important domain of social cognition that is closely associated with poor functioning and suicide in patients with schizophrenia (Smith et al, 2012; Wang et al, 2020, 2021). Specifically, our findings revealed that patients with alexithymia experienced greater difficulty in understanding the thoughts and emotions of others, consistent with previous research conducted in community samples as well as individuals with depression or autism (Banzhaf et al, 2018; Brett & Maybery, 2022; Butera et al, 2023; Yang et al, 2020). These results align with the theory that accurate identification of one's own emotions is vital for perceiving and comprehending the emotions of others (Di Tella et al, 2020).…”