Two systems for empathy in obsessive-compulsive disorder: mentalizing and experience sharing

Abstract

Objective: To investigate empathic abilities in patients with obsessive-compulsive disorder (OCD) compared to control subjects. OCD is characterized by persistent obsessions and compulsions. Previous studies have proposed specific emotion recognition deficits in patients with OCD. The ability to recognize emotion is part of the broad construct of empathy that incorporates mentalizing and experience-sharing dimensions. Methods: Twenty-four subjects with a diagnosis of OCD and 23 control subjects underwent empathic measures. Results: Patients with OCD compared to control subjects showed deficits in all mentalizing measures. They were incapable of understanding the mental and emotional states of other people. On the other hand, in the sharing experience measures, the OCD group was able to empathize with the emotional experience of other people when they expressed emotions with positive valence, but were not able to do when the emotional valence was negative. Conclusion: Our results suggest that patients with OCD show a difficulty in mentalizing ability, whereas the deficit in sharing ability is specific for the negative emotional valence.

Social Cognition and Obsessive-Compulsive Disorder: A Review of Subdomains of Social Functioning

“…Some of these studies find deficits in both affective and cognitive ToM (73,80) whereas in other studies deficits are limited to (social-)cognitive and higher-order domains (76,79). Yet other studies, however, show no clear deficits (36,47,74,77,78). The observed ToM deficits seem to depend in part on more general cognitive abilities (73,79), which is unsurprising as ToM tasks draw upon general cognitive and verbal abilities to a much greater extent than lower-level processes such as emotion recognition [see, e.g., (91)].…”

“…However, ToM deficits in OCD do not seem to be explained by more general cognitive deficits alone (73,76), highlighting the importance of investigating social cognition in the disorder as a separate construct. While most studies do not indicate a significant relation between ToM and symptom severity (47,76,78,79), level of illness insight of patients does appear to be an important moderator of ToM deficits (73,75,80). Poor insight in OCD is associated with several clinical characteristics, such as higher comorbidity rates, specifically depression and schizophrenia spectrum disorders, poorer treatment response, more severe symptoms, and longer illness duration (92,93).…”

“…Two studies in patients report lower RMET scores (73,80), although after controlling for general neurocognitive functioning, between-group differences in the study by Misir and colleagues (73) were not significant anymore. Yet, two other studies report scores similar in patients and controls (77,78).…”

“…İnanç and Altıntaş (75) observed a negative relation between symptom severity and RMET performance in patients, while Misir and colleagues (73) observed a moderate negative correlation between symptom severity and DEToMI total score. Yet, other patient studies did not demonstrate significant relations between symptom severity and ToM (47,76,78,79). There is however evidence to suggest that the extent to which patients are aware of the irrationality of their obsessions and/or compulsions, i.e., their level of insight, is related to ToM abilities (73,75,80).…”

“…In a study using different empathy measures (78), patients with OCD had lower scores than controls on the cognitive empathy subscale of the Basic Empathy Scale [BES; (107)] and on the Empathy Quotient (108), a questionnaire focusing mostly on cognitive empathy. Pino et al (78) also showed a negative relation between scores on the cognitive BES subscale and the presence of obsessions and compulsions (as assessed by the Y-BOCS). Participants in this study also performed an emotion attribution task, in which the ability to identify the emotions of other's based on short stories was assessed (109).…”