Insight in schizophrenia: associations with empathy

  title={Insight in schizophrenia: associations with empathy},
  author={Gerdina Hendrika Maria Pijnenborg and Joke Spikman and Bertus F. Jeronimus and Andr{\'e} Aleman},
  journal={European Archives of Psychiatry and Clinical Neuroscience},
Many people with schizophrenia (50–80 %) demonstrate impaired insight, something which has been associated with a poorer outcome. Two types of empathy can be distinguished: affective empathy via shared emotions and cognitive empathy, also referred to as Theory of Mind (ToM). ToM can be subdivided into cognitive ToM (knowledge about beliefs of other people via perspective taking) and affective ToM (knowledge about other people’s emotions via perspective taking). Recent studies show a… 

The relationship between empathy, emotion processing and clinical insight in remitted schizophrenia patients

The authors hypothesized that as patients gain insight, they experience greater depressive symptoms and that this increased personal distress may lead to deficits in empathy, and attempt to hypothesize reasons for diverse findings across these studies.

Affective empathy in schizophrenia: a meta-analysis

The relationship between clinical insight and cognitive and affective empathy in schizophrenia

Self-rated and performance-based empathy in schizophrenia: The impact of cognitive deficits

A double deficit related to empathic responding in schizophrenia is highlighted: diminished performance associated with cognitive deficits and inaccurate self-appraisal of empathic abilities.

Theory of mind correlates with clinical insight but not cognitive insight in patients with schizophrenia

Functional MRI examination of empathy for pain in people with schizophrenia reveals abnormal activation related to cognitive perspective-taking but typical activation linked to affective sharing

People with schizophrenia showed relatively intact brain activation when observing others’ pain, but showed abnormalities when asked to take the cognitive perspectives of others.

The relationship between insight and theory of mind in schizophrenia

A Meta-Analysis Taxonomizing Empathy in Schizophrenia

A longer duration of illness and younger age at clinical diagnosis enhances impairments in cognitive empathy in severe and enduring schizophrenia, and affective empathy is affected, compared to healthy controls.



Schizophrenia patients are impaired in empathic accuracy

The findings suggest that schizophrenia patients benefit less from social cues of another person when making an empathic judgement, and their empathic accuracy was less influenced by the emotional expressivity of the target.

Integration of emotional and cognitive aspects of theory of mind in schizophrenia and its relation to prefrontal neurocognitive performance

Schizophrenic patients appear to have considerable impairment in affective and cognitive ToM integration, which may be related to orbitofrontal dysfunction, in line with previous findings regarding empathy and the importance of the orbitof prefrontal area in the integration of cognition and affect.

The relationship between theory of mind and insight in psychosis: Evidence for specificity

The results suggest that medical professionals should be careful to distinguish simple recognition of their views from genuine insight, as the perspectives of unspecified “others” would likely vary more than that of medical professionals.

Theory of mind and unawareness of illness in schizophrenia: is poor insight a mentalizing deficit?

First and second order false belief tasks, the Eyes test and a battery of nonToM cognitive measures were administered and the Second order ToM tasks seems to have critical importance for the awareness of the disorder.

Insight in psychosis: relationship with neurocognition, social cognition and clinical symptoms depends on phase of illness.

Associations of insight with social cognitive and clinical symptom measures were observed, over and above a contribution of neurocognition, which supports theories that imply a role for deficient emotion recognition and mentalizing in reduced insight.

Who Cares? Revisiting Empathy in Asperger Syndrome

The data show that while the AS group scored lower on the measures of cognitive empathy and theory of mind, they were no different from controls on one affective empathy scale of the IRI (empathic concern), and scored higher than controls on the other (personal distress).

Taking the perspective of the other contributes to awareness of illness in schizophrenia.

It is predicted that a general difficulty with adopting other mental perspectives, indexed by performance deficits on theory of mind (ToM) tasks, will impair insight in schizophrenia and support the view that insight relies upon a cognitive capacity to adopt the other perspective, which, if intact, contributes to the metacognitive capacity to reflect upon "one's own" mental health.

"Theory of mind" in schizophrenia: a review of the literature.

  • M. Brüne
  • Psychology, Medicine
    Schizophrenia bulletin
  • 2005
It is still under debate how an impaired ToM in schizophrenia is associated with other aspects of cognition, how the impairment fluctuates with acuity or chronicity of the schizophrenic disorder, and how this affects the patients' use of language and social behavior.