Document Type


Publication Date



Maine Medical Center, Medical Education, Maine Medical Center Research Institute

MeSH Headings

Humans, Empathy, Psychotic Disorders


Purpose/Background: There is a large amount of literature exploring how individuals with psychotic spectrum symptoms or disorders experience empathy. The findings are often presented through a deficit-oriented frame, suggesting that these individuals are impaired in their ability to experience empathy. Unfortunately, claims of empathy deficits have the potential to contribute to the already high stigma faced by this population. This review, therefore, aims to contextualize the deficit-oriented discussion based on the following three questions: how is empathy defined, what methods are being used to understand it, and to what degree does the discussion around empathy in psychosis accurately reflect findings.

Methods/Approach: I will perform a conceptual survey of the literature discussing research on empathy in psychotic spectrum disorders, including schizophrenia, first episode psychosis, affective psychosis, and individuals with attenuated psychotic symptoms. I will organize findings based on how empathy is defined, which methods are used to measure it, and what is highlighted in the paper’s discussion. Finally, I will make suggestions for future research in this area.

Results: In a preliminary survey of the literature around empathy and psychosis, the construct of empathy is relatively inconsistent; it is sometimes defined as a single item, and otherwise divided into the sub-categories of cognitive empathy, defined as “the ability to construct a working model of the emotional states of others,” and affective empathy, defined as “the ability to be sensitive to and vicariously experience the feelings of others.” Results of the single item construct typically suggest that people with psychosis have impaired empathy. However, when studies differentiate between cognitive and affective empathy, deficits are almost exclusively found within the realm of cognitive empathy. Methods used vary widely between studies, and differences in both general empathy and cognitive empathy have been identified through neurophysiological, self-report, and performative/behavioral measures. However, these measures typically do not discriminate from mental health symptoms or other aspects of social cognition, such as social anhedonia, insight, and theory of mind. The literature also focuses almost entirely on deficits in empathy, overlooking a growing body of data which suggests affective empathy is largely maintained and potentially elevated in individuals with psychosis.

Conclusions: The current presentation of findings around empathy in people who experience psychosis is problematic and misleading. By reinforcing the rhetoric that individuals with psychosis experience deficits in empathy despite both the use of imprecise measures and the growing evidence of maintained affective empathy, the field inadvertently promotes dehumanizing stigma around this population. Claims around empathy deficits have significant implications around an individual’s morals and judgement, and ill-founded claims of this nature are nothing but harmful.


2020 Costas T. Lambrew Research Retreat