Shalev Ido, Shamay-Tsoory Simone G, Montag Christiane, Assaf Michal, Smith Matthew J, Eran Alal, Uzefovsky Florina
Psychology Department, Ben-Gurion University, Beer-Sheba, Israel.
Department of Psychology, University of Haifa, Haifa, Israel.
J Psychiatr Res. 2025 Jan;181:253-261. doi: 10.1016/j.jpsychires.2024.11.045. Epub 2024 Nov 26.
Schizophrenia involves substantial social difficulties, yet their nature remains unclear. Although empathy has been considered a promising social cognition construct, inconsistent findings have undermined its usefulness as a stable index for schizophrenia. This may be because previous studies overlooked the interdependency between the emotional and cognitive components of empathy. In this study, we investigated whether empathic disequilibrium, the intrapersonal imbalance between emotional and cognitive empathy, could be a meaningful schizophrenia marker. We conducted an individual-participant data meta-analysis, systematically searching the literature for studies involving participants with schizophrenia who completed the Interpersonal Reactivity Index, a validated empathy measure. Using emotional and cognitive empathy to capture empathic disequilibrium and the joint effect of cognitive and emotional empathy, we employed polynomial regression with response surface analysis to predict schizophrenia diagnosis and symptoms. Our analysis comprising ten studies (N = 1,080), revealed a non-linear association with the joint effect of cognitive and emotional empathy, as well as an association with empathic disequilibrium, suggesting emotional empathy overabundance, strongly and consistently predicted schizophrenia diagnosis. Additionally, empathic disequilibrium towards cognitive empathy overabundance was related to greater positive symptoms. The results suggest that empathic disequilibrium provides a stable behavioral marker related to schizophrenia, surpassing the utility of empathy alone. The findings deepen our understanding of schizophrenia phenomenology and can advance clinical and research practices.
精神分裂症涉及严重的社交困难，但其本质仍不清楚。尽管共情被认为是一个很有前景的社会认知结构，但研究结果的不一致削弱了其作为精神分裂症稳定指标的效用。这可能是因为先前的研究忽视了共情的情感和认知成分之间的相互依存关系。在本研究中，我们调查了共情失衡，即情感共情和认知共情之间的个体内部失衡，是否可能是一个有意义的精神分裂症标志物。我们进行了一项个体参与者数据荟萃分析，系统地在文献中搜索涉及完成人际反应指数（一种经过验证的共情测量方法）的精神分裂症患者的研究。利用情感共情和认知共情来捕捉共情失衡以及认知共情和情感共情的联合效应，我们采用多项式回归和反应表面分析来预测精神分裂症的诊断和症状。我们对十项研究（N = 1080）的分析显示，与认知共情和情感共情的联合效应存在非线性关联，以及与共情失衡存在关联，这表明情感共情过度强烈且一致地预测了精神分裂症的诊断。此外，对认知共情过度的共情失衡与更严重的阳性症状有关。结果表明，共情失衡提供了一个与精神分裂症相关的稳定行为标志物，超越了单纯共情的效用。这些发现加深了我们对精神分裂症现象学的理解，并可以推动临床和研究实践。
