Paper: "Empathic disequilibrium as a predictor
of non-suicidal self-injury in autistic and non-autistic people"
This paper was accepted in 2024, in the journal Autism in Adulthood.
The authors were Dr Rachel Moseley, Mr Ido Shalev, Dr Nicola Gregory, and Professor Florina Uzefovsky. Ido Shalev and I shared first-authorship.
You can click HERE to download a PDF of the paper in its accepted, not-yet-published form.
Why is this an important issue?
There is a common stereotype that autistic people lack empathy. This idea is very stigmatizing and harmful for autistic people: it gives the impression that they are unaffected by other people, or worse, do not care about the feelings of others. It also contradicts the lived experiences of autistic people, who say that they feel the emotions of other people strongly.
Empathy, the ability to understand and share the emotions of others, is a complicated ability. It is actually made up of two separate abilities or processes:
1. cognitive empathy is your ability to identify how someone else is feeling
2. emotional empathy (also known as affective empathy) is your ability to share the emotional states of others
These two processes work in tandem, and typically cooperate and regulate one another. But what if one of these processes is stronger than the other?
Here is a short (~10 minute) video summary. You can toggle your view by clicking the icon in the top right corner, and turn captions on and off by clicking the 'CC' button.
To give you an example, consider three hypothetical people at a party: Alex, Jamie and Charlie. They all notice that one of their friends is engaged in a conversation: it seems to be a negative one, and they can all pick up that their friend isn’t happy.
Alex has stronger emotional empathy than cognitive empathy. Alex feels the negative emotion from their friend strongly, although they might not know exactly what’s going on – they experience a strong mix of negative emotions, from upset to anxiety, which feels so intense and overwhelming, almost as if it was happening to them themselves. A person’s cognitive empathy would typically “put the brakes” on their emotional empathy: it would temper down their emotional (empathic) response, perhaps through the awareness that this situation is not happening to Alex themselves or through rationalising what is going on (being able to recognise that the friend doesn’t look that unhappy). Because Alex’s cognitive empathy is that much weaker than their emotional empathy, they cannot calm down their emotional response to their friend’s emotions.
Jamie has stronger cognitive than emotional empathy. He might have a very good understanding of what emotions his friend is feeling and how intense those emotions are, but he does not share his friend’s emotions as strongly – he’s relatively less affected by them. This could lead his response to be overly 'cognitive', for instance focusing on the logical facts of the situation, which his friend might experience as lacking emotional tone or sensitivity.
Charlie has roughly balanced levels of cognitive and emotional empathy: her cognitive and emotional empathy are equally strong. Because of her good cognitive empathy, Charlie has a good appreciation of what her friend is feeling and how intense those feelings are. Because she has that good cognitive understanding of the situation, her emotional empathic response is regulated by her cognitive empathy, and does not "run away with itself". Unlike Jamie, she is still able to respond to her friend sympathetically – she feels their emotion, but in a way that doesn’t incapacitate or overwhelm her.
Previous research has found that being autistic is associated with having relatively higher emotional than cognitive empathy, like Alex in the above example. When your emotional empathy is stronger than your cognitive empathy, you can be easily overwhelmed by the emotions of other people, since your cognitive empathy is not strong enough to effectively ‘dampen down’ your emotional response to the emotions of others.
This is a really difficult way to live, and might explain some of the mental health problems experienced by autistic people. One relevant problem might be self-injury, which often occurs when people are trying to manage overwhelming emotions. This is a common behaviour in autistic people and is associated with suicide, so it is important to understand it. It’s also extremely important that we correct the stigmatizing myth that autistic people lack empathy, and explore the possible consequences of feeling the emotions of others so strongly.
What was the purpose of this study, and what did the researchers do?
We wanted to see whether we could replicate the same pattern of empathic disequilibrium, specifically higher emotional than cognitive empathy, in autistic people. We also wanted to see whether this pattern was associated with self-injury, and whether this was because people with higher emotional empathy tend to be emotionally reactive – i.e. experience emotions strongly. This emotional reactivity, we thought, might put them at higher risk of engaging in self-injury as a way of coping with overwhelming emotions.
We conducted an online survey of 304 autistic and 289 non-autistic people. They completed questionnaires measuring cognitive and emotional empathy, emotional reactivity, and self-injury. We looked at the balance of cognitive and emotional empathy in autistic and non-autistic people. We then performed an analysis to see whether relatively higher levels of emotional than cognitive empathy could predict emotional reactivity, and through that, self-injury.
What were the results of the study?
We found that being autistic was associated with having relatively higher emotional than cognitive empathy, but not having lower empathy overall.
This state of empathic disequilibrium, where emotional empathy was stronger than cognitive empathy, was related to being more emotionally reactive, and through this, with greater incidence of self-injury in autistic people. In other words, autistic people with higher emotional empathy than cognitive empathy are more emotionally reactive, and because they are more emotionally reactive, they are more likely to have experience of self-injury.
Interestingly, these relationships seemed to work differently in non-autistic people, who might have different risk factors for self-injury. For them, having stronger cognitive than emotional empathy, the pattern showed by Jamie in the hypothetical example above, was actually associated with self-injury. It is possible that for non-autistic people, understanding other people’s emotions while not feeling much of an emotional response might have other consequences that relate to self-injury – perhaps through feeling disconnected to other people, or through impacts on relationships. This needs further investigation, but it does suggest that there are different mechanisms underpinning self-injury in autistic and non-autistic people.
What are potential weaknesses in the study?
This study measured people’s thoughts, emotions and behaviours at one point in time. This means we cannot confirm the direction of relationships between the variables in our study. Although we interpret our findings to suggest that levels of empathy increasing risk of self-injury, we cannot rule out the alternative interpretation that engaging in self-injury affected people’s levels of empathy in some way.
Our measures were not designed in autistic samples, meaning that we might not have captured all of the ways autistic people experience empathy.
Moreover, autistic people engage in self-injury for many different reasons. We focused here on self-injury which occurs as a way of regulating emotions, but empathic disequilibrium may not explain all forms of self-injury.
Our sample are not representative of all autistic people: especially, we did not include participants who would not have been able to complete the study independently. People of colour, trans autistic people and those with other non-binary gender identities were under-represented.
Thank you for reading!
How will these findings help autistic adults now or in the future?
These findings challenge the stigmatizing myth that autistic people lack empathy. They do not have lower empathy than non-autistic people: rather, they have higher emotional than cognitive empathy, whereas these two processes tend to be more equal in non-autistic people. The findings back up first-hand reports from autistic people who express how unpleasant it can be to experience other people’s emotions so strongly.
Far from being unemphatic, our findings suggest that autistic people experience other people's emotions to an extent that may be bad for their mental health. This pattern of higher emotional than cognitive empathy may be associated with negative outcomes related to emotional overwhelm and dysregulation, like self-injury. This kind of empathic disequilibrium could potentially be a factor in other problems associated with emotional overwhelm and dysregulation, like drug or alcohol use or disordered eating.
Below is a plain English summary and explanatory video.
If you found this interesting, you may like to read my other papers on self-injury:
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"A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability" (2019)
You may also want to look at resources around mental health and self-injury on the resources page, just in case there is anything helpful for you
there.