People with traumatic brain injury, who often lose empathy, can regain it with treatment

Most people can easily determine when a loved one is feeling sad or anxious. This recognition will often trigger the person to offer a comforting gesture or even have a contagious emotional reaction, causing them to also feel sad or anxious, too.

These important actions are referred to as emotion recognition and empathy, and they are fundamental to establishing human emotional connections and relationships.

But imagine waking up one morning and your loved one lost the ability to recognize and empathize with your feelings. For the last couple of decades, researchers have been showing this to be a common outcome for people who have suffered a traumatic brain injury. The inability to recognize and empathize with others’ emotions after brain injury has a resounding impact on family and friends and has sparked research leading to promising treatments.

I started studying emotion recognition and empathy in 2005, and this is exactly how the wife of my first research participant described it happened for her husband who was in a car accident and suffered a traumatic brain injury, or TBI. Once a very affectionate partner who responded to all of her emotional needs, he now failed to recognize her sadness or comfort her when she lost her father. Conversely, he was unable to feel the emotional contagion of her joy when she received recognition at work. This once very strong couple later divorced.

Crashes, blasts and falls that affect millions

Falls are a common cause of traumatic brain injury, but car and motorcycle crashes also are major causes. Andre Marcelo Santa Maria/
A TBI is when an external physical force leads to a disruption in brain function. Falls and motor vehicle accidents are the most common causes, but damage also results from many other injuries, including blast injuries that are frequently experienced by active duty military.

In 2014, almost 3 million Americans received some type of medical care or died from a TBI-related incident. Problems with attention, memory, planning, reasoning or problem solving are common. But often more troublesome are the frequent emotional and behavioral changes, such as increased anger and aggression. Emotional and behavioral changes have been linked with problems recognizing others’ emotions and an inability to share another’s feelings.

Prevalence rates of problems with emotion recognition and decreased empathy after brain injury are 39% and 60%, respectively.

This is quite concerning for people with TBI and their family members, as this impairment has been related to worse social relations after TBI.

The first step of empathy

A boy responds to a girl’s look of pain. fizkes/
It has been a longstanding theory that a person must recognize others’ emotions in order to empathize with them.

However, despite the strong theoretical rationale, scientific experiments have had trouble finding strong support for this belief, in people with and without brain injury.

When I looked at how the past studies were conducted, I saw clear design flaws. Many of the former studies assessed emotion recognition and empathy in isolation of one another. Empathy was typically measured with unrelated subjective questionnaires. So it is not too surprising little relationship was found between two unrelated tests.

For example, researchers would administer an emotion recognition test, such as pictures of facial expressions. The researchers would then give participants a questionnaire about their general empathic tendencies. But the researchers did not test how the person with TBI felt in response to the facial expressions they had to identify. For example, did they feel sad when looking at a sad person? By not gauging a person’s feelings in response to the emotional expression in the picture, researchers were not measuring a direct empathic response to another’s feelings.