Dissociation between affective and cognitive empathy in alcoholism: a specific deficit for the emotional dimension

Emotional impairments constitute a crucial and widely described dimension of alcoholism, but several affective abilities are still to be thoroughly explored among alcohol-dependent patients. This is particularly true for empathy, which constitutes an essential emotional competence for interpersonal relations and has been shown to be highly impaired in various psychiatric states. The present study aimed at exploring empathic abilities in alcoholism, and notably the hypothesis of a differential deficit between emotional and cognitive empathy.

Empathy abilities were evaluated among 30 recently detoxified inpatients diagnosed with alcohol dependence and 30 paired healthy controls, using highly validated questionnaires (Interpersonal Reactivity Index [J Pers Soc Psychol44:113] and Empathy Quotient [J Autism Dev Disord34:163]). Correlational analyses were performed to evaluate the links between empathy scores and psychopathological measures (i.e., depression, anxiety, interpersonal problems, and alexithymia).

When psychiatric comorbities are controlled for, alcoholism is not associated with a general empathy deficit, but rather with a dissociated pattern combining impaired emotional empathy and preserved cognitive one. Moreover, this emotional empathy deficit is not associated with depression or anxiety scores, but is negatively correlated with alexithymia and the severity of interpersonal problems.

At the theoretical level, this first observation of a specific deficit for emotional empathy in alcoholism, combined with the exact inverse pattern observed in other psychiatric populations, leads to a double-dissociation, which supports the notion that emotional and cognitive empathy are 2 distinct abilities. At the clinical level, this deficit calls for considering emotional empathy rehabilitation as a crucial concern in psychotherapy.