Lack of empathy


This page is part of our page about social cognition.


"From one day to the next, the empathetic capacity has gone ..."



Decreased empathy is particularly common with traumatic brain injury, but is also reported after a stroke and after degenerative injury, e.g. Frontotemporal Degeneration (FTD) and the like.
Although each injury varies by location and in severity and complaints, there are certain areas of the brain that are particularly vulnerable to traumatic brain injury, including the frontal and temporal areas of the brain.


She: "When I'm happy or down, he doesn't respond. From one day to the next, as a result of his accident, he no longer had empathy."
He: "I am constantly failing because she gives me the feeling that she wants something from me, which I apparently fail to understand."


What is it like when your loved one from one day to the next, because of an accident in which a brain injury has occurred, no longer seems to understand your feelings, does not recognize them and does not respond empathically?

How is that for the person with brain injury involved? If the person can no longer read how the other person feels, cannot recognize the joy of fear? It turns out to be difficult, lonely for both parties and it leads to people growing apart.


Relationships under pressure

This has a huge impact on social relationships, both for the person with a brain injury and the partner, and for family and friends. It puts (partner, family, friendship) relationships under pressure. Relationships are broken or function much less. Functioning emotionally is a very large part of well-being and quality of life.



It is estimated that between 13% and 39% of people with mild to severe traumatic brain injury can have significant problems with the recognition of emotional facial expression and therefore reduced emotion recognition.


More men than women

In a research into the lack of empathy, no striking link was found between depression and emotional empathy or between fear and emotional empathy. Of the people studied, significantly more men were found to have reduced empathy than women.


Recognition of facial expression

There is a possibility that the cause of what appears to be a lack of empathy is not really such a lack, but a reduced ability to recognize a facial expression, or a disability to express themselves verbally and thereby find the right empathic words. They can all be obstacles to good communication about feelings.

In a fraction of a second, the muscle movements of eyebrows, mouth corners, lips, forehead and pinching or opening of the eyes, amount of white of the eye that is visible, etc. must be scanned.


The recognition of facial expressions is, among other things, regulated by the posterior superior temporal sulcus, a groove on the right side of the brain, behind the ear, in the temporal lobe. It allows people to decode movements in certain parts of the face, and thereby understand the feeling expression.
Read more about the other brain areas involved on our social cognition page.

So it is very important to know whether the person with a brain injury can recognize and label the emotional reactions or facial expressions of the other person. If there is something wrong with this recognition, it also requires something from the conversation partner without a brain injury to name the emotions and not just react non-verbally. That means: learn to communicate differently.


Not being able to find the right words quickly

If the person with injury has difficulty finding the right words of comfort or expressing the joy of the other, but he or she does recognize an emotion, it is important to know that of each other. Communication is more than words.

A delayed processing of information or a reduced speed of thinking can also be the cause of not being able to give a socially desirable response 'on time'.

Only when the problem is recognized, it can be discussed and a therapy can be searched for.


Damage in emotional life

Finally, people with brain injuries can have damage in the emotion-regulating brain areas and actually feel less empathy, can no longer sympathize with the other. Read more on the social cognition page about the brain areas involved.



In this publication researchers write that they have shown emotional film fragments to people with and without traumatic brain injury. They showed how the character in the film clip felt, and investigated how people felt while watching the clip. Although participants with traumatic brain injury did not have as many empathic words as answers as people of the same age without injury, they appeared to respond empathically 67% of the times.

The empathic responses of traumatic brain injury participants, however, were more than doubled if they observed the emotion of the other person more precisely and were able to identify with it, compared to misrecognized emotions (71% versus 32% respectively). In practice, that means that with extra effort, concentration and practice, profit could be gained from people with whom this specific problem is involved. However, not everyone has any energy left for this extra concentration, partly due to neurofatigue.



A Dutch study shows that disorders in social cognition can be effectively tackled by using an extensive treatment protocol that leads to improvements of social functioning in daily life.

The therapy provides both training in emotion perception and lessons for acceptable behavioral responses to the emotions of others. So people actually learn to respond more empathically.
Finally, attention is also paid to emotion regulation. That is, to control emotional states and control behavior.




Hout, R.L.L, Williamns, C., Inability to empathize following traumatic brain injury, Journal of the International Neuropsychological Society, Volume 14Volume 14, Issue 2= March 2008 , pp. 289-296



Martinez, Alex, cognitief wetenschapper en professor 'electrical and computer engineering' aan de Ohio State University.

Neumann, Dawn; Westerhof-Evers, Herma J .; Visser-Keizer, Annemarie C .; Fasotti, Luciano; Schönherr, Marleen C .; Vink, Martie ; van der Naalt, Joukje ; Spikman, Jacoba M., Bron: Journal of Head Trauma Rehabilitation , Volume 32, Number 5, September / October 2017, pp. 296-307 (12) Effectiveness of a Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo) After Traumatic Brain Injury: A Randomized Controlled Trial, Wolters Kluwer DOI:


Radice-Neumann D, Zupan B, Tomita M, Willer B. Training emotional processing in persons with brain injury. J Head Trauma Rehabil. 2009;24(5):313–323. View Full Text | PubMed | CrossRef

Srinivasan, J. D. Golomb, A. M. Martinez. A Neural Basis of Facial Action Recognition in Humans. Journal of Neuroscience, 2016; 36 (16): 4434 DOI: 10.1523/JNEUROSCI.1704-15.2016

Tsaousides et al., The Journal Of Head Trauma Rehabilitation, September/October 2017 - Volume 32 - Issue 5 - p 354–365 2018, Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury, Doi: 10.1097/HTR.0000000000000345