Examining empathy in Autism Spectrum Disorders: cognitive, subjective and physiological correlates of the perception of pain

Doctoral Thesis


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University of Cape Town

Social-communication impairments in autism spectrum disorder (ASD) are often ascribed to deficits in empathy. I argue that social-communicative deficits in ASD stem from impairments in specific aspects of empathy, rather than a general empathy impairment. Empathy is defined as the sharing of another's emotion (affective empathy), understanding others' mental states (cognitive empathy), and regulation of one's own emotional state (self-regulation). Empathy can also lead to muscle mimicry and empathic concern for another's wellbeing. I argue that empathy should be measured on multiple levels: cognitive, subjective and physiological. Particularly, measurement of autonomic regulation can contribute to characterising the empathy profile in ASD. Furthermore, confounding factors such as lack of understanding of one's own emotions, or alexithymia, must be accounted for when measuring empathy. I measured subjective trait empathy ratings in people with varying levels of autism traits (N₁ = 519 & N₂ = 98, ages 14 - 45). I also investigated the association between physiological arousal, trait empathy, and empathic concern for (1) sensory pain and (2) facial pain expressions, controlling for alexithymia (N = 98); and examined the evidence for atypical autonomic arousal at rest and during empathy-induction in individuals with ASD. Autism traits were negatively correlated with cognitive empathy and self-regulation, but were not associated with atypical affective empathy per se. However, individuals with poor self-regulation showed heightened subjective affective states, whereas alexithymic individuals showed reduced affective empathy to facial pain expressions. Regarding the autonomic regulation of empathy, there was a significant association between autonomic arousal and affect regulation: Low sympathetic arousal and concurrent high parasympathetic arousal at rest predicted smaller changes in personal distress during pain observation than did autonomic co-inhibition. However, resting state arousal did not predict absolute affective state levels or dispositional empathy, and was not associated with amount of autism traits. In conclusion, the findings do not support the hypothesis of global empathy deficits in ASD. The results suggest that interventions focusing on own-emotion identification and self-regulation skills are important, but caution against the over-hasty adoption of interventions targeting resting state autonomic arousal, which was not related to either ASD or dispositional empathy.