Empathy as a “Risky Strength”: A Multilevel Examination of Empathy and Risk for Internalizing Disorders

Learning to respond to others\u27 distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements. However, this important interpersonal skill set may also confer risk for depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts. The purpose of this review is to describe an empirically grounded theoretical rationale for the hypothesis that empathic tendencies can be “risky strengths.” We propose a model in which typical development of affective and cognitive empathy can be influenced by complex interplay among intraindividual and interindividual moderators that increase risk for empathic personal distress and excessive interpersonal guilt. These intermediate states in turn precipitate internalizing problems that map onto empirically derived fear/arousal and anhedonia/misery subfactors of internalizing disorders. The intraindividual moderators include a genetically influenced propensity toward physiological hyperarousal, which is proposed to interact with genetic propensity to empathic sensitivity to contribute to neurobiological processes that underlie personal distress responses to others\u27 pain or unhappiness. This empathic personal distress then increases risk for internalizing problems, particularly fear/arousal symptoms. In a similar fashion, interactions between genetic propensities toward negative thinking processes and empathic sensitivity are hypothesized to contribute to excess interpersonal guilt in response to others\u27 distress. This interpersonal guilt then increases the risk for internalizing problems, especially anhedonia/misery symptoms. Interindividual moderators, such as maladaptive parenting or chronic exposure to parents\u27 negative affect, further interact with these genetic liabilities to amplify risk for personal distress and interpersonal guilt as well as for consequent internalizing problems. Age-related increases in the heritability of depression, anxiety, and empathy-related constructs are consistent with developmental shifts toward greater influence of intraindividual moderators throughout childhood and adolescence, with interindividual moderators exerting their greatest influence during early childhood. Efforts to modulate neurobiological and behavioral expressions of genetic dysregulation liabilities and to promote adaptive empathic skills must thus begin early in development

Social Cognition and Cognitive Flexibility in Bipolar Disorder

Considerable evidence indicates that acquisition and implementation of an array of social cognitive and behavioral skills are disrupted in the context of this psychiatric illness. Furthermore, numerous studies link the social deficits evident in bipolar disorder (BD) with atypical development in brain regions implicated in social and emotional processing. Elucidating the social disruptions evident across the life span in individuals with BD, how these disruptions relate to specific behavioral deficits or endophenotypes, and their underlying neural mechanisms may help inform our understanding not only of psychopathological processes but also of typical social development at the behavioral and neural levels. Additionally, clarification of social deficits and strengths associated with BD, as well as their neural underpinnings, may facilitate the development of effective and explicitly targeted interventions

Neural Responses to Feedback Regarding Betrayal and Cooperation in Adolescents with Anxiety and Mood Disorders

This study examined patterns of neural response to feedback regarding betrayal and cooperation in adolescents with anxiety/mood disorders and healthy peers. We compared performance on and neural activation patterns during the Prisoner’s Dilemma (PD) game, an economic exchange task involving betrayal and cooperation, between age- and IQ-matched groups of adolescents with anxiety/depressive disorders (A/D) (N=13) and healthy controls (n=17). Participants were deceived to believe that their co-player (a pre-programmed computer algorithm) was another study participant. Although participants responded similarly following feedback that the co-player had cooperated with them on preceding trials, A/D adolescents were more likely than controls to cooperate following trials when the other player betrayed them. Further, A/D participants differed significantly from controls in patterns of neural activation in response to feedback that they had been betrayed. In particular, A/D participants showed more activation relative to baseline in the precuneus, cerebellum, and supramarginal gyrus than did controls. Groups did not, in contrast, differ significantly in patterns of activation in response to feedback that their co-player had cooperated with them. Our findings provide preliminary evidence that A/D adolescents may not only behave differently than do healthy peers when they encounter potential social obstacles, but that they may also engage a different set of neural resources. These findings offer a first step toward elucidating the mechanisms underlying social impairment in youth with internalizing disorders

Socio-emotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences

Socio-emotional dysfunction is a core feature of bipolar disorder (BD) across the lifespan. Recent evidence indicates associations between this atypical functioning and the presence of neurally-based anomalies. This article critically reviews the literature on two types of core socioemotional skills that may represent endophenotypes for BD, with a focus on differences between individuals with BD, both youth and adults, and their typically developing peers. First, it examines studies of social cue perception and interpretation, with an emphasis on behavioral and neural studies of facial expression processing. Second, it shifts to examine behavioral and neural differences in cognitive and behavioral flexibility. Finally, the article summarizes potential future directions for research in this area

Associations among perceptual anomalies, social anxiety, and paranoia in a college student sample

Recent evidence suggests that normal-range paranoid ideation may be particularly likely to arise in individuals disposed to both social anxiety and perceptual anomalies. This study was designed to test the hypothesis that among college students in an unselected sample, social anxiety and experience of perceptual anomalies would not only each independently predict the experience of self-reported paranoid ideation, but would also interact to predict paranoid patterns of thought. A diverse sample of 644 students completed a large battery of self-report measures, as well as the five-factor Paranoia/Suspiciousness Questionnaire (PSQ). We conducted hierarchical multiple regression analyses predicting scores on each PSQ factor from responses on measures of social anxiety, perceptual aberration, and the interaction between the two constructs. Current general negative affect was covaried in all analyses. We found that both social anxiety and perceptual aberrations, along with negative affect, predicted multiple dimensions of paranoia as measured by the PSQ; the two constructs did not, however, interact significantly to predict any dimensions. Our findings suggest that perceptual aberration and anxiety may contribute to normal-range paranoid ideation in an additive rather than an interactive manner

Behavioral and neural representation of emotional facial expressions across the lifespan

Humans’ experience of emotion and comprehension of affective cues varies substantially across the lifespan. Work in cognitive and affective neuroscience has begun to characterize behavioral and neural responses to emotional cues that systematically change with age. This review examines work to date characterizing the maturation of facial expression comprehension, and dynamic changes in amygdala recruitment from early childhood through late adulthood while viewing facial expressions of emotion. Recent neuroimaging work has tested amygdala and prefrontal engagement in experimental paradigms mimicking real aspects of social interactions, which we highlight briefly, along with considerations for future research

Paranoid Thinking, Suspicion, and Risk for Aggression: A Neurodevelopmental Perspective

This article represents an effort to extend our understanding of paranoia or suspicion and its development by integrating findings across clinical, developmental, and neuroscience literatures. We first define “paranoia” or paranoid thought and examine its prevalence across typically and atypically developing individuals and theoretical perspectives regarding its development and maintenance.We then briefly summarize current ideas regarding the neural correlates of adaptive, appropriately trusting interpersonal perception, social cognition, and behavior across development. Our focus shifts subsequently to examining in normative and atypical developmental contexts the neural correlates of several component cognitive processes thought to contribute to paranoid thinking: (a) attention bias for threat, (b) jumping to conclusions biases, and (c) hostile intent attribution biases. Where possible, we also present data regarding independent links between these cognitive processes and aggressive behavior. By examining data regarding the behavioral and neural correlates of varied cognitive processes that are likely components of a paranoid thinking style, we hope to advance both theoretical and empirical research in this domain

Father Locus of Control and Child Emotional and Behavioral Outcomes: A Prospective Study

This prospective longitudinal study examined the associations between parent locus of control of reinforcement (LOCR), measured before the birth of a child, and behavioral/emotional outcomes in that child at age seven years. Three hundred seven couples completed questionnaires regarding their emotional status and LOCR at their first prenatal care appointment. When their children turned seven years old, teachers completed questionnaires regarding each participating child’s behavior. Findings indicate significant associations between fathers’ prenatal LOCR and child outcomes, particularly hyperactivity in sons. Hyperactivity and behavioral/emotional problems in girls, in contrast, were better predicted by maternal prenatal emotional distress. Results provide evidence that both paternal and maternal characteristics that predate the birth of a child relate to later behavioral outcomes in that child. Implications for prevention of child psychopathology are discussed