Concurrent Alexithymia Linked to Empathy Deficits in Depression

depression on boy's face
depression on boy’s face
Screening for high alexithymic traits in people with depression could allow for identifying those who would particularly benefit from metacognitive or compassion training.

In patients with major depressive disorder, alexithymia is associated with deficient scores in nearly all cognitive and emotional aspects of empathy, according to study results published in Psychiatry Research.

The investigators of this study sought to examine whether empathy deficits observed in patients with depression were related to concurrent alexithymia by assessing dissociable or interacting effects of depression and alexithymia on the cognitive and emotional components of empathy.

The study included 29 patients experiencing a moderate to severe major depressive episode with high (n=18) or low (n=11) alexithymia who were matched to 41 healthy controls with high (n=13) and low (n=28) alexithymia. Both cognitive and emotional components of trait empathy were assessed using the Interpersonal Reactivity Index questionnaire (IRI), including subscale measures of empathic concern, personal distress, perspective taking, and fantasy. State empathy, testing both emotional and cognitive empathy, was assessed using the Multifaceted Empathy Test (MET) and was computed separately for positive and negative valences.

The study results indicated that alexithymia affected the trait and state aspects of cognitive empathy, irrespective of depression. Specifically, participants with high alexithymia had lower scores in the perspective-taking component of the IRI and the cognitive empathy component of the MET. For measures of emotional empathy, the interaction of alexithymia and depression had a significant effect on trait empathy, in which patients with major depressive disorder had higher personal distress scores (IRI subscale) when affected by alexithymia. Participants with depression had higher MET scores for emotional empathy when confronted with negative stimuli vs positive stimuli.

Related Articles

Limitations to the study included an age bias within the healthy control group with high alexithymia, and investigators did not correct for multiple testing. In depression, it is possible that other personality traits besides alexithymia may influence empathy deficits.

The investigators suggest that alexithymia affected empathy on almost all levels. Irrespective of alexithymia, patients with major depressive disorder showed core deficits in emotional empathy, specifically personal distress, but all other empathy deficits were associated with concurrent alexithymia.


Banzhaf C, Hoffmann F, Kanske P, et al. Interacting and dissociable effects of alexithymia and depression on empathyPsychiatry Res. 2018; 270:631-638.