Back To Search Results


Editor: Anil Kumar Reddy Reddivari Updated: 11/5/2023 11:12:10 PM


The term "empathy" (translated from the German word Einfuhlung, which means feeling into) started over 100 years ago and was introduced by psychologist Edward Titchener.[1]

Empathy is a complex, psychological-influencing social interaction; it plays a role in understanding others' feelings, suffering, and behavior with a significant link to compassion. It is a motivated phenomenon that allows people to connect emotionally by sharing experiences and feelings.[2][3][4] Not limited to the comprehension of feelings, empathy is directly linked to the fundamentals of morality and plays an important role in many social relations.[5]

The start of an empathic process is triggered by many agents such as vocalization (screaming or laughing), a body posture or facial expression, and verbal descriptions; however, it is not limited to any expression and environmental interaction that may target another person and trigger the empathic process.[5]  

Neuroanatomical Structures  

Empathy is linked to neuroanatomical structures such as the amygdala, anterior cingulate cortex, and anterior insular cortex. Furthermore, a multidimensional empathy approach classifies it as cognitive, affective, or behavioral empathy.[6]

  1. The amygdala, located in the anterior medial part of each temporal lobe, consists of a diverse group of nuclei with distinct structures and functions. It serves as a recipient for sensory input from various cortical regions, including visual, auditory, somatosensory, and olfactory systems, as well as polysensory areas like the perirhinal cortex and the parahippocampal gyrus. Anatomically, the lateral nucleus segregates sensory modalities, but due to internal connections, the amygdala integrates multimodal information in regions such as the lateral, basal, and accessory basal nuclei. The amygdala's output extends to numerous target structures, encompassing the prefrontal cortex, striatum, sensory cortices (including primary sensory cortices unique to primates), hippocampus, perirhinal cortex, entorhinal cortex, basal forebrain, and subcortical structures responsible for physiological responses associated with emotions, such as autonomic and hormonal responses, as well as startle reflex. Notably, the central nucleus generates subcortical projections, while the basal, accessory basal, and sometimes lateral nuclei give rise to connections with the cortex and striatum.[7]
  2. The anterior cingulate cortex (ACC) is a key brain region involved in various important functions such as emotion, action, and memory. It receives input from the orbitofrontal cortex, providing information about rewards and non-rewards. This enables the ACC to connect actions and outcomes through action-outcome learning. Additionally, the ACC's involvement in emotional processes arises from its role in connecting rewards to actions. On the other hand, the ACC also interacts with the posterior cingulate cortex, which allows for transmitting spatial and action-related information from parietal cortical areas. Moreover, the ACC's outputs to the hippocampal system contribute to memory functions. This intricate network of connectivity and its positioning within the proisocortical limbic region highlight the multifaceted nature of the ACC in the brain.[8]
  3. The anterior insular cortex (AIC) is associated with a wide range of phenomena and actions, from the perception of bodily sensations like bowel distension and pleasure during orgasm to intense desires for cigarettes and maternal affection to cognitive processes such as decision-making and sudden moments of understanding. Its role in the reinterpretation of internal bodily signals provides a potential foundation for its involvement in the entirety of subjective emotions and experiences.[9]

Measuring Empathy  

To measure empathy, several scales have been designed that help identify an individual's capacity to be more empathic or less empathic. As empathy involves many psychological concepts, many scales are currently used to identify empathy. These include the Empathic Accuracy Task (EAT), Empathy Components Questionnaire, and the dated Interpersonal Reactivity Index (IRI).[10][11][12]

  1. Empathic Accuracy Task (EAT): The EAT is an assessment tool used to measure cognitive empathy. It involves participants watching videos where a target individual shares a personal story, and their task is to continuously rate the valence (positive or negative) of these videos using a turning device. The EAT calculates empathic accuracy by comparing the participants' ratings with the target individual's own ratings. This correlation-based index indicates how accurately the participants can perceive and understand the emotional experiences of the target individual.[13]
  2. Empathy Components Questionnaire (ECQ): The ECQ is a standardized assessment tool used to measure different components of empathy. It aims to capture empathy's cognitive and affective aspects by examining multiple dimensions. The questionnaire typically includes items that assess perspective-taking, which refers to the ability to understand and adopt the viewpoint of others, as well as empathic concern, which involves feeling compassion and concern for others' well-being. Additionally, the ECQ may include items related to personal distress, which measures the tendency to feel uncomfortable or distressed when witnessing others' negative emotions. By evaluating these various dimensions, the ECQ provides a comprehensive understanding of an individual's empathic abilities and helps researchers and practitioners gain insights into empathy-related traits and behaviors.[11]
  3. Interpersonal Reactivity Index (IRI): The IRI is a widely used self-report questionnaire to measure empathy and related constructs. The IRI consists of four subscales that capture different aspects of empathy. The perspective-taking subscale assesses the ability to adopt the point of view of others and understand their feelings and thoughts. The fantasy subscale measures the tendency to imaginatively identify with fictional characters in books, movies, or other media. The empathic concern subscale evaluates feelings of compassion, warmth, and concern for others' well-being. Lastly, the personal distress subscale examines the propensity to experience discomfort and distress when witnessing others' suffering. The IRI provides a comprehensive assessment of individual differences in empathy, allowing researchers and clinicians to better understand empathic tendencies and their implications in various social and interpersonal contexts.[14]

Issues of Concern

Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
  • Dropdown arrow Search engine and full access to all medical articles
  • Dropdown arrow 10 free questions in your specialty
  • Dropdown arrow Free CME/CE Activities
  • Dropdown arrow Free daily question in your email
  • Dropdown arrow Save favorite articles to your dashboard
  • Dropdown arrow Emails offering discounts

Learn more about a Subscription to StatPearls Point-of-Care

Issues of Concern

Influence of Empathy on the Healthcare Team and Delivery 

The healthcare professional has to bring empathy to the table when dealing with a patient as it helps them comprehend the emotional and cognitive state of the patient involved. This connection can help healthcare professionals build a therapeutic relationship with the patients, eventually leading to better health outcomes. This influence is determined by the words chosen and facial expressions, body language, and vocalization. The emotional and cognitive connection is invaluable in today's healthcare delivery to achieve the best patient-provider relationship.[3][15]

As empathetic behavior by providers gets modulated by motivation, healthcare providers should also have empathic support from their institutions to deliver the same high-quality care to the patients.[4] 

Clinical Significance

Clinical Significance of Empathy

  • Understanding a patient's feelings, concerns, and expectations can help a physician provide better care.
  • Imagining things from the patient's point of view can reveal a different perspective to address them.
  • Empathy can break down perceived barriers between the patient and the healthcare team.[16]

Increasing Empathy in the Practice

Cognitive empathy modulated by motivation can help to make better providers. There are many motivational triggers to increase empathy; those strategies apply to the interprofessional team and patient's care and are achievable by regular and thoughtful training.

  • Creating a desire to alleviate suffering
  • Increase kindness
  • Increase positive and friendly attitude

These modulations can increase patient satisfaction and improve the diagnostic process and treatment outcome.[2]

Disorders of Empathy

Disturbance in an appropriate empathic/vicarious response can be associated with some conditions, such as [1][8]

  • Psychopathy: Psychopathy, classified as a personality disorder, is characterized by a lack of empathy and guilt, a surface-level display of emotions, the manipulation of others, and the engagement in calculated and violent antisocial actions. Individuals with psychopathy impose significant burdens on society financially due to their criminal behavior and the disruption of normal work participation, as well as emotionally and psychologically, on their victims.[17]
  • Autism spectrum disorder (ASD): ASD refers to a range of neurodevelopmental conditions that affect communication, social interaction, and behavior. People with ASD may display challenges in social skills, repetitive behaviors, and have specific interests or sensory sensitivities. ASD is a spectrum, meaning individuals can vary widely in their symptoms and level of impairment.[18]
  • Alzheimer's disease: Alzheimer's disease is a progressive neurological disorder that primarily affects memory, thinking skills, and behavior. It is the most common form of dementia, characterized by the accumulation of abnormal protein deposits in the brain, leading to the loss of connections between brain cells and their eventual death. As the disease progresses, individuals may experience memory loss, confusion, difficulty completing familiar tasks, mood swings, and personality changes. Alzheimer's disease profoundly impacts individuals and their families, as it gradually impairs cognitive and daily functioning.[19]
  • Frontotemporal dementia: Frontotemporal dementia is an umbrella clinical term encompassing a group of neurodegenerative diseases characterized by progressive deficits in behavior, executive function, or language. It is a common type of dementia, particularly in patients younger than 65, and can often mimic psychiatric disorders due to its prominent behavioral features. The clinical phenotype of frontotemporal dementia is caused by the selective degeneration of the frontal and temporal cortices, with various underlying neuropathological entities contributing to the disease. Additionally, genetics plays a significant role as a risk factor for frontotemporal dementia.[20]

Nursing, Allied Health, and Interprofessional Team Interventions


Education and training through various seminars have been shown to train medical students for empathic communication; therefore, training healthcare professionals is essential to prepare them for excellent patient care.[21]


Empathy for nursing is described as both a human trait and a professional state. Empathy plays a vital role in decision-making to deliver patient-centered care.[22]

Understanding and Educating

Understanding the concept of empathy and delivering patient education about it is of utmost importance in health care. Empathy, which involves understanding and sharing others' feelings and experiences, is crucial for healthcare professionals to establish meaningful connections with their patients. By comprehending patients' emotional and cognitive state, healthcare providers can build therapeutic relationships that contribute to better health outcomes. Effective communication goes beyond verbal exchanges and encompasses facial expressions, body language, and vocalization. Empathy helps healthcare professionals gain insight into patients' perspectives and breaks down barriers, fostering a stronger patient-provider relationship.

Institutions should support healthcare providers in empathic care, recognizing its clinical significance. Understanding patients' feelings, concerns, and expectations allows physicians to provide better care and consider different perspectives. By increasing empathy through motivation and training, healthcare professionals can improve patient satisfaction, diagnostic processes, and treatment outcomes. Educating and training healthcare professionals in empathic communication is essential to ensure excellent patient care. In the nursing field, empathy is considered both a human trait and a professional state, playing a vital role in patient-centered care. Additionally, understanding empathic behavior and providing proper care for patients with conditions that affect empathy, such as Alzheimer's disease and frontotemporal dementia, requires specialized training and education.

Overall, promoting understanding and education about empathy is essential for enhancing the healthcare experience and improving patient outcomes.



Lockwood PL. The anatomy of empathy: Vicarious experience and disorders of social cognition. Behavioural brain research. 2016 Sep 15:311():255-266. doi: 10.1016/j.bbr.2016.05.048. Epub 2016 May 25     [PubMed PMID: 27235714]


Weisz E, Zaki J. Motivated empathy: a social neuroscience perspective. Current opinion in psychology. 2018 Dec:24():67-71. doi: 10.1016/j.copsyc.2018.05.005. Epub 2018 May 16     [PubMed PMID: 29966924]

Level 3 (low-level) evidence


Meyza KZ, Bartal IB, Monfils MH, Panksepp JB, Knapska E. The roots of empathy: Through the lens of rodent models. Neuroscience and biobehavioral reviews. 2017 May:76(Pt B):216-234. doi: 10.1016/j.neubiorev.2016.10.028. Epub 2016 Nov 4     [PubMed PMID: 27825924]


Riess H. The Science of Empathy. Journal of patient experience. 2017 Jun:4(2):74-77. doi: 10.1177/2374373517699267. Epub 2017 May 9     [PubMed PMID: 28725865]


Heyes C. Empathy is not in our genes. Neuroscience and biobehavioral reviews. 2018 Dec:95():499-507. doi: 10.1016/j.neubiorev.2018.11.001. Epub 2018 Nov 3     [PubMed PMID: 30399356]


Uribe C, Puig-Davi A, Abos A, Baggio HC, Junque C, Segura B. Neuroanatomical and Functional Correlates of Cognitive and Affective Empathy in Young Healthy Adults. Frontiers in behavioral neuroscience. 2019:13():85. doi: 10.3389/fnbeh.2019.00085. Epub 2019 May 1     [PubMed PMID: 31118891]


Salzman CD, Fusi S. Emotion, cognition, and mental state representation in amygdala and prefrontal cortex. Annual review of neuroscience. 2010:33():173-202. doi: 10.1146/annurev.neuro.051508.135256. Epub     [PubMed PMID: 20331363]


Rolls ET. The cingulate cortex and limbic systems for emotion, action, and memory. Brain structure & function. 2019 Dec:224(9):3001-3018. doi: 10.1007/s00429-019-01945-2. Epub 2019 Aug 26     [PubMed PMID: 31451898]


Craig AD. How do you feel--now? The anterior insula and human awareness. Nature reviews. Neuroscience. 2009 Jan:10(1):59-70. doi: 10.1038/nrn2555. Epub     [PubMed PMID: 19096369]


Coll MP, Viding E, Rütgen M, Silani G, Lamm C, Catmur C, Bird G. Are we really measuring empathy? Proposal for a new measurement framework. Neuroscience and biobehavioral reviews. 2017 Dec:83():132-139. doi: 10.1016/j.neubiorev.2017.10.009. Epub 2017 Oct 13     [PubMed PMID: 29032087]


Batchelder L, Brosnan M, Ashwin C. The Development and Validation of the Empathy Components Questionnaire (ECQ). PloS one. 2017:12(1):e0169185. doi: 10.1371/journal.pone.0169185. Epub 2017 Jan 11     [PubMed PMID: 28076406]

Level 1 (high-level) evidence


Konrath S, Meier BP, Bushman BJ. Development and validation of the Single Item Trait Empathy Scale (SITES). Journal of research in personality. 2018 Apr:73():111-122. doi: 10.1016/j.jrp.2017.11.009. Epub 2017 Nov 14     [PubMed PMID: 29527069]

Level 1 (high-level) evidence


van Donkersgoed RJM, de Jong S, Aan Het Rot M, Wunderink L, Lysaker PH, Hasson-Ohayon I, Aleman A, Pijnenborg GHM. Measuring empathy in schizophrenia: The Empathic Accuracy Task and its correlation with other empathy measures. Schizophrenia research. 2019 Jun:208():153-159. doi: 10.1016/j.schres.2019.03.024. Epub 2019 Apr 19     [PubMed PMID: 31006615]


Bonfils KA, Lysaker PH, Minor KS, Salyers MP. Empathy in schizophrenia: A meta-analysis of the Interpersonal Reactivity Index. Psychiatry research. 2017 Mar:249():293-303. doi: 10.1016/j.psychres.2016.12.033. Epub 2016 Dec 27     [PubMed PMID: 28142103]

Level 1 (high-level) evidence


Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel, Switzerland). 2020 Jan 30:8(1):. doi: 10.3390/healthcare8010026. Epub 2020 Jan 30     [PubMed PMID: 32019104]


Brown EL, Agronin ME, Stein JR. Interventions to Enhance Empathy and Person-Centered Care for Individuals With Dementia: A Systematic Review. Research in gerontological nursing. 2020 May 1:13(3):158-168. doi: 10.3928/19404921-20191028-01. Epub 2019 Nov 11     [PubMed PMID: 31697393]

Level 1 (high-level) evidence


Viding E, McCrory E, Seara-Cardoso A. Psychopathy. Current biology : CB. 2014 Sep 22:24(18):R871-R874. doi: 10.1016/j.cub.2014.06.055. Epub     [PubMed PMID: 25247365]


Iles A. Autism Spectrum Disorders. Primary care. 2021 Sep:48(3):461-473. doi: 10.1016/j.pop.2021.04.003. Epub 2021 Jul 8     [PubMed PMID: 34311851]


Eratne D, Loi SM, Farrand S, Kelso W, Velakoulis D, Looi JC. Alzheimer's disease: clinical update on epidemiology, pathophysiology and diagnosis. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2018 Aug:26(4):347-357. doi: 10.1177/1039856218762308. Epub 2018 Apr 3     [PubMed PMID: 29614878]


Bang J, Spina S, Miller BL. Frontotemporal dementia. Lancet (London, England). 2015 Oct 24:386(10004):1672-82. doi: 10.1016/S0140-6736(15)00461-4. Epub     [PubMed PMID: 26595641]


Wündrich M, Schwartz C, Feige B, Lemper D, Nissen C, Voderholzer U. Empathy training in medical students - a randomized controlled trial. Medical teacher. 2017 Oct:39(10):1096-1098. doi: 10.1080/0142159X.2017.1355451. Epub 2017 Jul 27     [PubMed PMID: 28749198]

Level 1 (high-level) evidence


Adams SB. Empathy as an Ethical Imperative. Creative nursing. 2018 Aug:24(3):166-172. doi: 10.1891/1946-6560.24.3.166. Epub     [PubMed PMID: 30567759]