Autism/Asperger's/ASD and Empathy

Autism/Asperger’s/ASD and Empathy

A recently popular post in this sub asked about differences and similarities in our experiences with empathy. I’ve been (somewhat obsessively) doing research on the topic since I was diagnosed, and since people seemed interested in that discussion, I am sharing my notes. If any of you are interested, I would like to hear your thoughts. I’m a scientist but in an entirely different field than psychology/neuropsychology/etc, so I know enough to know I don’t know enough. If you notice any mischaracterizations in my notes, anything you find incomplete, or any other problems, please let me know.
Empathy When discussing empathy, everyone has vastly different understandings of what it means. Personally, I believed I had no problems with empathy until I learned that I was mistaken about its meaning. (I naively understood it as “caring about other people.”)
Empathy involves our reactions to the experiences of other people [5]. It is the ability to understand and feel another person’s feelings from that person’s perspective by mirroring of their experience [3]. Empathy requires self-other awareness, perspective-taking, and emotional regulation [1], defined as follows:
Perspective-taking : Regarding a situation from another person’s perspective instead of your own. Self-other awareness : Maintaining a clear separation between another person’s perspective and yours. Emotional regulation : Reacting to someone else’s emotions without being swept away and overwhelmed. The complex process of empathy can be broken down into two related parts: affective empathy and cognitive empathy.
Affective empathy can be described most simply as shared emotion [5]. It is our unconscious ability to be affected by someone’s emotional state, vicariously feel their feelings, and respond with an appropriate emotion. The affective process of “catching” someone’s feelings is called emotional contagion . With poor self-other awareness, emotional contagion can result instead in personal distress. Personal distress is focused on your own negative emotional reaction to feeling another person’s pain or discomfort [1].
Cognitive empathy is simply described as emotion recognition. It is our conscious ability to understand another’s mental state from their perspective [3].
Empathy requires an understanding of the behaviors being reflected, rather than mere imitation. You must be able to toggle between your view and their view, and think through the entire situation from that person’s perspective and not your own [1].
Some related concepts In contrast with empathy, sympathy is feeling for (not with ) someone. You are not sharing feelings with someone else. Sympathy does not necessarily involve imitation or perspective-taking. Compassion , on the other hand, is a charitable feeling regarding someone else’s negative experiences. It can involve self-awareness, perspective-taking, or emotional regulation, but has no sharing of emotion [1].
Alexithymia is the inability to recognize and articulate emotions in yourself and others and has a high co-occurrence rate with autism, but is not always present. As a result, adults with ASD may not always be able to describe inner states verbally, regardless of cognitive/verbal abilities. Feelings can be observed from behavioral signs such as increased stimming. This difficulty in reporting inner states is one reason that some people with ASD may not be diagnosed until adulthood [2].
Theory of Mind A popular theory of some ASD symptoms is theory of mind. Theory of mind is the ability to attribute mental states and motivations to others, separately from our own [3,4]. It’s the “mind-reading” that goes into understanding someone else’s behavior – ascribing beliefs and desires to others and ourselves. There is confusion on the distinction between theory of mind and cognitive empathy, or if they are interchangeable [6]. (Note: I am also unsure on the distinction.)
Theory of mind requires perspective-taking along with the integration of our own experiences to develop inferences about another’s cognitive state. Strong self-other awareness is essential for integrating your own experiences while seeing the situation from the other person’s perspective. You also must have strong emotional regulation, or ability to process and react to someone else’s experiences without becoming overwhelmed [1].
Autism and Empathy Due the complex nature of ASD, current understandings of empathy and theory of mind within ASD are based on oversimplifications that cannot account for all social and communication symptoms [3,6]. Autistic people have been unfairly labeled and stereotyped as lacking empathy as a whole based on tests that do not distinguish between types of empathy [5]. Understanding is also made more difficult by the unclear distinction between empathy and theory of mind [6].
Tests that do distinguish between types of empathy show people with Asperger’s struggling with cognitive empathy/theory-of-mind tasks compared to NT folks, but not struggling with affective empathy [3,5]. In fact, folks with Asperger’s “scored significantly higher” than the NT group on one affective empathy test measuring personal distress (specifically, “feelings of anxiety and discomfort in response to tense interpersonal scenarios”) [5]. Even though we might not always be able to recognize emotional distress in other people, we tend to respond with the correct emotion after we are told about it [2]. Also of note – although folks with ASD struggled with cognitive empathy they still showed some level of empathetic skills, just at a lower level than the NT group [5].
Other studies looked at cognitive empathy in folks with ASD. These studies suggest that autistic people use different neurocognitive systems than NT people when we can infer others’ mental states. Instead of using social insight, autistic participants treated theory-of-mind tasks as logical reasoning and problem-solving tasks [6]. However, an autistic person’s success in theory-of-mind tasks was not guarantee for their social success. Theory-of-mind based in reasoning correctly about the social world “is not based on the same foundational social insights” as a NT person’s theory-of-mind [6].
Interestingly, high-functioning adults with ASD tend to have impaired nonverbal communication and social reciprocity as core symptoms, with less emphasis on special interests/stimming symptoms than the general ASD population [2].

Ultimately this is my opinion, for now. Aspies can experience empathy, though we may experience it differently than a NT person would. The amount of cognitive empathy we experience varies within the community. As adults many of us have come up with enough masking behaviors and logic-based social reasoning to create an ad-hoc system for attributing mental states and motivations to others.
Personally, I experience alexithymia. I’ve learned to identify when I am feeling anxious based on behaviors I perform rather than any internal feeling. Also, I can’t reliably pick up on my friends’ feelings but I care very deeply for them. Before I was diagnosed, I told people many times “I can’t read your mind,” so I chuckled when I saw theory of mind referred to as “mind-reading.” I’ve told close friends to please not expect me to intuit when they feel negative emotions, to just tell me directly. I feel emotions as much as any person, but have been told I’m “not very emotional” multiple times due to how I display emotions.
On the positive side, my close friends told me I am a good person to talk to when they have a crisis. I do not reflect their emotions back at them, which they say is very calming. I am glad I have a special way I can support my friends.
I am constantly on the lookout for new rules and techniques for smooth and positive social/interpersonal relationships. What are your experiences with cognitive and affective empathy, and what are your favorite techniques you’ve developed for social interactions?

[1] Segal, Elizabeth A., Karen E. Gerdes, and Cynthia A. Lietz. 2017. Assessing Empathy . New York: Columbia University Press.
[2] Barahona-Corrêa, Bernardo. “The High-Functioning Group: High- Functioning Autism and Asperger Syndrome in Adults.” In Autism Spectrum Disorders in Adults , edited by Bernardo Barahona-Corrêa, 129-78. 2017. New York, NY: Springer Berlin Heidelberg.
[3] Harmsen, Irene E. 2019. “Empathy in Autism Spectrum Disorder.” Journal of Autism and Developmental Disorders 49 (10): 3939–55.
[4] Montgomery, Charlotte B., Carrie Allison, Meng-Chuan Lai, Sarah Cassidy, Peter E. Langdon, and Simon Baron-Cohen. 2016. “Do Adults with High Functioning Autism or Asperger Syndrome Differ in Empathy and Emotion Recognition?” Journal of Autism and Developmental Disorders 46 (6): 1931–40.
[5] Rogers, Kimberley, Isabel Dziobek, Jason Hassenstab, Oliver T. Wolf, and Antonio Convit. 2007. “Who Cares? Revisiting Empathy in Asperger Syndrome.” Journal of Autism and Developmental Disorders 37 (4): 709–15.
[6] Tager-Flusberg, Helen. 2007. “Evaluating the Theory-of-Mind Hypothesis of Autism.” Current Directions in Psychological Science 16 (6): 311–15.

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