Two systems for empathy: a double dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventromedial prefrontal lesions

TLDR

Recent evidence indicates two empathy systems—an emotional contagion system and a cognitive perspective‑taking system—whose neuroanatomical bases and interdependence remain unclear. The study tested whether emotional empathy (mirror neuron system) and cognitive empathy are distinct and rely on separate brain substrates. Subjects with ventromedial prefrontal or inferior frontal gyrus lesions and controls were assessed using empathy measures covering both cognitive and affective dimensions. Results show a clear double dissociation: ventromedial prefrontal lesions disrupt cognitive empathy while inferior frontal gyrus lesions impair emotional empathy, with Brodmann areas 11/10 and 44 respectively, supporting distinct neural substrates and evolutionary differences.

Abstract

Recent evidence suggests that there are two possible systems for empathy: a basic emotional contagion system and a more advanced cognitive perspective-taking system. However, it is not clear whether these two systems are part of a single interacting empathy system or whether they are independent. Additionally, the neuroanatomical bases of these systems are largely unknown. In this study, we tested the hypothesis that emotional empathic abilities (involving the mirror neuron system) are distinct from those related to cognitive empathy and that the two depend on separate anatomical substrates. Subjects with lesions in the ventromedial prefrontal (VM) or inferior frontal gyrus (IFG) cortices and two control groups were assessed with measures of empathy that incorporate both cognitive and affective dimensions. The findings reveal a remarkable behavioural and anatomic double dissociation between deficits in cognitive empathy (VM) and emotional empathy (IFG). Furthermore, precise anatomical mapping of lesions revealed Brodmann area 44 to be critical for emotional empathy while areas 11 and 10 were found necessary for cognitive empathy. These findings are consistent with these cortices being different in terms of synaptic hierarchy and phylogenetic age. The pattern of empathy deficits among patients with VM and IFG lesions represents a first direct evidence of a double dissociation between emotional and cognitive empathy using the lesion method.