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Losing Empathy After Traumatic Brain Injury

A traumatic brain injury (TBI) can occur at any time and can have a profound impact on the lives of those affected. While protected by the skull, the human brain is highly susceptible to physical trauma. In some cases, a severe injury can lead to changes in the affected person’s behavior and relationships.

According to the Centers for Disease Control, 2.8 million Americans suffer a traumatic brain injury each year and approximately 56,000 people die. The most common causes of TBIs are falls, automobile accidents, and sports-related injuries.

Brain trauma can lead to a host of potential issues, including:

  • Mood swings 
  • Anxiety
  • Depression
  • Angry outbursts and increased irritability
  • Decreased empathy

The last item — a decrease in empathy — is one of the most difficult issues to understand for the friends and family members of the affected person. Fortunately, there are things that can be done to regain empathy.

What Is Empathy?

The Medical Dictionary defines empathy as:

Intellectual and emotional awareness and understanding of another person’s thoughts, feelings, and behavior.

Empathy may sometimes be confused with sympathy. Where empathy is the understanding of emotions, sympathy is the sharing of another person’s emotions and experiences.

Most researchers agree there are three kinds of empathy:

    1. Cognitive empathy: knowing how another person feels which is linked to recognition of facial expressions.
    2. Emotional empathy: experiencing a similar emotion to another person, e.g. feeling sadness when you see another person crying.
    3. Compassionate empathy: responding to others’ emotions by offering help when it’s needed.

One trait that may be connected to a loss of empathy is called alexithymia. This is when a person has difficulty identifying their own emotions or distinguishing them from physical sensations. While some people are born with alexithymia, researchers have identified this trait in patients who have experienced TBIs.

Why Do Traumatic Brain Injuries Sometimes Cause a Loss of Empathy?

Not every traumatic brain injury leads to a loss of empathy, so let’s talk about why some do. There are two key parts of the brain that regulate emotional responses. If either or both are damaged, the injured person’s ability to be empathetic may be affected.

The right supramarginal gyrus is responsible for helping us overcome egocentric bias – an emotional selfishness – before we make decisions. Another way to look at it is that the right supramarginal gyrus helps us to consider the emotions of others before we decide how to behave.

The orbitofrontal cortex is responsible for how we react to other people’s emotions, specifically how we recognize facial expressions and tone. If this part of the brain is damaged, it can be difficult to correctly identify emotions in other people and therefore impair empathetic responses.

A loss of empathy may be temporary or permanent. In many cases, empathy will return over time. However, it may be necessary to work with the patient to restore empathetic responses.

How to Regain Empathy After a Traumatic Brain Injury

While a loss of empathy can be upsetting to both the patient and their friends and family, there are things the patient can do to restore empathy and improve their relationships.

It is important to understand that a patient may not regain all three kinds of empathy. For example, a severe TBI to the orbitofrontal cortex might permanently alter one’s ability to recognize the facial expressions identified with strong emotions. However, it is often possible to restore compassionate empathy at the very least, which allows people to act with empathy even if they don’t feel it in the same way they did before the TBI occurred.

Here are some the things to help TBI patients regain empathy:

  1. Providers and clinicians treating patients with TBIs should evaluate them for empathetic responses, including their ability to identify emotions and to feel similar emotions. Evaluation is an essential tool for identifying the extent of empathetic impairment.
  2. Patient education can help people who have experienced TBIs understand how their brains may have changed.
  3. Clinicians can discuss with patients how to respond compassionately to their loved ones even if their emotional responses have changed because of the TBI.
  4. Finally, it can help the patient to ask their friends and family to be more specific about the way they are feeling to help them appropriately respond empathetically. For example, a patient with a TBI may not be able to recognize a sad expression but can still respond accurately if someone says, “I feel sad.”

With proper education and assistance, a patient who has experienced a loss of empathy can still respond empathetically and have healthy, happy relationships after a traumatic brain injury.

Losing Empathy After Traumatic Brain Injury


Coral Link, LPC

Coral Link, is a Licensed Professional Counselor (LPC) and has been in private practice since 2013. She specializes in helping individuals work through trauma, relationship issues, depression, life transitions, self-esteem & grief, and loss. Coral uses a variety of approaches in her therapy practice, from EMDR, CBT, DBT, mindfulness, to solution-focused brief therapy. Visit her website at https://wholetherapydenver.com.


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APA Reference
Link, C. (2020). Losing Empathy After Traumatic Brain Injury. Psych Central. Retrieved on December 4, 2020, from https://psychcentral.com/blog/losing-empathy-after-traumatic-brain-injury/
Scientifically Reviewed
Last updated: 21 Aug 2020 (Originally: 21 Aug 2020)
Last reviewed: By a member of our scientific advisory board on 21 Aug 2020
Published on Psych Central.com. All rights reserved.