Loss of Empathy After a Stroke

After surviving a stroke, a stroke survivor may become less empathetic towards others. Empathy is the ability to see things from another person's perspective. Empathy is especially important when it comes to understanding how another person is feeling. When someone lacks empathy, he often behaves insensitively towards others, and this makes others upset.

So a lack of empathy can have really serious repercussions when it comes to interpersonal relationships. Since much of our interactions with others depend on maintaining adequate relationships, a lack of empathy is a serious thing. When a stroke makes a person lose this important skill of empathy, it affects the stroke survivor and everyone she interacts with, especially close family members.

Sad woman and mother
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Types of Stroke That Can Cause Loss of Empathy

Not all strokes cause a loss of empathy. A stroke can be a devastating event, and sometimes it can make a stroke survivor more focused on himself and less focused on others for a while. But, after an adjustment period following a stroke, a stroke survivor will typically go back to being as sensitive and empathetic as he was prior to the stroke - unless he had a stroke on the area of the brain that controls empathy.

Overall, injuries to the right side of the brain are more likely to affect empathy than injuries to the left side of the brain. In right-handed people, the left side of the brain controls language and in left-handed people, the right side of the brain or the left side of the brain may control language. So whether a stroke survivor will have a deficit in language depends on whether he is left-handed or right-handed. But it is not clear whether handedness determines the side of the brain that controls empathy.

The areas of the brain that are most likely to cause a deficit in empathy are the right prefrontal cortex, the right insula, and the right temporal gyrus. These areas are typically associated with emotions, memory, and control of behavior. Relatively new technology has made it possible to locate and identify these areas as under-active in stroke survivors who lack empathy. All of this new information gained from studying stroke survivors may be helpful in the future in terms of gaining a better understanding of conditions such as autism, which is characterized, in part, by a lack of empathy.

What to Do

People who don't have empathy typically come across as oblivious to others’ feelings, socially awkward or rude. Ironically, people who display such off-putting behavior due to a neurological empathy handicap are often rejected by the people around them because even 'normal' individuals are usually not empathetic to the lack of empathy. This leads to further social isolation and trouble reaching out to others for support. The caregiver (usually a spouse or grown child) may feel saddened and rejected by the inconsiderateness of a stroke survivor who lacks empathy. The caregivers and loved ones may struggle to cope with the confusing behavior without understanding why the stroke survivor is being so mean.

Overcoming a lack of empathy is difficult. Many people have low levels of empathy, to begin with, and it is a handicap that is very hard to overcome, but not impossible to improve. One of the challenges when it comes to an injury of the 'empathy area' after a stroke is that the same area of the right frontal lobe that controls empathy is also located near the area of the brain that controls a person's ability to understand her stroke. So a stroke survivor who lacks empathy often cannot fully comprehend that she had a stroke, and therefore is less likely to make an effort to improve the problem.

Counseling may provide a degree of insight for caregivers and for some stroke survivors. Professional therapy can provide useful guidelines for patients and caregivers. For example, simpler ways to communicate feelings clearly and directly can prevent misunderstandings.

Straightforward methods for routinely asking about people's feelings can facilitate better relationships than completely ignoring the subject altogether. Exercises designed to name peoples' feelings and the appropriate responses to those feelings can help rebuild some of the skills lost when a stroke affects the right prefrontal cortex. This can help relieve some of the social, relationship and work-related consequences that result from having low levels of empathy.

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  • Hillis AE. Inability to empathize: brain lesions that disrupt sharing and understanding another's emotions. Brain. 2014;137(Pt 4):981-97. doi:10.1093/brain/awt317

  • Yuvaraj R, Murugappan M, Norlinah MI, Sundaraj K, Khairiyah M. Review of emotion recognition in stroke patients. Dement Geriatr Cogn Disord. 2013;36(3-4):179-96. doi:10.1159/000353440

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.