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Understanding Lack of Empathy After Brain Injury and How to Cope

girlfriend sitting on couch crying while boyfriend sits back ignoring her because he has lack of empathy after brain injury

Lack of empathy after brain injury can cause TBI patients to appear more self-centered than they used to.

However, this behavior does not mean your loved one is actually selfish. Their injury has just made it harder for them to identify the emotions of others.

Today you will learn why a brain injury can lead to a lack of empathy, plus what therapies can help people regain their empathy skills.

Causes of Lack of Empathy After Brain Injury

brain scan showing damaged areas of the brain that can cause lack of empathy after brain injury

Empathy is the ability to see things from another person’s perspective and feel what they feel.

Multiple areas of the frontal lobe play a role in empathy skills. For example, the right supramarginal gyrus helps people overcome egocentric bias (self-centeredness) when making decisions.

The orbitofrontal cortex is another area of the brain that helps us react to another person’s feelings. Therefore, if any of these brain regions become damaged, a lack of empathy can occur.

Other cognitive and behavioral problems that can accompany a lack of empathy after a brain injury include:

  • Childish behavior
  • Apathy or low motivation
  • Disinhibition
  • Aggressive behavior

It’s important to note that even though the person may display these behaviors, they are not fully responsible for them. Family members and friends should try not to take anything their loved one says or does personally during this time.

Alexithymia and Lack of Empathy

Sometimes TBI patients can still empathize with others, but they have trouble processing their emotions. This condition, called alexithymia, is also common in individuals with autism.

Alexithymia causes difficulties in identifying, describing, and processing one’s own emotions and those of others. It also makes it hard to distinguish bodily sensations from emotional feelings.

This can lead people to seem insensitive and non-empathetic when in fact they do experience the emotions of other persons. They just do not know how to react.

It can be difficult to distinguish alexithymia from a true lack of empathy. A neuropsychologist can help you get a proper diagnosis and teach you ways to process emotions again.

Is Lack of Empathy After Brain Injury Permanent?

Some brain injury side effects, such as a lack of empathy, can go away on their own. As their frontal lobe injury heals, you may notice your loved one becoming more responsive to others again.

Even if this does not occur naturally, it may still be possible to relearn empathy. Empathy is a skill, and like all skills, it can be improved through deliberate practice.

This is what the field of positive psychology is based on. Positive psychology, like the name suggests, is a method used to help train the brain to rest in more positive states.

For instance, by writing in a gratitude journal daily, you can help train the brain to notice more things to be grateful for. The repetitive practice of searching for gratitude helps the brain become more efficient at the skill of noticing things to be grateful for.

Some research suggests that empathy can be learned, too. But this research is broad. There are no studies specifically within the TBI field proving that practicing empathy helps improve empathy.

However, the principle of deliberate practice is clear: the brain becomes more efficient at the tasks that you repetitively practice, including emotion.

If your loved one is receptive to it, practicing empathy as a skill could be worth trying.

What If Empathy Never Returns?

senior woman with blank facial expression looking out window while her daughter puts hand on her shoulder

It is possible that your loved one’s empathy skills never return. However, that does not mean that they can never be compassionate again.

To understand how this can be true, we will need to discuss how empathy works. Most psychologists believe there are three different types of empathy:

  • Cognitive empathy. The ability to understand the positions and feelings of others.
  • Emotional empathy. The ability to share and experience the emotions of others.
  • Compassionate empathy. The ability to respond to others and help them when they are in need.

Even if patients lack cognitive or emotional empathy, they can still practice compassionate empathy. That’s because compassionate empathy involves actions and behavior, something most TBI survivors can more easily grasp.

While cognitive and emotional empathy can make it much easier to practice compassionate empathy, it is possible to be compassionate without them.

Depending on how severe the person’s cognitive deficits are, it may require a lot of work to help them learn how to respond compassionately again. It can be especially difficult if the person suffers from a lack of insight since that can make it hard for them to understand their own behavior.

But with help from a behavioral therapist, patients can learn how to control their behavior and recognize when to help others.

Dealing with Lack of Empathy After Brain Injury

Even though it is possible for TBI survivors to regain empathy, it will take time.

In the meantime, here are some steps that family members can take to help their loved ones improve their empathy skills.

Provide Feedback

mother sitting on couch with daughter talking about lack of empathy after brain injury

It’s important to give feedback to your loved one about their behavior, otherwise, they will never improve.

For example, if they do something rude or inappropriate, gently but firmly let them know. Try your best not to embarrass them, but make sure they understand they can’t do that anymore. It’s very likely they didn’t even realize they were acting selfishly.

In the same way, if they show empathy and compassion, give them praise. Direct their attention to specific instances when they were considerate of another person, and congratulate them. This helps them learn which behaviors are positive and which are negative.

Develop Awareness

Second, try to direct the person’s attention to the feelings of others. This can help them develop a better awareness of another person’s emotions.

One thing you can do is ask them questions about the people they see throughout the day and how they might feel.

For instance, if they saw a mother at a store with three little ones, try asking them what they think the mother was feeling. Was she stressed, tired, or anxious? Then, ask how they might feel if they had to take a child out shopping.

This exercise can help them practice putting themselves in another’s shoes.

Nurture Social Skills

four friends sitting on grass and laughing

Lack of empathy after brain injury can make it hard for patients to maintain relationships. Therefore, it is helpful to remind them how to keep their friendships alive, especially if they struggle with social skills.

Some things you can remind them to do include:

  • Make phone calls, write letters, and text friends to keep in touch.
  • Remember and acknowledge birthdays and special occasions.
  • Initiate contact and suggest activities with family and friends.
  • Say please and thank you, and take turns.
  • Ask someone what they would like to do.

Again, the more the person can practice these skills, the more they will improve.

Don’t Take Things Personal

Patients with low empathy can sometimes appear aggressive, dismissive, and demanding.

If your loved one acts this way to you, don’t take it personally. Remember they are not in complete control. They just have a lot more emotions and fewer inhibitions now, and they are struggling to cope.

Understanding Lack of Empathy After Brain Injury

A person who suffers a brain injury may experience a lack of empathy, especially if they damaged their frontal lobe.

Fortunately, the brain can be rewired to learn empathy again with the right therapy.

Even if empathy never returns, your loved one can still relearn how to practice compassion to others. While it might take a lot of patience and dedication, they can eventually improve.  

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