Empathic Deficits in Combat Veterans with Traumatic Brain Injury: A Voxel-Based Lesion-Symptom Mapping Study

Objective: To understand better which brain regions support emotional empathy. Background: Emotional empathy, the ability to interpret and share the affective states of others, is a key component in human social interaction. Previous research has suggested that emotional empathy relies on several distinct brain regions, although further evidence from human lesion studies is needed to determine which regions are critical. Methods: We studied 192 male Vietnam combat veterans who had sustained focal penetrating traumatic brain injuries, and 54 non-brain-injured veterans. We used voxel-based lesion-symptom mapping on computed tomographic scans to elucidate the neural bases of self-reported emotional empathy as measured by the Balanced Emotional Empathy Scale. Results: Damage in several brain regions, particularly the ventrolateral prefrontal cortex, left and right posterior temporal lobes, and insula, was associated with diminished emotional empathy. Conclusions: These findings provide further insight into the neural substrates of emotional empathy, and are consistent with the notion that emotional empathy is supported by a distributed network of brain regions. Additional work may advance our understanding of the empathic deficits commonly observed in patients with neurologic and psychiatric disorders.