Empatía y autoconciencia en los pacientes con traumatismo cráneo-encefálico moderado y severo

Abstract

Introduction

Traumatic Brain Injury (TBI) is the most common cause of neurological disability in young patients. Empathy, an important factor of social cognition, allows a satisfactory interaction of the subject with his environment. Their deficits will suggest inadequate social perceptions, inappropriate answers, and social isolation. The ability to understand, be sensitive and represent the mental states of others, apparently would be related to the ability to represent our mental states, being fundamental to self-awareness.

Materials and methods

A descriptive and quantitative study was performed. Objective: to observe the relationship between self-awareness and empathy in moderate or severe TBI patients.

Patients: 31 Outpatients, aged between 16 and 45 years with a diagnosis of moderate or severe TBI, who attended the Neuropsychology Department of the Clinics Hospital (Montevideo – Uruguay).

Instruments: Patient Competency Rating Scale (PCRS) (self-awareness = PCRS of the patient - PCRS family), Interpersonal Reactivity Index (IRI) that assesses empathy, and the Lesion Pattern (PL) by accessing the Computational Axial Tomography (CT) report.

Results

Significant differences between the patient report and the family report after the TBI in the IRI Fantasy dimension (p = 0.0485), as well as in the IRI Perspective Taking dimension (p = 0.0090). 52% of patients present an impairment of self-awareness. Association between activities of daily living of self-awareness and fantasy of empathy (r = − 0.63, p = 0.009). Significant behavior between personal distress of empathy (IRI) with high and low levels of self-awareness according to the median (p = 0.0207) (low levels of self-awareness are associated with less value in personal distress), and between self-awareness with patients with or without neurosurgery (p = 0,0295) (patients with surgery have less self-awareness).

Frontal (p = 0.0358, n = 24) and frontotemporal lesions (p = 0.0478, n = 24) have lower value in the fantasy dimension of empathy (IRI). Bilateral frontal (p = 0.0460, n = 24) lesions and rights (p = 0.0175), n = 24) have lower value in emotional self-awareness.

Conclusions

Patients who have suffered a moderate or severe TBI have a decrease in empathy and self-awareness. Neurosurgery, one of the most frequent interventions in the treatment of severe TBIs, can result in impaired self-awareness (ISA).

Patients with ISA have difficulties in managing their personal distress of the IRI (emotional dimension of empathy), losing the ability to perform a real examination of their emotional and behavioral states. We can also say that the difficulties in handling personal distress could be an obstacle to improving your self-awareness.

Fantasy (IRI), the cognitive dimension of empathy, is related to the self-awareness of the activities of daily life. The more fantasy, the patient “would be lost” more in the other person, implying difficulty in his capacity of self-awareness. A possible hypothesis about the relationship between self-awareness and empathy is proposed through Antonio Damasio's concept of extended consciousness.

The difficulties of self-awareness and empathy could have relevance in the problems of social functioning of these patients, and adversely affect the rehabilitation processes. From the therapeutic point of view, it could be useful for the treatment of these patients, to work on the self-evaluation of their internal states, trying to differentiate them from the others. Given the impact that TBI has on social cognition and social functioning, including these tests would be a valuable supplement with greater ecological value for a standard neuropsychological assessment, and a contribution to guide rehabilitation programs.

The neuropathology of TBI is complex and highly variable, combining focal and diffuse traumatic lesions. The heterogeneity of the lesions caused makes their study difficult and requires techniques with higher resolution than the CT used in this study. Despite its use, we were allowed to make some approximations. Frontal and frontotemporal lesions have a worse performance of the fantasy dimension of empathy (IRI), patients with bilateral frontal lesions and rights have a greater deterioration of emotional self-awareness.