Alexithymia, reading the mind in the eyes and empathy in patients with antisocial personality disorder

Objectives

This study was undertaken to compare subjects diagnosed with Antisocial Personality Disorder (ASPD) and healthy controls in terms of alexithymia, empathy and theory of mind.

Material and methods

A total of 43 patients diagnosed with ASPD and 43 healthy controls were included. Study tools administered include the Sociodemographic Data Form, Barratt Impulsivity Scale - Version 11 (BIS-11), Reading the Mind in the Eyes Test (RMET), Empathy Quotient (EQ), Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory (BDI).

Results

As compared to controls, patients had significantly lower RMET and total EQ scores (p<0.001) and significantly higher BIS total and planning, motor and attention, TAS-20 total, identifying feelings, describing feelings, and externally oriented thinking scores (p= 0.002; p=0.008; p <0.001; p<0.001; p<0.001; p<0.001; p<0.001; and p=0.017, respectively). There was a positive significant correlation between RMET and EQ scores (p=0.006, r=0.415), while EQ scores were negatively and significantly correlated with TAS-20 scores (p=0.001, r= -0.487). There was a significant negative correlation between EQ and BIS-11 scores (p< 0.001, r= -0.609), while a positive and significant correlation was identified between TAS-20 and BIS-11 scores (p=0.012, r=0.379). Patients with self-mutilating behaviors had significantly lower total RMET scores than patients without such behaviors (p=0.028).

Conclusion

In conclusion, ASPD patients experience difficulty in reading the mind in the eyes, exhibit less empathy toward others, and have more pronounced alexithymia. Our observations suggest that ASPD patients experience challenges in the theory of mind concepts as well as in understanding and identifying the emotions of others and the self. We believe that comprehensive therapy programs specifically developed for ASPD patients and encompassing both the theory of mind and emotional perception may assist in improving these concepts that have significant roles in social interactions.