Introduction: The alternative model for personality disorders (AMPD) of the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5) considers impairments in empathy a basic feature of personality disorders (PDs). In contrast, the AMPD pathological personality trait model and the categorical DSM-5 Section II PD model associate deficits in empathy to specific forms of personality pathology. The present study investigated to what extent impairments in cognitive and emotional empathy are markers of general versus specific personality pathology. Methods: In a clinical sample (n = 119), the Multifaceted Empathy Test was used to assess cognitive empathy, emotional empathy for positive emotions, and emotional empathy for negative emotions. Personality functioning, pathological personality traits, and DSM-5 Section II PDs were assessed via interviews and self-reports. Confirmatory factor analyses were applied to associate the three empathy facets with the three personality pathology approaches, each modeled with general personality pathology (common factor) and specific personality pathology (residuals of indicators). Results: Impairments in cognitive empathy and emotional empathy for positive emotions were significantly correlated with general personality pathology. All three empathy facets were also correlated to specific personality pathology when controlling for general personality pathology, respectively. Impairments in cognitive empathy were incrementally associated with identity and empathy (personality functioning), psychoticism (pathological personality traits), and paranoid and dependent PD (DSM-5 Section II PDs). Deficits in emotional empathy for positive emotions were incrementally associated with self-direction and intimacy (personality functioning) and detachment (pathological personality traits). Impairments in emotional empathy for negative emotions were incrementally associated with antagonism (pathological personality traits) and antisocial PD (DSM-5 Section II PDs). Conclusion: The results suggest that impairments in cognitive empathy and emotional empathy for positive emotions, but not for negative emotions, are markers of general personality pathology, while deficits in the three empathy facets are also markers for specific personality pathology.

1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
2.
Fonagy P, Gergely G, Target M, Jurist EL. Affect regulation, mentalization, and the development of the self. Other Press; 2002.
3.
Cuff BM, Brown SJ, Taylor L, Howat DJ. Empathy: a review of the concept. Emot Rev. 2016;8(2):144–53.
4.
Walter H. Social cognitive neuroscience of empathy: concepts, circuits, and genes. Emot Rev. 2012;4(1):9–17.
5.
Hall JA, Schwartz R. Empathy present and future. J Soc Psychol. 2019;159(3):225–43.
6.
Dziobek I, Rogers K, Fleck S, Bahnemann M, Heekeren HR, Wolf OT, et al. Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET). J Autism Dev Disord. 2008;38(3):464–73.
7.
Murphy BA, Lilienfeld SO. Are self-report cognitive empathy ratings valid proxies for cognitive empathy ability? Negligible meta-analytic relations with behavioral task performance. Psychol Assess. 2019;31(8):1062–72.
8.
Bonfils KA, Lysaker PH, Minor KS, Salyers MP. Affective empathy in schizophrenia: a meta-analysis. Schizophr Res. 2016;175(1–3):109–17.
9.
Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The “Reading the Mind in the Eyes” test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry. 2001;42(2):241–51.
10.
Kittel AFD, Olderbak S, Wilhelm O. Sty in the mind’s eye: a meta-analytic investigation of the nomological network and internal consistency of the “Reading the Mind in the Eyes” test. Assessment. 2022;29(5):872–95.
11.
Dziobek I. Comment: towards a more ecologically valid assessment of empathy. Emot Rev. 2012;4(1):18–9.
12.
Bender D, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM–5, part I: a review of theory and methods. J Pers Assess. 2011;93(4):332–46.
13.
Zettl M, Volkert J, Vögele C, Herpertz SC, Kubera KM, Taubner S. Mentalization and criterion A of the alternative model for personality disorders: results from a clinical and nonclinical sample. Personal Disord. 2020;11(3):191–201.
14.
Müller S, Wendt LP, Zimmermann J. Development and validation of the Certainty about Mental States Questionnaire (CAMSQ): a self-report measure of mentalizing oneself and others. Assessment. 2023;30(3):651–74.
15.
Rishede MZ, Juul S, Bo S, Gondan M, Bjerrum Møeller S, Simonsen S. Personality functioning and mentalizing in patients with subthreshold or diagnosed Borderline Personality Disorder: implications for ICD-11. Front Psychiatry. 2021;12:634332.
16.
OPD Task Force. Operationalized psychodynamic diagnosis OPD-2: manual of diagnosis and treatment planning. Hogrefe Publishing; 2008.
17.
Jauk E, Ehrenthal JC. Self-reported levels of personality functioning from the operationalized psychodynamic diagnosis (OPD) system and emotional intelligence likely assess the same latent construct. J Pers Assess. 2021;103(3):365–79.
18.
Zimmermann J, Müller S, Bach B, Hutsebaut J, Hummelen B, Fischer F. A common metric for self-reported severity of personality disorder. Psychopathology. 2020;53(3–4):168–78.
19.
Fossati A, Somma A, Krueger RF, Markon KE, Borroni S. On the relationships between DSM-5 dysfunctional personality traits and social cognition deficits: a study in a sample of consecutively admitted Italian psychotherapy patients. Clin Psychol Psychother. 2017;24(6):1421–34.
20.
Ball Cooper E, Anderson JL, Sharp C, Langley HA, Venta A. Attachment, mentalization, and criterion B of the alternative DSM-5 model for personality disorders (AMPD). Borderline Personal Disord Emot Dysregul. 2021;8(1):23–14.
21.
Blain SD, Udochi AL, Allen T, Xi M, DeYoung CG. Theory of mind and the agreeableness-antagonism dimension: differential associations with callousness, aggression, and manipulativeness. PsyArXiv; 16 Sept 2021.
22.
Lim DS, Gwee AJ, Hong RY. Associations between the DSM-5 section III trait model and impairments in functioning in Singaporean college students. J Pers Disord. 2019;33(3):413–31.
23.
Salgado RM, Pedrosa R, Bastos-Leite AJ. Dysfunction of empathy and related processes in borderline personality disorder: a systematic review. Harv Rev Psychiatry. 2020;28(4):238–54.
24.
Marsden J, Glazebrook C, Tully R, Völlm B. Do adult males with antisocial personality disorder (with and without co-morbid psychopathy) have deficits in emotion processing and empathy? A systematic review. Aggress Violent Behav. 2019;48:197–217.
25.
Lee RJ. Mistrustful and misunderstood: a review of paranoid personality disorder. Curr Behav Neurosci Rep. 2017;4(2):151–65.
26.
Rosell DR, Futterman SE, McMaster A, Siever LJ. Schizotypal personality disorder: a current review. Curr Psychiatry Rep. 2014;16(7):452–12.
27.
Ritter K, Dziobek I, Preissler S, Rüter A, Vater A, Fydrich T, et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 2011;187(1–2):241–7.
28.
Xiao F, Zhao J, Fan L, Ji X, Fang S, Zhang P, et al. Understanding guilt-related interpersonal dysfunction in obsessive-compulsive personality disorder through computational modeling of two social interaction tasks. Psychol Med. 2022;53(12):5569–81.
29.
Moroni F, Procacci M, Pellecchia G, Semerari A, Nicolò G, Carcione A, et al. Mindreading dysfunction in avoidant personality disorder compared with other personality disorders. J Nerv Ment Dis. 2016;204(10):752–7.
30.
Foell J, Brislin SJ, Drislane LE, Dziobek I, Patrick CJ. Creation and validation of an English-language version of the multifaceted empathy test (MET). J Psychopathol Behav Assess. 2018;40(3):431–9.
31.
Ohse L, Zimmermann J, Kerber A, Kampe L, Mohr J, Kendlbacher J, et al. Reliability, structure, and validity of module I (personality functioning) of the structured clinical interview for the alternative DSM–5 model for personality disorders (SCID-5-AMPD-I). Personal Disord. 2023;14(3):287–99.
32.
Beesdo-Baum K, Zaudig M, Wittchen HU. Strukturiertes Klinisches Interview für DSM-5® – persönlichkeitsstörungen (SCID-5-PD). Göttingen: Hogrefe; 2019.
33.
Bender D, Skodol A, First M, Oldham J. Module I: Structured clinical interview for the level of personality functioning scale. Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-AMPD) Arlington. Arlington, VA: American Psychiatric Association; 2018.
34.
Buer Christensen T, Hummelen B, Paap MC, Eikenaes I, Selvik SG, Kvarstein E, et al. Evaluation of diagnostic thresholds for criterion A in the alternative DSM-5 model for personality disorders. J Pers Disord. 2019;34(3):40–61.
35.
Panksepp J. Toward a general psychobiological theory of emotions. Behav Brain Sci. 1982;5(Supplement C):407–22.
36.
Arslan RC, Walther MP, formr TCS. A study framework allowing for automated feedback generation and complex longitudinal experience-sampling studies using R. Behav Res Methods. 2020;52(1):376–87.
37.
Hörz-Sagstetter S, Mokros A, Zimmermann J, Skodol AE, Bender DS. Strukturiertes Klinisches Interview für das DSM–5 – alternatives Modell für Persönlichkeitsstörungen (SCID-5-AMPD). German adaptation of the Structured Clinical Interview for the DSM–5 – alternative Model for Personality Disorders by Michael B. First John M. Oldham: Hogrefe. in press.
38.
First MB, Benjamin LS, Gibbon M, Spitzer RL, Williams JB. Structured clinical interview for DSM-IV Axis II personality disorders. American Psychiatric Press; 1997.
39.
Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV axis I disorders (SCID I) and axis II disorders (SCID II). Clin Psychol Psychother. 2011;18(1):75–9.
40.
Morey LC. Development and initial evaluation of a self-report form of the DSM–5 level of personality functioning scale. Psychol Assess. 2017;29(10):1302–8.
41.
Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. 2012;42(9):1879–90.
42.
Zimmermann J, Altenstein D, Krieger T, Holtforth MG, Pretsch J, Alexopoulos J, et al. The structure and correlates of self-reported DSM-5 maladaptive personality traits: findings from two German-speaking samples. J Pers Disord. 2014;28(4):518–40.
43.
Maples JL, Carter NT, Few LR, Crego C, Gore WL, Samuel DB, et al. Testing whether the DSM-5 personality disorder trait model can be measured with a reduced set of items: an item response theory investigation of the Personality Inventory for DSM-5. Psychol Assess. 2015;27(4):1195–210.
44.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55.
45.
Kenny DA, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of freedom. Sociol Methods Res. 2015;44(3):486–507.
46.
R Core Team. R:A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2023.
47.
Chu C, Victor SE, Klonsky ED. Characterizing positive and negative emotional experiences in young adults with borderline personality disorder symptoms. J Clin Psychol. 2016;72(9):956–65.
48.
Beblo T, Fernando S, Kamper P, Griepenstroh J, Aschenbrenner S, Pastuszak A, et al. Increased attempts to suppress negative and positive emotions in borderline personality disorder. Psychiatry Res. 2013;210(2):505–9.
49.
Carpenter RW, Trull TJ. Components of emotion dysregulation in borderline personality disorder: a review. Curr Psychiatry Rep. 2013;15:335–8.
50.
Kernberg O, Caligor E. A psychoanalytic theory of personality disorders. In: Lenzenweger MF, Clarkin JF, editors. Major theories of personality disorder. Guilford Press; 2005. p. 114–56.
51.
Bird G, Viding E. The self to other model of empathy: providing a new framework for understanding empathy impairments in psychopathy, autism, and alexithymia. Neurosci Biobehav Rev. 2014;47:520–32.
52.
Thoma P, Friedmann C, Suchan B. Empathy and social problem solving in alcohol dependence, mood disorders and selected personality disorders. Neurosci Biobehav Rev. 2013;37(3):448–70.
53.
Olderbak SG, Mokros A, Nitschke J, Habermeyer E, Wilhelm O. Psychopathic men: deficits in general mental ability, not emotion perception. J Abnorm Psychol. 2018;127(3):294–304.
54.
Green MF, Horan WP, Lee J. Social cognition in schizophrenia. Nat Rev Neurosci. 2015;16(10):620–31.
55.
Telle NT, Pfister HR. Positive empathy and prosocial behavior: a neglected link. Emot Rev. 2016;8(2):154–63.
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