A review of the role of empathy in violence risk in mental disorders

Despite an established link between certain mental disorders and violence, the origins of this are not always clear. Recent work has suggested a role for social cognition deficits in this relationship. We conducted a systematic literature search using EMBASE, SCOPUS, PsychINFO, Science Direct and Ovid Medline databases and search terms relating to empathy, violence and mental disorders. 15 studies were classified as assessing either theory of mind (ToM) (n = 6) or facial affect recognition (FAR) (n = 10). Better mentalizing ability may be linked with violence. Violent patients with schizophrenia perform worse than those with personality disorder, but outperform their non-violent counterparts on complex theory of mind tasks. Six studies examined facial affect recognition in violent psychopathy patients, three of which found impairments in high psychopathy patients. Four studies investigated FAR in violent schizophrenia patients, who again tended to outperform non-violent patients, though the evidence for specificity of emotion remains mixed. Empathy may play a mediating role in the relationship between violence and mental disorder. Current findings are limited by methodological inconsistencies. Future studies would benefit from more comprehensive assessments of violence and co-morbidities, and more standardized measures across studies.

► We reviewed studies of empathy in violent individuals with psychiatric disorders.
► Those with personality disorders are not impaired on theory of mind (ToM) tasks.
► Good mentalizing ability may be associated with a greater propensity to violence.
► Patients with psychopathy have poor FAR; evidence for specific deficits is mixed.
► Violent patients with schizophrenia are less able to recognize negative emotions.