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

Driscoll, David M. PhD*,†; Dal Monte, Olga MS*,†,‡; Solomon, Jeffrey PhD§; Krueger, Frank PhD∥,¶; Grafman, Jordan PhD#

Cognitive and Behavioral Neurology: December 2012 - Volume 25 - Issue 4 - p 160–166
doi: 10.1097/WNN.0b013e318280cf4e
Original Studies

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.

Supplemental Digital Content is available in the text.

*Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Department of Neuropsychology, University of Turin, Turin, Italy

§Expert Image Analysis LLC, Potomac, MD

Molecular Neuroscience Department, George Mason University, Fairfax, VA

Department of Psychology, George Mason University, Fairfax, VA

#Traumatic Brain Injury Research Laboratory, Kessler Foundation Research Center, West Orange, NJ

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

F.K. and J.G. jointly share senior authorship.

Supported in part by the US National Institute of Neurological Disorders and Stroke Intramural Research Program and a project grant from the US Army Medical Research and Material Command administered by the Henry M. Jackson Foundation (Vietnam Head Injury Study Phase III: a 30-year post-injury follow-up study). D.M.D. and O.D.M. were supported with funding from the Center for Neuroscience and Regenerative Medicine via the Henry M. Jackson Foundation.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the US Department of the Navy, Department of Defense, or the US Government.

The authors declare no conflicts of interest.

Reprints: David M. Driscoll, PhD, Department of Veterans Affairs, Nebraska-Western Iowa Health Care System, 600 South 70th Street, Lincoln, NE 68510 (e-mail:

Received October 18, 2011

Accepted August 15, 2012

© 2012 Lippincott Williams & Wilkins, Inc.