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Is damage to the ventromedial prefrontal cortex associated with impaired empathy? A neuropsychological study using an empathy motivation task
Journal article   Open access   Peer reviewed

Is damage to the ventromedial prefrontal cortex associated with impaired empathy? A neuropsychological study using an empathy motivation task

Julian A Scheffer, Justin Reber, C Daryl Cameron and Daniel Tranel
Social cognitive and affective neuroscience
09/02/2026
DOI: 10.1093/scan/nsag072
PMID: 42687436
url
https://doi.org/10.1093/scan/nsag072View
Published (Version of record) Open Access

Abstract

Patients with damage to the ventromedial prefrontal cortex (vmPFC) classically develop personality disturbances, emotion dysregulation, and social decision-making deficits that have been likened to psychopathic tendencies ("pseudopsychopathy"). These acquired deficits are thought to entail empathy impairments, viz., identifying other people's emotional experiences and caring about their well-being. However, these impairments may be due to either low motivation to empathize or impaired ability to empathize accurately. We examined whether patients with vmPFC lesions (who have been shown previously to have major deficits in empathy accuracy) would exhibit low empathy motivation. We conducted a lesion group comparison study to assess motivation to empathize. The results showed that damage to the vmPFC was not associated with low empathy motivation (including avoidance of affective or cognitive forms of empathy). Specifically, patients with vmPFC lesions did not avoid empathy any more so than comparison groups (participants with damage outside of the vmPFC or participants with no brain damage). Our findings suggest that patients with vmPFC damage may have preserved empathy motivation, at least in an off-line, laboratory task setting, despite their real-world impairments with deploying empathy. More research is needed to examine whether patients with vmPFC lesions would exhibit normal empathy motivation in everyday contexts.Patients with damage to the ventromedial prefrontal cortex (vmPFC) classically develop personality disturbances, emotion dysregulation, and social decision-making deficits that have been likened to psychopathic tendencies ("pseudopsychopathy"). These acquired deficits are thought to entail empathy impairments, viz., identifying other people's emotional experiences and caring about their well-being. However, these impairments may be due to either low motivation to empathize or impaired ability to empathize accurately. We examined whether patients with vmPFC lesions (who have been shown previously to have major deficits in empathy accuracy) would exhibit low empathy motivation. We conducted a lesion group comparison study to assess motivation to empathize. The results showed that damage to the vmPFC was not associated with low empathy motivation (including avoidance of affective or cognitive forms of empathy). Specifically, patients with vmPFC lesions did not avoid empathy any more so than comparison groups (participants with damage outside of the vmPFC or participants with no brain damage). Our findings suggest that patients with vmPFC damage may have preserved empathy motivation, at least in an off-line, laboratory task setting, despite their real-world impairments with deploying empathy. More research is needed to examine whether patients with vmPFC lesions would exhibit normal empathy motivation in everyday contexts.

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