Empathic disequilibrium as a predictor of non-suicidal self-injury in autistic and non-autistic people.

Abstract

Background Non-suicidal self-injury (NSSI) affects many autistic individuals, and has been linked to suicidality in this group. It has been closely linked to difficulties with intrapersonal emotion regulation, but a role of interpersonal emotion regulation processes in NSSI has been underexplored. Empathic disequilibrium is a state of imbalance between a person’s cognitive empathy (CE) and emotional empathy (EE). We recently found that autistic people exhibit heightened EE relative to CE, consistent with their first-hand reports of hyper-sensitivity to the emotions of others. Because this kind of empathic imbalance is associated with hyperarousal and emotional reactivity, we hypothesised that it might increase risk of NSSI, which often occurs as a means of trying to regulate overwhelming or distressing emotions. Methods We measured CE, EE, emotional reactivity, and NSSI behaviours in 304 autistic and 289 non-autistic participants, and used Polynomial Regression with Response Surface Analysis to examine empathic disequilibrium as a predictor of emotional reactivity and engagement in NSSI. Results Replicating previous research, individuals with an autism diagnosis were more likely to show a pattern of EE-dominance (OR = 4.51 [2.66, 7.63], p < 0.001), though they did not differ significantly in overall empathy levels. While empathic disequilibrium was associated with NSSI in autistic and non-autistic people, the nature of these pathways differed between groups. In autistic people, empathic disequilibrium towards EE-dominance was associated with higher incidence of NSSI through emotional reactivity. In contrast, for non-autistic individuals, incidence of NSSI was associated with overall empathy and, when accounting for emotional reactivity, with empathic disequilibrium towards CE-dominance. Conclusions While future studies should investigate the direction of relationships with longitudinal designs, these findings highlight different mechanisms for NSSI in autistic and non-autistic people. They corroborate growing evidence that the relative imbalance between empathic abilities may be relevant for meaningful outcomes, such as psychopathology.