When we say empathy, do we mean compassion and/or sympathy?

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When we say empathy, do we mean compassion and/or sympathy? They are not the same.

It is interesting that the architects of the DSM 5 recommended that a personality disorder be diagnosed when a person has diminished skills in two of the following -- either "empathy or intimacy" and either "identity or self direction".

Empathy is a very significant life skill and important for all future relationships.

The words the DSM architects use to rate impaired empathy are telling (each one is part of  rating):

• See others as controling

• Excessively self-referential

• Unawareness of effect of own behavior on others

• Unable to consider alternative perspectives

• Threatened by differences of opinion

• Bewildered about peoples’ thoughts

• Destructive motivations frequently misattributed to others

It might be eye opening to see how we score ourselves/partners in the last relationship using this scale.

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DSM 5 Empathy Assessment Levels

Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing. Is aware of the effect of own actions on others.

Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.

Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.

Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering. Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.

Extreme Impairment (4) Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance). Social interactions can be confusing and disorienting.

[MapleBob]

I'd put myself (in that relationship, particularly near the end) at a 1.5 - 2, and her at a 2.5 - 3. I think that I acted pretty self-centered in many ways (mistaking it for self-sufficiency and healthy attachment), and I certainly thought that she was being unreasonable in ways that I can now recognize were important to her.

[HurtinNW]

I have a job that requires radical empathy (I work with death row inmates). I think I have a really strong understanding of empathy. I think I have very healthy empathy for my clients. I have strong empathy while maintaining good boundaries. I feel good about being an empath in my daily life. I believe empathy is what lets us honor the truth in other people: the good, the bad, the ugly. It keeps us from minimizing or enabling, but it also keeps us from demonizing. We see life through the eyes of another.

With my ex my empathy got so confused. In some ways I empathized too much, until the empathy became impaired, and then more impaired. I was hypervigilant to him and myself. I lost myself. Real empathy requires a strong sense of self. You have to be strong to see life from another person's eyes. You can't be reactive. You can't be acting like a hurt child yourself.

In the case of my ex my empathy got mixed with guilt and compassion and pity. I'm still trying to unravel that mess.

[once removed]

in the context of that scale, ive been somewhere between 0 and 1. but ive never tended to ascribe motives to people. chances are if someone has unreasonable expectations or a wish to control me, its pretty obvious and well established.

i was somewhat hard on myself in my previous reply. the examples i provided, speaking to or treating another human being that way, there are no excuses for that, and if i felt that strongly, i should have left. i dont forget that i was dealing with a distorted perspective, but i dont want to outright dismiss anyones perspective as "distorted".

the growth for me has been with the communication skills, which have reaffirmed the idea that i ought not validate the invalid, but i ought not invalidate the valid either. someone ascribing me motives and being verbally abusive in the process is not something i have to validate. its also not something i need to label psychotic and respond aggressively to. and even if i deem it invalid, there was growth in understanding what was driving it, as well as the ability to depersonalize it, plus the awareness of what drove my responses, and forgiveness for myself for them while striving to do better.

its full circle. i did the best i could with what i had at the time, and so did she, and there are areas id give us both pretty strong marks. i have the skills, tools, and importantly, commitment, to do better next time. still learning though!

[Icanteven]

The words the DSM architects use to rate impaired empathy are telling (each one is part of  rating):

• See others as controlling

• Excessively self-referential

• Unawareness of effect of own behavior on others

• Unable to consider alternative perspectives

• Threatened by differences of opinion

• Bewildered about peoples’ thoughts

• Destructive motivations frequently misattributed to others

It might be eye opening to see how we score ourselves/partners in the last relationship using this scale.

1)  See others as controlling: asking my wife to do anything with me was referred to after she left as controlling behavior.  Spend time with the kids?  Controlling. Not stay out all night drinking while out on disability?  Controlling.  Joining me for dinner?  Controlling.

2) Excessively self-referential: best friend talking to another friend at a wedding?  She hates me.  You got 200 likes on an Instagram photo?  You're on your way to a million followers.  And, let's not forget that aberrant self-referential ideas are linked to the ever-present suicide ideation.

3)Unawareness of effect of own behavior on others:  Maybe the reason that the guy you met during a bachelorette weekend spent all night drinking and dancing with you is because you gave him the impression that he should?  Even though you're married? Maybe?  Bueller?  Alternatively, maybe your ex-boyfriend from ten years ago doesn't want to speak to you ever again because of the horrific, internet-legend, stranger-than-fiction way you broke up with him instead of, say, the idea that he's afraid if he starts talking to you he'll want to get you back.  Any self-awareness would be welcome.

I could do all of these in lurid detail, but the point is, there's a reason my wife was pushed towards DBT and schema and mindfulness and group CBT and has a GAF score of 40 etc ad nauseum.  

[gotbushels]

Eye opening. Thanks for the exercise. I found it useful.

In the relationship: 4 her, 1.5 me.

Out of relationship: 1 her, 0 me. <edit:retained to see effect>

Overall, I don't believe the partner was impaired in experience, consideration, or understanding of others. At moments, she's shown accurate and deep experience with others. But something in the identity seemed to obstruct her processing or holding stable appraisals of others' perspectives.

"Understanding" meanings occur thrice on every level except the last, there are more.

DSM 5 Empathy Assessment Levels

Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing. Is aware of the effect of own actions on others.

Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.

Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.

Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering. Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.

Extreme Impairment (4) Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance). Social interactions can be confusing and disorienting.

The framework seems to clarify distinction in meaning between the three words.



A detaching non would probably be interested to use this in an easier way, possibly to clarify their thinking or increasing empowerment:) Meaning to score themselves→ see how to move to a healthier category→ open eyes a bit more→ look for paths→ walk on it.

Tools could be a path. E.g. In the dysregulation dance, I was situationally a 0 - 3. Mindfulness and validation (self) helped me exit that 0 - 3 range. At that time, I didn't pursue the specific act of distinguishing understanding. Yet I feel I reaped benefits. Simple tiny bites like noticing (or naming feelings to the world) clarified understanding of her in that moment without having to feel compassion/sympathy/warmth/tolerance/pity/mercy/love from her behaviour.

The tools enable nons to more consistently "get the silver" from this distinction. That's hopeful:) A little bite of mindfulness practice can go a long way over time.

For nons seeking:

bpdfamily.com > The Learning Center > Workshops >

Topic: TOOLS: Radical Acceptance for family members

Board: Detaching board→

Lesson: Lesson 3. Tools→

Tools: Tools for self inquiry→

3.2 Our emotional health→

TOOLS: DBT for Non Borderlines- Mindfulness