Psychological Medicine, 2004, 34, 911–924. f 2004 Cambridge University Press DOI: 10.1017/S0033291703001624 Printed in the United Kingdom Measuring empathy: reliability and validity of the Empathy Quotient E. J. LAWRENCE, P. SHAW, D. BAKER, S. BARON-COHEN AND A. S. D A V I D* Section of Cognitive Neuropsychiatry, Department of Psychological Medicine, Institute of Psychiatry, DeCrespigny Park, Denmark Hill, London SE5 8AF, UK; Autism Research Centre, University of Cambridge, Departments of Experimental Psychology and Psychiatry, Downing Street, Cambridge CB2 3EB, UK ABSTRACT Background. Empathy plays a key role in social understanding, but its empirical measurement has proved difficult. The Empathy Quotient (EQ) is a self-report scale designed to do just that. This series of four studies examined the reliability and validity of the EQ and determined its factor structure. Method. In Study 1, 53 people completed the EQ, Social Desirability Scale (SDS) and a non-verbal mental state inference test, the Eyes Task. In Study 2, a principal components analysis (PCA) was conducted on data from 110 healthy individuals and 62 people reporting depersonalisation (DPD). Approximately 1 year later, Study 3, involved the re-administration of the EQ (n=24) along with the Interpersonal Reactivity Index (IRI; n=28). In the last study, the EQ scores of those with DPD, a condition that includes a subjective lack of empathy, were examined in depth. Results. An association was found between the Eyes task and EQ, and only three EQ items corre- lated with the SDS. PCA revealed three factors: (1) ‘cognitive empathy’; (2) ‘emotional reactivity’, and (3) ‘social skills’. Test–retest reliability was good and moderate associations were found between the EQ and IRI subscales, suggesting concurrent validity. People with DPD did not show a global empathy deficit, but reported less social competence. Conclusions. The EQ is a valid, reliable scale and the different subscales may have clinical applications. INTRODUCTION of other minds) overlaps with cognitive empathy There are several definitions of empathy reflect- and the terms are used interchangeably here. For an emotional response to count as ing its multidimensional nature. Social psychol- ‘affective empathy’ it has to be appropriate to ogists have conceptualized empathy as having the observed mental state. Emotional responses two main strands (1) cognitive empathy – to others’ mental states can be classified as: ‘the intellectual/imaginative apprehension of (1) parallel – the response matches that of the another’s mental state’ and (2) emotional empa- target, for instance, feeling fear at another’s thy – ‘an emotional response to … emotional fright, and (2) reactive – involves going beyond responses of others’. Recently, in the literature, a simple matching of affect – such as sympathy emotional empathy has also been labelled or compassion (Davis, 1994). However, some ‘affective’ empathy. The literature on ‘theory of mind’ (or the ability to think about the contents emotional responses are not considered truly empathic, i.e. happiness at another’s misfortune or, less obviously, ‘personal distress’ (Davis, * Address for correspondence: Professor Anthony David, Section 1980; Eisenberg et al. 1987). The latter occurs of Cognitive Neuropsychiatry, Box 68, Institute of Psychiatry, DeCrespigny Park, London, SE5 8AF, UK. when someone has a self-orientated state of (Email: [email protected]) ‘personal distress’ in response to another’s 911 912 E. J. Lawrence et al. negative state (Batson et al. 1987). What dis- have been hypothesised as having problems tinguishes this from an empathic response is employing ‘empathy’. Most obvious, are those that it is self- rather than other-orientated. diagnosed with autistic spectrum disorders and Several scales have been developed to people who display signs of psychopathy (Blair, measure empathy but each has important 1995). More recently, other groups have been weaknesses. The Questionnaire Measure of suggested, such as those who report deperson- Emotional Empathy (Mehrabian & Epstein, alisation (Senior et al. 2001; Baker et al. 2003), 1972) was designed to tap emotional empathy. who frequently complain of a subjective deficit However, with hindsight, the authors suggest in empathising. it may measure general emotional arousability The EQ was validated on 197 healthy control instead (Mehrabian et al. 1988). Items on a volunteers and 90 people with Asperger’s Syn- newer version – the Balanced Emotional drome and High-functioning Autism (AS/HFA) Empathy Scale (Mehrabian, 2000) – measure, and age and sex matched controls (a sex ratio more specifically, reactions to others’ mental of 2.6 : 1 m : f was found). It was shown to dis- states, but unfortunately, it is still not clear tinguish reliably between the clinical and control that they tap emotional empathy alone, e.g. groups. The authors also found sex differences ‘I cannot easily empathise with the hopes and in the control group with women scoring sig- aspirations of strangers/I easily get carried away nificantly higher. In addition, the EQ was found by the lyrics of a love song’. A questionnaire to have high test–retest reliability over a period measuring cognitive empathy (Hogan, 1969) of 12 months. Baron-Cohen et al. (2003) rep- was also developed in the 1960s; however, a licated the female superiority on the EQ and factor analysis suggested it may actually tap showed once again that it distinguished between social self-confidence, even temperedness, sensi- those with AS/HFA and controls. tivity and non-conformity (Johnson et al. 1983). The aim of this paper was to examine further Critics also argue that it measures simply the validity and reliability of the EQ across social skills rather than empathy per se (Davis, samples. Test–retest reliability was re-examined, 1994). and the association between the EQ and a The Interpersonal Reactivity Scale (Davis, well-validated measure of ‘social desirability’ 1980) adds further dimensions to the measure- (Crowne & Marlowe, 1960) was explored. This ment of empathy. It includes subscales that was included to address a general problem with measure perspective-taking, in line with tra- self-report measures, that is that people may ditional definitions of cognitive empathy, respond according to how they would like to empathic concern which specifically addresses appear, i.e. highly ‘empathic’. The association the capacity of the respondent for warm, con- between the EQ and the Eyes task (Baron- cerned, compassionate feelings for others, Cohen et al. 2001) was also considered as a fantasy items – which measure a tendency to means of assessing construct validity. Next, an identify with fictional characters and personal exploratory factor analysis was performed in distress which is designed to tap the occurrence order to explore the various components of of self-orientated responses to others’ negative empathy. As a further check on concurrent experiences. The author describes the question- validity, the relationship between the EQ and naire as tapping four separate aspects of the Interpersonal Reactivity Index (IRI; Davis, empathy but it is unclear whether the fantasy 1980) was then examined. Lastly, the EQ scores subscale taps pure empathy (Baron-Cohen & of people with DPD were considered in depth. Wheelwright, in press) – and personal distress, despite being important, is not empathy in Study 1 itself. The EQ (Baron-Cohen & Wheelwright, in Participants press) (see website for Appendix 1) is the most There were 53 volunteers [28 (52.8%) women recent addition, and unlike previous scales it and 25 (47.2) men] with a mean age of 32.5 years was explicitly designed to have a clinical appli- (¡10.9). Approximately, 50% of this group cation and be sensitive to a lack of empathy as were recruited from mental health professionals a feature of psychopathology. Several groups at the Institute of Psychiatry (40% of men and Measuring empathy 913 60% of women). The remainder were recruited Table 1. Mean and S.D. scores on the EQ from non-academic/clinical staff and through advertisements in the local area. Total score on the EQ n Mean S.D. Min Max Procedure . All measures were completed in a quiet room Male 25 41 31012258 Female 28 50.69.23066 as part of a wider testing session. Participants Group total 53 46.210.62266 were given the EQ (Baron-Cohen & Wheel- wright, in press) self-report measure of empa- thy. Responses are given on a 4-point scale and females 47.2(¡10.2). Sex differences were ranging from ‘strongly agree’ to ‘strongly also found (t=x3.5, df=51, p=0.001). The disagree’. Approximately half the items are data were normally distributed [slightly negative reversed. Participants received 0 for a ‘non- skew (x0.190) and kurtosis of less than 1 empathic’ response, whatever the magnitude, (x0.717)]. and 1 or 2 for an ‘empathic response’ depending Each item on the EQ was entered into a on the strength of the reply. There are 60 items Pearson’s Product Moment Correlation analysis including 20 filler items – and so the total score along with the total score on the SDS. A positive is out of 80. Missing values on the EQ, resulting correlation above 0.3 was taken as an indicator from a double endorsement or no endorsement, of socially desirable responding. Items 11, 18, were substituted with the group mean rounded 27, 34 and 37 of the EQ, all correlated signifi- to the nearest whole number. cantly with total SDS score but item 27 corre- Participants were also given the Social Desir- lated below 0.3, and item 37 had a negative ability Scale (SDS; Crowne & Marlowe, 1960) rather than positive relationship. Items 11, 18 which taps people’s tendency to respond to and 34 were therefore dropped from subsequent items in a socially desirable way. One point is analyses. allocated for each item endorsed, resulting in The mean score on the Eyes test was 27.6 scores ranging from 1 to 33 with a high score (¡4) which is very similar to the normative data indicating that the respondents are prone to (general population 26.2/students 28).