Recent evidence suggests that there are two possible systems for empathy: a basic emotional contagion system and a more advanced cognitive perspective-taking system. However, it is not clear whether these two systems are part of a single interacting empathy system or whether they are independent. Additionally, the neuroanatomical bases of these systems are largely unknown. In this study, we tested the hypothesis that emotional empathic abilities (involving the mirror neuron system) are distinct from those related to cognitive empathy and that the two depend on separate anatomical substrates. Subjects with lesions in the ventromedial prefrontal (VM) or inferior frontal gyrus (IFG) cortices and two control groups were assessed with measures of empathy that incorporate both cognitive and affective dimensions. The findings reveal a remarkable behavioural and anatomic double dissociation between deficits in cognitive empathy (VM) and emotional empathy (IFG). Furthermore, precise anatomical mapping of lesions revealed Brodmann area 44 to be critical for emotional empathy while areas 11 and 10 were found necessary for cognitive empathy. These findings are consistent with these cortices being different in terms of synaptic hierarchy and phylogenetic age. The pattern of empathy deficits among patients with VM and IFG lesions represents a first direct evidence of a double dissociation between emotional and cognitive empathy using the lesion method.

Human empathy relies on the ability to share emotions as well as the ability to understand the other’s thoughts, desires, and feelings. Recent evidence points to 2 separate systems for empathy: an emotional system that supports our ability to empathize emotionally and a cognitive system that involves cognitive understanding of the other’s perspective. Converging evidence from neuroimaging and lesion studies shows that a neural network that includes the inferior frontal gyrus and the inferior parietal lobule is necessary for emotion recognition and emotional contagion. On the other hand, the involvement of the ventromedial prefrontal cortex, temporoparietal junction, and the medial temporal lobe in self-reflection and autobiographical memory places these key regions as necessary for cognitive empathy. The proposed dissociation between these systems is supported by recent neurochemical experiments involving administration of oxytocin as well as by ethological, psychiatric, and developmental studies. Finally, although the emotional and cognitive systems appear to work independently, every empathic response may still evoke both components to some extent, depending on the social context.