Background: Emotional dysregulation is a core feature of eating disorders, yet research has predominantly focused on intrapersonal emotion processes rather than interpersonal emotional mechanisms. Empathy comprises affective empathy (AE; feeling others' emotions) and cognitive empathy (CE; understanding others' emotions), with recent research suggesting that empathic disequilibrium - imbalances between AE and CE – may contribute to psychopathology. We hypothesized that empathic disequilibrium characterized by AE-dominance underlies emotional difficulties in eating disorders through heightened emotional reactivity. Methods: We conducted a two-phase investigation. Study 1 examined empathy and eating disorder symptoms in 345 undergraduate students using the Interpersonal Reactivity Index (IRI) and Eating Disorder Examination Questionnaire (EDE-Q). Study 2 replicated findings in 835 participants (including 103 with eating disorder diagnoses) and tested emotional reactivity as a mediator using the Emotional Reactivity Scale (ERS). Results: Both studies demonstrated consistent associations between empathic disequilibrium characterized by AE-dominance and eating disorder pathology (Study 1) and diagnosis (Study 2), with CE being unrelated to eating disorder symptoms. Mediation analyses revealed that emotional reactivity mediated the relationship between empathic disequilibrium and eating disorder symptoms, with sensitivity analyses supporting pathway robustness. Conclusions: This study provides first comprehensive evidence that empathic disequilibrium, rather than specific empathic deficits, represents a potential risk factor for eating psychopathology. AE-dominance appears to create emotional hyper-arousal when encountering others' emotions, which may be regulated using disordered eating behaviours. These findings challenge traditional empathy approaches in psychopathology and highlight the importance of interpersonal emotional processes in eating disorder conceptualization and treatment, opening new therapeutic avenues targeting both intrapersonal and interpersonal emotional functioning.
Shalev et al. (Thu,) studied this question.