Impaired abilities of spontaneous empathic heterocentered visuo-spatial perspective-taking co-variate with low clinical insight in Alcohol Use Disorder

Up to 50% of patients with alcohol use disorder (AUD) attending detoxification programs relapse in the following year. Poor insight – insight referring to the capacity of psychiatric patients to recognize and accept their mental disorders – is considered a candidate explanation for therapeutic failure and relapse. New clinical models posited that insight growth necessitates intact empathic abilities (Empathy-Based Insight Model [EBIM]). Psychical insight (recognition) requires the visuo-spatial and cognitive dimensions of empathy (heterocentered visuo-spatial (hVSPT) and psychological perspective-taking (PPT)): i.e., changing visuo-spatial and psychological perspective on one’s own mental states enables to develop a more objective viewpoint on one’s pathological conditions. Emotional insight (acceptance) requires the embodied and emotional dimensions of empathy: i.e., emotionally sharing the psychological perspective of someone else on one’s own pathological mental states enables to self-validate the suitability of this perspective. Deficits on empathy are assumed to precipitate relapse in AUD while non-dysfunctional empathic PPT abilities to predict treatment seeking. However, the relationship between empathic hVSPT abilities – a prerequisite for empathic PPT abilities – and insight has never been explored in AUD. We tested whether spontaneous empathic hVSP abilities relate to psychical insight in 26 recently detoxified AUD patients, compared to 26 healthy controls. We assessed spontaneous empathic hVSPT abilities using the Empathy-Sympathy Test and insight using the Hanil Alcohol Insight Scale. We calculated repeated measures ANOVA, Bayesian analyses and correlation matrix. One-third of AUD patients exhibited difficulties using spontaneous empathic hVSPT patterns. In the remaining two-thirds, these abilities were intact. Scores on one subcomponent of clinical insight (recognition of the necessity of treatment) was significantly higher in AUD-hVSP. These preliminary findings, needing to be confirmed in longitudinal studies with larger populations, showed that greater spontaneous empathic hVSP abilities co-variate with better clinical insight into the necessity of treatment. Evaluating both status of clinical insight and spontaneous empathic hVSPT abilities in routine AUD examination over the detoxification time course could provide a key criterion to anticipate the risk of symptoms worsening, and better predict relapse. Not applicable.