Can an ‘Extreme Female Brain’ be characterised in terms of psychosis?
Introduction
Sex differences are of great interest to humans. One framework for investigating and understanding sex differences is the empathising–systemising (E–S) theory (Baron-Cohen, 2002, Baron-Cohen, 2003, Baron-Cohen, 2009). Empathising is the drive to identify another person’s emotions and thoughts, and to respond to these with an appropriate emotion. Empathising also allows one to predict a person’s behaviour, and to care about how others feel. Systemising is defined as the drive to analyse the variables in a system, to derive the underlying rules that govern the behaviour of a system. Systemising allows you to predict the behaviour of a system, and to control it (Baron-Cohen, 2002). The relationship between empathising and systemising is currently unclear. While some research has shown a negative correlation between empathising and systemising (Goldenfeld et al., 2005, Wheelwright et al., 2006), other findings have been inconsistent with this (Carroll and Chiew, 2006, Voracek and Dressler, 2006). Bowler, Briskman, Gurvidi, and Fornells-Ambrojo (2005) developed a mechanical (systemising) analogue to an empathising task and showed that performance upon the two tasks was significantly correlated. This raises the possibility a common mechanism may underlie systemising and empathising performance, which would predict a correlation between measures of these abilities within individuals.
A number of studies have shown that females do better on tests of empathising compared to males. For example, on the Reading the Mind in the Eyes test, which requires people to read the mental and emotional states of others from the eye regions, females score significantly higher than males (Baron-Cohen et al., 1997, Baron-Cohen et al., 2001). Research using the Empathising Quotient (EQ), which is a questionnaire designed to tap into empathising ability, has shown that females score higher than males (Auyeung et al., 2009, Baron-Cohen and Wheelwright, 2004, Wakabayashi et al., 2006). Together, these findings illustrate an advantage for females over males in terms of empathising ability.
On the other hand, males typically outperform females on tasks measuring systemising. In the intuitive physics task, where participants have to predict the outcome position of a series of pulleys and levers, males score higher than females (Carroll and Chiew, 2006, Lawson et al., 2004). This was found to be the case irrespective of whether their academic discipline was in science or humanities (see also Focquaert et al., 2007, Wheelwright et al., 2006). Males also score higher than females on the Systemising Quotient (SQ), a questionnaire designed to tap into systemising ability (Auyeung et al., 2009, Baron-Cohen et al., 2003, Wakabayashi et al., 2006).
Therefore, the male-typical profile involves systemising exceeding empathising abilities (S > E), while the female-typical profile has empathising exceeding systemising (E > S: see Fig. 1). In this model, a ‘Balanced’ brain type is represented by relatively equivalent levels of empathising and systemising ability (E = S). The Extreme Male Brain (EMB) occurs at one end of the continuum and is characterised by systemising abilities that are far better than empathising abilities (S » E). Conversely, the Extreme Female Brain (EFB) appears at the opposite end of the continuum and is characterised by empathising abilities that are much better than systemising abilities (E » S). In a study of 1761 students (Wheelwright et al., 2006), females were far more likely to register as EFB (E » S), while males were more likely to register as EMB (S » E). In addition, almost two-thirds of a sample with a diagnosis of autism or Asperger Syndrome, which are both Autism Spectrum Disorders (ASD), met an EMB profile of S » E (see also Baron-Cohen, 2002, Baron-Cohen et al., 2003, Baron-Cohen, 2009). ASD are characterised by deficits in social cognition and communication, alongside repetitive behaviour and restricted interests (APA, 2000).
Consistent with the Extreme Male Brain theory of autism (Baron-Cohen & Hammer, 1997), people with ASD perform worse than typical males and females on the Reading the Mind in the Eyes task (Baron-Cohen et al., 1997, Baron-Cohen et al., 2001). People with ASD also score significantly lower on the Empathising Quotient than both males and females (Baron-Cohen & Wheelwright, 2004). On the other hand, people with ASD score higher than both typical males and female controls on both the Systemising Quotient (Baron-Cohen et al., 2003), and in tests of intuitive physics (Baron-Cohen et al., 2001, Lawson et al., 2004).
Unfortunately, there has been a dearth of theories and research about the opposite end of the spectrum to the EMB, where empathising skills far exceed systemising skills. A recent model by Badcock and Crespi, 2006, Badcock and Crespi, 2008, Crespi and Badcock, 2008 specifically addresses the EFB and proposes it is associated with psychosis. More specifically, the autism-psychosis model by Badcock and Crespi (2008), proposes that hyper-empathising underpins paranoia, and represents the opposite pattern of behaviour to the hypo-empathising behaviours associated with autism. From this perspective, the gaze deficits seen in autism may be the exact opposite to paranoid delusions of being watched or spied upon. Further, the autistic inability to appreciate what goes on in groups can be seen as the antithesis to paranoid delusions of conspiracy, which involves imagining group activity everywhere. Therefore, Crespi and Badcock (2008) conceptualise ASD and psychosis at opposing ends of a social brain continuum.
A number of early studies on mentalising (empathising) in schizophrenia reported deficits compared to controls (e.g. Corcoran, Mercer, & Frith, 1995; see Frith, 1992/2003). Thus schizophrenia was characterised by impaired mentalising, similar to autism; deficits were more evident for those with negative schizophrenic symptoms, and less clear for those with predominantly paranoid symptoms (Langdon et al., 1997). Langdon and Brock (2008) argue that the same schizophrenic patient can demonstrate both hyper-mentalising and hypo-mentalising and the deficit is best characterised as impaired perspective taking. Montag, Heinz, Kunz, and Gallinat (2007) characterise impaired perspective taking as a deficit in ‘cognitive empathy’ in schizophrenia which is distinct from ‘affective empathy’. A study by McCabe and colleagues using clinical interviews with schizophrenic outpatients showed that the participants with schizophrenia had an understanding of the interviewer’s beliefs during the conversations, even when the beliefs differed from their own (McCabe, Leudar, & Antaki, 2004). These findings are consistent with more recent conceptualisations of mentalising in schizophrenia suggesting those who show predominantly positive symptoms have intact mentalising abilities, and may actually over-attribute beliefs to others (Abu-Akel & Bailey, 2000). Frith (2004) similarly associates separate mentalising difficulties to positive versus negative schizophrenia. A person with negative symptoms may have no awareness of, or take no account of, the beliefs and desires of others. However, a person with positive symptoms has no problem ascribing intentions to others. In fact, they may inappropriately and excessively ascribe intentions to others (e.g. ‘over-mentalising’). Evidence for over-mentalising in schizophrenia comes from patients attributing intentions to behaviour seen as random by control participants and people with affective disorders (Blakemore et al., 2003, Russell et al., 2006).
In the Crespi and Badcock model, psychosis is characterised as a triad of three main conditions: schizophrenia, bipolar depression and major depression. This idea fits in well with prevalence rates of major psychiatric conditions, as females have a higher prevalence compared to males for mood disorders such as depression and anxiety (Kessler et al., 1994, Kuehner, 2003, Pigott, 1999). While the evidence is less clear for schizophrenia, there is evidence to suggest some sex differences evident in timing and severity (see Crespi & Badcock, 2008 for an overview). To address the issue of why schizophrenia is not a female-dominated disorder, Crespi and Badcock argue that schizophrenia with positive symptoms is relatively more frequent in females, while schizophrenia with negative symptoms is more frequent in males. To date, however, there have been no published research reports testing the nature of the EFB profile. The present study aims to fill this gap with initial evidence characterising the EFB profile, by looking at associations between empathising and systemising ability and measures of psychosis, depression, and anxiety. According to Crespi and Badcock (2008) hyper-empathising should positively correlate with measures of psychosis, and particularly with paranoia.
Section snippets
Participants
An opportunity sample of 70 healthy female undergraduates was recruited for the study, all of whom reported having no clinical diagnosis. Ages ranged from 19 to 23, with a mean of 21 years (SD = 1.0). Participants were recruited from the various available university departments, to provide a wide academic background (9% from physical sciences, 19% biological sciences, 41% social sciences, 24% humanities, 6% arts).
Results
The ranges, means and standard deviations for the five assessments, and the difference between the z-scores for empathising and systemising (‘Empathising Bias’), are reported in Table 1. Shapiro–Wilk tests showed that all measures were normally distributed. Kurtosis and skewness were all within acceptable parameters. Cronbach’s alpha measures revealed good internal reliability in the empathising (α = .90), systemising (α = .83) and depression (α = .80) scales, but lower levels of agreement in the
Discussion
The present study represents the first empirical data the authors are aware of characterising the EFB. The findings showed that hyper-empathising was positively correlated with higher psychosis, but was not associated with measures of depression or anxiety. Furthermore, the two psychosis items that correlated most significantly with hyper-empathising were mania (feeling elated) and paranoia (feeling others are against you). These findings are consistent with Crespi and Badcock’s theory (2008)
References (41)
The extreme male brain theory of autism
Trends in Cognitive Science
(2002)- et al.
Schizophrenia, symptomatology and social inference: Investigating “theory of mind”’ in people with schizophrenia
Schizophrenia Research
(1995) - et al.
Empathizing and systemizing cognitive traits in the sciences and humanities
Personality and Individual Differences
(2007) - et al.
Self-reported empathic abilities in schizophrenia
Schizophrenia Research
(2007) - et al.
A latent class analysis of positive psychosis symptoms based on the British Psychiatric Morbidity Survey
Personality and Individual Differences
(2007) - et al.
Do you see what I see? Interpretations of intentional movement in schizophrenia
Schizophrenia Research
(2006) - et al.
Lack of correlation between digit ratio (2D: 4D) and Baron-Cohen’s “Reading the Mind in the Eyes” test, empathy, systemising, and autism-spectrum quotients in a general population sample
Personality and Individual Differences
(2006) - et al.
Development of short forms of the empathy quotient (EQ-Short) and the systemizing quotient (SQ-Short)
Personality and Individual Differences
(2006) - et al.
Predicting autism spectrum quotient (AQ) from the systemizing quotient-revised (SQ-R) and empathy quotient (EQ)
Brain Research
(2006) - et al.
Theory of mind in autism schizophrenia and in-between
Psychological Medicine
(2000)
The children’s empathy quotient and systemizing quotient: Sex differences in typical development and in autism spectrum conditions
Journal of Autism and Developmental Disorders
Imbalanced genomic imprinting in brain development: An evolutionary basis for the aetiology of autism
Journal of Evolutionary Biology
Battle of the sexes may set the brain
Nature
The essential difference: Men, women and the extreme male brain
Autism: The empathizing–systemizing (E–S) theory
Annals of the New York Academy of Science
Is autism an extreme form of the male brain?
Advances in Infancy Research
Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome
Journal of Child Psychology and Psychiatry
The systemizing quotient: An investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences
Philosophical Transactions of the Royal Society of London B: Biological Science
The empathy quotient: An investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences
Journal of Autism and Developmental Disorders
Cited by (31)
Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome
2018, Progress in Neuro-Psychopharmacology and Biological PsychiatryCitation Excerpt :In social settings, patients with schizophrenia can be overly sensitive and more reactive to the feelings of other people when compared to HC (Michaels et al., 2014). Dysfunctional emotion regulation (Van der Velde et al., 2015), excessive awareness of others' feelings (Masillo et al., 2012) and a hyper-empathising profile (Brosnan et al., 2010) can be associated with psychosis. Enhanced empathy could also help to explain why some patients with schizophrenia attribute mental states better to others than to themselves (Langdon et al., 1997), or find it easier to reason about their own mental states when taking the perspective of another (Gambini et al., 2004).
Validation of the French Autism Spectrum Quotient scale and its relationships with schizotypy and Eysenckian personality traits
2016, Comprehensive PsychiatryCitation Excerpt :Importantly, we would like to note that both we and Dinsdale and colleagues [29] found results supporting the model by Crespi and Badcock [24], but only partially. So far, findings favor a model in which ASp–SSp can be placed on opposite ends of a mentalism continuum, but not on opposite ends of a mechanism continuum (but see Ref. [12]). We give a pertinent example on AttDet.
The 'extreme female brain': Increased cognitive empathy as a dimension of psychopathology
2016, Evolution and Human BehaviorCitation Excerpt :In this context, our hypothesis also predicts that depression and BPD should be associated with low prenatal testosterone (or low prenatal testosterone relative to prenatal estrogen), in direct contrast to the relatively-high prenatal testosterone associated to some degree with autism (Baron-Cohen et al., 2003; Lutchmaya et al., 2002a, 2002b; Lutchmaya, Baron-Cohen, Raggatt, Knickmeyer, & Manning, 2004). Third, major gaps remain in the literature on the roles of empathizing and systemizing in BPD, depression and other psychotic-affective conditions, especially with regard to (1) how these psychological dimensions may be related to dysfunction through effects of high empathizing combined with low systemizing, (2) how clinical and sub-clinical psychotic phenotypes are related to empathic interests and abilities in females and males (Brosnan, Ashwin, et al. (2010); Brosnan, Daggar, et al. (2010)), and (3) how females diagnosed with BPD or depression differ from males diagnosed with BPD or depression with regard to empathic skills. Given the success of the EMB model in advancing our understanding of autism, increased study of hypotheses motivated by its logical opposite, an EFB framework, should generate novel perspectives and insights for addressing these and other questions.
The Empathy Quotient (EQ) predicts perceived strength of bodily illusions and illusion-related sensations of pain
2015, Personality and Individual DifferencesIs Empathizing intuitive and Systemizing deliberative?
2014, Personality and Individual Differences