Lack of empathy is not a mental illness on its own. It is not listed as a standalone diagnosis in any psychiatric manual. Instead, reduced empathy is a feature, or symptom, that appears across several different mental health conditions, personality disorders, neurological diseases, and even certain personality traits. Some people with low empathy have a diagnosable condition; others do not. Understanding where empathy difficulties come from matters more than the label itself.
A Symptom, Not a Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which clinicians use to diagnose psychiatric conditions, does not include “lack of empathy” as its own category. You will not receive a diagnosis of “empathy deficit disorder” because no such diagnosis exists. What the DSM-5 does is list impaired empathy as a specific criterion within several personality disorders. It functions more like a fever in medicine: a sign that something else is going on, not a disease by itself.
That said, low empathy exists on a spectrum. Everyone has moments of being less attuned to others, especially under stress, fatigue, or emotional overload. A persistent, pervasive inability to recognize or respond to other people’s feelings is what draws clinical attention, particularly when it causes harm to relationships or functioning.
Conditions Where Low Empathy Is a Core Feature
Narcissistic Personality Disorder
Lack of empathy is one of the defining traits of narcissistic personality disorder (NPD). The DSM-5 describes this as an impaired ability to recognize or identify with the feelings and needs of others, combined with being excessively tuned in to other people’s reactions only when those reactions are perceived as relevant to oneself. People with NPD may overestimate or underestimate their effect on others. The American Psychiatric Association defines the disorder as a pervasive pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood.
Antisocial Personality Disorder
In antisocial personality disorder (ASPD), the empathy deficit takes a slightly different form. The DSM-5 criteria describe it as a lack of concern for the feelings, needs, or suffering of others, along with a lack of remorse after hurting or mistreating someone. People with ASPD often understand what others are feeling on an intellectual level but do not share those feelings emotionally. This distinction is important: they can read the room, which sometimes enables manipulative behavior, but they do not feel distressed by someone else’s pain.
How Autism Differs
Autism is sometimes associated with empathy difficulties, but the pattern is essentially reversed compared to ASPD. A 2024 review found that autistic people may struggle with cognitive empathy, meaning they find it harder to read social cues, recognize emotions in others, or take someone else’s perspective in the moment. Their affective empathy, the ability to genuinely feel for someone once they understand what that person is going through, is typically intact. People with ASPD show the opposite profile: strong cognitive empathy but reduced affective empathy. This distinction matters because it means the social difficulties in autism are not rooted in indifference to others.
Two Types of Empathy and Why It Matters
Empathy is not a single skill. It breaks down into at least two components that can function independently. Cognitive empathy is the ability to understand another person’s perspective, to mentally step into their shoes and figure out what they might be thinking or feeling. Emotional (or affective) empathy is the actual shared feeling: your chest tightening when a friend describes a loss, or feeling a rush of joy when someone shares good news.
A person can have strong cognitive empathy and weak emotional empathy, or the reverse. This is why blanket statements about someone “lacking empathy” can be misleading. Someone with autism might miss a social cue but feel deeply once they understand the situation. Someone with psychopathic traits might read a room perfectly while feeling nothing. The type of empathy that is reduced, not just whether empathy is “low,” points toward very different underlying causes.
Alexithymia: When You Can’t Read Your Own Emotions
Alexithymia is a personality trait, not a disorder, characterized by difficulty identifying and describing your own emotions. It affects roughly 10% of the general population and is more common in people with autism, depression, and trauma histories. Research published in Frontiers in Behavioral Neuroscience found that people with alexithymia show impaired emotional empathy specifically. They can name what others are feeling at a normal level, but they do not experience the corresponding emotional response internally. The study concluded that alexithymia involves a deeper disability of emotion regulation that becomes visible through reduced emotional concern for others and higher levels of personal distress.
If you recognize yourself in descriptions of low empathy but also struggle to identify your own feelings, alexithymia may be a more accurate framework than a personality disorder. The two can coexist, but they are not the same thing.
Brain Changes That Reduce Empathy
Empathy is not purely a personality trait. It depends on specific brain structures, and damage to those structures can reduce empathy in someone who previously had no difficulty with it. Frontotemporal dementia, which causes the frontal and temporal lobes to shrink, is a clear example. According to the Mayo Clinic, people with this condition may show less response to other people’s feelings, act in socially inappropriate ways, or become impulsive. These changes reflect physical brain deterioration, not a personality disorder or choice.
Traumatic brain injuries affecting the frontal lobes, strokes, and certain tumors can produce similar effects. Neuroimaging research has identified several brain regions involved in empathic processing. The anterior insula is linked to the emotional experience of empathy, while areas in the frontal cortex, particularly the anterior cingulate cortex, are associated with perspective-taking. When these regions are damaged or underdeveloped, empathy can be measurably reduced regardless of a person’s intentions or upbringing.
Psychopathy and Empathy Assessment
Psychopathy is not a formal DSM-5 diagnosis, but it is widely studied in forensic psychology using tools like the Psychopathy Checklist-Revised (PCL-R). This 20-item assessment rates individuals on traits grouped into two factors. Factor 1, called Emotional Detachment, captures traits like superficial charm, manipulativeness, shallow emotions, and the absence of guilt or empathy. Each item is scored from 0 to 2 based on how closely a person’s behavior matches the description.
The empathy deficit in psychopathy overlaps with ASPD but is more specific. Not everyone with ASPD scores high on psychopathy measures, and the PCL-R is primarily used in criminal justice and research settings rather than everyday clinical practice.
Can Empathy Be Improved?
For people whose low empathy stems from personality traits rather than brain damage, there is evidence that empathy can be strengthened. A meta-analysis in Frontiers in Psychology found that mindfulness-based interventions improved empathy with a small to moderate effect size in healthy populations. Programs that ran for more than 24 hours total showed better results than shorter ones, and the format (online versus in-person) and specific type of intervention also influenced outcomes. Separate research on meditation practices found significant improvements in both empathy and compassion.
For personality disorders like NPD and ASPD, therapeutic progress is slower and more complex. Schema therapy and mentalization-based therapy aim to help people develop greater awareness of others’ internal states, though the effectiveness varies widely depending on the individual’s motivation and the severity of the disorder. Empathy that was never fully developed is harder to build than empathy that has been dulled by stress, burnout, or emotional exhaustion.
If low empathy is caused by a neurological condition like frontotemporal dementia, the trajectory is different. The underlying brain changes are progressive, and treatment focuses on managing behavior and supporting caregivers rather than restoring empathy itself.