Neurological changes in bipolar disorder may contribute to a lower capacity for empathy, but sometimes empathy is there — just hidden behind self-focused symptoms.

Bipolar disorder is a mental health condition featuring extreme mood and energy shifts. It includes episodes of mania, a state of heightened energy and agitation, and periods of low mood that meet the criteria for major depressive episodes.

Several types of bipolar disorder exist, including bipolar I disorder, bipolar II disorder, and cyclothymia.

Mood disturbance is a hallmark symptom of bipolar disorder. Still, it is also a condition that can create cognitive change, including change in the area of empathy — the ability to be attuned to another person’s feelings and emotions.

This article takes a closer look at the types of empathy and their relationship to bipolar disorder.

Bipolar disorder appears to be related to low empathy in a two-fold way: neurologically and through symptomology.


The exact cause of bipolar disorder is unknown, but it is a condition that can feature changes both in brain structure and chemistry.

Cognitive symptoms are common, but some of these changes may also be linked to a lower capacity to experience empathy. According to a 2017 study, individuals living with bipolar disorder show lower neurological activity in brain areas associated with empathy toward the pain of others.

Similarly, a 2021 paper reported weaker neural connectivity in areas related to cognitive empathy among those living with bipolar disorder.

Even outside of mood episodes, empathy may be low.

A small 2022 cross-sectional study notes that during periods of mood stability, people with bipolar disorder can exhibit low empathy.

However, empathy is a multidimensional concept. It can be broken down into types, most commonly cognitive and emotional empathy.

Cognitive empathy is the ability to recognize and understand someone else’s mental state. Emotional empathy, also known as affective empathy, takes that one step further and allows one to feel what others feel as if it is happening personally.

While research shows the ability to experience cognitive empathy may be lower in those living with bipolar disorder, there may be times when emotional empathy increases.

A small 2017 study found that during mania, emotional empathy levels were higher than during depressive episodes in bipolar disorder.


A lower level of empathy does not mean the absence of empathy.

Ryan Sheridan, a board certified psychiatric mental health nurse practitioner from Washington, D.C., explains mood symptoms can sometimes override someone’s ability to focus on others.

“People with manic or hypomanic episodes may have decreased empathy as they become overly self-absorbed and focused on their own thoughts and feelings,” he says. “On the other hand, during depressive episodes, individuals with bipolar disorder may struggle with feelings of hopelessness and worthlessness, making it difficult for them to respond to the needs of others with empathy.”

It is important to note that the effects of bipolar disorder on empathy can vary greatly among individuals.

Overall, existing research on empathy in bipolar disorder is limited and sometimes conflicting.

A 2021 study, for example, found individuals living with bipolar disorder showed no deficits in cognitive or emotional empathy.

The conflicting findings can be a result of studying empathy from different perspectives. Having empathetic feelings and acting in empathic ways are two different things.

While empathy is the ability to recognize how people feel — which may be intact during a manic episode — the ability to use the brain’s executive function to allow this recognition to influence one’s behavior can be lower during a manic episode. That may explain why a person can appear self-absorbed in this state.

There are no medications that specifically target empathy, but empathy may be improved by managing symptoms and improving neurological function.

Finding the right medication can be important, as some patients report feeling “numb” when they take mood-stabilizing agents.

Medication is only one part of bipolar disorder treatment, though. Symptom management often requires a multidisciplinary approach of psychotherapy, life skill support, self-care, and community outreach.

The effects of bipolar disorder on empathy can be significant, but empathy can still be built. The following strategies may help.

Gaining insight into emotions

Candace Kotkin-De Carvalho, a licensed social worker and clinical director at Absolute Awakenings, Morris Plains, New Jersey, recommends developing awareness of personal emotions and the emotions of others.

This can be done through:

  • putting names to feelings in a journal
  • engaging in mindfulness to stay focused on feelings in the moment
  • casually observing people and their reactions
  • discussing emotions and their interpersonal impact during psychotherapy

Learning to recognize personal emotions can help improve the ability to recognize them in others.

Understanding bipolar disorder

Recognizing how bipolar disorder can change a person’s behavior may help improve someone’s understanding of how it impacts those around them.

“Spend time learning more about bipolar disorder and the different ways it can manifest,” suggests Megan Tangradi, a licensed professional counselor and clinical director at Achieve Wellness, Northfield, New Jersey. “Try to gain an understanding of how it might affect your own behavior and the behavior of those around you.”

This way, a person can develop an understanding of how different people perceive and experience emotions.

Timing empathy practice

It might not always be easy to practice empathy. For example, if someone is in a manic, hypomanic, or depressive episode, now may not be the time to teach certain skills.

The best time to develop skills and condition empathy responses is during periods of stability. This will help prepare the person for times of instability.

Bipolar disorder can cause a lack of empathy, but symptoms may also make it more challenging to focus on the feelings of others.

While there is no medication to improve empathy, treating bipolar disorder can help. Introspection, guided emotional learning, and observing emotions in others may also help build empathy.