Thesis
Correlation of empathy and personality traits
among final year medical students in a public
sector medical college
A THESIS IS SUBMITTED TO UNIVERSITY OF HEALTH SCIENCES IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF
Masters of Health Professional Education (MHPE)
Submitted By
Dr. Naeem Liaqat
Supervisor
Dr. Muhammad Shahzad Anwar
MHPE Batch IV-B
Department of Medical Education
University of Health Sciences
Lahore – Pakistan
Certificate
It is certified that this thesis is submitted based on the results of the study conducted
by Dr. Naeem Liaqat and that it has not been presented before for MHPE degree. Dr.
Naeem Liaqat has done this research work under my supervision. He has fulfilled all
requirements and is qualified to submit the accompanying thesis for the degree of MHPE
Prof. Muhammad Shahzad Anwer
Supervisor MHPE Candidate
II
AUTHOR’s DECLARATION
I, Dr. Naeem Liaqat hereby state that my MHPE thesis titled Correlation of empathy and
personality traits among final year medical students in a public sector medical college
is my own work and has not been submitted previously by me for taking any degree from
University of Health Sciences or anywhere else in the country/world.
At any time if my statement is found to be incorrect even after my Graduate the university
has the right to withdraw my degree.
Dr. Naeem Liaqat
30th August, 2020
III
ACKNOWLEDGMENT
Any research of this type cannot be completed without the help of many individuals. At
this stage of completion of my research it is a great pleasure for me to acknowledge all of
them who helped me and encouraged me to look forward and work hard till I achieve
success.
No words are noble and no sayings are worthy without praise of God, who gave me strength
and capabilities to start the research and took it to the height of completion.
It will be wrong if I forget to mention the prayers and sincere wishes of my family
members. They all supported me at every strong and weak moment of life. My father,
whose encouragement and prayers always showed me the path to achieve success at every
step of my life.
My special gratitude and thanks to my supervisor Dr. Muhammad Shahzad Anwar
who is a dynamic personality and a great teacher. He helped me in compiling this
research and guided me every time I needed any suggestions. I am very thankful to him
for providing his valuable time for completion of my research.
It is impossible to ignore my younger, who more than a brother helped me like my best
friend in every single technical point in completion of this project. I am also thankful to all
my teachers who taught me from very beginning and made me reach this level.
IV
At the end my special thanks to all the participants, who were part of my research. They
were all great human beings who supported me by taking part in this research activity. May
god give them a happy and healthy life.
V
DEDICATION
I dedicate this research to my Parents and my family
VI
TABLE OF CONTENTS
Certificate ............................................................................................................ ii
Acknowledgement… .......................................................................................... iii
Author’s Declaration …………………………………………………………iv
Dedication ............................................................................................................v
Table of Contents ............................................................................................... vi
List of Abbreviations ........................................................................................ vii
List of Tables .................................................................................................... viii
List of Figures .................................................................................................... ix
Abstract… ............................................................................................................x
CHAPTERS
Introduction .........................................................................................................1
Literature Review ................................................................................................6
Materials & Methods.........................................................................................47
Results .................................................................................................................51
Discussion ...........................................................................................................63
Conclusions and Recommendations.................................................................65
References...........................................................................................................68
Proforma
Annexure I
…………………………………………………………………....87
…………………………………………………………………93
Annexure II ………………………………………………………………….94
Annexure III …………………………………………………………………95
VII
LIST OF ABBREVIATIONS
BFI
Big Five Inventory
CS
Conditioned Stimulus
FFM
Five-Factor Model
LMX
Leader-Member Exchange
MRI
Magnetic Resonance Imaging
fMRI
Functional Magnetic Resonance Imaging
IRI
Interpersonal Reactivity Index
mPFC
Medial Prefrontal Cortex
sgACC
Subgenual Anterior Cingulate Cortex
TPJ
Temporo-parietal Junction
VS
Ventral Striatum
VIII
List of Tables
Table#
Title
Page#
Table-1
Different measure for assessing Empathy
23
Table-2
Empathy scale and its values
54
Table-3
Mean scores of Empathy scale
57
Table-4
Total empathy score was compared according to gender
58
Table-5
The personalities of participants as per BFI
59
Table-6
The personality traits were compared in both groups
60
according to gender
Table-7
Correlation of Empathy and BFI
IX
61
List of Figures
Figure#
Title
Page No.
Figure-1
Empathy in animals
13
Figure-2
19
Figure-3
Overview of key regions associated with four forms of
empathy
Regions of brain involved in empathy
Figure-4
Big Five personality traits
26
Figure-5
Six facets of Openness to Experience
29
Figure-6
Six facets of Extraversion
35
Figure-7
The dark triad
37
Figure-8
Six facets of Agreeableness
38
Figure-9
Six facets of Neuroticism
41
Figure-10
Six facets of Conscientiousness
43
Figure-11
Gender distribution of participants in the study
53
Figure-12
Correlation of Empathy and BFI
62
X
20
Abstract:
Introduction: As the personality traits of the medical students are particularly different
than those in other professions, the empathy among them may have a correlation with these
traits. Given this assumption, this study was designed
Objective:

To measure different personality traits of medical students in a public sector
medical college

To measure empathy of medical students in a public sector medical college

To correlate empathy with personality traits among medical students in a public
sector medical college.
Material and Methods:
This correlational study was conducted over a period of 2 months at Rawalpindi Medical
University (RMU), Rawalpindi. All medical students of final year MBBS studying at RMU
were included. All the participants were given the Questionnaire which included 3 portions:
1) Biodata, 2) Tool for Big Five Invenotry (BFI), and 3) Tool for Empathy (Interpersonal
Reliability Index). All data was analyzed using SPSS version 26.
Results: A total of 270 students were included in the study. The mean age of participants
was found to be 22.35 ± 1.16 years (Range: 19-26 years). They were divided into two
groups and most of the participants (56.7%) had age ≥22 years (Table 1). Most of the
participants were female in this study (Figure 1). The total mean Empathy score was found
to be 61.60 ± 10.99. Maximum score was observed for Perspective-taking subscale
XI
followed by Fantasy subscale, personal distress and Empathic concerns. The mean score
was higher for total empathy score and all its subscales among those Age ≥22 years. total
empathy scale and its all subscales were higher among female participants than male. This
difference was significantly higher in the subscale of Empathic concern (p=0.044),
Personal distress (p=0.019) and Total empathy score (0.014). The personalities of
participants were assessed in 5 scales as per BFI and total scores are given in table 6. The
highest mean score was noted for Openness (34.41) and Agreeableness (32.77). In all five
domains, personalities were comparable and no significant difference was observed in two
age groups. It was found that females were having significantly more Extroversion than
males (p=0.038). Females also had higher score in Agreeableness, Conscientiousness,
Neuroticism and Openness than male, however this difference was not significant. Total
empathy score and its subscales were correlated with personality traits and it showed
moderate to week correlation with all personality traits. The strongest positive correlation
was found between personal distress subscale and Neuroticism (r=0.488), followed by
perspective taking and Agreeableness (r=0.350) and empathic concern and Openness
(r=0.341). The strongest negative correlation was found between personal distress and
Conscientiousness (r= -0.267), personal distress and Extroversion (r= -0.189) and
perspective taking and Extroversion (r= -0.134).
Conclusion: It is concluded that Empathy and personality had a significant correlation.
These results can help to us to design individualized programs to improve empathy in
medical students. So I recommend more training sessions for medical students to
incorporate Empathy among them keeping in consideration their personality traits.
Keywords:
XII
Medical students; Empathy; Personality traits; Correlation; Big five; Interpersonal
Reliability Index
XIII
Introduction:
Empathy is ability of physician to understand the feelings and perspective of
patients and to understand the situation through which he/she is passing through. It is a
complex phenomenon which enables the physician to understand the feelings of patient
and respond them accordingly maintaining the respect, altruism and sympathetic behavior
(Epley et al. , 2004). In medical practice, role of empathy can never be over-emphasized.
It definitely improves compliance of patients, their trust upon the physician and patientdoctor relationship. This better patient-doctor relationship ultimately turns up into better
patient outcomes and clinical results (Derksen et al. , 2013, Jordan and Foster, 2016).
Empathy improves patient’s satisfaction and facilitates early and accurate diagnosis.
Patients in many studies have reported lesser distress, better and more comfortable zone
and trust over the doctor, when doctor is more empathetic (Zachariae et al. , 2003)
As both domains of empathy including affective and cognitive have been
understood deeply and in a better way now by medical personnels and educationists, so
importance of empathy has increased among curriculum designers and they consider it
important to create an environment conducive to learn empathy. Therefore, recently, the
medical educationists have put forward their attention towards this important aspect and
there is a continuous focus to impart empathy into medical students and to teach them
empathy as part of curriculum (Mooradian et al. , 2011).
The word "personality" is derived from the Latin word “persona”, which
means “mask”. Personality of any person usually refers to the differences in particular and
1
individual ways of thinking, feeling and behaving. A trait on the other hand is a
distinguishing quality or characteristic, so personality trait is basically a particular feature
attributed to a person with a specific personality type.
Personality type refers to the psychological classification of different types of
people. However, there is a clear-cut difference between personality types and personality
traits. Personality type is a grouping based on shared characteristics, and personality trait
is a specific quality. Everybody is born with a different and distinct personality. It is not
humanly possible to assess all aspects of a personality and categorize it. Previously Gordon
Allport has listed even few thousand personality traits, a person could have. However, few
attempts have been made and most of the researchers are now agreed that five traits or
personality types when combined give a clearer picture of the personality of a person
(McCrae and Costa, 2003). This combination of five traits is called a five-factor model or
sometimes as Big Five traits. The five factors have been defined as Openness,
Conscientiousness , Extroversion, Agreeableness, and Neuroticism, usually abbreviated as
OCEAN or CANOE. These five factors describe the essential traits that are the building
blocks of a personality. All these five factors are not just a word; rather they describe a
whole personality behind ever trait (Babaei et al. , 2018). In order to assess these five traits,
man tools are available including Big Five Inventor (BFI), Neo Personality Inventor,
International Personality Item Pool and self-reported questionnaires. However, most
famous and most validated is BFI (Hamby et al. , 2016).
BFI also called five factor model is a fundamental concept that evolved with the
efforts of a number of psychologists. Ernest Tupes and Raymond Christal narrowed down
2
various aspects of personality traits into five basic factors which they labeled: "surgency",
"agreeableness", "dependability", "emotional stability", and "culture". Warren Norman
subsequently relabeled "dependability" as "conscientiousness" (Funicelli, 2012).
Big five traits in their present form are as follows:
Extraversion: This parameter compares an extrovert person with an introvert person.
Extraversion depicts assertiveness, sociability, and talkativeness. A person with a low score
on extraversion may be regarded as cold/aloof and one with high score may be considered
attention-seeking and domineering/bossy.
Agreeableness: simply defines helpful and trusting nature of a person which make him/her
a socially acceptable figure. Contrary to that a person with low agreeableness may be
regarded as a social outcast or argumentative personality.
Conscientiousness: high score shows that a person is always prepared and plans
beforehand. Low score is indicator of a spontaneous behavior.
Openness: gives a picture of how much a person is receptive for intellectual ideas, and
variety of experience. People with high score on this are said to eventually achieve “selfactualization” and those with low score are considered pragmatic or even conservative.
Neuroticism: A person on its lower pole is considered emotionally stable and one on upper
pole is thought to be a nervous person (McCrae and Costa Jr, 1999).
It has been shown in researches that different personality traits are
associated with certain behaviors, learning process and aptitudes. Similarly, personality
traits have been studies with empathy in some studies previously. In a study conducted on
Portuguese medical students, it was found that agreeableness and openness are more
associated with empathy. (Costa et al. , 2014). In another study conducted on first year
3
medical students, empathy was associated with higher sociability and lower aggressive
hostility (Hojat et al. , 2005). In another study on Chinese medical students, it was fond
that agreeableness was strongly associated with higher empathy scores (Song and Shi,
2017). Among medical students in Pakistan, limited studies have been done to assess
empathy and both of these studies have shown variable results (Bangash et al. , 2013, Imran
et al. , 2013). In a study (Costa, Alves, 2014) conducted on Portuguese medical students,
it was found that agreeableness and openness are more associated with empathy.
In a study (Song and Shi, 2017) including 560 medical students from China, authors
administered Big Five Invenotry (BFI) and Interpersonal Reactivity Index (IRI) to
determine a correlation among these. They found they Agreeableness was strongly
associated with empathic concern and moderately associated with perspective taking.
Neuroticism was strongly associated with personal distress and moderately associated with
perspective taking. Also, Openness was moderately associated with perspective taking and
personal distress.
In a study, authors included one hundred &fifty medical students to determine the
correlation between empathy and personality traits. They found there was a significant
correlation between empathy and each of the five domains of personality. Note that for
neuroticism, the correlation was inverse, while for the other four domains, the correlation
was positive.
In a study by Magalhaes et al, (Magalhaes et al. , 2012), authors included 350
students from consecutive six classes entering in the medical school. They used JSPE scale
for determining the empathy and correlated it with personality traits. They found that total
4
score of JSPE scale was positively associated with Openness, Agreeableness and
Conscientiousness.
In a study authors (Lourinho and Severo, 2013) have found a strong positive
correlations between the total score of IRI with agreeableness and openness. Regarding the
subscales of empathy, they found that personal distress was positively associated with
Neuroticism and Empathetic Concern was positively correlated with Extraversion.
To my knowledge, no study has been conducted on medical students to assess their
personality traits in Pakistan. Medical students are the future doctors and need to be trained
to the best in order to improve our healthcare services. And as per dramatic rise in conflicts
among doctors and patients in our society, it is imperative to assess the level of empathy
of our future physicians and as well their personality traits. In order to formulate empathy
promoting culture for our medical students in our country with its own culture and social
setup, the first step may be to determine the personality traits and current level of empathy
of our medical students. The manuscript will be a pilot project looking at empathy and
personality traits of medical students in their final year of studies in a public sector medical
college and mat serve as a baseline for future work in this area. By understanding
personality traits, students can be provided with appropriate support during counselling
and assistance in improving their communication skills in order to prepare them better for
future challenges arising in our county.
5
Literature Review
Empathy
Empathy is the ability to step outside of your own bubble and into the bubbles of
other people.
(C. Joybell)
Have compassion and empathy in your heart. Many people are suffering deep
emotional anguish beneath the surface of their lives, and smile even as they hurt inside.
(Jim Palmer)
The usage of term “empathy’ is not very old and dates back to a century almost, but this
concept had been a. part of medical practice since ages. Though being an old concept, there
hasn’t been a consensus yet over its definition and there had been around 50 definitions in
the literature (Cuff et al. , 2016). This was described for the first time in English by the
British critic and author, Vernon Lee, who explained the word “empathy”.
Definition of Empathy:
As there are certain types of empathy, therefore, in defining it, same problem has been
faced and consideration whether it is primarily a cognitive construct, an affective construct
or both. Another issue in understanding the empathy concerns had been the process by
which a person understands and shares other’s mental states. Frans de Waal defines it as:
‘the capacity to be affected by and share the emotional state of another, assess the reasons
6
for the other's state, and identify with the other adopting his or her perspective’ (PerezManrique and Gomila, 2018). Baron-Cohen & Wheelwright define empathy as “…the
drive or ability to attribute mental states to another person/animal, [which] entails an
appropriate affective response in the observer to the other person’s mental state”. In these
terms, empathy is comprised, not just understanding and feeling another's perspective, yet
additionally reacting after understanding the feeling of the beholder. Empathy definition
must include caring for other people as well as the desire for helping others, understand the
emotions and feelings of other person and making no difference between oneself and
others. Some authors believe empathy as being able to have the matching of emotions of
other people, while others think that empathy means to have a soft corner towards other
persons.
Having empathy means to understand that the decision making is a complex process
and among many factors influencing decision making, past experiences, upbringing and
thought process play an important role. Once we understand this concept, it becomes easy
to understand other person which might be taking an illogical decision as per our
understanding.
Perspective taking is understanding the emotional condition of other person and
identifying their story and narrative (for example understanding of the feelings, or
cognitive empathy) (Dadds et al. , 2009), which brings to the observer’s mind shared
representations of those emotions automatically. Carrying these common thoughts to mind
prompts a comparable empathetic state in both (De Waal, 2008).This is known as
emotional empathy (Dadds, Hawes, 2009) or empathic concern (Baron-Cohen and
7
Wheelwright, 2004). Another important concept which is an integral part of this definition
is emotional reactivity, which is the physiological response of the person to the emotions
of others (Baron-Cohen and Wheelwright, 2004).
There are some other terms at the same time which are associated with empathy but have
a slightly different meanings and understandings. Compassion is defined as an emotion
which we feel when we see someone in a need for help and it motivates us to help others.
Sympathy is a feeling of care and understanding for someone in need. Similarly pity and
emotional contagion are different than empathy. Pity is a sympathetic feeling which is felt
when someone saws others in distress or difficulties as they can’t solve their problems
rather feel “sorry’ for them.
Classification of Empathy:
There are broadly three types of empathy:
a) Affective empathy
b) Cognitive empathy
c) Somatic empathy
i) Affective empathy:
It is sometimes also called as emotional empathy as it is a capacity to understand
the emotions of other persons. It can further be classified into Empathic concern and
Personal distress.

Empathic Concern: it is the feeling of sympathy or compassion
after seeing someone in problem or distress

Personal distress: It is a the feeling of distress and discomfort after
8
watching others in difficult situations and sufferings.
It is important to narrate that feeling of emotions or distress or compassion don’t
necessariy explain the problems and situations of other persons, rather it is a self-distress
after seeing others in trouble. More empathic concern, there is more desire to help others
and it has been evident while observing people to help injured or unknown suferers on a
raod although the injured person is stranger, they try to help them.
ii) Cognitive empathy:
It is the capacity to understand the other’s perspective. Affective and cognitive
empathy are different concepts as one deals with that the emotions while other is
understanding the situation of other person. So, if a person has a strong cognitive empathy,
he may not have that strong emotional empathy. A common example which may be
narrated is that after seeing someone in trouble during a road traffic accident, some person
may move forward to help which others may start crying at their own place. So, both of
these concepts may be held together, or may be different ratios of these be present in a
person.
There are 2 main types of cognitive empathy:

Perspective Taking: to understand and adopt other’s perspective

Fantasy subscle: tendency to fantasize or idealize others situation
Scope of empathy and related factors:
a) Empathy in animals
A significant literature has shown that concept of empathy is not only limited to
humans; rather it is found in animals and neuroscience has proven this concept. Many
reports saying that Dolphins had saved human beings from drowning and other animal
9
attacks is an example. Empathy is conveyed through spindle cells and they have been found
three times in number among aquatic mammals like Cetaceans than humans which makes
them social friendly and gives them the awareness of feeling of others (Bekoff, 2009).
Animals, whether free or kept in zoo, have shown empathetic behavior. Rats have shown
their empathy to make a struggle to help their mates trapped. Different tales like Dolphins
saving their mates from trapping, gentleness of Elephants and other animals have been
narrated since ages (Perez-Manrique and Gomila, 2018). Palagi E and Norsica tested three
hypothesis, self-protection hypothesis, victim-protection hypothesis, relationship-repair
hypotheses among Aonobos by collecting data over 10 years duration. They also looked
into the factors which affect the distribution of these traits. They reported that the
consolation seen among Bonobos may be Empathy-based phenomenon (Palagi and
Norscia, 2013).
Similarly, in slaughter houses, where animals are slaughtered in front of each other,
stress and empathy has been observed among animals when they hear, see or smell other
mates being slaughtered. This inhuman handling causes fear and stress among them.
Therefore, Islam has strictly forbidden the slaughtering of animals inform of other animals
(Khan et al. , 2018). As per Jean Decety, who is working as a neurobiologist at University
of Chicago, empathy is not something specific to humans. According to him, there is strong
evidence that empathy has deep evolutionary, biochemical, and neurological
underpinnings, and that even the most advanced forms of empathy in humans are built on
more basic forms and remain connected to core mechanisms associated with affective
communication and social attachments (Decety, 2011). The neuroimaging has documented
a circuit of brain parts involving brainstem, amygdala, hypothalamus, basal ganglia, insula
10
and orbitofrontal cortex. These parts are supposed to be taking part in human behavior,
care and empathy. However, humans have a more distinct function than animals and that
is the cognitive ability which helps them execute different functions, mentalizing and
language (Decety, 2011).
b) Empathy in children
Previously it was thought that children don’t have a capacity to empathize; however,
later many researchers confirmed that children do have and exhibit different levels of
empathy from very younger ages. They are able to display their empathetic behaviors in a
variety of ways. However, it is not easy to measure the complex processes like empathy in
younger children because of their non-verbal expresses. One way of determining the
empathy in children is to examine their distress while they observe others in difficulties or
distress.
In neonatal life, even being at first few days of life, neonates start crying when they
hear cry of another neonate, which is formally labeled as “reflective crying’. They have
shown more reflective crying and distress after hearing another infant’s cry than the control
stimuli which included synthetic cry sounds, noise, silence, or their own cry (McDonald
and Messinger, 2011). This response of cry of a neonate is not just a simple cry, but it is
indicator of early development of empathy which can be expressed only in this way. In
infantile age, they tend to develop a feeling of personal distress after observing others in
distress. In this age, they can’t differentiate between self and others and have limited basic
regulation capacity for their emotions. Young infants, usually become distressed when they
observe negative emotions of other people around then and they may engage in behaviors,
11
such as self-comforting, to reduce their own distress. As they grow older and are able to
differentiate between themselves and others (self-other differentiation) and are better able
to express their emotions in the second year of life, there appears to be a transformation
from concern for the self to a capability for concern for the others (Knafo et al. , 2008).
Toddler life has been considered as one of the most important phases for development
of empathy in the life of a person. In a recent study Huang H et al (Huang et al. , 2017)
included 84 Chinese toddlers to observe the developmental trends of different components
of empathy and factors related to development of empathy among them. Among these
participants, empathetic responses were assessed while exposing them to observe three
simulated distress procedures being performed on the primary care-giver, another
unacquainted adult and baby doll. They measured different manifestations of empathic
responding, including concern (e.g., sad look, “I’m sorry”), hypothesis testing (e.g., “What
happened?”), prosocial behavior (e.g., hugs, “Are you ok?”), as well as precursors to
empathy such as personal distress and self-referential behaviors (i.e., “trying on” another’s
experience). Many of these behaviors underwent significant development over the second
year of life, with age related increases in empathic concern, hypothesis testing, and
prosocial behavior between 14 and 24 months of age. Authors concluded that empathy
among toddlers contained three factors namely sympathy, personal distress and orientation.
Toddlers in this age-group are thought to be other-centered rather being self-centered, so
they behave whatever they observe.
As the children grow and enter in pre-school age group, their cognitive empathy
component develops. It may be because in this age-group, they start developing speech,
can express themselves and start verbalizing, so accessors can access this component of
12
Figure 1: Empathy in animals
13
empathy also as it is difficult before this age. By this age, they are able to take another’s
perspective in false belief tasks. In false belief tasks, children are exposed to an experiment
in which one person enters the room and places a thing at a particular place and then leave
the room. Later on, another person enters the rooms, picks that thing up and relocates it to
another place and leaves the room. Now first person enters the room again and looks for
that particular item and on asking the child about location, child will point to the first
location where he left it. It indicates that as per theory of mind, child has a limited
perspective of the situation. The trajectory of development of these character remained the
same in all cultures, as shown y a meta-analysis conducted by Wellman et al (Wellman et
al. , 2001).
In a study conducted in 2008 by Decety J et al from University of Chicago found that
children within the age group of 7 to 12 years have the tendency to feel empathy while they
observe others in distress. They used functional MRI while presenting children to short
videos which had animated visuals of painful and non-painful situations. Similar to adults,
the neuronal pathway of empathy among these 17 children, was activated and this pathway
included insula, somatosensory cortex, anterior midcingulate cortex, periaqueductal gray,
and supplementary motor area (Decety et al. , 2008).
c) Empathy in different genders
In a general perception, and supported by many studies, female gender has more
empathy than males. However, many meta-analysis, systematic reviews, randomized trials
and neuroimaging have shown mixed findings with no difference in two genders. Many
authors do argue that these differences which are shown to be higher among females are
not spatial as they are reported to be higher in self-reported proforma and scales. Similarly,
14
females have shown higher scores on Empathy Quotient than males. Yang CY and
colleagues conducted a study measuring electroencephalography determining the mu
receptor suppression among both genders. They included equal number of males and
females and let them experience both painful and non-painful situations. They found that
although both genders showed mu receptor suppression, but it was higher among females.
Also they found that this mu receptor suppression was correlated with personal distress in
IRI scale of empathy. Their findings confirm the presence of higher empathy at brain level
even than males (Yang et al. , 2009).
d) Empathy in different environments
Many environmental factors like parental relationships, parental style, brought up
of a person, family structure and a lot others may have a role to play. These factors
have an important impact on development of empathy. Empathy help the person to
process the aggression and help promote prosocial relationships. An interesting study
conducted as PhD thesis by Tisot in 2003 tried to look at different environmental
factors which may have an impact on empathy development among children. Author
looked at the impact of parenting style, empathy of parents and previous social
experiences onto the empathy of children. All the children included in the study were
assessed for effective empathy and parents of these children were requested to fill the
questionnaires related to parental practices and balanced emotional empathy scale.
Author found that not all parenting styles, but a few practices had a role to play in the
development of empathy in children. These parental gestures and practices included
the encouragement of children to think about the other’s perspectives, and teaching
them to reflect in own’s feelings. It was also found that empathy had a varied
15
development depending upon the gender of the child as well as parent. Another
important factor was parental warmth which had significant positive correlation with
empathy, particularly in boys. And maternal warmth had a negative correlation,
particularly in females (Tisot, 2003).
e) Genetic role in Empathy
Many genes have also been thought to be having a role in Empathy and it is
not only the environmental factors which play a role.

Gene 5-HTTLPR determines the sensitivity to negative emotions and it is
further enhanced by the deletion variant of ADRA2b.

Higher social skills and enhanced self-esteem was found among carriers of
double G variant of OXTR gene.

Increased and higher activation of Amygdala was seen after viewing
emotionally arousing situations among those who have deletion variant of
ADRA2B gene.

Another gene located on Chromosome 3 has the ability to control human
ability to respond to other’s emotions (Naudts et al. , 2012, Warrier et al. ,
2018).
f) Empathy in different countries
Difference in diffent cultures and countries have been postulated and reported. An
interesting question remains that why this difference in countries exists. In many countries,
socializing and communication particularly on individualized or cultural basis, cultural
practices may lead to different levels of empathy. In a study published in Journal of Cross16
Cultural Psychology in 2016, authors aimed to determine the cultural variation of empathy.
They included 104,365 participants from 63 countries globally and found that levels of
empathy do vary from country to country. They found that those countries who have higher
levels of empathy also had higher levels of Conscientiousness, self-esteem and prosocial
behavior. Among included countries in the survey, they found that highest levels of
empathy included Ecuador, Saudi Arabia, Peru, Denmark and United Arab Emirates. The
lowest
ranking
countries
in
this
survey
found
were
Bulgaria, Poland, Estonia, Venezuela and Lithuania (Chopik et al. , 2017).
Neuroscientific basis of empathy:
The ability of a person to understand and process the emotions has a particular basis
and this neural channel has been understood well due to better imaging studies. Similarly,
the process of empathy can be delineated and explained in a better way. It has been
observed that people who have a higher empathy as detected by certain tests and measures,
have busy mirror neurons and their pathways. Emotional empathy for negative emotion is
associated with activity in dorsal mid- anterior cingulate cortex (dmACC) and amygdala;
emotional empathy for positive emotion is associate with activity in medial prefrontal
cortex (mPFC); cognitive empathy (mentalizing) is associated with activity in mPFC,
temporo-parietal junction (TPJ) and precuneus; and empathic concern is associated with
activity in amygdala, ventral striatum (VS), subgenual anterior cingulate cortex (sgACC),
and periaqueductal gray (PAG).
In a recently publish meta-analysis in 2019, Xiong RC et al had the objective to
determine the signal pattern of empathy in the brains caused by facial expressions of pain.
17
They included a total of 178 participants from 8 trials and found that anterior cingulate
cortex (BA32), anterior central gyrus (BA44), fusiform gyrus, and insula (BA13) were the
main regions of the brain which were positively activated (Xiong et al. , 2019).
For activation of empathy and its response, both affective and cognitive empathy need
to be activated and interestingly both pathways are interlinked in these tasks. Affective
domain of empathy may be disrupted by some disorders of psychopathic traits while
cognitive domain is affected in autism. In a study, it had been found that lesions involving
ventromedial prefrontal cortex lead to impairment in the cognitive domain while lesion in
the inferior frontal gyrus leads to impairment of affective domain (Shamay-Tsoory et al. ,
2009). The ventromedial prefrontal gyrus plays an important role in integration of both
components of empathy during response to mental state of others. Many emotional states
including anger, fear, social bonding and distress have a connection related to neural
network in the forebrain.
Some main functions of brain part taking part in empathy neuronal network are being
summarized:

Amygdala processes emotional stimuli

Cerebellum has many roles to play. Left side of the Cerebellum processes
cognitive empathy while right side has a role to play for sympathy and concerns

Cingulate cortex has a role in both cognitive and affective domains of empathy

Dorsomedial portion of the Thalamus processed the portions and signals for
affective domain and cognitive-evaluative empathy

Fusiform gyrus interprets facial portion of the emotions
18
Figure 2: Overview of key regions associated with four forms of empathy
After permission from Abigail Marsh (Marsh, 2018) (attached as Annexure I)
19
Figure 3: Regions of brain involved in empathy
After permission from John J. McCreary (McCreary et al. , 2018) (attached as Annexure
II)
20

Inferior frontal gyrus help in the processing of comments in affective domain
of empathy and also the response to other’s emotions. If a problem or lesion
occurs in this portion of brain, it directly impacts the affective part of empathy
(Decety, 2011, Decety, Michalska, 2008, McCreary, Marchant, 2018, ShamayTsoory, Aharon-Peretz, 2009).
Measurement of Empathy:
The measurement of empathy has been a difficult task as in measuring these traits
has a lot of aspects which need to be taken care of like, how to measure it, who should
perform this measurement and how to calculate the total empathy. For this matter, multiple
scoring systems have been devised, but still this job is not easy as empathy may have a lot
of perspectives. Behavioral measures for empathy require the accessors to look for either
the presence of absence of certain responses and behaviors among the participants. Certain
ways of determining the behavioral empathy include picture viewing paradigms, picture
stories, Kids empathetic development scale and Comic Strip Scale (Neumann et al. , 2015).
Physiologic responses can be determined by sophisticated equipment which can assess the
response electronically using Magnetic Resonance Imaging (MRI), functional MRI
(fMRI), Electroencephalography, facial Electromyography and Event-rated potentials
(Neumann, Chan, 2015).
Some measure of Empathy which involve paper and pencil which are easy to
administer and can assess empathy. Empathy Quotient (EQ) is a self-administered
questionnaire which was developed by Baron-Cohen and Wheelwright in 2004 (BaronCohen and Wheelwright, 2004). Since its development, it has translated into many
languages and validated (Berthoz et al. , 2008, Castelhano-Souza et al. , 2018, Jankowiak21
Siuda et al. , 2017, Preti et al. , 2011, Zhao et al. , 2018). EQ has 60-items and it measures
self-reported empathy. Each item in EQ is scored on a 4-point Likert scale ranging from 1
(strongly agree) to 4 (strongly disagree). Of these 60-items, 40 items assess the empathy
as a single construct and 20-items as filler. These 20-items acting as a filler are not scored
and they have been added to prevent monotony of the answers by the participants. The
maximum score of EQ is 80 and higher the score, higher is the empathy.
Interpersonal Reactivity Index (IRI) is a 28-item scale which accesses both
emotional and affective domains of empathy. It assesses empathy in four subscales namely
perspective taking, empathic concern, personal distress and fantasy. For each subscle, there
are 7-items and each of these is answered on a 5-point Likert scale from 0 (does not
describe me well) to 4 (describes me very well). For each subscle, the range of score is 0
to 28 and higher score denotes higher empathy (Davis, 1980).
Toronto Empathy Questionnaire was devised by Spreng et al as they combined 11
previously reported questionnaires including IRI, Hogan’s Empathy Scale, Questionnaire
Measure of Emotional Empathy, BEES, Scale of Ethnocultural Empathy, Jefferson Scale
of Physician Empathy, Nursing Empathy Scale, Japanese Adolescent Empathy Scale, and
the Measure of Emotional Intelligence. By combing all these scales, they identified 142
items and then they added 36 more items. It has been validated by the authors (Spreng* et
al. , 2009).
22
Table 1: Different measure for assessing Empathy
Self-reported
Measures
Behavioural
Measures
Balance Emotional EMpathy
Scale
Picture Viewing Paradices
Neuroscientific
Measures
Magnetic Resonace Imaging
Multidimensional Emotional
empathy scale
Functional Magnetic
Rasonance Imaging
Emotional Quotient
Comic Strip Task
Feeling and Thinking Scale
Facial electromyography
Basic empathy Scale
Picture Stories
Griffith empathy Measure
Electroencephalogram
Torronto empathy
Questionaiire
Questionaiire of Cognitive
and Affective Empathy
Kids Empathetic
Development Scale
23
Event-Related Potentials
The Big Five Personality Traits
“When people label you by saying that you have attitude. Just tell them that you have a
personality which is unshakable and unaffected by what people say about you.”
Aarti Khurana
“Maybe that's what a person's personality is: the difference between the inside and the
outside.”
Jonathan Safran Foer
Wood had stated the personality of a person as the set of characteristics that distinguishes
a particular person on the basis of their unique thoughts and actions (Wood and Roberts,
2006). Mischel and Shoda referred to the personality as a combination of different traits in
an individual (Mischel and Shoda, 2008). A trait is a particular quality of a person and it is
supposed to be fixed and invariant. It allows us to predict the stability of personality traits
and to guess how a person will act in a particular situation.
The term “Big Five” does not mean that five personality traits define the personality
of a person only. These five domains actually represent a whole spectrum of personality
charcteristics and specific qualities. However, many researchers have thought that these
dimensions do not include some traits and personality aspects. To investigate the debates,
Paunonen and Jackson (Paunonen and Jackson, 2000) in 2000 looked at the work of Saucier
and Goldberg (Saucier and Goldberg, 1998) who had concluded that there may be more
dimensions to be looked for other than Big Five. Paunonen and Jackson (Paunonen and
24
Jackson, 2000) also found some differences and variances in the behavior of human beings
which they consider as important and which may have an important role to play in
personality; rather they concluded that there may be plenty of dimensions which may be
considered and they fall in the criterion wo be considered as factor along with Big Five.
Hough LM et al stated that industrial research needs more directions and more specific
traits to be seen so that they may be fit in with the ever changing needs of the society,
particularly industrial organizations (Hough et al. , 2015). Smith and Canger (Smith and
Canger, 2004) had narrated the importance of Big Five and presented many reasons of their
importance and them being essential: (a) It permits us to divide the personality traits into a
meaningful classification, (b) It also leads us to conduct researches over a particular laid
down framework, and (c) It includes almost all basic characteristics of personality traits.
The urge to determine the types of personality traits is not new and it dates back to
the start of 20th Century when physicians started their work and tries to analyze and rate
the more than 2500 individuals in the 1909 investigations of Heymans and Wiersma. Then
we find some more studies related to personality traits in 1900s and later on. Since its
inception, the Big Five model has undergone many changes and faced many
transformations. The Big Five model by 2006 had recorded over 300 publications per year
and the number keeps on rising. It enforces that this Big Five model has been extensively
accepted and implicated globally in researches (Beer and Watson, 2008).
Big-Five Personality Traits /Five-Factor Model (FFM)
The Big Five or Five-Factor model comprises of five dimensions, namely
Agreeableness, Extraversion, Openness to Experience, Emotional Stability or Neuroticism,
and
25
Figure 4: Big Five personality traits
Openness
Conscientio
usness
Big Five
Personality
Traits
Extroversion
Neuroticism
Agreeablenss
26
Conscientiousness. FFM is one of the most commonly narrated and used personality model
in the literature (Gurven et al. , 2013, Wilt and Revelle, 2015).
History and Development of Big-five Personality Traits
Francis Galton in 1884 (Galton, 1884) proposed his famous “lexical hypothesis” in
1884 and he proposed that aspects of the personality of a person other than cognitive ability
are also measurable as he observed similar behaviors among parents and children and
between pairs of twins. He proposed that all the different qualities and differences among
human being interactions may be depicted by single or few words in literateure, be it
English literature or some other language. So, he searched in the dictionary for
identification of the terms that may be used to explain individuals’ differences. Later on,
Allport and Odbert (Allport and Odbert, 1936) revised and reduced Galton’s (Galton, 1884)
described terms from the Second and Third edition of Webster’s dictionary, respectively.
Alport and Odbert’s study set a base for modern personality traits.
Louis Thurstone was the first person who identified personality descriptors of
Galton and then Thurstone and Scedule (Thurstone and Schedule, 1952), proposed five
commo factors from sixty descriptive adjectives. Then, Thurstone used identified and
proposed seven factors instead of five (Thurstone and Schedule, 1952). A the same time,
Cattell (Cattell, 1943) identified 35 bipolar variables and currently available five factors
are produced as a derivative of these bipolar variables. Although Cattel proposed 16
personality traits after applying factor analysis out of these bipolar variables and they
mentioned it several times, but most of the other authors extracted only 5 variables out of
these variables. (Laher, 2013).
27
Domains of Five-factor Model and Hypothesis Development
The FFM has been invariably stated as the best representation of personality traits
globally and across many cultures. It comprises of five domains: (I) Openness vs. closeness
to experience, (II) Extraversion vs. introversion, (III) Agreeableness vs. antagonism, (IV)
Conscientiousness vs. negligence, and (V) Emotional stability vs. neuroticism.
i)
Openness vs. Closeness to Experience
Openness to experience is a broad terminology and it has at least six definite facets
including fantasy, aesthetics, feeling, actions, ideas, and values (Beaty et al. , 2016). So,
more the openness, more the person is creative (i.e. fantasy facet of openness to
experience), and it makes them highly amenable and attuned to new ideas. Aesthetics facet
explains that openness to experience means being more perceptive, keen and inclined
towards art and beauty.
Individuals with high openness to experience have more
inclination towards emotion as compared to those having more Closeness to experience
and it falls in the “feeling” facet. Action facet of Openness to experience means that
individuals are more flexible in behaviors, and they are perceptive to accept new ideas. At
the same time, subjects with higher openness are more intellectual and curious. Finally,
individuals who are more Open to experience, are more liberal in values. So, these persons
usually raise their concerns and question the views of others more as compared to those
with low Openness.
On the other hand, individuals with closeness to experience have particular
characteristics and they are generally more realistic, difficult to be impressed, down to
earth, are not fascinated by art and beauty, and emotionally shallow. In addition, they do
not try new experiences easily and they perform their tasks in a set way which has been
28
Figure 5: Six facets of Openness to Experience
Fantasy
Aesthetics
Actions
Openness
to
Experience
Feelings
Ideas
Values
29
laid down before. Furthermore, they are not curious and usually they don’t like to challenge
the standardized and traditional ways of doing particular tasks (Song et al. , 2017).
Openness to experience is also narrated as a symbol and sign of being proactive. It is
supposed that openness has a direct relationship with proactivity as more openness is
directly related to higher intellectual understanding and more mental capacity. A
significant relationship and association has been found between intellect and openness
(Dinc and Akcakanat, 2020). Thus, more open individuals are usually more perceptive,
intelligent, rational and analytical (Judge et al. , 2002), and they tend to embrace and
understand untoward and new situations and experiences (Watanabe et al. , 2011).
Another important aspect of this trait is that the different facets of Openness exist
together and covary with each other. For instance, subjects which are more curious tend to
have higher and better imagination and more artistic. This may be due to the fact that all
these three traits have the same gene responsible. It has been proposed by some authors
that Openness to experience is heritable along with other facets of the Openness (Yamagata
et al. , 2006). Although openness shows differential stability throughout the life of a person
(Terracciano et al. , 2006), but its level may change during the lifespan and shows a
particular pattern called as maturational trend (i.e. the level of openness to experience
usually rises from teenage uptill third decade of life and then starts decreasing slowly). In
a study by Schwaba et al, authors tried to examine the development of Openness and test
their change with cultural activities like attending opera or museums. They included 7353
individuals and study spanned over 7-years in which they did 5 assessments of the
personality. They found that Openness remains stable in early adulthood and then decreases
30
in midlife and old age. Also they found significant change and correlation of Openness
with cultural experiences (Schwaba et al. , 2018).
There has been genetic basis of Openness to experience explained by some authors.
Rehman M S et al conducted a trial on 3112 individuals and tried to find association
between serotonin-transporter-linked polymorphic region (5-HTTLPR) and personality
traits among Swedish cohorts. They found that 5-HTTLPR was significantly associated
with Openness to experience and it was particularly observed that those having a short
allele had lower levels than those having long allele (Rahman et al. , 2017).
Openness to experience may have many associations like it has been found by Kaufman et
al to be associated with creativity and divergent thinking process. Authors included 1035
individuals in their study and they found that Openness to experience predicts creative
achievement in the arts and intellect predicts creative achievement in the sciences
(Kaufman et al. , 2016, Xu et al. , 2014). Moren CC et al contended that individuals with
more openness to experience have better academic performance (Cárdenas Moren et al. ,
2019). Alternatively, it may be narrated that those students having higher openness, read
more and in broader context. Openness to experience has also been found to be associated
with cardiovascular stress response processing. Soye A, O'Súilleabháin PS conducted a
trial over 66 female participants and confirmed that “feeling” facet of Openness was
associated with active stress activity and adaptation to cardiovascular stress (Soye and
O'Suilleabhain, 2019).
It is clear from the literature that people who have higher openness to experience can
be recognized easily through their daily habits. In a recent study Sutu A et al have reported
that individuals with higher openness to experience have higher humor and humor
31
production ability of an individual is predicted directly by openness to experience. Among
two aspects of the openness (openness and intellect), it is the openness which is directly
correlated with humor of a personality (Sutu et al. , 2020). In a study, Tan CS et al, included
198 undergraduates into their study and tried to found that people who had higher openness
to experience, tend to have more intrinsic motivation. This intrinsic motivation led these
individuals to have higher self-reported creativity (Tan et al. , 2019). Open people are
reported to be having higher abilities to decorate their homes and offices. They have higher
artistic skills, so they can express their preferences and capabilities in a better way (Gosling
et al. , 2002). As these individuals like to explore new ideas and have tendency to look for
new things, so they are more motivated to new knowledge and skills. Hogan Mj et al
(Hogan et al. , 2012) in a study found that openness to experience is correlated with
intelligence and a particular type of intelligence called crystallized intelligence. This
intelligence is the ability of a person to use life experience sought throughout the life and
then utilizing them.
Openness has been narrated a multi-faceted experience and it directs a person’s
response to any new experience. Individuals with less openness tend to produce a particular
and set response and less likely to think out of box to create new solutions. So, they have
a narrower scope to act against any new situation (Woo et al. , 2014). Marcus et al
conducted an interesting study and they observed the personal websites of individuals with
higher openness to assess the content, expressions and viewership of visitors. They
reported that individuals with higher openness tend to have more expression and reflect
their emotions on their websites (Marcus et al. , 2006). Mehl et al studied the participants
of their study and their daily lives. They found that people having more openness tend to
32
spend more time in Cafes and restaurants. Another interesting finding of their study was
that these people tend to use less frequently the past tense in their language and third-person
pronouns (Mehl et al. , 2006).
ii)
Extraversion vs. Introversion
Extraversion is a quality which enables individuals to be more assertive, energetic,
talkative, outgoing, high spirited, cheerful, positive, ambitious, optimistic, upbeat,
gregarious and active. On the other end, introverts tend to be quieter and more independent.
Extraverts are inclined to seek social attention and excitement, generally spend most of
their time with other people, have much more social circle and contacts, spend their leisure
time in a company and for social contacting, and favour more social activities (JacquesHamilton et al. , 2019). Many positive traits and qualities have been found associated with
the Extraversion. Individuals with higher Extraversion usually show better performance in
jobs like sale representatives, managerial positions, and those which need better and higher
degree of interpersonal skills. Harai MB et al conducted a study over students employed in
a public sector university of USA. They found that extraversion had a direct relationship
with job satisfaction than all other personality traits (Harari et al. , 2018). Extraversion has
also been found positively associated with extrinsic career success, which had been defined
as the occupational status and income. It may be explained as that extraverts have a
tendency to be more successful in their lives, have better and more chances to get to higher
positions and usually earn more income than those having less extraversion (Judge et al. ,
1999)(Lucas and Baird, 2004). It has been noted that extraversion is significantly
.
.
associated wi th a ggregated momentari ly positi ve affect. So, individuals with higher
.
.
.
.
33
extraversion tend to be happier in general as well as in sh ort peri ods of time (Spain et al. ,
.
2000).
.
.
.
.
Extraverts, by their personality, have more surgency from activities and situations and
tend to get higher energy from these situations. They get involved with people around them
and develop a communication. They like to communicate with new people and develop
new connections. Often, they are considered by others to be full of energies. They are more
visible in a group, have an assertive nature and they like to talk. On the other hand,
introverts have lower social engagement. They usually like to keep quiet and have low
energy. Some may misunderstand them as depressed or unfriendly, but they are reserved
to their own situations. They don’t like to be dominant in a group and are independent of
their social world. (de Jong et al. , 2019, Du et al. , 2020).
Extraversion has also been narrated as a combination of two main traits: dominance
and affiliation. The dominance component means the extraverts tend to be more
authoritative, want to be controlling the situations and combative. This quality helps the
Extraverts to stand firmly on their opinion and positions and they tend to influence others.
The affiliation component refers to their tendency to be a part of social settings and
gatherings and them being more friendly. Which of these characteristic is more dominant,
is debatable among researchers as some consider one component as a core to this trait
while others consider the second component as the most important component (Bono and
Judge, 2004). In a study by Sołtysik M et al, mountaineers were found having higher levels
of Extraversion in their personality (Soltysik et al. , 2019). Extraversion has also been
found having an effect on the motivatio n to process own-gender face s more deeply tha n
.
.
.
opposite-gende r faces (Morgan and Hills, 2019).
.
.
34
.
.
Figure 6: Six facets of Extraversion
Gregariousnes
s
Friendliness
Activity level
Extraversion
Assertiveness
Cheerfulness
Excitement
seeking
35
Like other personality traits, extraversion also has a genetic basis. Fischer R et al found
that Dopamin e genes are linke d to Extraversio n development (Fischer et al. , 2018). A
.
.
.
.
p olymorphism in period circadia n cloc k (PER-3) gen e has been found to be associ ated
.
.
.
.
.
.
wi th hi gher level s of Extraversion (Jiménez et al. , 2017). Jang and his colleagues (Jang et
.
.
.
al. , 2002) found tha t sam e gene s account ed for hi gh covari ation amo ng extraversi on’s
.
.
.
.
.
.
.
.
.
facets .
.
iii)
Agreeableness vs. Antagonism
This is the personality trait which determines the general response of a person to social
harmony. Individuals with higher Agreeableness, are considered to be more ki nd, trusti ng,
.
.
altruisti c, courteo us, good-natured , modes t, helpfu l, hone st, sympatheti c to others , soft
.
.
.
.
.
.
.
.
hearted, and tole rant. On the other extreme, those having low scores in this domain are
.
more likely to be skeptical, competitive, uncaring, critical, and hostile (Bergh and Akrami,
2016). Also, these people tend to behave a selfish behavior and show less empathy. Another
important aspect is that those individuals who have very low score in this domain, they
have dark triad behavior which is a combination of narcissism, Machiavellianism,
and psychopathy. These individuals are found to be performing more crimes and cause
problems in the organization (Vize et al. , 2020).
Another important hallmark quality of Agreeableness is the tendency to trust other
human beings and to establish relationships with others. So, by means of this trait of the
personality, any person can have a relationship with others and develop interpersonal
relationship. People who score high in Agreeableness, generally are good at maintaining
relationships and create less conflict in the working environments. Those with less
36
Figure 7: The dark triad
Narcissism
The Dark
Triad
Psychopathy
Machiavellianism
37
Figure 8: Six facets of Agreeableness
Trust
Sympathy
Morality
Agreeableness
Modesty
Altruism
Cooperation
38
Agreeableness generally have less tolerance and they are usually short-tempered (Bergh
and Akrami, 2016).
In a recently published study, authors included 2 models and tried to see the relationship
of daily challenges like low income, difficult children, with the Agreeableness of the
mothers. They examined three parenting styles at three stages of development of children
at 6 months, 54 months old and 5th grade. They found that mothers who had high
Agreeableness tend to show less harshness to their children and had more sensitivity. Also
it was observed that mothers with higher Agreeableness had more supportive behavior
towards harsh and difficult children (Bradley and Corwyn, 2019).
In a study conducted on young age group on a sample from USA, soci al medi a use and
.
.
soci al isolation was assessed with reference to personali ty traits and it was found that
.
.
.
agreeableness was associ ated with lower odd s of soci al i solation (Whaite et al. , 2018). In
.
.
.
.
another study which included samples from both USA and China, and they found that low
.
.
agreeablenes s and hi gh rejectio n sensi tivity were associated with wi thdrawal, fri endship
.
.
.
.
.
.
dissatisfacti on, and adverse confli ct consequences (Wang et al. , 2017).
.
iv)
.
.
.
Neuroticism vs. Emotional Stability
Neuroticism is the susceptibility of any person to negative emotions and thoughts. The
persons who have higher neuroticism are expected to be more prone to develop guilt,
paranoid, anger, self-consciousness, mood swings, disgust, depression, anxiety, fear and
embarrassment and tend to perform their actions with poor control over emotions. Also,
individuals with high neuroticism tend to be more self-conscious and they usually find any
39
inevitable situation as more stressful (Chang et al. , 2018, Sosnowska et al. , 2019).
Individuals with higher Neuroticism usually like to avoid situations which demand their
higher control of emotions, and commitment. In other words, they tend to react to any
situation in an intense way and usually have negative perception to their surrounding events
happening on daily basis (Driskell et al. , 2006, Smillie et al. , 2015). While those having
higher emotional stability are usually better composed and have a tendency to show
themselves as more confident, secure, well-adjusted, relaxed, and tend to deal better in
untoward and stressful circumstances (Kandler, 2012).
Emotional stability is also narrated as in indicator to predict the job performances of
individuals. In a study conducted in Taiwan, in which authors included Pilots and compared
their personalities with those working on ground and other military personnels taken as
controls. They found that fighter pilots tend to be more Extroverts and had more emotional
stability (less Neuroticism) than controls and those on ground jobs (Chang, Lee, 2018).
Higher Neuroticism level has been found associated with higher risk of mental disorders.
Also patients with bipolar disorders have been found having a strong association with
Neuroticism (Dukalski et al. , 2019). Neuroticism
is inversely related to job performance as it decreases the job satisfaction which ultimately
leads to poor performance. Another important thing noted was that employees having high
job satisfaction performed well even being poor workaholism. It signifies the importance
of higher emotional stability in workstation performance (Mazzetti et al. , 2016).
Higher Neuroticism has an association with poor mental health and physical status
of any person. Neuroticism has also been found having genetic transmission. In a large
study, which included 329,821 individuals from UK, 116 genetic loci for Neuroticism were
40
Figure 9: Six facets of Neuroticism
Anxiety
Vulnerability
Anger
Neuroticism
Immoderation
Depression
Selfconsciousness
41
found o genome wide association (Luciano et al. , 2017). Dopamine genes have also been
found directly linked to Neuroticism trait (Fischer, Lee, 2018).
Conscientiousness vs. Negligence
Conscientious means to act disciplined and dutifully. Individuals with high
Conscientiousness are usually better organized, more disciplined, purposeful, detailoriented, punctual, determined, reliable, risk averse, dependable, responsible, and
achievement-oriented. While those with lower conscientiousness, usually do not value
prospective results and are unreliable (Costantini et al. , 2015).
In literature, conscientiousness is named also as conformity, dependability and will to
achieve It reflects thoroughness, planfulness, and responsibility. It is the way through
which people control their impulses. Individuals with low Conscientiousness have more
flexibility in their plans but at the same time are less reliable. It may also be labelled as
“will to achieve” as it is found to be strongly associated with educational achievement.
Egan M et al suggested in their study that fostering Conscientiousness of the students in
early life may help them prevent from unemployment in future. In the organizational
context, those employees who had higher conscientious showed better and stronger urge to
achieve the tasks and they tend to strive more for fulfilment of their tasks and goals (Bono
and Judge, 2004).
Persons with higher Conscientiousness usually have planning and follow a methodical
approach for every activity and usually don’t try to act spontaneously. They follow the
steps and follow their plans that’s why they are usually considered as reliable. However,
this quality may make them rigid and difficult to change. They tend to be perfectionist and
workaholics. Higher score in Conscientiousness is considered as the best predictor of
42
Figure 10: Six facets of Conscientiousness
Cautiousnes
s
Selfefficacy
Selfdescipine
Conscientiousness
Achievem
entstriving
Orderliness
Dutifullnes
s
43
success in academic records. This trait has also been shown to mediate the role between
amotivation and academic performance (Kertechian, 2018). Another study by Conard and
Patry found that although Conscientiousness has a strong relationship with good academic
record, but two factors which mediate this relationship are academic self-efficacy and test
anxiety (Conrad and Patry, 2012). In a meta-analysis, Poropat AE (Poropat, 2009) found
that of all the five personality traits, Conscientiousness was strongly correlated with
academic performance and important thing was that this relationship was independent of
the intelligence. After controlling the secondary academic performance, they found that
role of Conscientiousness is as much important as of intelligence in predicting the academic
performance. Wang S et al took it a step further and tried to underpin the mechanism and
brain structure behind that. They included 148 high school students in their study and
measured gray matter volume of their brains. They found that conscientiousness was
positively associated with the gray matter volume in the bilateral superior parietal lobe and
was negatively associated with the GMV in the right middle frontal gyrus (Wang et al. ,
2019).
Ellershaw et al. (Ellershaw et al. , 2016) noted that nursing staff with higher levels of
conscientious performed significantly better than those having lower levels of
conscientiousness. This quality of higher conscientiousness provides the employees to be
better in their decision-making capabilities and more organized personnels, which
ultimately helps them to get better job positions. Higher levels of Conscientiousness have
been shown to be associated with better health and health related issues. Similarly, low
levels of Conscientiousness was found having a strong correlation with low intentions
towards fruit and vegetable consumption which may have a mediation role in the health of
44
an individual (Wilson et al. , 2016). Higher levels of Consciousness have also been
associated with less mortality risk as these people are usually well-planned and do not get
involved in salubrious health behaviours and maintain their social networks particularly
related to their health (Duggan, 2016).
Big-Five personality traits and its Global Application
As all these personality traits are derived from language, therefore, there has been
a question of applicability of FFM across different languages and cultures. Many studies
have been reported to examine the cross-cultural acceptability of FFM and they have
proven its generalizability. It has been attested that FFM is universal and applicable across
all continents and cultures (Ion et al. , 2017).
The measurement instruments of big-five personality
There are a lot of tests available to assess the personality traits of a person. Many
of them have proven to be having good psychometric properties. NEO and revised NEO
personality inventories are one of the most comprehensive measurements of the Big-Five
personality traits. Big five inventory (BFI) is also one of the most commonly employed
inventories for this purpose. It is reliable and has shown higher Cronbach alpha in studies
(Feldt et al. , 2014, Ward, 2017).
45
Objective:

To measure different personality traits of medical students in a public sector
medical college

To measure empathy of medical students in a public sector medical college

To correlate empathy with personality traits among medical students in a public
sector medical college.
46
Material & Methods:

Study Population: Final year medical students

Study Duration: 2 months (November, 2020 to December, 2020)

Study Sample: Final year medical students

Sample Size: A total 270 subjects will be taken in this study using level of
significance as 5%, power of test as 80% and population correlation coefficient of
empathy and Neuroticism as 0.171 (Bertram et al. , 2016) using following formula
N=[
Z∝ + Zβ 2
C
] + 3

Sampling Technique: Non-probability, consecutive sampling

Study Design: Correlational study

Inclusion Criteria:
o Medical students of final year MBBS studying at Rawalpindi Medical
College, Rawalpindi

Exclusion Criteria
o Students with emotional or psychotic disorders.
o Partially filled proforma
47
Methodology:
Instrument
Tool for assessment of BFI:
In this study, BFI will be used in order to assess the personality of the participants.
There are 44 items in BFI, which are answered by the participants on a 5-point Likert scale,
ranging from 1 to 5 as being disagree strongly, disagree a little, neither agree nor disagree,
agree a little, agree strongly respectively. It assesses the personality in five traits. There are
16 questions, which are scored as reverse when analyzing the scale. The scoring of each
trait is as follows, as ‘R’ denotes reverse score:
Extraversion: 1, 6R, 11, 16, 21R, 26, 31R, 36
Agreeableness: 2R, 7, 12R, 17, 22, 27R, 32, 37R, 42
Conscientiousness: 3, 8R, 13, 18R, 23R, 28, 33, 38, 43R
Neuroticism: 4, 9R, 14, 19, 24R, 29, 34R, 39
Openness: 5, 10, 15, 20, 25, 30, 35R, 40, 41R, 44
Ultimately BFI scores assess the personality traits in 5 dimensions:

Extraversion vs. introversion

Agreeableness vs. antagonism

Conscientiousness vs. lack of direction

Neuroticism vs. emotional stability

Openness vs. closedness to experience
Tool for Empathy:
48
In this study, for assessment of empathy, Interpersonal Reliability Index (IRI), will
be used. There are 28-items answered on a 5-point Likert scale ranging from “Does not
describe me well” to “Describes me very well”. The measure has 4 subscales, each made
up of 7 different items.
These subscales are:

Perspective Taking – the tendency to spontaneously adopt the psychological point
of view of others

Fantasy – taps respondents' tendencies to transpose themselves imaginatively into
the feelings and actions of fictitious characters in books, movies, and plays

Empathic Concern – assesses "other-oriented" feelings of sympathy and concern
for unfortunate others

Personal Distress – measures "self-oriented" feelings of personal anxiety and
unease in tense interpersonal settings
There are some items which are score reverse in the scale. It is intended to be used as a
continuous measure of empathy-related dimensions in normal populations, rather than as a
categorical measure (“high empathy” versus “low empathy”).
Data Collection Procedure:
Data will be collected after approval from the Ethical review board. All those included in
the study will be asked for consent for inclusion in the study. As the proforma is going to
be anonymous, they will be told that filling the proforma means they are giving us consent
for inclusion in the study. All the participant will be given the Questionnaire which will be
consisting of 3 portions: 1) Biodata, 2) Tool for BFI, and 3) Tool for Empathy. The entire
questionnaire will be anonymous and they will be asked to put down their signatures only
49
in the consent form for inclusion in the study in order to maintain the anonymity.
Statistical Analysis:
All the data will be analyzed by using SPSS version 24. The quantitative variables like age,
scores of BFI and Empathy will be presented as mean ± SD. Qualitative variables like
gender will be presented as frequency and percentages. Analysis of variance and twosample t-tests will be used as appropriate to test for differences in mean scores among
groups. The relationship between each of the five personality scores and empathy scores
will be assessed using Pearson's Correlation Coefficient. P-value ≤ 0.05 will be considered
as significant
50
Results:
A pilot study to determine the characteristics of tow questionnaires included in this
study was done. All it is given as an Annexure III.
A total of 270 students were included in the study. The mean age of participants
was found to be 22.35 ± 1.16 years (Range: 19-26 years). Most of the participants were
female in this study (Figure 11).
Regarding Empathy score, the minimum mean score was found for Q18 which
narrates “When I see someone being treated unfairly, I sometimes don't feel very much
pity for them”. Maximum score was for Q22 “I would describe myself as a pretty softhearted person” (table 2).
The total mean score of empathy was calculated and for its subgroups. The total
mean Empathy score was found to be 61.60 ± 10.99. Maximum score was observed for
Perspective-taking subscale followed by Fantasy subscale, personal distress and Empathic
concerns. All data is given in table 3.
Total empathy score was compared according to gender and it was found that total
empathy scale and its all subscales were higher among female participants than male. This
difference was significantly higher in the subscale of Empathic concern (p=0.044),
Personal distress (p=0.019) and Total empathy score (0.014). All details are given in table
4.
The personalities of participants were assessed in 5 scales as per BFI and total
scores are given in table 5. The highest mean score was noted for Openness (34.41) and
Agreeableness (32.77).
51
Further, the personality traits were compared in both groups according to gender.
It was found that females were having significantly more Extroversion than males
(p=0.038). Females also had higher score in Agreeableness, Conscientiousness,
Neuroticism and Openness than male, however this difference was not significant (table
6).
Total empathy score and its subscales were correlated with personality traits and it
showed moderate to week correlation with all personality traits. The strongest positive
correlation was found between personal distress subscale and Neuroticism (r=0.488),
followed by perspective taking and Agreeableness (r=0.350) and empathic concern and
Openness (r=0.341). The strongest negative correlation was found between personal
distress and Conscientiousness (r= -0.267), personal distress and Extroversion (r= -0.189)
and perspective taking and Extroversion (r= -0.134). All these details are given in table 7
and figure 12.
52
Figure 11: Gender distribution of participants in the study
71; 26%
199; 74%
Male
Female
53
Table 2: Empathy scale and its values
Minimum Maximum
Mean
Std.
Deviation
1. I daydream and fantasize, with some
regularity, about things that might happen to
.00
4.00
2.3370
1.34182
.00
4.00
2.5963
1.28329
.00
4.00
1.6481
1.30708
.00
4.00
1.1148
1.27813
.00
4.00
2.3556
1.48583
.00
4.00
2.0630
1.29041
.00
4.00
1.6407
1.32203
.00
4.00
2.6370
1.21703
.00
4.00
2.6111
1.22879
.00
4.00
2.6037
1.34219
me.
2. I often have tender, concerned feelings for
people less fortunate than me.
3. I sometimes find it difficult to see things
from the "other guy's" point of view.
4. Sometimes I don't feel very sorry for other
people when they are having problems.
5. I really get involved with the feelings of the
characters in a novel.
6. In emergency situations, I feel
apprehensive and ill-at-ease.
7. I am usually objective when I watch a
movie or play, and I don't often get
completely
caught up in it.
8. I try to look at everybody's side of a
disagreement before I make a decision.
9. When I see someone being taken
advantage of, I feel kind of protective
towards them.
10. I sometimes feel helpless when I am in
the middle of a very emotional situation.
54
11. I sometimes try to understand my friends
better by imagining how things look from
.00
4.00
2.6296
1.22696
.00
4.00
1.4037
1.40762
.00
4.00
1.4481
1.27132
.00
4.00
1.2407
1.24260
.00
4.00
2.2593
1.34393
.00
4.00
1.8407
1.45586
.00
4.00
2.2630
1.38812
.00
4.00
1.0481
1.29393
.00
4.00
2.0704
1.22195
.00
4.00
2.5148
1.16236
.00
4.00
2.4556
1.28034
.00
4.00
2.6407
1.24678
their perspective.
12. Becoming extremely involved in a good
book or movie is somewhat rare for me.
13. When I see someone get hurt, I tend to
remain calm.
14. Other people's misfortunes do not usually
disturb me a great deal.
15. If I'm sure I'm right about something, I
don't waste much time listening to other
people's arguments.
16. After seeing a play or movie, I have felt as
though I were one of the characters.
17. Being in a tense emotional situation
scares me.
18. When I see someone being treated
unfairly, I sometimes don't feel very much
pity for them.
19. I am usually pretty effective in dealing
with emergencies.
20. I am often quite touched by things that I
see happen.
21. I believe that there are two sides to every
question and try to look at them both.
22. I would describe myself as a pretty softhearted person.
55
23. When I watch a good movie, I can very
easily put myself in the place of a leading
.00
4.00
1.8444
1.42399
.00
4.00
1.8111
1.25749
.00
4.00
1.9926
1.20097
.00
4.00
2.1704
1.39324
.00
4.00
2.0630
1.22236
.00
4.00
2.4407
1.20493
character.
24. I tend to lose control during emergencies.
25. When I'm upset at someone, I usually try
to "put myself in his shoes" for a while.
26. When I am reading an interesting story or
novel, I imagine how I would feel if the
events in the story were happening to me.
27. When I see someone who badly needs
help in an emergency, I go to pieces.
28. Before criticizing somebody, I try to
imagine how I would feel if I were in their
place.
56
Table 3: Mean scores of Empathy scale
Empathy scale
Total Score
Perspective taking
17.48 ± 4.26
Fantasy scale
15.50 ± 5.86
Empathic concern
14.42 ± 3.67
Personal distress
15.28 ± 5.02
Total empathy score
61.60 ± 10.99
57
Table 4: Total empathy score was compared according to gender
Empathy scale
Male
Female
P-Value
Number Mean ± SD
Number
Mean ± SD
Fantasy scale
71
14.67 ± 5.21
199
15.79 ± 6.06
0.167
Empathic concern
71
13.67 ± 3.95
199
14.6 ± 3.53
0.044
Perspective taking
71
16.73 ± 4.39
199
17.75 ± 4.19
0.082
Personal distress
71
14.08 ± 4.67
199
15.71 ± 5.08
0.019
Total empathy
71
58.60 ± 11.48
199
62.67 ± 12.02
0.014
score
58
Table 5: The personalities of participants as per BFI
PERSONALITY TRAIT
MEAN ± SD
EXTROVERSION
23.92 ± 5.34
AGREEABLENESS
32.77 ± 5.35
CONSCIENTIOUSNESS
29.52 ± 5.50
NEUROTICISM
25.71 ± 5.80
OPENNESS
34.41 ± 5.68
59
Table 6: The personality traits were compared in both groups according to gender
Personality traits
Male
Female
P-Value
Number Mean ± SD
Number
Mean ± SD
Extroversion
71
22.80 ± 5.04
199
24.33 ± 5.40
0.038
Agreeableness
71
31.77 ± 5.72
199
33.12 ± 5.18
0.068
Conscientiousness
71
29.40 ± 5.44
199
29.56 ± 5.54
0.840
Neuroticism
71
25.50 ± 6.02
199
25.79 ± 5.73
0.721
Openness
71
33.47 ± 5.79
199
34.74 ± 5.62
0.108
60
Table 7: Correlation of Empathy and BFI
Variables
1
1. Extroversion
1
2
3
4
2. Agreeableness
.224**
1
3. Conscientiousness
.327**
.194**
1
4. Neuroticism
-.411** -.194**
-.375**
5. Openness
.145*
6. Fantasy scale
.053
.279**
5
.015
.269**
.086
.350**
.097
7
8
9
10
1
.185** -.043**
.062
6
1
.149* .188**
1
7. Empathic concern
-.057
.100 .341** .324**
1
scale
8. Perspective taking
.063
-.134* .225** .202** .402**
1
scale
9. Personal Distress
-.189**
.008
-.064
.224**
-.267**
.488**
-.087 .226** .293**
.048
1
scale
10. Overall Empathy
.227** .232** .727** .701** .609** .541**
-.063
scale
*Significant at the 0.05 level (two-tailed)
** Significant at the 0.01 level (two-tailed)
61
1
Figure 12: Correlation of Empathy and BFI
.053
Extroversion
.062
Agreeableness
.015
Conscientiousness
Fantasy Scale
.149
Neuroticism
.188
Openness
Extroversion
Agreeableness
-.057
.269
.086
Conscientiousness
Empathic concern Scale
.100
Neuroticism
.341
Openness
Extroversion
.063
.350
Agreeableness
.097
Conscientiousness
Perspective taking Scale
-.134
Neuroticism
.225
Openness
-.189
Extroversion
.008
Agreeableness
-.267
Conscientiousness
Personal Distress Scale
.488
Neuroticism
Openness
-.087
62
Discussion:
Regarding medical students, studies have shown that different personality traits are
strongly correlated with empathy scales. It has been confirmed by studies from Portuguese
(Magalhaes, Costa, 2012), China (Song and Shi, 2017) and America (Toto et al. , 2015). A
study which included sample from four countries including China, Germany, Spain, and
the United States of America found that Agreeableness and Conscientiousness were the
most dominant predictors of empathy (Melchers et al. , 2016). Previously it has been shown
that agreeableness, which represents the person to be having more adjustable, cooperative,
understanding and helpful, is more correlated with empathy. Similarly we have noticed it
to be associated with perspective taking and empathic concern. We found cognitive domain
to be positively correlated with Agreeableness and Openness as some authors consider
empathy as Cognitive (perspective taking and fantasy) and emotional (empathic concern
and personal distress) (Song and Shi, 2017),. Emotional domain was correlated more with
Agreeableness, Conscientiousness and Neuroticism. Neuroticism and Consciousness
which share the feature of being less emotionally stable and becoming distressed after
seeing the others in trouble, makes sense to be more associated with the emotional domain
of empathy. It also shows the importance of inculcating these particular traits among
medical students as the incidences of violence on healthcare workers are on the rise
globally and generally, the trust over doctors has dropped drastically.
In this study, perspective taking subscale of IRI was positively correlated with
Extroversion, Agreeableness, Conscientiousness and Openness while it had significant
negative correlation with Neuroticism. Similar findings were observed by Guilera T
63
(Guilera et al. , 2019), however, they found negative correlation with Neuroticism and
Extroversion, both. A study conducted on Chinese medical students found negative
correlation with Extroversion only and modest positive correlation with Agreeableness,
Neuroticism, Openness and Conscientiousness (Song and Shi, 2017).
Fantasy scale of IRI had positive correlation with all personality traits. However,
Guilera T found its positive correlation with Openness only (Guilera, Batalla, 2019).
Melchers (Melchers, Li, 2016) also found similar results.
Empathic concern subscale of IRI showed week negative correlation with
Extroversion and positive correlation with all other personality traits, particularly with
Openness. Contrary to this, Guilera T found a positive correlation of Empathic concern and
Extroversion (Guilera, Batalla, 2019). Song & Shi (Song and Shi, 2017) reported negative
correlation of Empathic concern and Extroversion, like this study. However. They showed
strong correlation of Empathic concern and Agreeableness (B= 0.477, P<0.01).
Personal distress subscale of IRI was found moderately positively correlated with
Neuroticism and negatively correlated with Extroversion, Conscientiousness and
Openness. Guilera T have also found positive correlation between personal distress and
Neuroticism (Guilera, Batalla, 2019). Song and Shi showed positive strong correlation of
Personal Distress with Neuroticism and modest correlation with Openness (Song and Shi,
2017).
In a study by MAGALHA˜ ES, (Magalhaes, Costa, 2012), who included 350
medical students from six entering classes, significant and positive correlations between
total score in the JSPE scale and Openness to Experience (r¼0.22, p50.01), Agreeableness
(r¼0.24, p50.01), and Conscientiousness (r¼0.14, p50.05) were found. The magnitudes of
64
correlations between personality and scores of self-reported empathy were low, ranging
from _0.01 to 0.24.
In a study, authors (Lourinho and Severo, 2013) had found positive significant
correlations between the total score of IRI with agreeableness and openness. They had used
the logistic regression model using the five dimensions NEO-FFI to predict top tercile
empathy and it revealed excellent discrimination. They also found a positive correlation
between PD and neuroticism, EC and extraversion and between PT and conscientiousness.
In this study, Neuroticism was found having moderate correlation with personal
distress. It may be expected that personality trait of Neurotic people may allow them to
have higher personal distress after observing some distressing event. As these individuals
usually tend to keep their emotions to themselves and avoid to share them to others, so it
may be an expected outcome. As neurotics are expected to be feeling more loneliness and
moody, so this domain of empathy is higher among them.
Conclusion and Recommendations:
This study depicted the true picture of state of Empathy and its correlation with
personality traits among our future doctors. In this study, it has been concluded that
Empathy and personality had a significant correlation. On the basis of this, following
recommendations are being proposed:
1. These results can help to design programs to study if some individualized
interventions can be planned improve the empathy in medical students.
2. It is proposed that following admission of medical students in first year of their
medical college, their personality traits may be assessed and they can be grouped
according to them. Following this grouping, individualized and more targeted
65
strategies may be easy to be implemented and can be applied. In this way, their
empathy can be improved until they enter their practical life and it will help them
to make them a more empathetic doctor and individual.
3. As empathy has higher impact over patient care and if empathy is low, patientdoctor relationship can’t develop and be compromised. At the same time, a doctor
with low empathy can’t understand the perspective and feelings of the society,
which is an basic pillar of medical profession. Empathy development is although a
new area in medical science, however, it can’t be left behind and its importance
can’t be negated. Previously it was thought to be part of hidden curriculum and it
was assumed that empathy is incorporated into doctors by default. But, now many
aspects of hidden curriculum are being thought to be properly addressed. Focusing
on these results, it is also recommended to make changes in curriculum of medical
schools as till now, no formal program is being taught to them during these five
years. A dedicated course (may be small) may be added to their curriculum so as to
foster this important aspect into their personalities.
4. Nobody can negate the importance of empathy in the personality development of
medical students and future physicians. So, I recommend more training sessions
for medical students to incorporate Empathy among them keeping in consideration
their personality traits.
5. All these suggestions and proposals are doable in the context that now many
medical universities exist and they can change the curriculum according to the need
of the society. Considering the important of empathy and personality traits in any
doctor, changes in the curriculum is direly needed and strongly recommended.
66
Limitations of the study:
There were few limitations of this study which need to be acknowledged. It was a single
center study so I acknowledge that its results cannot be generalized. In order to extrapolate
these results, future studies with a larger sample size may be needed. Secondly there was a
large female population of the same age group in this study which was due to a general
trend of higher number of female medical students and it may had skewed the results, so
may be a more gender proportionate study sample chosen for future studies.
Conflict of interest:
o None
67
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86
PROFORMA
Correlation of Empathy and Personality Traits among medical
students in a public sector medical college
Serial No:
Age: ______________ years
Gender: _________________
INTERPERSONAL REACTIVITY INDEX
The following statements inquire about your thoughts and feelings in a variety of
Situations. For each item, indicate how well it describes you by choosing the
appropriate
Letter on the scale at the top of the page: A, B, C, D, or E. When you have decided on
your
Answer, fill in the letter next to the item number. READ EACH ITEM CAREFULLY
BEFORE RESPONDING. Answer as honestly as you can. Thank you.
ANSWER SCALE:
A
B
C
D
E
DOES NOT
DESCRIBE ME
DESCRIBES
VERY WELL
ME WELL
1. I daydream and fantasize, with some regularity, about things that
might happen to me.
2. I often have tender, concerned feelings for people less fortunate than
me.
3. I sometimes find it difficult to see things from the "other guy's" point
of view.
4. Sometimes I don't feel very sorry for other people when they are
having problems.
5. I really get involved with the feelings of the characters in a novel.
6. In emergency situations, I feel apprehensive and ill-at-ease.
87
7. I am usually objective when I watch a movie or play, and I don't
often get completely caught up in it.
8. I try to look at everybody's side of a disagreement before I make a
decision.
9. When I see someone being taken advantage of, I feel kind of
protective towards them.
10. I sometimes feel helpless when I am in the middle of a very
emotional situation.
11. I sometimes try to understand my friends better by imagining how
things look from their perspective.
12. Becoming extremely involved in a good book or movie is somewhat
rare for me.
13. When I see someone get hurt, I tend to remain calm.
14. Other people's misfortunes do not usually disturb me a great deal.
15. If I'm sure I'm right about something, I don't waste much time
listening to other people's arguments.
16. After seeing a play or movie, I have felt as though I were one of the
characters.
17. Being in a tense emotional situation scares me.
18. When I see someone being treated unfairly, I sometimes don't feel
very much pity for them.
19. I am usually pretty effective in dealing with emergencies.
20. I am often quite touched by things that I see happen.
21. I believe that there are two sides to every question and try to look
at them both.
22. I would describe myself as a pretty soft-hearted person.
23. When I watch a good movie, I can very easily put myself in the
place of a leading character.
24. I tend to lose control during emergencies.
88
25. When I'm upset at someone, I usually try to "put myself in his
shoes" for a while.
26. When I am reading an interesting story or novel, I imagine how I
would feel if the
events in the story were happening to me.
27. When I see someone who badly needs help in an emergency, I go to
pieces.
28. Before criticizing somebody, I try to imagine how I would feel if I
were in their place.
89
How I am in general
Here are a number of characteristics that may or may not apply to you. For example, do you
agree that you are someone who likes to spend time with others? Please write a number next
to each statement to indicate the extent to which you agree or disagree with that statement.
1
Disagree
Strongly
2
Disagree
a little
3
Neither agree
nor disagree
4
Agree
a little
5
Agree
strongly
I am someone who…
1. _____ Is talkative
15. _____ Is ingenious, a deep thinker
2. _____ Tends to find fault with
others
16. _____ Generates a lot of enthusiasm
17. _____ Has a forgiving nature
3. _____ Does a thorough job
18. _____ Tends to be disorganized
4. _____ Is depressed, blue
19. _____ Worries a lot
5. _____ Is original, comes up with
new ideas
20. _____ Has an active imagination
6. _____ Is reserved
21. _____ Tends to be quiet
7. _____ Is helpful and unselfish with
others
22. _____ Is generally trusting
23. _____ Tends to be lazy
8. _____ Can be somewhat careless
24. _____ Is emotionally stable, not
easily upset
9. _____ is relaxed, handles stress well.
10. _____ Is curious about many
different things
25. _____ Is inventive
26. _____ Has an assertive personality
11. _____ Is full of energy
27. _____ Can be cold and aloof
12. _____ Starts quarrels with others
13. _____ Is a reliable worker
28. _____ Perseveres until the task is
finished
14. _____ Can be tense
29. _____ Can be moody
90
30. _____ Values artistic, aesthetic
experiences
31. _____ Is sometimes shy, inhibited
32. _____ Is considerate and kind to
almost everyone
33. _____ Does things efficiently
34. _____ Remains calm in tense
situations
35. _____ Prefers work that is routine
36. _____ Is outgoing, sociable
37. _____ Is sometimes rude to others
38. _____ Makes plans and follows
through with them
39. _____ Gets nervous easily
40. _____ Likes to reflect, play with
ideas
41. _____ Has few artistic interests
42. _____ Likes to cooperate with
others
43. _____ Is easily distracted
44. _____ Is sophisticated in art, music,
or literature
91
CONSENT FORM
I acknowledge that Dr. Naeem Liaqat, has informed me in detail about the research titled
“Correlation of empathy and personality traits among final year medical
students in a public sector medical college”.
I am also informed regarding purpose, nature, aims and objectives of the study. All the
information in this study will be kept confidential and the data will be utilized only for
research purpose.
I give my full consent and willingness and allow Dr. Naeem Liaqat to consider me in his
study.
Signature:
Date:
92
Annexure I
93
Annexure II
94
Annexure III
Pilot study of two scales to be used
All the data were entered in SPSS version 26. Regarding the initial report, following
2 qualities were assessed:

Reliability

Validity
Reliability of IRI:
After entering all data in SPSS software, reliability was assessed by calculating
Cronbach’s alpha. Cronbach’s α was 0.638 when assuming one-factor model (internal
consistency of the total questionnaire). It is being shown in Table 1. Then after analysis of
results, deletion of Item 18 was considered, which raised the value of reliability to 0.660.
Then item 12 was deleted and reliability increased to 0.686. Then item 13 was deleted and
reliability was 0.702.
Validity of IRI:
Also, content validity of all the questions was assessed by discussing it with the
students filling the proforma. There were few points found out during discussion:

Question No, 2 which states that ‘2. I often have tender, concerned feelings for
people less fortunate than me. Students mentioned that tender is a word which may
be defficult to understant ad interpret. So I think that it must be replaced with word
“warm feelings”.
Reliability of BFI:
The reliability of BFI was considered and it was found to be 0.755 which is in
acceptable range, so it was not changed.
95
Validity of IRI:
Content validity of all the questions was assessed by discussing it with the students
filling the proforma. All students approved the content and suggested no change. So it was
implemented as such and no change in the statements was made.
96
Table 1: Cronbach’s Alpha and Internal consistency of IRI questionnaire
Scale
variance if
item deleted
111.343
115.160
123.225
122.175
113.673
115.170
120.874
114.565
111.655
Corrected
item-total
Correlation
.354
.231
-.061
-.023
.230
.229
.019
.274
.385
Squared
multiple
correlation
.302
.288
.163
.350
.332
.251
.263
.362
.337
Cronbach’s Alpha
if item deleted
E1
E2
E3
E4
E5
E6
E7
E8
E9
Scale mean
if item
deleted
55.4074
55.1481
56.0963
56.6296
55.3889
55.6815
56.1037
55.1074
55.1333
E10
E11
E12
E13
E14
E15
E16
E17
E18
E19
E20
E21
E22
E23
E24
E25
E26
E27
E28
55.1407
55.1148
56.3407
56.2963
56.5037
55.4852
55.9037
55.4815
56.6963
55.6741
55.2296
55.2889
55.1037
55.9000
55.9333
55.7519
55.5741
55.6815
55.3037
109.898
111.158
125.318
123.005
123.136
117.366
109.589
112.972
125.432
120.689
113.137
112.310
113.699
111.183
119.408
115.369
111.673
112.508
114.145
.408
.406
-.131
-.051
-.055
.137
.376
.280
-.136
.037
.351
.340
.298
.332
.079
.247
.325
.354
.294
.351
.391
.238
.237
.355
.133
.362
.383
.259
.245
.318
.333
.361
.418
.314
.223
.440
.283
.286
.608
.610
.662
.652
.652
.635
.610
.621
.660
.644
.616
.616
.620
.615
.640
.625
.616
.615
.621
97
.614
.626
.654
.650
.626
.627
.647
.623
.612
Table 1: Cronbach’s Alpha and Internal consistency of BFI questionnaire
Scale mean
if item
deleted
Scale
variance if
item deleted
Corrected
Squared
item-total
multiple
Correlation correlation
Cronbach’s Alpha
if item deleted
P1
146.1444
223.202
.195
.412
.752
P2
146.8000
234.183
-.055
.248
.762
P3
145.7407
222.550
.265
.291
.748
P4
146.4296
234.276
-.060
.354
.763
P5
145.7519
224.091
.246
.470
.749
P6
145.8667
225.254
.156
.403
.754
P7
145.4296
222.357
.309
.398
.747
P8
146.2000
227.551
.114
.351
.755
P9
146.1630
226.524
.150
.458
.753
P10
145.3370
219.734
.404
.392
.743
P11
145.8667
218.926
.363
.541
.744
P12
147.1556
235.017
-.078
.325
.762
P13
145.3481
218.741
.431
.432
.742
P14
145.5593
222.560
.352
.438
.746
P15
145.4259
216.446
.481
.535
.740
P16
145.7481
215.981
.465
.554
.740
P17
145.5815
219.471
.331
.442
.745
P18
146.5407
228.383
.100
.381
.756
P19
145.7741
227.930
.103
.443
.756
P20
145.4370
217.749
.437
.429
.741
P21
145.7889
229.914
.052
.410
.758
P22
145.2741
223.018
.281
.327
.748
P23
145.9778
229.784
.058
.391
.758
P24
146.3185
226.567
.134
.426
.754
P25
146.0296
218.594
.423
.512
.742
P26
146.1593
222.662
.329
.274
.746
P27
146.4074
228.451
.098
.277
.756
98
P28
145.7444
221.856
.309
.381
.747
P29
145.6519
222.228
.294
.414
.747
P30
145.4667
221.938
.311
.331
.747
P31
145.7185
222.173
.277
.400
.748
P32
145.4222
220.936
.378
.461
.744
P33
145.5407
222.420
.354
.499
.746
P34
146.1370
228.357
.104
.550
.755
P35
145.7815
226.617
.161
.270
.753
P36
146.0963
223.775
.219
.458
.750
P37
146.1667
229.322
.082
.414
.756
P38
146.1000
226.551
.149
.380
.753
P39
146.0556
232.618
-.015
.428
.760
P40
145.7704
221.308
.339
.385
.746
P41
146.0815
229.205
.079
.202
.756
P42
145.3370
219.890
.445
.575
.743
P43
145.9926
224.654
.201
.361
.751
P44
145.9444
217.629
.385
.402
.743
99