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Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
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ABSTRACT
Objectives (1) To examine the psychometric properties of
the Basic Empathy Scale (BES) with Spanish adolescents,
comparing a two and a three-dimensional structure;(2) To
analyse the relationship between the three-dimensional
empathy and social and normative adjustment in school.
Design Transversal and ex post facto retrospective study.
Conrmatory factorial analysis, multifactorial invariance
analysis and structural equations models were used.
Participants 747 students (51.3% girls) from Cordoba,
Spain, aged 12–17 years (M=13.8; SD=1.21).
Results The original two-dimensional structure was
conrmed (cognitive empathy, affective empathy), but a
three-dimensional structure showed better psychometric
properties, highlighting the good t found in conrmatory
factorial analysis and adequate internal consistent
valued, measured with Cronbach's alpha and McDonald's
omega. Composite reliability and average variance
extracted showed better indices for a three-factor model.
The research also showed evidence of measurement
invariance across gender. All the factors of the nal three-
dimensional BES model were direct and signicantly
associated with social and normative adjustment, being
most strongly related to cognitive empathy.
Conclusions This research supports the advances
in neuroscience, developmental psychology and
psychopathology through a three-dimensional version
of the BES, which represents an improvement in the
original two-factorial model. The organisation of empathy
in three factors benets the understanding of social and
normative adjustment in adolescents, in which emotional
disengagement favours adjusted peer relationships.
Psychoeducational interventions aimed at improving
the quality of social life in schools should target these
components of empathy.
INTRODUCTION
Empathy dimensions
The study of empathy has predominantly been
carried out from three study areas: neuropsy-
chology, developmental psychology and social
psychology.1 Every one of these scientific
perspectives has significantly contributed to
the configuration of the concept, in which
at least three different cognitive-emotional
processes are identified: (1) feeling what
another person is feeling; (2) knowing how
to interpret what the other person is feeling,
that is, recognising his/her emotions and (3)
showing interest in responding when facing
the other person’s emotion.1 2
The main theoretical contributions have
recognised that empathy is a capacity that
includes affective elements, which allow
us to automatically react before the other
person’s emotion and cognitive elements,
which implies understanding the other
person’s perspective, being this process more
controlled and conscious.3–5
Studies of empathy have consistently
demonstrated the use of examining both the
cognitive and affective elements of empathy
Suitability of a three-dimensional
model to measure empathy and its
relationship with social and normative
adjustment in Spanish adolescents: a
cross-sectional study
Mauricio Herrera-López,1 Olga Gómez-Ortiz,2 Rosario Ortega-Ruiz,2
Darrick Jolliffe,3 Eva M. Romera2
To cite: Herrera-LópezM,
Gómez-OrtizO, Ortega-
RuizR, etal. Suitability of
a three-dimensional model
to measure empathy and
its relationship with social
and normative adjustment in
Spanish adolescents: a cross-
sectional study. BMJ Open
2017;7:e015347. doi:10.1136/
bmjopen-2016-015347
►Prepublication history for
this paper is available online.
To view these les, please visit
the journal online (http:// dx. doi.
org/ 10. 1136/ bmjopen- 2016-
015347).
Received 29 November 2016
Revised 15 August 2017
Accepted 23 August 2017
1Department of Psychology,
University of Nariño, Pasto,
Nariño, Colombia
2Department of Psychology,
University of Córdoba, Córdoba,
Andalucía, Spain
3Department of Criminology,
University of Greenwich, Old
Royal Navy College, London, UK
Correspondence to
PhD Mauricio Herrera-López;
mherrera@ udenar. edu. co
Research
Strengths and limitations of this study
►This paper could benet the understanding and
study of school violence given the offers an updated
perspective of the study of empathy from three
dimensions (cognitive empathy, emotional contagion
and emotional disengagement), and its inuence on
social and normative adjustment in school.
►The application of rigorous analysis to test the
relationships between study variables and for the
analysis of the psychometric properties of the Basic
Empathy Scale(conrmatory factorial analyses,
structural equation models and multigroup factorial
invariance analyses were used).
►This study acknowledges the need for longitudinal
and cross-cultural studies to improve condence
in these results; likewise, the analysis could be
limited by not having deepened the measurement
of empathy in each dimension according to gender
differences.
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2Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
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to better understand adolescent behaviour.6 7 In addition,
gender is an essential aspect to consider in the studies of
empathy at this age. Multiple studies show that women
present higher levels of affective empathy than men.8
However, studies outline that the gender differences
could be biased by the way of measuring this concept9 and
also due to the cultural aspects, which has traditionally
linked the most affective values to the female gender.10
Recent research suggests that the classical two-dimen-
sional model of empathy (affective vs cognitive) may
benefit from a reconceptualisation,11 12 which includes a
third process based on the concept named by Decety and
Jackson2 as ‘intention to respond to the others’ emotion’.
The advances in neuropsychological and neuroim-
aging research show that empathy may be conceptual-
ised into three components, each involving interacting,
yet partially non-overlapping neural circuits.11 13 From
this perspective, it seems to be more coherent to show
a three-dimensional empathy construct made up of: (1)
emotional contagion, which refers to the ability to expe-
rience others’ emotional states,14 (2) cognitive empathy,
which implies the ability to understand others’ emotions
and (3) emotional disengagement, the ability to avoid
other people’s emotions; perhaps as a form of self-protec-
tion against the anxiety generated by others’ emotional
states.15 Emotional contagion appears to be associated
with subcortical structures such as the limbic system,
which provides a rapid assessment of the valence of
others’ emotions (pleasant or aversive), essentially auto-
matically,16 17 and mirror neurons. This motor neurons
are located in the premotor, motor and anterior intra-
parietal area and are activated when we do some move-
ments if we are being watched by other people (eg, facial
mimicry of basic emotional expressions). They contribute
to share the affective world with the others from the first
childhood.18 19 However, this process of emotional conta-
gion is not sufficient in the later developmental stages
to understand the others’ emotions. Empathy requires
understanding those emotions and their development,
which implies building a representation of them which
allows us to be conscious of them without confusing them
with ours. This sophisticated function which refers to the
cognitive empathy lies on the mind theory and appears
to involve activation of the insular cortex, the ventrome-
dial prefrontal cortex (PFC) and the medial PFC.11 These
phylogenetically recent structures which are more slowly
developed than other brain areas reach their maturation
at the end of adolescence or at the beginning of adult-
hood. Therefore, it is not until that moment that we
can fully display the executive and regulation functions
linked to them. The emotional disengagement, which
completes the empathy construct, plays an essential role
to display an adaptive empathetic response because it is
an ability which avoids the fact that an extreme emotional
affectation occurs compromising our welfare. It is located
in the orbitofrontal cortex, the medial and dorsolateral
prefrontal cortex and the anterior cingulate cortex. Its
full power is reached in later developmental stages.13
The emotional regulation has been proved to be the
affective process which allows to combine the previous
empathic dimensions, being involved to an extent in
others’ emotion and managing to understanding it, but
without causing high levels of stress or discomfort.20 From
a developmental point of view, the processes related to
emotional contagion are the first to appear. Later, as
age and brain maturation progress, other cognitive and
emotional regulation functions are developed (cognitive
empathy and emotional disengagement); all are related
to the executive functions and to the development of the
theory of the mind, acquired at later ages.21–23
On the other hand, a three-factor empathy model
can offer certain potential benefits to differentiate
between primary and secondary psychopathy. Both forms
of psychopathy are associated with severe antisocial
behaviour, and the empathic deficits are one of the most
proffered causes. For primary psychopaths, these deficits
appear to be limited to affective empathy, with cognitive
empathy being at normal levels, thus the psychopath’s
glib and superficial charm but inappropriate affect.24
In contrast, secondary psychopaths are characterised by
affect instability and anxiety, which is not well accounted
by a two-factor conceptualisation of empathy.25 However,
using a three-factor model, secondary psychopaths could
have sufficient cognitive empathy and emotional conta-
gion but more limited abilities to emotionally disen-
gage; thus anxiety occurs, being overwhelmed with
others’ emotions. There is clearly explanatory power in
further exploring this proposed ‘new’ factor structure
of empathy, as this could contribute to a more coherent
understanding of the relationship between empathy and
this and other antisocial and prosocial behaviours.
Measurement of multidimensional empathy
One instrument which could accommodate this new
conceptualising of the definition of empathy4 is the
Basic Empathy Scale (BES).5 This device has shown good
psychometric properties and is one of the most widely
used in Europe. Although there are other instruments
that are commonly used to measure empathy in adoles-
cents, this scale is the only one that has been originally
developed using this population. The items on this scale
were selected based on four of the five ‘basic emotions’
(fear, sadness, anger, happiness) and it has been validated
in a number of countries using samples of varying ages
including children from France26 and Spain27; preadoles-
cents from Slovakia28 and a combination of adolescents
and adults from France,21 29 Italy,30 Portugal,31 China,32 33
Singapore,34 El Salvador,35 Peru36 and Spain.37 Although
appropriate psychometric properties were observed
in these baseline studies and the two-factor structure
proposed by the authors was an evidence (cognitive
empathy and affective empathy), recent research using
a French sample showed optimal results using an alterna-
tive structure, with the reorganisation of the items into the
three factors.21 26 A further potential benefit of this study
is that Spanish is one of the most widely used languages in
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Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
Open Access
the world; therefore, a new three-dimensional version of
the BES—translated and validated in Spanish—could be
a significant contribution to the study of empathy in the
many Spanish-speaking countries.
Three-dimensional empathy and social and normative
adjustment
There is growing interest in the study of empathy and its
potential associations with the development and mainte-
nance of peer relations.38 This is because studies continue
to demonstrate that empathy is positively associated with
psychosocial adjustment21 39 and negatively associated
with aggressive behaviours such as bullying and cyberbul-
lying.27 40 41 For example, greater levels of empathy have
been associated with an increased likelihood of self-re-
ported prosocial behaviour among school-aged children.5
However, there is limited research in studies considering
empathy from a three-factor conceptualisation.
Clearly, a more comprehensive understanding of the
relationship between the three factors of empathy and
social behaviour is warranted. This includes examining
how empathy and its constituent parts might relate to
social and normative adjustment in schools. Social adjust-
ment refers to the degree to which a person engages in
socially competent behaviours adaptive to the immediate
social context,42 and normative adjustment refers to the
ability to align behaviour with social conventions and
norms that guarantee respect towards the others.43 This
collection of attitudes and behaviours (eg, cooperation,
solidarity, mutual acceptance, respect) are key compo-
nents of a good collective school climate.43 44
This study presents two aims: (1) to analyse the
psychometric properties of the BES in a large sample of
Spanish adolescents and compare the three-factor struc-
ture (shown to be the best in studies conducted with
non-Spanish adolescents) with the two-factor structure
(the only factorial structure tested with Spanish popula-
tions); (2) to examine the associations between empathy
and social and normative adjustment in school.
The hypotheses of this study were: (1) the three-factor
structure will show better psychometric properties than
the two-factor structure, showing invariance across gender
and (2) cognitive empathy will show the strongest associa-
tion with both social and normative adjustment.
MATERIALS AND METHODS
Study design
The study was a cross-sectional design, ex post facto, retro-
spective study with one group and multiple measures.45
Participants
The sampling was incidental, selected under the following
criteria of accessibility: permission given by the educa-
tional centre and geographical proximity for a better
displacement. According to statistical requirements, to
carry out an instrument validation, it is necessary to have
at least 400 participants in total.46 Thus, four educational
centres of Córdoba, Andalusia, southern Spain, were
chosen, where all the students took part. The public and
private character of the centres was controlled so that they
were represented in the sample, so half of the selected
centres belonged to every simple type of school. The final
sample was composed by 747 Spanish adolescents (51.3%
girls). They were students of secondary education (high
school) and were aged between 12 and 17 years (M=13.84,
SD=1.22).
Instruments
Empathy was measured with the BES.5 This scale has 20
Likert-type items with five possible responses (1=strongly
disagree to 5=strongly agree), originally organised into
two dimensions: cognitive empathy (nine items) and affec-
tive empathy (11 items).5 Additionally, we used the three-
factor version that redistributes the original elements
by organising them in: emotional contagion (six items),
cognitive empathy (eight items) and emotional disen-
gagement (six items).21 Higher scores indicate higher
levels of empathy.
To measure social adjustment, which refers to the degree
to which a person engages in socially competent behaviours
adaptive to the immediate social context, the Social Adjust-
ment Scale was applied. This presents nine Likert-type
items, with seven possible responses (1=strongly disagree to
7=strongly agree). An example item for the social adjust-
ment scale is: ‘My classmates are interested in me’.43 To
measure the normative adjustment, which refers to the
ability to align behaviour with conventions and social norms
that guarantee respect for others, the Normative Adjust-
ment Scale was applied. This contains five Likert-type items,
also with seven possible responses (1=strongly disagree to
7=strongly agree). An example item for the social adjust-
ment scale is: ‘I ask as a question and wait for an answer
before I speak’.43 Higher scores indicate higher levels of
social and normative adjustment. These two last scales were
created and validated in a study on multidimensional social
competence in educated Spanish adolescents.43
Procedure
Permission of both school management teams and the
expressed authorisation of the adolescents’ families—
through informed and signed consent—were obtained.
Adolescents were also informed that their participation
was voluntary. The paper questionnaires were adminis-
tered by trained researchers and were anonymous. The
average completion time was 30 min. The study was
approved by the Biomedical Research Ethics Committee
of Andalusia and developed in accordance with the
considerations of the Declaration of Helsinki and the
Spanish Society of Psychology.
Initially, the BES scale was translated into Spanish
through the process of ‘parallel back-translation’.47 The
scale content was further validated using a pilot study
with 60 students who assisted in assessing the degree of
comprehension of each item. The students’ proposed
changes were incorporated into the final version.
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Table 1 Frequencies and percentages of responses for each item
Items (BES)
1
Fr/%
2
Fr/%
3
Fr/%
4
Fr/%
5
Fr/%
BES-1 Las emociones de mis amigos no me afectan mucho. (My friends’ emotions don’t affect me much). 112/15% 72/9.6% 115/15.4% 104/13.9% 344/46.1%
BES-2 Después de estar con un amigo que está triste por algo, por lo general me siento triste. (After being with a friend
who is sad about something, I usually feel sad).
104/13.9% 86/11.5% 141/18.9% 168/22.5% 248/33.2%
BES-3 Puedo entender la felicidad de mi amigo(a) cuando le va bien en algo. (I can understand my friend’s happiness
when s/he does well at something).
13/1.7% 10/1.3% 39/5.3% 85/11.3% 600/80.4
BES-4 Me asusto cuando veo los personajes de una buena película de terror. (I get frightened when I watch the
characters of a good horror lm).
185/24.8% 59/7.9% 92/12.3% 101/13.5% 310/41.5%
BES-5 Me quedo atrapado en los sentimientos de otras personas fácilmente. (I get caught up in other people’s feelings
easily).
125/16.7% 90/12% 177/23.7% 135/18.1% 220/29.5%
BES-6 Me resulta difícil saber cuándo mis amigos se asustan. (I nd it hard to know when my friends are frightened). 106/14.1% 80/10.7% 118/15.8% 116/15.6% 327/43.8%
BES-7 No me pongo triste cuando veo a otras personas llorando. (I don’t become sad when I see other people crying). 143/19.1% 60/8.1% 117/15.7% 104/13.9% 323/43.2%
BES-8 Los sentimientos de otras personas no me molestan en absoluto. (Other people’s feelings don’t bother me at
all).
81/10.8% 49/6.6% 62/8.3% 69/9.2% 486/65.1%
BES-9 Cuando alguien se está sintiendo ‘bajo de ánimos’, usualmente puedo entender cómo se siente. (When
someone is feeling ‘down’, I can usually understand how s/he feels).
15/2% 18/2.4% 54/7.2% 126/17% 534/71.4%
BES-10 Por lo general, puedo saber cuándo mis amigos tienen miedo. (I can usually work out when my friends are
scared).
50/6.7% 51/6.8% 142/19.1% 181/24.2% 323/43.2%
BES-11 A menudo me pongo triste cuando veo cosas tristes en la televisión o en las películas. (I often become sad
when watching sad things on TV or in lms).
128/17.1% 57/7.6% 102/13.7% 117/15.7% 343/45.9%
BES-12 A menudo puedo entender cómo la gente se siente incluso antes de que me lo digan. (I can often understand
how people are feeling even before they tell me).
34/4.5% 33/4.4% 131/17.6% 161/21.6% 388/51.9%
BES-13 Ver a una persona que se ha enfurecido no tiene ningún efecto sobre mis sentimientos. (Seeing a person who
has been angered has no effect on my feelings).
100/13.4% 82/11% 139/18.6% 129/17.3% 297/39.7%
BES-14 Por lo general, puedo saber cuándo la gente está alegre. (I can usually work out when people are cheerful). 19/2.5% 21/2.8% 83/11.1% 135/18.1% 489/65.5%
BES-15 Tiendo a sentir miedo cuando estoy con amigos que tienen miedo. (I tend to feel scared when I am with friends
who are afraid).
195/26.1% 83/11.1% 168/22.5% 122/16.3% 179/24%
BES-16 Normalmente puedo darme cuenta rápidamente cuando un amigo está enojado. (I can usually realise quickly
when a friend is angry).
31/4.1% 18/2.4% 67/9% 125/16.7% 506/67.8%
BES-17 A menudo me dejo llevar por los sentimientos de mis amigos. (I often get swept up along my friends’ feelings). 170/22.8% 92/12.3% 180/24.1% 150/20.1% 155/20.7%
BES-18 La infelicidad de mi amigo no me hace sentir nada. (My friend’s unhappiness doesn’t make me feel anything). 70/9.4% 48/6.4% 99/13.2% 100/13.4% 430/57.6%
BES-19 Normalmente no soy consciente de los sentimientos de mis amigos. (I am not usually aware of my friends’
feelings).
70/9.4% 65/8.7% 91/12.2% 100/13.4% 421/56.3%
BES-20 Tengo problemas para averiguar cuando mis amigos están felices. (I have trouble guring out when my friends
are happy).
70/9.4% 65/8.7% 91/12.2% 100/13.4% 421/56.3%
1= strongly disagree; 2= moderately disagree; 3= neither agree nor disagree; 4= moderately agree; 5= strongly agree.
BES, Basic Empathy Scale; Fr, frequency.
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Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
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Table 2 Descriptive of the scales
Scale/Factor
n=767
Skewness KurtosisM SD
Total empathy 3.86 0.59 −0.29 −0.51
Twofactors Affective empathy 3.56 0.76 −0.14 −0.64
Cognitive empathy 4.22 0.60 −0.73 0.29
Threefactors Emotional contagion 3.33 0.94 −0.25 −0.57
Cognitive empathy 4.23 0.60 −0.72 0.38
Emotional disengagement 3.89 1.00 −0.80 −0.12
Social adjustment 5.86 0.82 −0.87 0.58
Normative adjustment 5.59 1.08 −0.96 1.37
Analysis of data
Questionnaires with missing data or those partially
completed were removed. Eight per cent (64) of the data
collected were lost. Only fully completed questionnaires
were used (747).
To test the multivariate normality, the Mardia’s coef-
ficient was analysed using the MVN48 package in R
program.49
Confirmatory factor analyses (CFA) and structural equa-
tion modelling (SEM) were performed using the EQS
V.6.2 program.50 Given the categorical nature of the vari-
ables and the absence of multivariate normality, the esti-
mation method of maximum likelihood was chosen with
robust scaling51 and polychoric correlations.52 To assess
the fit of the models the following indices were used: χ2
Satorra-Bentler (
χ
2
S-B),53 value significance (p>0.001), χ2
party by the df (
χ
2
S-B/df) (≤5), the Comparative Fit Index
(CFI), the Non-Normed Fit Index (NNFI) (≥0.90), the
root mean square error approximation (RMSEA) (≤0.08)
and the standardised root mean-square residual (SRMR)
(≤0.08).54 The Akaike Information Criterion (AIC) was
also evaluated to compare the obtained models, being
lower values more desirable.
Given the fact that it was necessary to recognise the
factorial stability of the instrument (three-dimensional
BES) from the measures and differences of empathy
according to gender, a multifactorial invariance analysis
was performed. This kind of testing includes a number of
sequential analyses with progressively restricted models.
Four different models were tested: model 1, where the
same factor structure is imposed on the two groups
(configural invariance); model 2, where covariances are
constrained to be equal across groups; model 3, where
factor loadings are constrained to be equal across groups
(metric invariance) and model 4, where factor load-
ings and covariances are constrained to be equal across
groups (residual invariance). The χ2 difference test (Δχ2
S-
B) was used to test the invariance degree. Non-significant
changes in χ2 suggest intergroup invariance.47 55 Delta (Δ)
differences between the adjustment indicators (NNFI,
IFC, RMSEA and SRMR) were also considered. The cut-off
point suggested in the literature to accept the hypothesis
of invariance across groups is a change of 0.01.56 A multi-
group analysis was performed using EQS V.6.2.50
In addition to calculated the Cronbach’s alpha (α), the
McDonald’s Omega (Ω)57 was used to estimate the internal
consistency of the instruments (α/ Ω ≥0.60) given that
the variables were categorical and reflected the absence
of multivariant normality.58 The analysis was performed
using the Factor V.9.2 programme.59 Moreover, to esti-
mate the construct reliability, composite reliability (CR)
and the average variance extracted (AVE) were computed.
The cut-off points for these indices are 0.70 and 0.50,
respectively. Discriminant validity was also examined by
comparing the AVE of the pairs of latent variables to the
shared variance—square of the correlation between the
pairs of variables. If the first indicator was higher than the
last indicator, the questionnaire would be considered as
having shown good discriminant validity.60 The adopted
level of significance was 0.05.
RESULTS
Psychometric properties of BES
First, descriptive statistics were established for each item
and dimension (see table 1 and table 2). The Mardia anal-
ysis showed a skewness coefficient of 57.38, p<0.001 and a
kurtosis coefficient of 544.83, p<0.01, indicating non-com-
pliance with the assumption of multivariate normality.
The CFA of the original two-factor structure of the
BES (cognitive empathy, emotional empathy), demon-
strated appropriate fit,
χ
2
S-B=839.355;
χ
2
S-B/(169)=4.967;
p<0.001; NNFI=0.904; CFI=0.915; RMSEA=0.069 (90%
CI 0.063 to 0.075); SRMR=0.088; AIC=968.962. In addi-
tion, the structure of the three-factor solution (emotional
contagion, cognitive empathy, emotional disengage-
ment) showed a CFA with good fit and indicators,
χ
2
S-B=618.163;
χ
2
S-B/(167)=3.702; p<0.001; NNFI=0.919;
CFI=0.929; RMSEA=0.063 (90% CI 0.058 to 0.069);
SRMR=0.077; AIC=284.163 (see figure 1). Internal
consistency values were adequate for both the
two-factor model: αaffective-empathy=0.70; αcognitive-empathy=0.67;
Ωaffective-empathy=0.76; Ωcognitive-empathy=0.71 and the three-
factor model: αemotional-contagion=0.66; αcognitive-empathy=0.69;
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Figure 1 Conrmatory factor analysis -BES- of three
factors.*p<0.05; BES, Basic Empathy Scale.
Table 3 CR, AVE and square correlations (below the
diagonal)
Factor/
Dimension
BES two
dimensional BES three dimensional
AE CE EC CE ED
CR 0.69 0.63 0.71 0.75 0.83
AVE 0.21 0.17 0.36 0.34 0.55
SC AE-CE (0.68**) EC-CE
(0.18**)
EC-ED
(0.08**)
CE-ED
(0.33**)
—
**p<0.01.
AE, affective empathy; AVE, average variance extracted; BES,
Basic Empathy Scale; CE, cognitive empathy; CR, composite
reliability; EC, emotional contagion; ED, emotional disengagement;
SC, square correlations.
αemotional-disengagement=0.80; Ωemotional-contagion=0.82; Ωcognitive-em-
pathy=0.71; Ωemotional- disengagement=0.80.
The CR analysis showed inadequate values below the
cut-off points for the two-factor BES, whereas for the
three-factor model, the values were suitable for each
factor (see table 3). Regarding the AVE, the values were
not adequate for the two-factor model. However, in the
three-dimensional model, the values of emotional conta-
gion and cognitive empathy ranged from 0.33 to 0.55,
which are below the established cut-off points, although
they are higher than the SC values (see table 3).
CFA results of BES by gender were distributed in three
factors with adequate values, for both boys:
χ
2
S-B=406.162;
χ
2
S-B/(167)=2.408; p<0.001; NNFI=0.901; CFI=0.909;
RMSEA=0.067 (90% CI 0.059 to 0.076); SRMR=0.080;
AIC=72.162 and girls:
χ
2
S-B = 371.461;
χ
2
S-B/(167)=2.224;
p<0.001; NNFI=0.933; CFI=0.941; RMSEA=0.059 (90% CI
0.051 to 0.067); SRMR=0.077; AIC=37.461.
The results of the multigroup analysis were adequate.
χ2differences were non-significant between models 11
and 3 and between models 1 and 4. Changes on CFI,
NNFI, RMSEA and SRMR were minimal between all the
models (see table 4). These results show evidence of
measurement invariance across gender groups.54 55
The CFA of the Social Adjustment Scale showed
adequate fit for the Spanish sample:
χ
2
S-B=126.338;
χ
2
S-B/(27)=4.679; p<0.001; NNFI=0.948; CFI=0.961;
RMSEA=0.079 (90% CI 0.073 to 0.083); SRMR=0.070;
AIC=122.339. The internal consistency was adequate:
αsocial-adjustment=0.79; Ωsocial-adjustment=0.80.
The CFA of the Normative Adjustment Scale also
indicated adequate fit:
χ
2
S-B=24.073;
χ
2
S-B/(5)=4.815;
p<0.001; NNFI=0.982; CFI=0.991; RMSEA=0.034 (90% CI
0.028 to 0.038); SRMR=0.040; AIC=19.073. The internal
consistency was also adequate: αnormative-adjustment=0.79;
Ωnormative-adjustment=0.78.
Explanatory model
We proposed a SEM in which empathy—organised into
three factors—directly influenced social and normative
adjustment. The analysis of polychoric correlations coef-
ficients (PCC) between model variables showed moderate
values between cognitive empathy and polychoric adjust-
ment (PCC=0.40; p<0.01) and between cognitive empathy
and normative adjustment (PCC=0.38; p<0.01). The
final model (see figure 2) showed good fit indices,
χ
2
S-
B=1544.337;
χ
2
S-B/(521)=2.964; p<0.001; NNFI=0.922;
CFI=0.931; RMSEA=0.056 (90% CI 0.053 to 0.059);
SRMR=0.080; AIC=502.377. This indicated that emotional
contagion was directly related to social adjustment (
β
=0.12; p<0.05) and normative adjustment (
β
=0.05; p<0.05).
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Table 4 Multigroup analysis of BES three-dimensional by gender
Model
χ
2
S-B df p NNFI CFI RMSEA SRMR AIC ∆
χ
2
S-B ∆p∆df ∆NNFI ∆CFI ∆RMSEA ∆SRMR
Model 1 773.746 334 0.000 0.919 0.928 0.063 0.091 105.75
Model 2 781.257 337 0.000 0.918 0.928 0.063 0.091 107.26 7.511 0.852(NS) 3 0.001 0.000 0.000 0.000
Model 3 792.588 351 0.000 0.922 0.928 0.061 0.092 90.59 18.842 0.881(NS) 17 0.003 0.000 0.002 0.001
Model 4 800.911 354 0.000 0.922 0.927 0.062 0.093 106.65 27.168 0.898(NS) 20 0.003 0.001 0.001 0.002
Model 1=without restrictions; Model 2=covariance restriction; Model 3=restriction factor weights; Model 4=residual restrictions.
AIC,Akaike Information Criterion; BES, Basic Empathy Scale; CFI, Comparative Fit Index; NNFI, Non-Normed Fit Index; RMSEA, root mean square error approximation; SRMR, standardised
root mean-square residual.
Cognitive empathy was also found to be directly related
to both social adjustment (
β
=0.61; p<0.05) and normative
adjustment (
β
=0.40; p<0.05). Finally, emotional disen-
gagement was found to have a direct and negative influ-
ence on social adjustment (
β
= –0.08; p<0.05) and a direct
influence on normative adjustment (
β
=0.07; p<0.05).
Together these direct relationships accounted for 39% of
the total variance of social adjustment and 17% of norma-
tive adjustment (see figure 2).
DISCUSSION
The first aim of this study was to analyse the psychometric
properties of BES5 in a sample of Spanish adolescents,
specifically to compare the two-factor structure (cognitive
and affective empathy) with the three-factor structure
(emotional contagion, cognitive empathy and emotional
disengagement). This had not been previously examined
in any Spanish sample. The results, when compared with
those obtained in France21 26 showed better psychometric
properties for the three-factor version, compared with the
original—and much more commonly used—two-factor
structure. The evidence for this comes from numerous
improvements in the adjustment NNFI, CFI, RMSEA,
SRMR indices and the AIC index. In addition, the three-
factor solution showed adequate values of internal consis-
tency for all the factors. This was different Akaike low
value reported for cognitive empathy of α=0.69 with a
French sample.21 When the composite reliability values
were compared, better results were found for the three-
factor structure in comparison to the two-factor structure,
and although low values were obtained in the AVE in
the dimensions of emotional contagion and cognitive
empathy, these values exceeded those of the square of
the correlations.60 Therefore, this suggests that this solu-
tion provides significantly better discriminant validity
compared with the two-factor structure.
Unlike previous research using the BES and empathy
more generally, this new conceptualisation allows to
assess the extent to which an individual retreats from
or does not engage in the emotional states of others, in
addition to the more commonly assessed abilities related
to emotional understanding (cognitive empathy) and
emotional experience (emotional contagion).12 15 Finally,
in contrast with the studies carried out in France which
eliminated one21 and two items,26 this Spanish validated
scale maintains all the items of the original design.
The analysis of the CFA for each gender, as well as the
analysis of the factorial invariance indicated that the
three-factor solution was optimal for the measurement
of empathy for both men and women. Despite existing
socialisation aspects which could contribute to a different
self-perception of empathy between both genders, results
indicate that both girls and boys actually understand
this construct in the same way, which is important to
delve into the understanding of the building process of
emotional identity that female and male children must
develop throughout their lives.61
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Figure 2 Structural equation modelling nal. Relationship between empathy of three factors and social and normative
adjustment. *p<0.05; **p<0.01; PCC,polychoric correlations
The second objective of this study was to evaluate the
magnitude of the relationship between the three identi-
fied dimensions of empathy and both social and norma-
tive adjustment. In general, the percentage of variance
explained suggested that empathy was significantly associ-
ated with both of these forms of adjustment. The results of
the final model suggested that cognitive empathy played a
primary role. The relationship between emotional conta-
gion and social adjustment was low but direct, but the
relationship with emotional disengagement was low and
inverse, indicating that higher levels of disengagement—
or failing to fully engage with the others’ emotions—did
not develop to optimal interpersonal relationships.62
However, it is important to consider the moral char-
acteristics of the peer group. Aggressive groups could
expect immoral actions from their members. In this case,
emotional disengagement from peer’s negative emotions
(eg, anger, hostility), particularly those involved in recruit-
ment for bullying for example, could facilitate prosocial
behaviour when facing up considerable emotional peer
pressure. In this case, emotional distancing could there-
fore benefit moral action.
The results also showed a direct relationship between
cognitive empathy and normative adjustment. This could
suggest that understanding others’ emotions such as
sadness, anger or fear facilitates compliance with school
rules, perhaps because this ability facilitates a sense of
connection and group cooperation.63 In other words,
attitudes and behaviours such as respect for the others’
opinions, waiting in turn to speak, letting others work
and in general, engagement with social and normative
conventions benefitted from increased levels of cognitive
empathy. Cognitive empathy might benefit acceptance,
respect and solidarity, favoring an improvement in social
interactions and interpersonal relationships. Conse-
quently, adolescents who understand others’ emotions
and understand the purpose of school rules are more
likely to regulate their behaviour accordingly.64
Emotional contagion and emotional disengagement
showed a low but direct association with normative adjust-
ment. This suggests that although it may be necessary
to be involved to some degree in the others’ emotions
(for example, feeling anger, sadness or fear when others
experience these), it is also important to keep emotional
distance. This may be beneficial for providing space to
evaluate what behavioural responses are most appro-
priate, and at the same time it may allow some control
over one’s own emotional response. This affective space
could offer the opportunity to interpret social situations
more carefully when dealing with emotional experiences
that could be potentially overwhelming.
In summary, this study suggested that a Spanish version
of the BES structured into three factors measured
empathy in adolescents more adequately and fit more
coherently with what is known about emotional func-
tioning from a psychological and neuropsychological
point of view. In spite of the limitations that measuring a
psychological construct through self-reports entail—due
to the neuropsychological ability it implies—this research
presents some strong points: on the one hand, it offers
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Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
Open Access
scientific evidence based on confirmatory, reliability,
validity and factorial invariance analyses which support
the suitability of measuring empathy from a three-factor
model, following the recent contributions from neuropsy-
chology, psychology and psychopathology. On the other
hand, it allows us to have a Spanish version of the BES,
which will foster its use in Spanish-speaking countries and
which will allow a cross-cultural comparison. Furthermore,
this work reaffirms the potential importance of strength-
ening these three components of empathy for improving
the quality of peer relationships in school.64 That is, social
adjustment appears to be related with the understanding
of others’ emotions, and to some extent, it seems to be
involved or invested in these. On the other hand, norma-
tive adjustment appears to be related to the understanding
of others’ emotions and to the ability to strike a balance
between being overwhelmed by the others’ emotional
experiences and being emotionally disengaged. This key
result illustrates the potential importance of emotional
regulation for both the emotional contagion and disen-
gagement components of empathy, as possible ways to
stimulate improved interpersonal relationships and the
establishment of moral reciprocity. Emotional regulation
and subsequent controls on contagion and disengage-
ment could restrict the emergence of uncritical and risky
attitudes towards the others’ emotions, which have been
found to be present among those involved in bullying and
cyberbullying.65 66
This study also showed that empathy contributed to
the development of a healthy school culture. It further
suggests that individuals suffering from cyberbullying
to understand each other’s feelings may be more able
to negotiate egocentric positions and achieve sufficient
emotional distance to make decisions that best fit the
group, in opposition to individual goals. Empathy also
promotes critical judgements that prevent individuals
from getting carried away by emotions such as anger or
sadness, and also benefits the emergence of more satis-
fied perhaps less conflicted relationships in the class-
room. Overall, it seems that better skills in understanding
others’ emotions foster interpersonal relationships,
resulting in the prosocial behaviour necessary for better
social life and school environment.64
Finally, having a better instrument with recognised
and proven prosocial properties to assess the dimensions
of empathy demonstrated to be related to optimal peer
interpersonal relationships should help to guide the
design and implementation of educational programmes.
These ought to be aimed at promoting the identification
of others’ emotions and the emotional regulation, which
appears to allow a certain affective distancing without
becoming fully emotionally disengaged.
The limitations of the study are related to social desir-
ability, the use of self-report questionnaires and the fact
that the sample was selected based on convenience.
All of these aspects could bias its results. This potential
response bias was mitigated as far as possible by providing
anonymity to the participants and by ensuring that they
were aware their responses would not be connected with
them. This should encourage honest responding. In addi-
tion, in the analysis of the psychometric properties of the
three-factor BES, low values in the average variance were
extracted for emotional contagion and cognitive empathy.
The adequate values of the other parameters and the fact
that this device has been validated with different partic-
ipants and cultures suppose sufficient criteria of validity
and reliability to support the adequacy of this scale for
measuring empathy. In future research, it would be advis-
able to carry out cross-cultural and prospective longitu-
dinal studies which would allow to consolidate the results
obtained here in different samples, as well as to investi-
gate whether empathy changes over time and whether
these changes are associated with changes in social or
normative adjustment.
Acknowledgements The authors acknowledge the invaluable participation of the
study subjects.
Contributors MHL conceived the study, in consultation with EMR, OGO and ROR,
who participated in its design, review and drafting of the manuscript. DJ authorized
the use of the BES scale and reviewed and supported the drafting and nal
structure of the paper. All authors read and approved the nal manuscript.
Funding This study was carried out within the framework of the following projects:
projects PSI2016-74871-R and PSI2015-64114-R funded by the Spanish National
I+D+i Plan and Project EDU2013-44627-P funded by the Spanish National I+D
Plan.
Competing interests None declared.
Patient consent Obtained.
Ethics approval CE-UCO, Faculty of Education Sciences, Department of
Psychology.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Open Access This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http:// creativecommons. org/
licenses/ by- nc/ 4. 0/
© Article author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.
REFERENCES
1. Davis MH. Empathy a social psychological approach. Boulder CO:
Westview, 1996.
2. Decety J, Jackson PL. The functional architecture of human
empathy. Behav Cogn Neurosci Rev 2004;3:71–100.
3. Davis MH. Measuring individual differences in empathy:
evidence for a multidimensional approach. J Pers Soc Psychol
1983;44:113–26.
4. Cohen D, Strayer J. Empathy in conduct-disordered and comparison
youth. Dev Psychol 1996;32:988–98.
5. Jolliffe D, Farrington DP. Development and validation of the Basic
Empathy Scale. J Adolesc 2006;29:589–611.
6. Van Lissa CJ, Hawk ST, Meeus WH. The effects of affective and
cognitive empathy on adolescents' behavior and outcomes in
conicts with mothers. J Exp Child Psychol 2017;158:32–45.
7. Vossen HGM, Piotrowski JT, Valkenburg PM. The longitudinal
relationship between media violence and empathy: was it sympathy
all along? Media Psychol 2016:1–19.
8. Hawk ST, Keijsers L, Branje SJ, et al. Examining the (IRI) among
early and late adolescents and their mothers. J Pers Assess
2013;95:96–106.
group.bmj.com on September 25, 2017 - Published by http://bmjopen.bmj.com/Downloaded from
10 Herrera-LópezM, etal. BMJ Open 2017;7:e015347. doi:10.1136/bmjopen-2016-015347
Open Access
9. Joseph DL, Newman DA. Emotional intelligence: an integrative meta-
analysis and cascading model. J Appl Psychol 2010;95:54–78.
10. Toussaint L, Webb JR. Gender differences in the relationship
between empathy and forgiveness. J Soc Psychol 2005;145:673–85.
11. Decety J. Dissecting the neural mechanisms mediating empathy.
EmotRev 2011;3:92–108.
12. Decety J, Svetlova M. Putting together phylogenetic and ontogenetic
perspectives on empathy. Dev Cogn Neurosci 2012;2:1–24.
13. Decety J, Michalska KJ. Neurodevelopmental changes in the circuits
underlying empathy and sympathy from childhood to adulthood. Dev
Sci 2010;13:886–99.
14. Iacoboni M, Dapretto M. The mirror neuron system and the
consequences of its dysfunction. Nat Rev Neurosci 2006;7:942–51.
15. Lamm C, Batson CD, Decety J. The neural substrate of human
empathy: effects of perspective-taking and cognitive appraisal.
J Cogn Neurosci 2007;19:42–58.
16. Derntl B, Finkelmeyer A, Eickhoff S, et al. Multidimensional
assessment of empathic abilities: neural correlates and gender
differences. Psychoneuroendocrinology 2010;35:67–82.
17. Phillips ML, Drevets WC, Rauch SL, et al. Neurobiology of emotion
perception I: the neural basis of normal emotion perception. Biol
Psychiatry 2003;54:504–14.
18. Decety J, Meidenbauer KL, Cowell JM. The development of
cognitive empathy and concern in preschool children: a behavioral
neuroscience investigation. Dev Sci 2017:e12570.
19. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev
Neurosci 2004;27:169–92.
20. Diamond A. Normal development of prefrontal cortex from birth to
young adulthood: cognitive functions, anatomy, and biochemistry. In:
Stuss DT, Knight RT, eds. Principles of Frontal Lobe Function. New
York: Oxford University Press, 2002:446–503.
21. Carré A, Stefaniak N, D'Ambrosio F, et al. The Basic Empathy Scale
in adults (BES-A): factor structure of a revised form. Psychol Assess
2013;25:679–91.
22. Goldstein TR, Winner E. Enhancing empathy and theory of mind.
J Cogn Dev 2012;13:19–37.
23. Völlm BA, Taylor ANW, Richardson P, et al. Neuronal correlates
of theory of mind and empathy: a functional magnetic resonance
imaging study in a nonverbal task. Neuroimage 2006;29:90–8.
24. Jolliffe D, Murray J. Low Empathy and Offending. In: Loeber R, Welsh
BC, eds. The future of criminology. Oxford: Oxford University Press,
2012:62–70.
25. Yildirim BO. A treatise on secondary psychopathy: psychobiological
pathways to severe antisociality. Aggress Violent Behav
2016;31:165–85.
26. Bensalah L, Stefaniak N, Carre A, et al. The Basic Empathy Scale
adapted to French middle childhood: structure and development of
empathy. Behav Res Methods 2016;48:1 11.
27. Sánchez-Pérez N, Fuentes LJ, Jolliffe D, et al. Assessing children’s
empathy through a Spanish adaptation of the Basic Empathy Scale:
parent’s and child’s report forms. Front Psychol 2014;5:1438.
28. Čavojova V, Sirota M, Belovičova Z. Slovak validation of the Basic
Empathy Scale in pre-adolescents. Stud Psychol 2012:195–208.
29. D’Ambrosio F, Olivier M, Didon D, et al. The Basic Empathy Scale: a
French validation of a measure of empathy in youth. Pers Individ Dif
2009;46:160–5.
30. Albiero P, Matricardi G, Speltri D, et al. The assessment of empathy
in adolescence: a contribution to the Italian validation of the “Basic
Empathy Scale.”. J Adolesc 2009;32:393–408.
31. Pechorro P, Ray J V, Salas-Wright CP, et al. Adaptation of the Basic
Empathy Scale among a Portuguese sample of incarcerated juvenile
offenders. Psychol Crime Law 2015:7.
32. Geng Y, Xia D, Qin B. The Basic Empathy Scale: a Chinese validation
of a measure of empathy in adolescents. Child Psychiatry Hum Dev
2012;43:499–510.
33. Li C, Lv R, Liu J, et al. The adaptation of Basic Empathy Scale
among Chinese adolescents. Chinese J Clin Psychol 2011:163–6.
34. Ang RP, Goh DH. Cyberbullying among adolescents: the role of
affective and cognitive empathy, and gender. Child Psychiatry Hum
Dev 2010;41:387–97.
35. Salas-Wright CP, Olate R, Vaughn MG. Assessing empathy in
Salvadoran high-risk and gang-involved adolescents and young
adults: a Spanish validation of the basic empathy scale. Int J
Offender Ther Comp Criminol 2013;57:1393–416.
36. Merino-Soto C, Grimaldo-Muchotrigo M. Validación estructural de
la escala básica de empatía (Basic Empathy Scale) modicada en
adolescentes: un estudio preliminar. Revpsicol 2015;24:261–70.
37. Villadangos M, Errasti J, Amigo I, et al. Characteristics of empathy
in young people measured by the Spanish validation of the Basic
Empathy Scale. Psicothema 2016;28:323 9.
38. Blanke ES, Rauers A, Riediger M. Does being empathic pay
off?Associations between performance-based measures of empathy
and social adjustment in younger and older women. Emotion
2016;16:671–83.
39. Allemand M, Steiger AE, Fend HA. Empathy development in
adolescence predicts social competencies in adulthood. J Pers
2015;83:229–41.
40. Casas JA, Del Rey R, Ortega-Ruiz R. Bullying and cyberbullying:
Convergent and divergent predictor variables. Comput Human Behav
2013;29:580–7.
41. van Noorden TH, Haselager GJ, Cillessen AH, et al. Empathy and
involvement in bullying in children and adolescents: a systematic
review. J Youth Adolesc 2015;44:637–57.
42. Crick NR, Dodge KA. A review and reformulation of social
information-processing mechanisms in children's social adjustment.
Psychol Bull 1994;115:74–101.
43. Gómez-Ortiz O, Romera-Félix E-M, Ortega-Ruiz R.
Multidimensionality of social competence: measurement of the
construct and its relationship with bullying roles. Revista de
psicodidáctica 2017;22:37–44.
44. Cialdini RB, Reno RR, Kallgren CA. A focus theory of normative
conduct: recycling the concept of norms to reduce littering in public
places. J Pers Soc Psychol 1990;58:1015–26.
45. Montero I, León OG. A guide for naming research studies in
psychology. Int J Clin Heal Psychol 2007;7:847–62.
46. Lloret-Segura S, Ferreres-Traver A, Hernández-Baeza A, et al.
El análisis factorial exploratorio de los ítems: una guía práctica,
revisada y actualizada. An Psicol 2014;30:1151–69.
47. Muñiz J, Elosua P, Hambleton RK. Psicothema. Directrices para la
traducción y adaptación de lostests: segunda edición. International
test commission guidelines for test translationand adaptation. 2nd
ed, 2013:151–7.
48. Kormaz S, Goksuluk D, Zararsiz G. Mutivariate normality tests:
package “MVN”. 2015 http://www. biosoft. hacettepe. edu. tr/ MVN/
49. Team RDC. R: a language and environment for statistical computing.
Manual y software de cómputo, 2008.
50. Bentler RM, Ej W. EQS for windows. [Statistical program for
windows]. 2012.
51. Bryant FB, Satorra A. Principles and practice of scaled difference
chi-square testing. Struct Equ Model a Multidiscip J 2012;19:372–98.
52. Morata-Ramírez María de los Ángeles, Holgado-Tello FP. Construct
validity of likert scales through conrmatory factor analysis: a
simulation study comparing different methods of estimation
based on pearson and polychoric correlations. Int J Soc Sci Stud
2013;1:54–61.
53. Satorra A, Bentler PM. A scaled difference chi-square test statistic
for moment structure analysis. Psychometrika 2001;66:507–14.
54. Hu Li‐tze, Bentler PM. Cutoff criteria for t indexes in covariance
structure analysis: conventional criteria versus new alternatives.
Struct Equ Model a Multidiscip J 1999;6:1–55.
55. Bollen KA. Structural Equations with Latent Variables. New York:
Wiley, 1989.
56. Dimitrov DM. Testing for factorial invariance in the context of
construct validation. Meas Eval Couns Dev 2010;43:121–49.
57. Revelle W, Zinbarg RE, . Coefcients alpha, beta, omega and the
GLB: comments on sijtsma. Psychometrika 2009;74:145–54.
58. Elosua OP, Zumbo BD. Coecientes de abilidad para escalas de
respuesta categórica ordenada. Psicothema 2008;20:896–901.
59. Lorenzo-Seva U, Ferrando PJ. Factor: a computer program to
t the exploratory factor analysis model. Behav Res Methods
2006;38:88–91.
60. Hair J, Black W, Babin B, et al. Multivariate data analyses. 6th Ed.
Nueva York: Prentice-Hall, 2005.
61. Zajdel RT, Bloom JM, Fireman G, et al. Children’s understanding
and experience of mixed emotions: the roles of age, gender, and
empathy. J Genet Psychol 2013;174:582–603.
62. Chow CM, Ruhl H, Buhrmester D. The mediating role of interpersonal
competence between adolescents’ empathy and friendship quality: a
dyadic approach. J Adolesc 2013;36:191–200.
63. Boor-Klip HJ, Segers E, Hendrickx MM, et al. The moderating role of
classroom descriptive norms in the association of student behavior
with social preference and popularity. J Early Adolesc 2015:27.
64. Barr JJ, Higgins-D'Alessandro A. Adolescent empathy and prosocial
behavior in the multidimensional context of school culture. J Genet
Psychol 2007;168:231–50.
65. Brewer G, Cyberbullying KJ. self-esteem, empathy and loneliness.
Comput Human Behav 2015;48:255–60.
66. van Langen MAM, Wissink IB, van Vugt ES, et al. The relation
between empathy and offending: A meta-analysis. Aggress Violent
Behav 2014;19:179–89.
group.bmj.com on September 25, 2017 - Published by http://bmjopen.bmj.com/Downloaded from
adolescents: a cross-sectional study
social and normative adjustment in Spanish
measure empathy and its relationship with
Suitability of a three-dimensional model to
Jolliffe and Eva M. Romera
Mauricio Herrera-López, Olga Gómez-Ortiz, Rosario Ortega-Ruiz, Darrick
doi: 10.1136/bmjopen-2016-015347
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