Beth’s capacity for empathy serves her well with her husband, James, as well as in other relationships. Others experience her as a good listener and often seek her out to share their stress. However, these conversations often leave Beth feeling anxious and distraught, even though she may not recognize the source of her discomfort. At other times, she is able to recognize and admit that her tension is related to feeling overwhelmed by others’ suffering. This tendency has been described as “empathic personal distress.” It entails self-focused anxiety, fear, or discomfort aroused when witnessing others’ pain.

Beth’s sensitivity to feeling overwhelmed is due to difficulty in differentiating others' pain from her own. She has difficulty experiencing empathy without an ability to disengage from it. Additionally, this often contributes to her being unsure of her own emotions.

Empathy is developed in childhood and reflects the quality of our early interactions. If parents are sufficiently present and provide safety and validation, children develop the capacity for healthy empathy. These children can be healthily attuned to others from a place of caring and compassion.

By contrast, some children develop empathy motivated by fear and responsibility. Some may develop empathic skills through efforts to detect a parent’s mood, or to predict and avoid potential conflict, tension, or even harm. Their development of empathy is fear-based and underlies their hypervigilance to avoid emotional or physical pain.

Other children may learn to be empathic to have a greater influence on a parent’s mood. Such children may unwittingly experience a sense of responsibility to soften a parent’s difficulties—whether marked by anxiety, depression, other mental health issues, or simply the........

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