Interpersonal distress, empathy, emotion recognition, and clinical symptom burden in functional heart complaints: A cross-sectional case-control study.

OBJECTIVE: This study examined self-reported empathy, performance-based emotion recognition, and clinical symptom burden in patients with non-cardiac chest pain (NCCP) compared with closely matched control participants. METHODS: Group comparisons were conducted in 52 patients with NCCP and 50 controls. Self-reported empathy was assessed with the Saarbrücker Persönlichkeitsfragebogen based on the Interpersonal Reactivity Index (SPF-IRI), emotion recognition with an Emotion Recognition Task (ERT), and clinical symptom burden with PHQ-D summary scores and the Hospital Anxiety and Depression Scale (HADS). Independent-samples t-tests and chi-square/Fisher's exact tests were used; Hedges' g was reported as effect size. RESULTS: Among the secondary outcomes, SPF-IRI Fantasy, Empathic Concern, Perspective Taking, and Personal Distress did not differ significantly between groups. Patients showed lower ERT total and percentile scores than controls (ERT total: g = -0.70 [95% CI -1.09, -0.30]; ERT percentile: g = -0.73 [-1.13, -0.33]). They also reported higher clinical burden, including PHQ-D somatic symptoms (g = 1.05 [0.64, 1.47]) and HADS total scores (g = 0.84 [0.43, 1.24]). PHQ-D psychosocial stressors were elevated but did not survive Bonferroni correction; PHQ-D depressive symptoms did not differ significantly. CONCLUSION: Patients with NCCP showed no statistically significant differences in self-reported empathy but lower performance on an emotion-recognition task alongside elevated clinical burden. This pattern suggests a task-specific difference rather than evidence of broad self-reported empathy differences.