The empathy experiments part one: somatic empathy
How sex, hormones, neurodevelopment, and childhood trauma shape empathy
My obsession with empathy
As a positive psychology expert and self-identified “empath”, I have always been obsessed with empathy. So much so, I made a career out of training corporations on how to cultivate empathy and put people at the heart of everything they do. Ask me anything about empathy - I could speak for hours on the topic.
My bread and butter was facilitating and coaching groups through positive organisational change. Like an emotional thermometer, I could step into a room and, within seconds, read everyone’s mood. This innate ability often left me on high alert and emotionally overwhelmed.
It wasn’t until I discovered I’m autistic that I began to unpick the mechanisms behind my sensitivity to others’ emotions. Over the past two years, I’ve been exploring what it means to be “different” and why, as a neurodivergent woman, I feel things so intensely.
Today, my passion is researching sex differences in mental illness, neurodivergence, empathy, and human behaviour. Over the next few weeks, I’ll be offering a masterclass in empathy. This is Part One of The Empathy Experiments: Somatic Empathy - How sex, hormones, neurodevelopment, and childhood trauma shape empathy. Be sure to follow me on Substack for Part Two: Affective Empathy.
What is somatic empathy?
Somatic empathy is the most understudied and underdiscussed form of empathy. Although it is arguably the most fascinating. It is the first form of empathy to develop, and before a baby even leaves the womb. fMRI brain imaging and rodent models of somatic empathy and mimicry offer illuminating insights into how humans form empathy. Any lesson on empathy should rightly start here.
While other discussions on empathy often centre on our ability to read others' intentions, emotions, or physical state through listening or observation and articulate this through the spoken word (cognitive empathy), this is arguably the last skill humans develop. Empathy is innately embodied, depends strongly on our senses and needs no words.
Somatic means embodied. Somatic empathy is defined as physically experiencing and sensing another person’s pain, bodily or emotional state, typically through close proximity and sensory input (Decety & Jackson, 2004; Preston & de Waal, 2002). It is believed to support emotional contagion, co-regulation, social bonding and prosocial behaviour (Hatfield, Cacioppo, & Rapson, 1993; Decety & Meyer, 2008). It depends heavily on sensory input, including touch, taste, smell, hearing, and observation.
Somatic empathy is closely related, and often discussed interchangeably, with motor mimicry. Motor mimicry is the automatic imitation of another person’s physical movements or expressions, such as wincing in reaction to the sight of another person being injured (Iacoboni, 2009; Gallese et al., 2004). It is thought to facilitate somatic empathy by allowing individuals to understand and resonate with others' feelings through physical mirroring and behavioural contagion (Dimberg, Thunberg, & Elmehed, 2000).
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How somatic empathy is formed
Somatic empathy begins in utero, where a baby, through the placenta, begins to co-regulate with its mother. Heartbeat, breathing, feeding, sleep-wake cycles, immunity, mood, and stress levels synchronise with mum. This shapes the baby’s autonomic nervous system and vagal tone, preparing it for the world (Porges, 2007; Feldman, 2015).
The anterior insula is a small part of the brain responsible for interoception, emotional processing and empathy (Craig, 2009; Singer et al., 2004). Interoception is awareness of our internal bodily states, such as hunger, tiredness, nausea, anxiety or fear. The insula begins forming very early in gestation, around 6–8 weeks, and its basic structure is visible by 13 weeks (Kostović & Judaš, 2006). By late gestation, the insula receives full sensory processing input from the body (e.g., touch, temperature, or taste sensations) (Sherer et al., 2004).
Touch is the very first sense to develop, around 8 weeks, and supports non-verbal bonding (Bremner et al., 2012). Skin-to-skin contact releases oxytocin (the love hormone) in both mother and baby. This co-regulation soothes distress, lowers stress hormones (like cortisol), and fosters emotional safety (Uvnas-Moberg et al., 2015; Feldman et al., 2010).
Taste develops next, followed by smell, fully forming by around 18 weeks (Schaal et al., 2004). This allows the baby to recognise the scent of her mother after birth and when she has milk. Babies prefer the taste of their mother’s milk and may even show aversion to unfamiliar ones (Marlier, Schaal, & Soussignan, 1998).
Lastly, the baby learns to hear before developing the last of the five senses: sight. Newborns recognise and prefer voices and sounds they heard during pregnancy (Kisilevsky et al., 2003). Sight continues to grow in the first year (Johnson, 2001). Hours after birth, babies begin to mimic their caregivers and communicate their physical states.
These non-verbal cues, such as yawning, crying, smiling, laughing, and wincing, tell Mum when the baby has unmet bodily needs (Meltzoff & Moore, 1977; Field et al., 1982). Babies develop physical awareness and empathy long before they learn to speak.
Did I make you yawn? You just experienced somatic empathy. Read the BBC article.
Facilitating emotional contagion
What is the purpose of empathy? Emotions are designed to be contagious and have evolved to elicit specific behavioural actions. This supports social bonding and prosocial behaviour. A wounded man wailing in pain motivates helping behaviours. A woman screaming signals distress, prompting others to come to her aid. Laughter and joy spread around the dinner table, just as crying and grief rebound through a crematorium. Even yawning is contagious, an ancient signal to the group that it's time to rest.
Sex differences in somatic empathy
Behavioural studies show that females tend to demonstrate higher levels of automatic mimicry (like contagious yawning, smiling, and laughter) than males. For example, females generally show greater susceptibility to emotional contagion and more frequent mimicry of facial expressions (Norscia & Palagi, 2011; Provine, 2005). Neuroimaging studies have found that brain regions involved in somatic empathy, particularly the anterior insula, light up more brightly in females when observing others’ pain or distress (Stevens & Hamann, 2012; Singer et al., 2004).
Studies consistently show that insula activation, both structural and functional, accompanies somatic empathy, particularly in contexts of emotional and pain-related motor mimicry (Allen et al., 2017; Sims et al., 2013). The insula is a small region of the brain responsible for interoception (perceiving internal bodily signals such as hunger), emotional processing, and empathy (Craig, 2009; Gu et al., 2013). The amygdala, the brain’s central threat alarm, triggers it (LeDoux, 2000; Seeley et al., 2007).
Sex hormones
Females have higher levels of estrogen receptor alpha (ERα), especially in the amygdala, which upregulates oestrogen and oxytocin expression (the cuddle hormone). This is theorised to support a tend-and-befriend response to perceived threat and caregiving behaviour (Taylor et al., 2000; Osterlund et al., 1998). Males have much lower levels of ERα, which help to maintain higher levels of testosterone, supporting the fight-or-flight response (Sisk & Zehr, 2005; Goetz et al., 2014).
Sex differences in the ratio of ERα:ERβ may lead to differences in the activation of the insula, somatosensory, and motor cortex - key players in motor mimicry - in response to perceived threats (Derntl et al., 2010; Goldstein et al., 2001). For example, males are more likely to be indifferent to pain or temperature changes, whereas females are more sensitive; ERβ activation reduces pain sensitivity (Goldstein et al., 2001; Osterlund et al., 1998).
Childhood trauma
Curiously, fMRI studies show hypoactivity of the insula in people with narcissistic and antisocial personalities (Decety & Moriguchi, 2007; Blair, 2005). Behavioural contagion is markedly reduced in people with narcissistic and antisocial personality, or psychopathic traits (Rundle et al., 2015; Blair, 2005). All three are diagnosed in three times as many males (American Psychiatric Association [APA], 2013).
Conversely, research shows hyperactivity of the insula amongst individuals with borderline personality, CPTSD (Etkin et al., 2009), and social anxiety disorder (SAD) (Eccles, 2023), which are two to three times more common in females (APA, 2013). Women with these profiles often demonstrate heightened sensitivity to others’ emotional states, increased emotional reactivity, and pronounced rejection sensitivity (Domsalla et al., 2014; Staebler et al., 2011).
These findings suggest that early trauma may rewire the brain in a sexually dimorphic way, particularly in regions associated with emotional regulation and somatic empathy, such as the insula. This may help explain why trauma manifests differently in males and females, especially in terms of empathy, emotional contagion, and interpersonal behaviour.
Neurodevelopmental differences
Somatic empathy might also be related to what has previously been considered a distinct phenomenon described as “echopraxia,” or the involuntary mimicry of another person’s behaviour and actions. Echopraxia is common in Tourette’s (Cavanna & Termine, 2012), schizophrenia (Park & Holzman, 1992), autism (Wing & Shah, 2006), and catatonia. fMRI imaging in Tourette’s show hyperactivity in the motor area, primary motor cortex, and somatosensory cortex (Wang et al., 2014).
Both reduced and heightened levels of somatic empathy have been observed in autistic individuals and people with schizophrenia (Helt et al., 2010; Simões-Franklin et al., 2009). Reduced levels of reciprocal smiling, yawning, and crying contagion have been observed in studies of autistic boys (Senju et al., 2007; Helt et al., 2010). This has not, however, been replicated with autistic girls.
Contrarily, autistic girls and women have been found to engage in higher levels of “social camouflaging” or “masking” (Lai et al., 2017). Masking is defined as the imitation or mimicry of neurotypical people and the suppression of neurodivergent traits to blend in and comply with neurotypical norms (Hull et al., 2017).
Within the animal kingdom, mimicry is employed to prevent social threat where animals impersonate other species to avoid detection (Provine, 2005). Researchers have suggested that masking is a conscious strategy to fit in and avoid discrimination, exclusion, bullying or abuse. I wonder to what extent sex differences - higher levels of social motivation and automatic mimicry amongst autistic females - explain social camouflaging behaviour.
Taken together, this suggests that highly heritable genetic differences and neurodevelopmental conditions might also be involved in the aetiology of somatic empathy.
Somatic empathy
Somatic empathy is the first form of empathy to develop. It is experienced through our bodies and expressed through action, not words. Long before a child learns to talk, they feel with and through others. This deeply embodied, sensory form of empathy lays the neurological foundation for human connection, safety, and a sense of belonging. Yet it remains widely ignored in both science and practice and underdiscussed.
Somatic empathy is formed and reshaped by biological, psychological and social factors, including sex, sex hormones, neurodevelopment, childhood trauma and personality disorder. By shifting our understanding of empathy back to its preverbal, somatic roots, we not only deepen our grasp of human nature but also open new doors for understanding mental health, trauma, and neurodiversity. If we want to build a more empathetic world, we need to start where empathy begins, in the body.
Thanks for reading
If you found this article useful, please consider sharing it with others. I am also about to onboard another group of neurodivergent women for a 3-month group coaching. The last group called it “life-changing.” (blushing). The cost is 450 GBP for six biweekly 90-minute sessions. If you would love to join, please email
About the author
Hello, I am Leanne. I am a late-diagnosed neurodivergent (woman!), Positive Psychology Coach, and the founder of More Human. More Human is on a mission to close the gender gap in ADHD and autism recognition and diagnosis, widen access to good support, and create equal opportunity.
More Human are launching the first ADHD and autism self-screening service for ADHD and autism in adult women, non-binary and AFAB. Over the past several months, I have been working with what is now 267 neurodivergent women to conduct research into their lived experience, co-design, and test a breakthrough service. As a brave survivor diagnosed with CPTSD, I feel privileged to lead this work.
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