Background <p>Empathy, encompassing cognitive mentalizing and affective sharing, is pivotal for navigating social interaction during adolescence. However, the characteristics and its electrophysiological mechanisms of different empathic dimensions impairments in adolescents with MDD remains unclear.</p> Methods <p>The study enrolled 26 adolescents with MDD (age:15.15 ± 1.62) and 19 healthy controls (age:15.25 ± 1.89) to investigated the neurophysiological underpinnings of empathy impairments by analyzing event-related potentials (ERPs) and event-related spectral perturbations during a pain empathy task. A conventional pain empathy task and the Chinese version of Interpersonal Reactivity Index (IRI-C) were used to measure cognitive and affective components of empathy.</p> Results <p>Adolescents with MDD demonstrated increased Perspective-Taking (PT) scores, decreased Personal Distress (PD) scores and accuracy in judging painful stimuli compared to healthy controls (HCs). Electrophysiological findings revealed reduced P3 amplitudes and theta-band oscillation among adolescents with MDD, particularly in the pain task. Correlation analyses showed that P3 amplitude was negatively associated with PT score, while theta-band oscillation inversely correlated with Empathic Concern (EC) score within adolescents with MDD. </p> Conclusions <p>These findings suggest that adolescents with MDD exhibit pain empathy impairments, specifically manifested as impaired emotional sharing and aberrant cognitive evaluation. The observed behavioral and electrophysiological alterations may indicate that excessive concern for others may hinder emotional resonance, while high PT demands might deplete cognitive resources, leading to diminished late cognitive evaluation. Future clinical interventions probably can target the modulation of PT and the alleviation of excessive empathic distress to restore social-cognitive functioning in this population.</p> Clinical trial number <p>Not applicable.</p>