Borderline personality disorder (BPD) is a complex mental health condition characterized by difficulties with emotional regulation, impulsivity, and unstable relationships.
A key feature of BPD is impaired empathy, which contributes to the interpersonal dysfunction seen in these patients.
A new review analyzes 45 studies on empathy and related constructs like theory of mind in BPD, finding consistent deficits that help explain their social difficulties.
Key Facts:
- 80% of studies showed impaired empathy and related skills like mentalizing in BPD patients
- No studies found enhanced cognitive empathy or emotional intelligence in BPD
- 8 studies showed increased emotional empathy, specifically personal distress
- Neuroimaging studies show abnormal brain activation patterns linked to empathy
- More research needed with consistent methods to clarify empathy deficits in BPD
Source: Harv Rev Psychiatry
What is Empathy and How is it Measured?
Empathy is a complex, multidimensional construct that includes both cognitive and emotional components.
Cognitive empathy refers to understanding others’ mental states, while emotional empathy involves vicariously experiencing others’ emotions.
Related concepts include theory of mind (inferring others’ mental states), mentalizing (understanding mental states), social cognition (processing social information), and emotional intelligence (managing emotions).
These constructs are typically measured using self-report questionnaires like the Interpersonal Reactivity Index, performance-based tests like the Reading the Mind in the Eyes test, or neuroimaging methods like fMRI.
Each approach has limitations, and results can vary based on the specific assessment used.
The Landscape of Empathy Research in BPD
The review, published in Harvard Review of Psychiatry, included 45 studies on empathy and related skills in adults with BPD compared to healthy controls.
The vast majority (36 studies, 80%) found significant deficits in BPD patients on at least one measure.
Cognitive Empathy and Related Deficits
Many studies using tests like the IRI perspective taking subscale and MET cognitive empathy subscale showed reduced cognitive empathy in BPD.
Theory of mind skills were also impaired, with tests like the Faux Pas task revealing deficits.
Likewise, studies consistently demonstrated reduced mentalizing abilities, social cognition, and emotional intelligence in BPD patients.
Increased Emotional Empathy and Personal Distress
While cognitive empathy deficits were clear, findings for emotional empathy were more complex.
Most studies showed no difference in emotional empathy between BPD patients and controls.
However, 8 studies found increased scores on the IRI personal distress subscale, indicating elevated personal distress in response to others’ suffering.
Neuroimaging Findings
Though limited, neuroimaging studies supported behavioral results.
fMRI showed abnormal activation in brain regions linked to empathy and mentalizing in BPD patients during empathy tasks.
This offers clues about the neural underpinnings of their empathy deficits.
The Role of Comorbidities
Some studies indicated comorbid PTSD may exacerbate social cognition problems in BPD.
However, most found no major impact of other comorbid diagnoses like depression on empathy impairments.
This suggests empathy dysfunction is inherent to BPD itself.
Deficits in Cognitive Empathy & Emotional Intelligence in BPD
The review highlights some consistent themes:
- Cognitive empathy, theory of mind, mentalizing, and emotional intelligence are broadly impaired in BPD
- Emotional empathy is often intact, though personal distress is frequently elevated
- These deficits likely contribute to the interpersonal problems characteristic of BPD
However, methodological limitations temper conclusions.
Approaches differed greatly between studies, and some tests may be inaccurate measures of empathy-related constructs.
Small sample sizes and comorbidities also complicate interpretation.
Future Research: Empathy & BPD
More research is needed to clarify the nature of empathy deficits in BPD.
Studies should use consistent, ecologically valid tests and control for factors like trauma history.
Neuroimaging can help unravel neural underpinnings of empathy dysfunction.
Cutoffs demarcating impaired empathy in BPD are also lacking.
Establishing norms would aid assessment and diagnosis.
Finally, novel methods like hyperscanning, which scans two brains simultaneously during social interaction, could provide insights into BPD patients’ empathy impairments during real-world social functioning.
BPD & Social Difficulties
In summary, substantial evidence demonstrates impaired empathy and related processes like theory of mind in BPD.
This offers insight into a core interpersonal difficulty for these patients.
However, open questions remain.
As research continues to elucidate empathy deficiencies in BPD, findings can inform treatment approaches aiming to improve social functioning for these individuals.
References
- Study: Dysfunction of empathy and related processes in borderline personality disorder: a systematic review
- Authors: Rui M. Salgado et al. (2020)
