Impairments of Interpersonal Functioning: Empathy and Intimacy in Borderline Personality Disorder

Abstract

Impairments of interpersonal functioning are central to borderline personality disorder (BPD). Patients with BPD suffer from severe psychosocial dysfunction in general and - among others - disturbed romantic relationships. Compounding the problem, the diagnosis of BPD interferes with therapeutic relationships and results in pejorative and discriminatory clinical practices. Previously, interpersonal dysfunction has been related to emotional dysregulation, behavioral dyscontrol, and impaired social cognition. However, these features may be intertwined yet separate. In this review, we will focus on disturbed empathy and intimacy as they are referred to as two discrete impairments of interpersonal functioning in the new DSM-5 Section III. The aim of this review is to contribute to a comprehensive, integral understanding of interpersonal dysfunction in BPD based on the behavioral and neurobiological studies available up to now. Despite some inconsistencies, behavioral studies in BPD patients indicate impaired cognitive and affective empathy particularly in complex and ecologically valid measurements. These findings are reflected even more consistently in functional magnet resonance imaging studies. Low quality of intimate relationships in BPD may at least partially result from lower mentalizing abilities and cognitive empathy, higher personal distress and affective empathy in the social context. Finally, the evaluation of the severity and quality of impairment of interpersonal functioning may enable clinicians and researchers to describe and to understand the mechanisms of interpersonal dysfunction better, and to improve the effectiveness of the treatment of patients with BPD.

Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis

“…Since the importance of facial expression for the recognition of others' emotions has been shown (Künecke et al, 2014;Sel et al, 2015), a lack of automatic facial emotional expressivity in patient groups could be an explanation for shortcomings in social interaction (e.g. Harrison et al, 2014;Jeung and Herpertz, 2014;Lavelle et al, 2014;Tchanturia et al, 2013) The evidence from studies in PTSD summarized in this review does not suggest altered facial expression in response to emotional stimuli in individuals with this diagnosis. It is of note that patients with PTSD nevertheless show problems in the recognition of emotional expressions (Kret and Ploeger, 2015), which suggests that this patient group may have problems in some domains of social emotional interaction, i.e.…”

Towards a second-person neuropsychiatry

“…In contrast to neurodevelopmental disorders, differences in interaction styles and impairments of interpersonal functioning associated with personality disorders present later in life after a period of relatively normal social functioning. Nonetheless, personality disorders are thought to be characterized by alterations of developmental trajectories during which relevant experiences (or a lack thereof) made in social interactions may bring about maladaptive patterns of thought and behaviour, which can constrain and increasingly limit flexibility in social interactions later in life [52]. This, in turn, negatively affects experiences of social interaction in individuals with personality disorders and can even lead to derailments thereof.…”

“…This development appears essential as patients often show normal performance in non-interactive social cognitive tasks (cf. [4,27,52]). Therefore, the use of more complex and ecologically valid paradigms is likely to help tap into those processes that underlie social dysfunction in everyday-life social interactions.…”

Mentalization in adults with attention deficit hyperactivity disorder: Comparison with controls and patients with borderline personality disorder

“…Developmentally, ADHD represents a potential risk marker for the emergence of BPD in adulthood (Faraone et al, 2003;Matthies and Philipsen, 2014). Furthermore, the development of social cognitive processes, subsumed under the term of mentalizing, appears to be altered in both disorders, which seems to critically contribute to emotional dysregulation and dysfunctions in interpersonal relationships Fonagy, 2004, 2016;Jeung and Herpertz, 2014;Uekermann et al, 2010).…”