The Borderline Empathy Paradox: Evidence and Conceptual Models for Empathic Enhancements in Borderline Personality Disorder

Abstract

Empirical evidence and therapeutic interactions have suggested that individuals with borderline personality disorder (BPD) may demonstrate enhancements in aspects of social-emotional cognition. To assess the empirical evidence for this phenomenon, and to comprehensively evaluate alternative hypotheses for its possible role in BPD etiology and symptoms, the authors systematically searched the literature for investigations of empathy in BPD and reviewed 28 studies assessing a range of empathic abilities. Considered together, these data demonstrated comparable levels of evidence for enhanced, preserved, and reduced empathic skills in individuals with BPD. Evidence for empathic enhancements is thus substantial but inconsistent across studies, being found mainly under more socially interactive experimental paradigms. Based on the results of the review and previous explanations for BPD symptoms, the authors propose a new model for explaining the borderline paradox: that a combination of increased attention to social stimuli and dysfunctional social information processing may account in part for the specific empathic enhancements and reduced overall social functioning in BPD.

Aberrant link between empathy and social attribution style in borderline personality disorder

“…Although this conflicting pattern has been explained by referring to the different domains of empathy that show reduced cognitive empathy in BPD patients with unchanged or even heightened affective empathy (reviewed in Dinsdale and Crespi, 2013), here we found that even the affective domain of empathy may be reduced, possibly reflecting a compensatory response in order to protect from emotional contagion through the emotions of others that has been found in BPD (Dinsdale and Crespi, 2013).…”

“…Previous findings regarding empathy in BPD have been conflicting: some studies showed that patients exhibit less empathy compared to controls (Minzenberg et al, 2006;Preißler et al, 2010;Fertuck et al, 2009), while others found evidence for heightened empathy (Franzen et al, 2011;Dinsdale and Crespi, 2013) in patients. Although this conflicting pattern has been explained by referring to the different domains of empathy that show reduced cognitive empathy in BPD patients with unchanged or even heightened affective empathy (reviewed in Dinsdale and Crespi, 2013), here we found that even the affective domain of empathy may be reduced, possibly reflecting a compensatory response in order to protect from emotional contagion through the emotions of others that has been found in BPD (Dinsdale and Crespi, 2013).…”

The Independent Contributions of Emotion Dysregulation and Hypermentalization to the “Double Dissociation” of Affective and Cognitive Empathy in Female Adolescent Inpatients With BPD

“…This may be due, in part, to inconsistent definitions and measurement of empathy. Indeed, several studies purport to examine empathy (see Dinsdale and Crespi, 2013, for a review) but instead examine empathy-related components or skills (e.g., mentalization or theory of mind, emotion recognition and discrimination). For instance, recent research shows that patients with BPD amplify subjective perceptions of negative affect in others' faces (Daros, Uliaszek, & Ruocco, 2014;Mitchell, Dickens, & Picchioni, 2014), suggesting a propensity toward hyperactive affective empathy in this population.…”

Mentalization, embodiment, and narrative: Critical comments on the social ontology of mentalization theory

“…Taken together, they give an impression of Krohn originally termed "the borderline empathy paradox" (Krohn, 1974), referring to clinical anecdotes of the apparent paradox of enhanced empathy in people diagnosed with BPD in spite of impaired interpersonal functioning (Dinsdale & Crespi, 2013).…”