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.Clinical anecdotes and recent empirical evidence have suggested that individuals with borderline personality disorder (BPD) may demonstrate enhanced empathy in spite of impaired interpersonal functioning, a paradox referred to as "borderline empathy" (Franzen et al., 2011;Krohn, 1974). Drawing from therapeutic interactions with borderline patients, the psychoanalyst Alan Krohn (1974) first identified the paradoxical nature of the diagnosis, describing how some individuals with BPD appear to possess an uncanny sensitivity to other people's subconscious mental content and This article was accepted under the editorship of Paul S. Links.From Simon Fraser University.Address correspondence to Bernard J. Crespi, Professor of Evolutionary Biology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; E-mail: crespi@sfu.caWe are grateful to Felix Breden, Alex Chapman, three anonymous reviewers, and members of the Simon Fraser University Fab-Lab and the University of California-Santa Barbara Center for Evolutionary Psychology for helpful comments and discussion, and we thank NSERC for financial support.

Oxytocin, testosterone, and human social cognition

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A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder

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A Further Look at Reading the Mind in the Eyes-Child Version: Association With Fluid Intelligence, Receptive Language, and Intergenerational Transmission in Typically Developing School-Aged Children

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