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Cited by 73Personality Disorders and PsychopathologyPersonality Traits and PsychologyPsychopathy, Forensic Psychiatry, Sexual Offending

Dysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic Review

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Salgado, Rui M., Pedrosa, Raquel, Bastos-Leite, António J.·2020·Harvard Review of Psychiatry
DOI 10.1097/hrp.0000000000000260PMC PMC7357542
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Abstract

Learning objectives: After participating in this activity, learners should be better able to: • Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes • Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.

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  • BPD is characterized by impulsive, intrusive, and angry enmeshment in, rather than only detachment from, primary relationships in reaction to a combination of a terror of abandonment and a fragmented and unstable sense of self, which is acted out as hostile and impulsive demands in relationships.

    “BPD, by contrast, is characterized by impulsive, intrusive, and angry enmeshment in, rather than only detachment from, primary relationships in reaction to a combination of a terror of abandonment and a fragmented and unstable sense of self, which is acted out as hostile and impulsive demands in relationships [30, 108, 127, 144].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [144]

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  1. [33]American Psychiatric Association Diagnostic and statistical manual of mental disorders. 3rd ed., rev Washington, D.C.: American Psychiatric Press, 1987.

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Authors
Salgado, R. M., Pedrosa, R., & Bastos-Leite, A. J.
Affiliations
Universidade do Porto (PT)
ORCID
Venue
Harvard Review of Psychiatry
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-07
Volume
28
Issue
4
Pages
238-254
ISSN
  • 1067-3229 (ISSN-L)
  • 1465-7309
DOI
10.1097/hrp.0000000000000260
PMC
PMC7357542
OpenAlex
W3041709498
Cited by
67
References
133
Citations by year
2026: 18 · 2025: 14 · 2024: 11 · 2023: 13 · 2022: 6 · 2021: 5
FWCI
0.47
Type
journal article
Language
en
Open access
Licence
Locations
  • Harvard Review of Psychiatry (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
borderline personality disorder, empathy, affective empathy, cognitive empathy, theory of mind, mentalization, social cognition, emotional intelligence, social functioning, interpersonal relationships, personal distress, Interpersonal Reactivity Index
MeSH terms
Adult, Borderline Personality Disorder, Cognition, Emotions, Empathy, Humans, Interpersonal Relations

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