Borderline personality disorder is an innate empathy anomaly: a scoping and narrative review

Abstract

Background Studying empathy in borderline personality disorder (BPD) is essential because difficulties with interpersonal functioning are integral. Objectives This scoping and narrative review explores the aetiological theory that BPD is an innate anomaly of cognitive empathy, with a normal or heightened emotional empathy. Eligibility criteria and sources of evidence Ovid MEDLINE(R) ALL was searched using the terms empathy; theory of mind; mentalisation or mentalising; borderline empathy; emotion recognition and BPD. For inclusion in the scoping review, articles needed to empirically assess an empathic skill in people with BPD, or self-reported empathy in a BPD group compared to controls, or empathic skill as a ‘borderline feature’ in a nonclinical sample. Charting method The results of empirical studies were categorised as per their methodological approach, with results in the BPD group reported as comparable, enhanced or reduced compared to controls. Results 320 articles were returned, with 38 eligible. The majority affirmed that people with BPD have an anomalous empathetic ability, especially a deficient cognitive empathy. Furthermore, this is trait, evident early in development, correlates with syndrome severity, and is mediated by atypical neural networks. Conclusions This substantiates the theory that BPD is, at least in major part, an innate empathy anomaly.