I was diagnosed with Borderline Personality Disorder after years of struggling with various mental illnesses. It was initially a huge relief, a weight off my chest. The validation that I didn’t imagine all of this, that there really was something wrong with me. The comfort in knowing that I was far from alone, almost 1.6% of the population is believed to have BPD. These weird thoughts and feelings, the behaviour I exhibit and never understand, was a symptom of more, and a symptom that many others were feeling. My diagnosis coincided with Rebecca Bunch’s on Crazy Ex-Girlfriend, an incredible twist of fate that fooled me into thinking the disorder could be correctly recognised and discussed.

But just like Rebecca in the episode “Josh is irrelevant”, I decided to google my new diagnosis. And I quickly discovered that:

1. People don’t understand BPD.

2. People hate BPD.

I could dedicate an entire article to why people hate BPD, all the things they say about us, the way even trained psychologists refuse to treat Borderline patients. Maybe one day, I will, when I feel the strength to immerse myself in their cruel assumptions again. But for today, I’ll merely pick up one slice of those assumptions. Because time and time again, I see this question on the internet. I don’t think it is even intended as an insult, but an honest question.

Do people with BPD feel empathy?

Something has led people to doubt whether BPD individuals feel empathy. And it’s okay to ask if you’re genuinely unsure, as at least you’re looking for the answer, you’re not phrasing it as a statement to further tear us down. So let’s find out the answer to this question.

What is empathy?

Let’s first get our basics out of the way; what is empathy? Broadly speaking, empathy is the way we react to one another and explains how we conduct ourselves with the world around us (Davis, 1983). Empathy is considered to be the capacity to feel or understand what someone else is experiencing. This is based on their frame of reference, also known as putting yourself in someone else’s shoes.

So if my friend is struggling, I can imagine their pain, feel distressed with them and wish to help them. All of this is part of empathy but is referring to the three different types of empathy, as defined by Daniel Goleman.

1. Cognitive Empathy. This is knowing how they feel and what they might be thinking. It focuses on the recognition of emotion and finding that within your own bank of experiences. It is also known as perspective-taking. So this would be that my friend was just dumped by their girlfriend, I can recognise they are hurting, and I understand that this is a difficult time for them. Maybe I’ve been dumped before and draw upon on that, or I can simply use other experiences of pain and rationality to determine.

2. Emotional Empathy. This is almost the next phase to empathy when you feel their pain. It’s a physical sensation as if their emotions are contagious. My friend is dumped and is sad, and subsequently, I feel sad. I watch a video of an abandoned puppy, I cry and my mood drops.

3. Compassionate Empathy. So I have recognised their pain, I have felt their pain, and now I wish to solve it. I not only feel the person’s predicament, but I am moved to assist them where I can. In our break up scenario, this would probably take the form of arriving at their door with a tub of Ben&Jerrys and telling them they’re better off without that loser!

It could be said that some individuals are more proficient in certain types of empathy, but generally speaking, we consider empathy to be the collection of the three aspects. Cognitive and emotional empathy together aim to create compassionate empathy within an individual. You could look at it as evolutionary, in that it brings us to help others, and survive as a group. John Donne said it best with “No man is an island”.

Why do people think BPD individuals don’t feel empathy?

Now that we know empathy let’s try to set the scene and use our own empathy to understand why individuals could believe this before we investigate whether it is true. I’ll be using general symptoms and traits of Borderline Personality Disorder for this, so there can be individual differences.

Individuals with BPD are subject to black and white thinking; they are all or nothing. This applies to interests as well as people. They love someone, and within minutes they hate them. This could seem like a lack of empathy, given that they are not trying to understand the other persons situation or reasons for doing so. They are not giving empathy to the moment and instead they make a rash judgement.

They are controlled by their emotions. They don’t take a step back to reflect on the moment. For example, their partner isn’t messaging them while at a party. A non-BPD individual could think that they’re just enjoying themselves and busy, or that their phone ran out of battery. But someone with BPD could jump to conclusions, e.g. They don’t love me anymore! They’re with someone else! They’re feeling guilty for just cheating and avoiding me! If they loved me, they would make more effort to make me feel safe! This was me, time and time again, jumping to conclusions and starting fires from the smallest of timbers.

They don’t consider alternative viewpoints. They feel this way, and so that is the truth. They message their partner when they’re out drinking because they love them and miss them. So if their partner doesn’t do the same, then it means they don’t feel the same way.

Individuals with BPD can do spontaneous things, especially actions that are self-sabotaging. They can use sex to imitate a connection or convince themselves of their worth. They could try to hurt their partner, and ultimately themselves, through being unfaithful or doing things they know that they shouldn’t. Addiction is entangled in BPD. They could say cruel things to push you, to see if you’ll stay, trapped in their fear of abandonment. If you’re the person being hurt by their actions, time and time again, it makes sense why you would even question if they feel empathy. Do they not realise how much they hurt you, or are they choosing to do this anyway?

So do people with BPD feel any empathy?

The million-dollar question - if only!

Yes

In 1992, the World Health Organisation labelled Borderline Personality Disorder as an individual being “hyper-empathic”.  Park et al. found that BPD individuals have certain heightened abilities, and one of these is empathy. In the reasoning for their study, they said the following:

Almost all clinicians who have significant experience with borderline patients are impressed at times with their exceptional ability to sense the psychological characteristics of significant others in their lives, including therapists. (Park et al., 1992)

Individuals with BPD both fear abandonment and have a low sense of self-worth. They will do everything possible to keep you in their life and make up for their lack of worth. They are constantly reading into your smallest behaviours or words. They are over-using their empathy, to make sure that you like them, that you’re not angry at them, that you’re not leaving them.

Individuals with BPD actually seem to have an uncanny sensitivity to other people’s subconscious mental content. This includes feelings, thoughts and even physical sensations. This allows them to involve and influence others successfully. Frank and Hoffman (1986) found that BPD individuals displayed a heightened sensitivity to nonverbal cues compared to the non-BPD sample. Fertuck et al. (2012) asked individuals with and without BPD to react to photographs of people’s eyes. They found that individuals with BPD were able to correctly guess the emotions expressed in the eyes more often than others, which displays their enhanced sensitivity to another’s mental state.

This suggests that people with BPD don’t have issues with empathy, or at least with the first two aspects of empathy (cognitive and emotional). They can recognise other people’s feelings and feel the same way, but this might not translate into behaviour. Why? The extreme emotions felt by someone with BPD can be overwhelming, which is why they do self-sabotaging behaviours. You feel so much sadness and guilt for upsetting someone that you self-harm, which only goes to upset that person further when they find out. Or you drink excessively to try and numb the shame, which leads them to have to help and care for you, worsening the moment. The issue is in the actions carried out, not the emotions leading up to them, which is Schema Therapy is so successful with BPD individuals.

No

Individuals with BPD often struggle to maintain interpersonal relationships. An fMRI study done by the University of Georgia found that people with BPD traits had reduced activity in the specific brain regions that support empathy. This would suggest that people with BPD have difficulty understanding and/or predicting how other people feel. An interesting aspect of this study is also that they didn’t investigate BPD as binary, that someone either has it or doesn’t. Instead, they conceptualised and measured it in a continuum of no traits to very many. So they found a link between high BPD traits and reduced neural activity in the temporoparietal junction and superior temporal sulcus. The lead researcher, Haas, said that the next step would be to test this in real-life settings, as opposed to a lab environment, such as a BPD individual reading their partner’s emotions.

Many studies suggested that people with BPD feel greater empathy. But such studies are now being questioned, as their main method was to have a BPD and a non-BPD person rate their own personality, speak to the other and then rate their personality. The individuals with BPD were better are determining how the other person saw themselves. So they had a higher level of empathy? Maybe not, given that researchers now believe this is due to individuals with BPD having a more complex identity and sense of self, and thus being harder to read than the non-BPD counterpart. An interesting way forward could be to have BPD individuals rate each other, and the same for non-BPD, and see what trends emerge.

What disorders cause a lack of empathy?

We can’t know if individuals with BPD feel less empathy, but we do know that they do feel empathy somewhat. It is not a disorder characterised by a complete lack of empathy. So what are some disorders that lack empathy, for a frame of reference?

1. Psychopathy. An infamous disorder, to say the least. It is characterised by persistent antisocial behaviour, impaired empathy and remorse, as well as egotistical traits. Psychopaths are skilled at manipulation, so they know how someone expects them to act, but are able to feel no empathy. It is one of the most difficult disorders to spot and can be a dangerous one.

2. Antisocial Personality Disorder. People with APD are also known as sociopaths. This disorder fixates on a lack of regard for other people’s feelings or a violation of their rights. They struggle to consider consequences, feel no guilt or remorse and don’t respect social norms or laws.

People have theorised about other disorders being linked to a lack of empathy, such as Bipolar or BPD, but this has not been proven and is not included in the latest DSM.

People with BPD often say that they feel so much. I feel great sadness from the smallest of things, a sadness that will weigh me down and make me question everything I have ever said or done. As children, individuals who will go on to develop BPD had to increase their own empathic functioning to protect themselves, from confusing or neglectful parenting. They trained themselves to be highly attuned to the subconscious cues of their parent, to be prepared for anything. It was a survival mechanism that had gone on to do more harm than good when they left that negative environment.

Many people who ask if someone with BPD feels empathy do so because they doubt it. How could someone feel empathy and hurt you so much? How could someone feel empathy and do these horrible things? The answer is, I don’t know, and I don’t know whether they feel more or less empathy. But I do know that their larger focus on themselves isn’t because of less empathy. And that many of their self-destructing behaviours are not the result of lowered empathy, but rather heightened emotions. Having reduced empathy wouldn’t mean that they feel less or even nothing. They feel more; they feel so much all the time.

So try to support people struggling with BPD, however that may be. For some, it's small notes or messages. For others, it's being a presence in their day and life. And for others, it could be through expressing your feelings through loving gifts. You can engrave a customised lapel pin and give it to them, to literally wear your feelings on their heart!

Do you have any other questions regarding BPD? If so, please leave them in the comments, so that I can know what to address in future articles. The mystery around BPD is ripe for misunderstandings, and so I am happy to take the time to address them one by one and help to bring BPD into the conversation.