How the Brain Sees Empathy in Borderline Personality Disorder – Part 1

This is your brain on empathy. In this scientific journal researchers utilized fMRI technology to map and monitor empathic responses in the brain of those with Borderline Personality Disorder.  The conclusions are illuminating. I’ll attempt to relay the information in a more reader friendly way for you, but the original article can be found by clicking on the article title below. I’m breaking this into two parts.
By: Isabel Dziobek, Sandra PriBler, Zarko Crozdanovic, Isabella Heuser, Hauke R. Heekeren, and Stefan Roepke.
The article begins with a brief but legitimate description of Borderline Personality Disorder. It is a severe psychiatric condition involving profound emotion regulation deficits and interpersonal impairment. People with BPD often have other comorbid psychiatric disorders, such as PTSD. This is often associated with childhood traumatic experiences involving neglect and sexual abuse. BPD is generally regarded as a disorder of emotion regulation, though emotional regulation impairments are found in a variety of other disorders as well, such as anxiety, PTSD, depression or bipolar disorders. In diagnosing BPD, it’s been argued that the unstable relationship style would be one of the best indicators. But what causes this instability?
This article argues that impaired empathy may be the cause for dysfunctional interpersonal style in BPD.
Again, we have a two part definition of empathy. First is the cognitive component, which allows a person to infer the mental states of others. It’s also known as mentalizing, Theory of Mind or social cognition. The second aspect of empathy is the affective component which inspires an appropriate emotional reaction to another person.
Something that needs to be distinguished is that the appropriate response of emotional empathy is different from emotional contagion or personal distress.  Emotional contagion and personal distress are self-oriented responses as opposed to other-oriented responses and are seen as less mature emotional reactions. What this means is that when someone with BPD sees a scenario their response is personal and often influenced by a perceived threat to themselves as well as the others involved creating a reaction based on their own personal distress, as opposed to having an emotional response based solely on relating to the distress of how the Other person is  experiencing the situation. That’s the theory anyways.
This study attempts to quantify cognitive and emotional empathy in BPD patients with a healthy control group of individuals. This is achieved by utilizing the Multifaceted Empathy Test (MET – which I couldn’t find on-line), and a study of brain functioning through the use of brain scans taken by an fMRI machine.  
The MET consists of photographs showing people in emotionally charged situations and is intended to produce strong emotional reactions.  Cognitive empathy is assess when subjects infer the mental states of the individuals show in the pictures. To rate emotional empathy, subjects rate their level of empathic concern for the individuals portrayed. This test was performed on its own, and then again in conjunction with the fMRI machine to get an accurate interpretation of how the brain actually responds to stimuli. Questions like “What is the person feeling” (cognitive empathy; “How much are you feeling for the person?” (emotional empathy); and “How old is the person/Is this person female or male?” (higher-level baseline conditions), were asked.
In the behavioral study patients with BPD showed trends toward lower scores than controls on the emotional scales. On the more objective MET patients with BPD showed significant impairments in both facets of empathy compared to healthy controls. 
fMRI main effects
Cognitive Empathy: Contrasting cognitive empathy with a higher-level baseline, revealed activations in areas that typically respond to social cognition for both groups. (Brain areas such as the superior temporal sulcus and gyrus (STS/STG) extending into the temporal parietal junction bilaterally, the orbito-frontal cortex, temporal pole, and paracinulate gyrus).
Emotional Empathy: The comparison of emotional empathy and higher-level baseline revealed similar activations for the BPD and control groups.
Group Differences
Cognitive empathy: Contrasting brain activity in cognitive empathy between patients with BPD and the healthy control group found greater changes in the left STS/STG from the control group.
Associations with level of intrustions: Correlation analysis revealed contrasting activity between the BPD and the control group during cognitive empathy. Levels of intrusions were measure din the BPD group.
Emotional empathy: There was a greater increase in the BOLD signal in the right insular cortex and the right STS in the patient group. This seems to be specific to emotional empathy. Emotional empathy responses in the right insular cortex were negatively correlated with mean arousal measured by duration of skin conductance reaction during emotional empathy in the BPD group.
Associations with skin conductance response. Changes in the BOLD signal were found in the right insular cortex ROI of contrasting activity between the BPD and control groups during emotional empathy which correlated to levels of arousal.
This is the first study reporting cognitive and emotional empathy functions and their neuronal correlates in individuals with BPD. In both cognitive and emotional empathy patients with BPD were found to have impairments. Individuals with BPD seem to have less activation than controls in the STS/STG region during cognitive empathy. Greater changes in the BOLD signal in the middle unsula region in the patients during emotional empathy were found, where this activation reflected levels of arousal.
So what does this mean? 
(I’ll have the conluding results for you tomorrow in Part 2)

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