So what does this mean?
The cognitive empathic results (discussed yesterday in Part 1) actually seem to be at odds with previous research done on emotion recognition abilities in those with BPD. In other tests it’s been shown that emotional recognition is not impaired and often heightened in individuals with BPD. However in this study it seems that the combination of integrated facial stimuli with intonation (sound/voice) stimuli resulted in emotion recognition deficits in BPD. It was also suggested that individuals with BPD tend to misread others’ minds when in intense interpersonal encounters, often when emotionally aroused.
This doesn’t surprise me. When I’m in an emotionally neutral state it’s pretty easy to gauge how other people feel. But when I’m emotionally turbulent it’s often difficult for me to accurately gauge how someone else is feelings for a variety of reasons.
The study hypothesizes that this may provide evidence for both (a) the suggestion that the misinterpretation of the mental states of others leads to extreme and dysfunctional emotional responses in social interactions, and (b) that emotional arousal causes impairments in interpreting others’ mental states.
Here’s where I think it gets even more interesting. The STS part of the brain is known for its role in social cognition and is an important part of the brain network that mediates thinking about others. During cognitive empathy there’s a cluster in the STS/STG region the is more activated in the healthy control group than in the BPD group. This article actually provides hypothesis as to why though. BPD research of attachments suggests that maltreatment in childhood leads to the inhibiton of mentalizing abilities in affected individuals., which might reflect this decrease in activity in the STS. Childhood maltreatment by a caregiver such as emotional neglect or sexual abuse is in fact on the most important psychosocial risk and prognostic factors for BPD symptoms. This could also account for the high comorbid rate of PTSD with BPD. Childhood maltreatment likely has effects on the developing brain. Interestingly, the STS region matures late in development, which means it is particularly vulnerable to ongoing early psychosocial stressors. That difficulty inferring the mental states of others may be the behavior consequences of those changes in the brain. Recent findings that show impaired emotional recognition in people with BPD and comorbid PTSD further indicate how relevant intrusive memories are for empathic functions.
Lets talk more about the brain. Brain activiation during emotional empathy did not differe in the anterior insula for either group. However there was a cluster in the right mid-insula that was more activated in those with BPD. The mid-insula has been shown to react streongly to bodily states of arousal. This study those that there are associations between activation of the right mid-insula and skin conductance responses in those with BPD which supports the idea that there is increased arousal during emotional empathy. However, you’ll remember that increased arousal in those with BPD often interferes with the ability to accurately judge another’s emotional response. Emotional empathy requires an other-oriented appropriate emotional response. This can be interpreted as the ability to regular emotions in interpersonal situations. However those with BPD have an inability to regulate their emotions which could be a direct effect of the increased arousal and personal distress function. Even in healthy subjects the tendency to experience personal distress in response to the suffering of others has been associated with the mid-insular activation. This is important to note because it means this is a consistent measurement across both BPD and healthy individuals. It just seems that in those with BPD this region of the brain is more easily activated, more often. Since personal distress is reported with higher frequency in those with BPD and was also found in the currenty study it could indicate that the results represent the reason for reduced behavioral empathic concern in BPD. There seems to be a direct relationship between personal distress and empathy. Low levels of arousal and personal distress are considered to be important for more mature empathic concern, however they seem to be detrimental and indicative of reduced emotion regulation when they are at very high levels, like those displayed in people with BPD.
It was also found that the right anterior STS/STG region was more activated in the BPD group when engaging emotional empathy. The posterior of the STS is a prime area for mentalizing, and the right STS has been shown to be sensitive to perceived congruency (truth) between a person’s actions and their emotional expression. In those with BPD there is increased activation in the right STS/STG during emotional empathy which could indicate that patients with BPD mistrust the truthfulness of other’s emotional reactions. This is supported by separate research that indicates reduced trust in those affected with BPD and further supports the idea that those with BPD have problems interpreting others’ emotions when emotionally aroused.
This study concludes that deficits in cognitive and emotional empathy are central to BPD. It also indicates that the misinterpretation of the mental states of other people might provide an explanation for dysfunctional emotional responses in interpersonal situations for someone with BPD. BPC can be conceptualized as involving deficits in both inferring mental states and being emotionally attuned to another person.
So there you have it. One highly scientific hypothesis on the effects of brain function in regards to empathy and BPD. Something that I think is important to note: the entire study indicates an impaired function of empathy, not a lack of empathy. People with Borderline Personality Disorder do have and experience empathy. It determined that some empathic responses comes from a different motivational perspective than normally functioning individuals though. This is especially true if the person with BPD is experiencing a heightened emotional reaction already.
Ok. So what does that mean? We do have empathy, but in some regards it is different. I know many, many people with BPD that will disagree with these results. I do agree with what they are presenting. However, I don’t think that it means the empathic response those with BPD do have is any less valuable than those with a more nuerotypical brain. I understand the idea that our empathic responses are often self-directed as opposed to other-directed. I don’t believe this is always true. I’m sure of it in fact. Though, I know when I am very emotionally turbulent, it is definitely harder for me to relate and to care about what others are going through. It’s more difficult for me to recognize that others are going through something at all. And when I do recognize it, the feeling I have is influenced by any threat I perceive to myself, how the situation will affect me. It actually took me a very long time to realize I did this. I don’t consciously think about that reaction. It’s just a feeling of doom and anxiety that threatens my stability depending on the situation and I react based on that feeling. That’s me though. Not necessarily everyone.
What do you think?
Like I said, I’m also positive that our empathic response is not always self-directed. Tomorrow I’ll post a video that I watched recently that absolutely infuriated me. The situation has no bearing on me or my life, but well, you’ll just have to wait and see! Stay tuned.