A few days ago, I came across this question in an online support group for people who care about someone with borderline personality disorder:
"Do people with BPD feel empathy? It is hard for me to think that someone couldn't feel empathy. Maybe it is just wishful thinking. But I think they can feel it a little. Like most of the time they are so self absorbed you wouldn't know....but a little piece is there... somewhere."
Two of the responses were:
"Definitely NO. It's all about them, all the time. It's always "all about me" with BPD, and that includes the kids. I struggle to comprehend how they can live their lives in this manner."
"In my experience as a therapist BPDs do indeed lack empathy. They can manufacture, however, a faux empathy when it is aligned with their needs to secure an object. But it is a strategy to manage a situation."
Many people--even professionals, as you can see, are confident that people with BPD are unable to put themselves in someone else's shoes. Even the American Psychiatric Association's new description of borderline personality disorder on the DSM-5 website says that people with BPD are "severely lacking in empathy."
So are they right? Can folks with BPD or BPD traits (BPs) have empathy toward others? Yes! Some people with the disorder feel shame and remorse when they hurt someone they love.
In my book The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Working on Eggshells, clinical psychologist Debra Resnick, Ph.D., say that when they calm down, many of her patients know they've lost control and feel very badly about it.
In my Welcome to Oz family online family support group, recovered BPs (like Rachel Reiland, (author of Get Me Out of Here: My Recovery from Borderline Personality Disorder) join to help hurting members make sense of their experience by explaining the splitting, fears, and unstable emotions behind unreasonable behavior toward others.
The problem, however, is that the empathy isn't always available or felt by others.
But before we go on, let's take a look at what "empathy" really means.
Main Entry: em•pa•thy
Etymology: Greek empatheia, literally, passion, from empathēs emotional, from em- + pathos feelings, emotion
The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another without having the feelings, thoughts, and experience fully communicated in an explicit manner.
Empathy is different from sympathy. Sympathy just requires compassion. To have empathy you have to be able to put yourself in someone else's shoes. To do that, we use something called "emotional intellegence," or EI. That's a measure of the following:
1. Knowing one's emotions
2. Recognizing emotions in others
3. Managing emotions
4. Motivating oneself
5. Handling relationships
People with BPD, compaired to most of those without the disorder, have low EI--although they may be very smart intellectually.
BPs not only have trouble comprehending other people's emotions, they have trouble understanding their own, which shift rapidly. They're so overcome with their own feelings they can't access yours. The empathy is there, just not accessible, especially in conditions that provoke triggers.
Here is my response to the thread:
From my experiences having a borderline family member and knowing many people with BPD, I don't believe they lack empathy (although the majority of family members think that they do). Narcissists lack empathy***. To lack it entirely is, in some ways, be lacking a major part of what it is to be human, which is why with NPD it is so striking. (A study discussed in the 1995 book Emotional Intelligence by Daniel Goleman suggests that even primates have empathy.
I think that people with BPD seem to lack empathy because in some developmental ways they are like children. Children are so oriented to themselves and their own needs that they need to mature before they really express it. But I think the seed is there--just observe the way children act when an animal is hurt.
Keep in mind that we know that in some developmental ways, people with BPD use child-like primitive defenses like splitting. I think that's what happens with empathy. Fear of abandonment is core, as is emptiness and emotional intensity. That means that in a relationship, the other person's needs are swept under the rug--especially if those needs conflict with theirs (such as the non-BPs needs for separateness).
In other words, the appearance of empathy WITHIN A RELATIONSHIP is limited. However, I bet if you conducted an experiment to measure empathy in some way independent of a relationship, I believe the results for people with BPD would be similar to those of non-disordered people.
Kiera Van Gelder, author of the forthcoming book The Buddha & the Borderline: My Recovery from Borderline Personality Disorder Through Dialectical Behavior Therapy, Buddhism, and Online Dating (which I read and loved) gave me her response.
Asking "does a person with BPD have empathy" is another form of wondering, "Why doesn't the person with this mental illness seem incapable recognize my feelings?"
When I am "emotion mind," I can't be responsive to people in appropriate ways. But there is a double standard here. People with other mental illnesses aren't seen as lacking empathy, but having certain developmental deficits.
Take Asperger syndrome, for example. People with that disorder appear not to understand, empathize with or be sensitive to others' feelings. But we don't ascribe this to lacking a conscious. Instead, we say they have genetically-related structural abnormalities in several regions of the brain--the exact same thing we could say about BPD!
When there seems to lack empathy, it's not a deficit so much as a complication of being too overloaded with the perceived feelings of others and the pain within oneself, and defending against all of that or being consumed.
So why do we have a different set of expectations for those with BPD? Two reasons:
1) We don't see BPD as an illness.
2) The lack of empathy appears willful because those of us with the disorder can appear so functional and in control on the outside for limited amounts of time (apparent competency).
I think it would be helpful if all those who suffer in relationships with BPD could reframe their definition of empathy in light of the other person being seriously impaired-- not "incapable." As Randi said, this often happens in the context of a relationship. And relationships are the equivalent of standing in a burning building for us.
A more practical question might be "Since the person in my life cannot treat me in a way that is acceptable, how can I manage the situation so that I get my needs met?" Demanding empathy doesn't work.)
If getting a person with BPD into therapy is an option, a new treatment called "Mentalization" is an excellent one because it teaches people with BPD to understand the workings of their own minds and to tease out what are projections, what are other people's realities, and how one's behavior influences another person.
I hope that people in relationships with others with BPD will see this "lack of empathy" as the result of a serious mental illness that may be biologically based, but is treatable. People can change. I know I have.
Of course, the question is, 'If i can't feel the empathy, does it matter that it's there? That answer will depend much on the type of relationship (partners need more empathy than parents), your own personality, and knowing the difference between what you want and what you need.
One thing's for sure: YOU need to have empathy for YOU. Get validation from others, and get validation from yourself, if you can. If possible, talk with your BP during calm times. Your expectations can make all the difference, too. It may be comforting to know that even if you can't see it, it's there.
On April 13, James Breiling from the National Institute of Mental Health forwarded this 2010 study to me. The study results suggest that a dysfunctional pattern of "empathic capacity" may account for behavioral difficulties in BPD.
Psychiatry Res. 2010 Feb 28;175(3):277-9. Epub 2009 Dec 31.
Double dissociation between cognitive and affective empathy in borderline personality disorder.
Harari H, Shamay-Tsoory SG, Ravid M, Levkovitz Y.
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel.
We sought to characterize the cognitive and affective empathic abilities of patients with borderline personality disorder (BPD). While controls showed higher cognitive as compared with affective empathy scores, the BPD group demonstrated the opposite pattern. These results suggest that a dysfunctional pattern of empathic capacity may account for behavioral difficulties in BPD.
*On page 42 of the second edition of Stop Walking on Eggshells, I talk about "narcissistic DEMANDS" as being an unofficial trait of BPD.
"Narcissistic demands" doesn't mean they have NPD. It means that some people with BPD frequently bring the focus of attention back to their own needs or emotions, draw attention back to themselves when others are the focus of attention. They may not even consider how their actions affect others because of their nearly child-like self-absorption.
Others people with BPD act in the opposite way: their low-self esteem and other factors may lead them to consider anyone but themselves. They may get involved in abusive relationships. Marsha Linehan's Dialectical Behavior Therapy skills training includes a section on assertiveness to help those lower-functioning, "conventional" BPs with this aspect of their personalities.
About 25% of people with BPD also have full-blown narcissistic personality disorder in addition to BPD [NPD is comorbid]. See the next post for information about narcissistic personality disorder.
Author, "The Essential Family Guide to Borderline Personality Disorder"
(Available at www.BPDCentral.com)
Special thanks to Gretchen Little for granting me permission to use her painting "Heart in Hand." Please visit her site to see more of her beautiful work. All rights reserved.