Emotional and Cognitive Empathy among People with Borderline Personality Disorder: The Role of Attachment Orientation, Self-Esteem, and Social Support

Severe instability in relationships is a salient feature of borderline personality disorder (BPD). However, in recent years there has been a growing recognition that alongside this characterization, people with BPD are gifted with a special sensitivity to the emotional state of others, an empathic ability unique to them. The aim of the present study was to examine differences in emotional and cognitive empathy between people with BPD and people without the disorder. The study also examined the personal and interpersonal factors that may be associated with empathy: attachment orientation, self-esteem, and social support.

Method: The study included 169 participants, 84 diagnosed with BPD and 85 without a diagnosis of BPD. Participation in the study was voluntary. Data collection was performed using self-report questionnaires, including empathy (dependent variable), attachment orientation, self-esteem, and social support (independent variables), as well as a socio-demographic questionnaire. Statistical analyses were performed using Jamovi software to examine the association between the dependent and independent variables. The study hypotheses dealing with correlations between variables were tested using Pearson’s correlation analysis, and differences between the study groups were tested using t-tests for independent samples. To examine the unique and joint contribution of the study variables to the explained variance of empathic ability, we used a hierarchical linear regression. The Lavan procedure was used to examine self-esteem as a mediating variable between attachment orientation and emotional and cognitive empathy, and the moderating role of study group in the association between the independent variables and emotional and cognitive empathy.

Results: Higher levels of emotional and cognitive empathy were found among people with BPD compared to the control group, and these differences were more pronounced for emotional empathy. In addition, the study found a positive correlation between attachment anxiety and emotional empathy, and a negative correlation between attachment avoidance and emotional and cognitive empathy. It was also found that self-esteem mediates the association between the dimensions of attachment and emotional empathy. Additionally, group affiliation moderates the association between attachment anxiety and emotional empathy. The study revealed a positive correlation between social support and cognitive empathy, and found that group affiliation does not moderate the association between social support and empathy.

Discussion: The present study found higher levels of emotional and cognitive empathy among people with BPD, which suggests that hypersensitivity can be an advantage. The findings further show that, contrary to the hypotheses, attachment anxiety contributes to emotional empathy. One possible explanation is that anxiety states are characterized by an increased attention to one’s surroundings, which may result in increased sensitivity to others. This positive correlation between anxiety and emotional empathy was only observed among the control group, a finding that emphasizes the uniqueness of the study group. Another important finding, which contradicts the literature, is that low self-esteem contributes to emotional empathy. One possible explanation refers to emotional empathy as a form of emotional dysregulation, which has been associated with low self-esteem in previous studies. This study’s results show that emotional empathy is a complex ability that does not behave as expected.

Contribution: This study contributes significantly to our knowledge regarding the strengths of people with BPD, who are often identified with dysfunctional relationships. In addition, the study contributes to a better understanding of empathic ability and the variables associated with it, in a meaningful observation made possible by the division between emotional and cognitive empathy. Examining the empathic ability among people with BPD, and its associated variables, can enrich the literature on the strengths of people with mental disabilities and contribute important elements to the rehabilitation and empowerment of people coping with the disorder.