Friday, December 30, 2011

How the Brain Sees Empathy in Borderline Personality Disorder – Part 2

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.
Conclusion
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.

7 comments:

  1. Ok, so I talk a lot. Emiy

    Post 1/2:

    The material a few weeks back regarding a Borderline's ability to ACCURATELY interpret emotions based of facial expressions – I admit I was a little confused by that. In my experience, yes my Borderline (I’ll call him N) could pick up on emotion immediately and intensely. But as the non, I don’t feel like my emotions were ever interpreted correctly. And like I said before, there are 2 scenarios (1.) where I display emotion that he HAS CAUSED and (2.) where I display emotion that HE HAS NOT CAUSED.
    In a case where my emotion/distress/happiness is resulting from something NOT RELATED TO HIM, something he HAS NOT CAUSED, he definitely picks up on my emotions. He would make an attempt to respond appropriately – but it didn’t seem genuine to me. There was something about it that seems mechanical, that he feels obligated to do…and in some strange way, I sensed fear in him with it. And it’s predictable that following these moments (that again have nothing to do with him) there is something dramatic that happens. He devalues me, normally immediately and he goes away for a couple days, finds other women, or circles back to old ones. If it’s happiness I’m experiencing, I suppose he interprets it to be happiness that doesn’t include him. If I talk about the pain of my past, he sees it as a weakness in me. So like you said, his empathetic response is self-directed. My survival instinct over the past 2 year cycle then has become to shut down everything to him. We nons begin showing Borderline symptoms to survive with them, so they won’t go away. And ironically, this was my childhood. I had siblings that died and others that are disabled, and my parents weren’t right because of it. I was the one thing right and happy and healthy in their world. So the second I started showing weakness or emotional struggle, my parents immediately withdrew from me. It’s like they couldn’t handle their own pain, let alone mine. In fact my Dad has said later in life in my eating disorder family therapy, ‘she is always happy, and when she’s not, what do we do? ‘. I’ve found myself fighting to stay in these same times of situations.

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  2. Post 2/2

    Back to N. In an emotional situation not created by him – while he definitely picks up on my emotions whether it be happiness, sadness, fear, in my opinion always results in something negative for me. And this isn’t how empathy is supposed to be! Now, there may be times that I think he TRULY FELT EMPATHY, maybe even the Emily version of empathy, way after-the-fact. It’s delayed, by perhaps weeks, months. You mentioned in your write-up that you think you feel true empathy when you are not in a horribly turbulent position yourself. I truly believe that, even with N. The difference is, he is nearly always in an emotionally turbulent place. He has very, very few moments of calmness. This is the heart-breaking part with him. He recently wrote me a letter (because I have blocked every form of communication I can think of to keep us away from each other), responding to our final explosion 3 weeks ago. He said he “is sorry for the way things happened”. Honestly, I don’t know if he is or isn’t. I think he is sorry I can’t play anymore, sorry he can’t depend on me anymore. I don’t think he’s sorry that he broke my heart in a million pieces, made me feel worthless, and unwanted. It’s that feeling of sadness that he hurt me, that he broke my heart – that is empathy. I’m not convinced that even now, that’s the case with him. He also said that he “looks at me trying to find something wrong with me and reasons he shouldn’t want me. And that he realizes no one is perfect and he needs to let it go”. Well knowing what I know, I can only guess what he’s talking about is the constant process of devaluing and re-idolizing me, reaffirming feeling unwanted. Great, now it’s even in writing. Son-of-a bitch, there’s no winning! :-D
    Now with a situation where he has undoubtedly caused my pain, his emotional response is definitely self-directed. He goes into survival mode. I can see his pain, but I can certainly see that his pain isn’t because of mine. His pain is that he wishes he was different, wishes he was better. And then the result is – he sees me as negative because I spark these feelings. Talk about a fucking vicious cycle. But as this article (or maybe the one yesterday) suggests, relationship issues are what defines a Borderline. And empathy or an inadequate amount is what feeds the relationship troubles. All interesting. Good write-up! EM

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  3. Anonymous in the above comment what you wrote really scared me I saw a little but of myself in your words. But like you say you emotionally shut down to accommodate his needs, exhibited borderline symptoms to survive. I too had a bpd mother and I wonder if my feelings/emotions or lack of them are learned survival behaviours or if the bpd gene was passed down to me. My psychiatrist has yet to diagnose me because he too is unsure. I guess only a lot of therapy will help me make that discovery.
    And the author of this blog thanks for your posts they are very interesting and informative. I look forward to reading whatever else you have to say on this topic.

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  4. Hi there, I came across your blog a few days ago.It is a amazingly informative read! loads of info. I actually bought a book about surviving living with BPD and am still getting through it. I agree with this post in that while I can find it hard to emphatise and understand thatt someone else is hrting or has another point of view.I find that this isn't true all of the time. It's like I can emphatise with people who are not close to me say a woman on the street is upset i have many times gone over and sat with people and listened to them and offered advice right there on the street. I was a first aider for 5years and had to have empathy with people who were very physically ill or had been injured (sometimes very badly.So i know i have empathy but sometimes nit towards my partner for example.Maybe beacuse we are always worried about the same things or I feel that he can cope better with certain stresses than me so feel that he doesn't fully uderstand what i,m going through. Thanyou for such a information rich blog it looks like you did loads of research. May I link to it as i,m starting a blog about my own experiences with BPD. www.insidemyboderlinepersonality.blogspot.com I,m also a artist/designer so well be showing creative ideas to help slleviate symptoms. Do drop by I,d love to hear your thoughts and have you take part! Take care,Keep well.

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  5. Im not sure about this, because from where I seat one might say I have more empathy than any other persn I know. Sometimes when I am calm, o maybe I should rewrite, when I am sometimes calm, I go in to emotional turmoil just by watching someone suffering, like if I was codependant of their feelings, so much that I want to save everyone around me.

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  6. This doesn't surprise me. I've actually heard a lot of Borderlines say things like this. It's a perspective I hope to present very soon actually.

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  7. May I suggest further resources to learn more about empathy and compassion.
    The Center for Building a Culture of Empathy
    The Culture of Empathy website is the largest internet portal for resources and information about the values of empathy and compassion. It contains articles, conferences, definitions, experts, history, interviews,  videos, science and much more about empathy and compassion.
    http://CultureOfEmpathy.com


    Also, I invite you to post a link to your article about empathy to our Empathy Center Facebook page.
    http://Facebook.com/EmpathyCenter

    I posted a link to your article in our
    Empathy and Compassion Magazine
    The latest news about empathy and compassion from around the world
    http://bit.ly/dSXjfF

    ReplyDelete

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