Empathy for somatic and psychological pain in patients with Borderline Personality Disorder
Human Cognitive and Systems Neuroscience
Final Report Abstract
Borderline personality disorder (BPD) is a common personality disorder that is associated with impairments in social interactions. Symptoms such as emotional instability, impulsiveness, fear of being abandoned, emptiness and self-harming behaviours are also characteristics of this disorder. How exactly, and under which conditions, social interaction is disturbed in BPD has so far been investigated insufficiently. Therefore, the present project aimed to further identify the neural basis of the altered social interaction in BPD with a special focus on empathy. More specifically, we utilized an fMRI version of the Social Interaction Empathy Task (SIET) with the aim to investigate empathy for somatic pain as well as empathy for psychological pain and brain activations during the task. In order to further identify modulating factors of BPD and empathy, oxytocin levels, trait empathy, borderline symptom severity, including self-harming behaviour, and rejection sensitivity were analysed and examined whether these variables were related to brain activation and behaviour during the SIET. Patients with BPD show altered empathy behaviour with higher pain ratings for psychological pain and neutral conditions during the SIET, and higher pain ratings for psychological pain when rating from a first-person perspective compared to a third-person perspective. These results confirm previous findings and emphasize that patients with BPD are more sensitive to psychological pain and interpret neutral social situations already as painful, which is accordance with the idea of hypermentalizing in BPD. The difference between perspectives in the BPD group, i.e. higher pain ratings for psychological pain when rating for themselves compared to ratings for another person revealed that patients seem to be aware of the higher relevance of psychological pain for themselves. Analysis of saliva samples before and after the SIET showed that oxytocin levels increased during the task, whereas no effect for group emerged. Brain activations were in general lower during the task in the patients group in empathy-for-pain core regions such as the right insula, bilateral superior and middle frontal gyrus, left middle temporal gyrus, left precentral gyrus, left putamen and right anterior cingulum. Correlations between brain activations and psychometric data suggest that high symptom severity including self-harm behaviour and BPD symptoms, as well as personal distress and rejection sensitivity were related to reduced brain activation during the SIET. Likewise, the above mentioned psychometric scales were positively related to higher pain ratings for psychological pain and neutral scenarios. These findings indicated that patients with BPD showed altered processing of social interactions in general, possibly due to deficits in emotion regulation, trait empathy and rejection sensitivity which could result in hypermentalization and over-interpretation of social threat and brings the attention to the importance of social cognition training for patients with BPD.
