Impairment 6 – Compromised ability to recognize the feelings and needs of others

 We now switch from impairments in self-functioning to impairments in interpersonal functioning. The first group of impairments in this section center around lack of empathy. It includes compromised ability to recognize the feelings and needs of others, interpersonal hypersensitivity, and perceptions of others with negative attributes or vulnerabilities. In this article, we will concentrate on the ability to recognize the feelings and needs of others* (aside: I am going to get very technical with this one so please bear with me; besides, I really like this stuff). 

In my own life, I made a science out of recognizing and meeting the needs of others.  I learned to analyze, predict, and meet their needs before they even knew what they wanted. Sometimes I missed on, blundered, and made matters worse, but most of the time I was bang on. As a result, I was viewed as a good father, husband, and counselor.  However, I did it for all the wrong reasons. I did it so they would value and love me. My work was different. I was not supposed to get personally involved so there was no emotional threat there. My children were also different.  That was unconditional love; so I was motivated to just meet their needs and stay attuned to their feelings. However, I was hypersensitive here too and felt deeply hurt whenever I sensed they did not give me the love and respect I thought I deserved.

 When we look at the literature, it basically deals with lack of empathy as a whole rather than each of the three descriptors. It would appear that the ability to feel empathy may be related to the way we are parented. Herta Guttman (2004) studied the families of 27 women with BPD, 28 women with restricting anorexia nervosa, and 27 controls.  Daughters and both parents were administered the Interpersonal Reactivity Index (IRI), an instrument for assessing four dimensions of empathy. In addition, they were interviewed with the Family Interview for Protectiveness and Empathy (FIPE). On the IRI, women with BPD scored highest on the immature and lowest on the mature aspects of empathy. Parents of BPDs had the lowest IRI scores, and BPDs’ scores were negatively correlated with those of their parents. On the FIPE, borderline daughters and parents agreed about the relative absence of empathetic parenting. The responses of the daughters and parents of the other two groups indicated no specific problems with empathy. This study confirms my belief that many of us borderliners may have impairments in interpersonal functioning because of early childhood experiences with negative aspects of parenting. It just might also have something to do with the social learning between baby and mother that we met in the last article. It might be that we fail to learn empathy during the first year of our existence. 

So what is happening in the brain? Dziobek et al (2011) conducted two studies with fifty BPD patients and  fifty matched controls. In the first study, they applied the Multifacited Empathy Test (MET) to assess cognitive and emotional empathy. The MET consists of a series of photographs which depict people in emotionally charged situations. Subjects were required to infer the mental states of the individuals shown in the photographs and rate their emotional reactions (emotional empathy). In the second study they administered a scanner version of the MET while conducting fMRI scans.  Patients with BPD showed impairments in cognitive and emotional empathy on the MET. Brain responses were significantly reduced in the left superior temporal sulcus (STS) and gyrus (STG)* (aside: I hope you are getting these. The quiz is coming).   These areas are part of the temporal lobe, the area that involves verbal processing.  The STG is also involved in social cognition. This includes the perception of emotions in facial stimuli * (aside: remember mama smiles, baby smiles, mama smiles – I must be special). Patients with BPD also exhibited greater brain activity in the right middle insular cortex (aside: we have had this one already. You should know it by now – just kidding). The insula is involved in conveying a sense of emotional balance with negative emotional experience, along with images of and degree of pain. Further, the insula is where a person imagines pain when looking at images of painful events while thinking about what’s happening to one’s own body.These studies suggests that language is more than just the comprehension of words and sentences. We are also trained during childhood to respond to the body language that goes along with verbal language. It is part of a neural circuitry involving the occipital and temporal processing centers, the amygdala, and the prefrontal cortex, which are all involved in visual and verbal social emotional/cognition processes. This circuitry is essential for developing empathy.

So what does this mean? From these studies we see that we borderliners have a difficult time with situations involving empathy, especially involving the ability to recognize the feelings and needs of others. It suggests that our parents may not have spent time with us as babies cooing and smiling and demonstrating emotions through verbal tones and visual expressions. As a result, we may not have developed the neural circuitry needed to subconsciously recognize the feelings of others or we may have associated lack of affirmation from the parents as disapproval and pain. Therefore, when presented with a potentially painful situation, our brain has to over analyze what is happening in the hope of making sense of the situation and finding some way to avoid the potential pain that may be involved in an interaction. As a result, we become more self-centered during social interactions because we feel we may have to protect ourselves. When something essentially harmless is said or demonstrated through facial expressions or body language, we immediately interpret it as a potential threat. Because we are so concerned with our own safety, we fail to see the feelings being expressed by others, especially those nearest to us, who have the potential to inflict the greatest emotional pain. We fail to meet their needs because we are obsessed with our own need to be accepted and loved.

Dziobek, Isabel; Preiffler, Sanda, Grozdanovic,Zarko; Heusen, Isabella; Heekeren, Hauke R; and Roepke, Stefan. Neuronal correlates of altered empathy and social cognition in borderline personality disorder. NeuroImage. (2011).

Guttman, Herta A, Empathy n Famlies of Women with Borderline Personality Disorder, Anorexia Nervosa, and a Control Group. Family Process. (2004).