The Neural Basis of Empathy in Borderline Personality Disorder

Research on empathy, the ability to resonate with the feelings of others, provides insights into both normative and altered social processing, such as in borderline personality disorder (BPD). This article reviews key models of empathy, focusing on three core components and their neural bases. One central aspect is shared neural representations, i.e., similar brain activation during one’s own emotional experiences and while empathizing. In BPD, this is marked by hyperactivation of the amygdala and insula, indicating heightened affective resonance. Second, cognitive regulation mechanisms are central but impaired in BPD. The third component, self-other distinction, which is supported by the temporo-parietal junction, also shows altered activity patterns in BPD. Research in this field is hindered by conceptual and methodological inconsistencies and by the heterogeneity of BPD, underscoring the need for clearer theoretical frameworks and stronger interdisciplinary integration with clinical practice.