Impact of social exclusion on empathy in women with borderline personality disorder

Abstract

Unstable interpersonal relationships and fear of abandonment are core symptoms of borderline personality disorder (BPD) that often intensify during stress. Psychosocial stress, which includes components of social exclusion and increases cortisol secretion, enhances emotional empathy in healthy individuals. Women with BPD, on the contrary, react with reduced emotional empathy. The aim of the present study was to investigate the effects of perceived social exclusion without accompanying cortisol increase on empathy in women with BPD and healthy women. To induce social exclusion, we randomized 98 women with BPD and 98 healthy women to either an exclusion or an overinclusion (control) condition of Cyberball, a virtual ball game. Subsequently, participants underwent the Multifaceted Empathy Test (MET), which assesses cognitive and emotional empathy. There was no increase in cortisol release after Cyberball. Cognitive empathy did not differ between groups or conditions. Women with BPD reported lower emotional empathy for positive emotions (group by valence interaction), but not for negative emotions. Exploratory analyses suggested that this effect might be more pronounced after social exclusion. Our results confirm previous findings that cognitive empathy does not differ between women with BPD and healthy women and extend this evidence to social exclusion. Emotional empathy in women with BPD seems to be more sensitive to the effects of stress or ambiguous social situations. Specifically, emotional empathy seems to be reduced for positive emotions, and might further decline after social exclusion. Empathic reactions to emotional stimuli of different valences and to specific emotions should be further investigated.

Evidence of deviant parasympathetic response to social exclusion in women with borderline personality disorder

“…Overall, our findings match previously reported differential reactions to objective and perceived social exclusion and extend them to the level of autonomous functioning. We can interpret them according to the tend-and-befriend vs. fight-and-flight discrepancy [ 11 , 50 ]. The heightened vagal response of HC seems to adaptively compensate (perceived) social exclusion and activate the vagally mediated social engagement system, allowing a tend-and-befriend approach.…”

“…The sample consisted of 62 female patients with BPD and 87 female healthy controls (HC). Here, we report the results for those participants described by Graumann et al [ 11 ] for which HRV data were collected. Native German speakers between the ages of 18 and 55 with a BMI between 17.5 and 30 were included and underwent the Structural Clinical Interview for DSM-5 Disorders (SCID) (German versions of SCID-5-CV, SCID-5-PD) [ 40 ].…”

“…The task lasted around three minutes, during which HRV was continuously recorded. After the Cyberball task participants remained quietly seated and gave saliva samples, completed computer-based tasks and filled out the Need Threat Questionnaire (NTQ) and other questionnaires (see Graumann et al [ 11 ] for details). Fifty minutes after Cyberball, participants took a resting position for the third HRV measurement.…”

The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder

“…Overall, studies employing Cyberball quite consistently show stronger feelings of ostracism in BPD patients compared to healthy controls, both after exclusion [ 159 , 161 , 162 ], but, importantly, even after inclusion [ 148 , 163 - 165 ]. Only when an overinclusion condition was used BPD patients’ emotional responses align with those of healthy controls, yet even then, BPD patients showed lower feelings of connection [ 147 ] and higher need threat [ 148 , 166 ].…”

“…While Cyberball has been repeatedly used to study RS, only one recent study from our group employed the Cyberball task to study empathy in BPD patients [ 166 ]. In a large sample of female patients with BPD and tightly matched control participants, the MET was employed to compare cognitive and emotional empathy after either the exclusion of overinclusion condition of the Cyberball.…”