Disentangling empathy for psychological and physical pain in borderline personality disorder: the interplay with clinical features and emotional competence

• Margherita Bechi ^[2] ; Martin Brüne ^[3] ; Giulia Agostoni ^[4] ; Roberta Bortolla ^[1] ; Maria Vittoria Bongiorno ^[1] ; Gea Spada ^[1] ; Martina Ceresi ^[1] ; Anna Rosini ^[1] ; Laura Sforzini ^[2] ; Marta Bosia ^[4] ; Roberto Cavallaro ^[4] ; Vera Flasbeck ^[3]
  1. [1] Vita-Salute San Raffaele University

     Vita-Salute San Raffaele University

     Milán, Italia

     
  2. [2] IRCCS San Raffaele Scientific Institute, Milan, Italy
  3. [3] LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr-University, Bochum, NRW, Germany
  4. [4] IRCCS San Raffaele Scientific Institute, Milan, ItalyVita-Salute San Raffaele University, Milan, Italy

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• Localización: European journal of psychiatry, ISSN 0213-6163, Vol. 40, Nº 1, 2026
• Idioma: inglés
• DOI: 10.1016/j.ejpsy.2025.100339
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  • Background and objectives : Patients with Borderline Personality Disorder (BPD) often struggle in social interactions, exhibiting altered empathy and biased emotion recognition. Understanding how these aspects intertwine and relate to BPD symptoms remains unclear. This study aims at evaluating the ability to perceive both psychological and physical pain from a third-person and first-person perspective in BPD people and healthy controls, as well as to explore the interplay with childhood traumas, subjective empathy, alexithymia, emotion dysregulation and severity of symptoms.

    Methods : We utilized the 'Social Interaction Empathy Task' on an Italian sample (49 BPD patients, 52 healthy controls) to explore empathy for physical and psychological pain. We also evaluated emotion recognition alongside traits like alexithymia, childhood trauma, parenting style, dissociation, and impulsivity.

    Results : BPD patients perceived psychologically painful and neutral social situations as more distressing than controls, especially in the first-person perspective. A linear regression analysis revealed that 'Difficulty Describing Feelings' (DDF) subscale of the Toronto Alexithymia Scale (TAS-20) predicted ratings for psychologically painful images from a third-person view. Additionally, BPD patients frequently misinterpreted happy and neutral faces. We also observed correlations between emotion recognition and adverse childhood experiences, parenting style, and symptom severity.

    Conclusion : These findings suggest altered empathy for psychological pain in BPD patients, partly influenced by challenges in articulating emotions.