Borderline personality disorder is an innate empathy anomaly: a scoping and narrative review.

Background: Studying empathy in borderline personality disorder (BPD) is essential because difficulties with interpersonal functioning are integral.

Objectives: This scoping and narrative review explores the aetiological theory that BPD is an innate anomaly of cognitive empathy, with a normal or heightened emotional empathy.

Eligibility criteria and sources of evidence: Ovid MEDLINE(R) ALL was searched using the terms empathy; theory of mind; mentalisation or mentalising; borderline empathy; emotion recognition and BPD. For inclusion in the scoping review, articles needed to empirically assess an empathic skill in people with BPD, or self-reported empathy in a BPD group compared to controls, or empathic skill as a 'borderline feature' in a nonclinical sample.

Charting method: The results of empirical studies were categorised as per their methodological approach, with results in the BPD group reported as comparable, enhanced or reduced compared to controls.

Results: 320 articles were returned, with 38 eligible. The majority affirmed that people with BPD have an anomalous empathetic ability, especially a deficient cognitive empathy. Furthermore, this is trait, evident early in development, correlates with syndrome severity, and is mediated by atypical neural networks.

Conclusions: This substantiates the theory that BPD is, at least in major part, an innate empathy anomaly.