Empathy Anomalies in Emotionally Unstable (Borderline) Personality Disorder - Prospective, Longitudinal, Cohort Study

Emotionally unstable personality disorder (EUPD) is a mental disorder characterised by a pervasive pattern of emotion dysregulation, inconsistent identity, and difficulties with interpersonal functioning. It is often associated with deliberate self-harm, has a high burden on affected individuals, family members, and health-care systems, and is associated with low occupational and educational attainment, lack of long-term relationships, increased partner conflict, low life satisfaction, and increased statutory service use.

Recently, an impaired ability to understand other people's motives and perceptions ('mind read' or empathise) has been shown to be characteristic of EUPD.

Empathy has two components; cognitive empathy (the ability to imagine someone else's thoughts and feelings) and emotional empathy (the reciprocal emotional response). People with EUPD score low on measures of cognitive empathy and high on measures of emotional empathy compared to non-clinical controls. This suggests that they do not easily understand other peoples' perspectives, but their own emotions are especially sensitive.

Healthcare services need outcome measures and predictors of treatment response to develop evidence-based guidelines for EUPD. Hence, this study will use a computer-based empathy assessment tool and short questionnaires to investigate whether empathy changes during the course of EUPD, and if the extent of an empathy impairment correlates with syndrome severity.

Many of the established empathy tests only elicit severe empathy anomalies, produce results that do not translate into real life scenarios, do not describe cognitive and emotional empathy separately, or are cumbersome so not routinely applicable. However, the empathy test this study will use (multifaceted empathy test or MET) has been shown to quantify the EUPD empathy anomaly, is ecologically valid, does not require training to administer, can be gone through in 30 minutes in a clinic room, and has NHS IT security clearance. The empathy questionnaire that will be used (questionnaire of cognitive and affective empathy or QCAE) is an amalgam of other validated questionnaires which improves on their limitations but is still concise (31 questions in total).