Saturday, December 31, 2011

After Tomorrow it'll all be over!

For many of us this is the end of an old year and the beginning of a new one. Not for me mind you, my New Years is Oct. 31st, but still this is the end of the holiday season in general, and I for one couldn't be more stoked. Yay no more holidays!

I hope everyone has a much happier and healthier 2012!

And if not, hey! The world's supposed to end anyways. Enjoy!

















Other-directed Empathy

Other-directedness is what empathy is all about. That's the ability to feel for another person without any selfish or self-centered motivation, without any motivation of personal distress. This is where the subject of empathy and Borderline Personality Disorder gets a little cloudy I think. Often for those of us that are BPD there's a constant feeling of personal distress. When we're emotionally turbulent our ability to feel for another person 100% without some influence of our own situation is likely compromised. This is probably why our efforts to provide comfort when we do recognize someone else needs an emotional shoulder to lean on may come across as slightly off, a little less than fully genuine, or even a little hollow. Often we are so wrapped up in the turmoil that is our emotional instability that we can't see anyone else's trouble at all. However, if we can see past our own pain and enough to recognize that you need our support, I do think that counts for something. Maybe not the absolute ideal that you hope for, but we wouldn't do it if we didn't care on some level. And that level is going to be pretty significant most of the time.

Now, contrary to the Borderline hype, we are not ALWAYS in an emotionally traumatic or unstable place. These times of emotional lucidity are the times when I do believe it is possible for someone with BPD to display true empathy for another person. I saw this video the other day. I don't know how up on current events many of you are but I saw this video of the protests in Egypt. 




The story of The Girl in The Blue Bra is incredibly important for women's rights all over the world, but especially in Egypt, the Middle Eastern countries, etc. where women have so few rights, if any.

When I saw this, I was beginning to write up this blog series on empathy, and as is usual, looking inward trying to assess my own empathic abilities. As soon as I saw this though, I knew, that absolutely it is possible for us to have spontaneous empathic responses. Sometimes I do forget. I can go very numb and feel quite hollow and it's difficult for me to remember all the times how I've felt for other people. Especially since I have a lack of object constancy which makes all events in the past feel like they've happened to someone else. Cognitively I know this is not a foreign experience. It's one I've had many, many times. But as this was so visceral I thought I'd use it as one small example of a personal proof.

When I saw this video I was absolutely outraged. My stomach clenched and I was brought nearly to tears of sadness and fury for this woman that I've never met, for this woman that I do not share the same problems. Her experience is a violation of basic human rights. No woman, no person, should ever have to experience this. I wanted to jump through my monitor and defend her with my own hands, even though I have no idea who she is. And I would have too. If I saw this on the streets in front of me, nothing would stop me from throwing caution for my own personal preservation to the wind, and not let her fall alone.

I don't know, maybe it's silly to use this as 'evidence', but when I saw it I know how I felt, and it had absolutely nothing to do with me. It was all about her. 

Friday, December 30, 2011

How the Brain Sees Empathy in Borderline Personality Disorder – Part 2

So what does this mean?
The cognitive empathic results (discussed yesterday in Part 1) actually seem to be at odds with previous research done on emotion recognition abilities in those with BPD. In other tests it’s been shown that emotional recognition is not impaired and often heightened in individuals with BPD.  However in this study it seems that the combination of integrated facial stimuli with intonation (sound/voice) stimuli resulted in emotion recognition deficits in BPD. It was also suggested that individuals with BPD tend to misread others’ minds when in intense interpersonal encounters, often when emotionally aroused.
This doesn’t surprise me. When I’m in an emotionally neutral state it’s pretty easy to gauge how other people feel. But when I’m emotionally turbulent it’s often difficult for me to accurately gauge how someone else is feelings for a variety of reasons.
The study hypothesizes that this may provide evidence for both (a) the suggestion that the misinterpretation of the mental states of others leads to extreme and dysfunctional emotional responses in social interactions, and (b) that emotional arousal causes impairments in interpreting others’ mental states.
Here’s where I think it gets even more interesting. The STS part of the brain is known for its role in social cognition and is an important part of the brain network that mediates thinking about others. During cognitive empathy there’s a cluster in the STS/STG region the is more activated in the healthy control group than in the BPD group. This article actually provides hypothesis as to why though. BPD research of attachments suggests that maltreatment in childhood leads to the inhibiton of mentalizing abilities in affected individuals., which might reflect this decrease in activity in the STS. Childhood maltreatment by a caregiver such as emotional neglect or sexual abuse is in fact on the most important psychosocial risk and prognostic factors for BPD symptoms.  This could also account for the high comorbid rate of PTSD with BPD.  Childhood maltreatment likely has effects on the developing brain. Interestingly, the STS region matures late in development, which means it is particularly vulnerable to ongoing early psychosocial stressors. That difficulty inferring the mental states of others may be the behavior consequences of those changes in the brain. Recent findings that show impaired emotional recognition in people with BPD and comorbid PTSD further indicate how relevant intrusive memories are for empathic functions.
Lets talk more about the brain. Brain activiation during emotional empathy did not differe in the anterior insula for either group. However there was a cluster in the right mid-insula that was more activated in those with BPD.  The mid-insula has been shown to react streongly to bodily states of arousal. This study those that there are associations between activation of the right mid-insula and skin conductance responses in those with BPD which supports the idea that there is increased arousal during emotional empathy. However, you’ll remember that increased arousal in those with BPD often interferes with the ability to accurately judge another’s emotional response. Emotional empathy requires an other-oriented appropriate emotional response. This can be interpreted as the ability to regular emotions in interpersonal situations. However those with BPD have an inability to regulate their emotions which could be a direct effect of the increased arousal and personal distress function.  Even in healthy subjects the tendency to experience personal distress in response to the suffering of others has been associated with the mid-insular activation. This is important to note because it means this is a consistent measurement across both BPD and healthy individuals. It just seems that in those with BPD this region of the brain is more easily activated, more often. Since personal distress is reported with higher frequency in those with BPD and was also found in the currenty study it could indicate that the results represent the reason for reduced behavioral empathic concern in BPD.  There seems to be a direct relationship between personal distress and empathy.  Low levels of arousal and personal distress  are considered to be important for more mature empathic concern, however they seem to be detrimental  and indicative of reduced emotion regulation when they are at very high levels, like those displayed in people with BPD.
It was also found that  the right anterior STS/STG region was more activated in the BPD group when engaging emotional empathy.  The posterior of the STS is a prime area for mentalizing, and the right STS has been shown to be sensitive to perceived congruency (truth) between a person’s actions and their emotional expression. In those with BPD there is increased activation in the right STS/STG during emotional empathy which could indicate that patients with BPD mistrust the truthfulness of other’s emotional reactions. This is supported by separate research that indicates reduced trust in those affected with BPD and further supports the idea that those with BPD have problems interpreting others’ emotions when emotionally aroused.
Conclusion
This study concludes that deficits in cognitive and emotional empathy are central to BPD. It also indicates that the misinterpretation of the mental states of other people might provide an explanation for dysfunctional emotional responses in interpersonal situations for someone with BPD. BPC can be conceptualized as involving deficits in both inferring mental states and being emotionally attuned to another person.

So there you have it. One highly scientific hypothesis on the effects of brain function in regards to empathy and BPD. Something that I think is important to note: the entire study indicates an impaired function of empathy, not a lack of empathy. People with Borderline Personality Disorder do have and experience empathy. It determined that some empathic responses comes from a different motivational perspective than normally functioning individuals though. This is especially true if the person with BPD is experiencing a heightened emotional reaction already.

Ok. So what does that mean? We do have empathy, but in some regards it is different. I know many, many people with BPD that will disagree with these results. I do agree with what they are presenting. However, I don’t think that it means the empathic response those with BPD do have is any less valuable than those with a more nuerotypical brain. I understand the idea that our empathic responses are often self-directed as opposed to other-directed. I don’t believe this is always true. I’m sure of it in fact. Though, I know when I am very emotionally turbulent, it is definitely harder for me to relate and to care about what others are going through. It’s more difficult for me to recognize that others are going through something at all. And when I do recognize it, the feeling I have is influenced by any threat I perceive to myself, how the situation will affect me. It actually took me a very long time to realize I did this. I don’t consciously think about that reaction. It’s just a feeling of doom and anxiety that threatens my stability depending on the situation and I react based on that feeling. That’s me though. Not necessarily everyone.

What do you think?

Like I said, I’m also positive that our empathic response is not always self-directed. Tomorrow I’ll post a video that I watched recently that absolutely infuriated me.  The situation has no bearing on me or my life, but well, you’ll just have to wait and see! Stay tuned.

Thursday, December 29, 2011

How the Brain Sees Empathy in Borderline Personality Disorder – Part 1

This is your brain on empathy. In this scientific journal researchers utilized fMRI technology to map and monitor empathic responses in the brain of those with Borderline Personality Disorder.  The conclusions are illuminating. I’ll attempt to relay the information in a more reader friendly way for you, but the original article can be found by clicking on the article title below. I’m breaking this into two parts.
By: Isabel Dziobek, Sandra PriBler, Zarko Crozdanovic, Isabella Heuser, Hauke R. Heekeren, and Stefan Roepke.
The article begins with a brief but legitimate description of Borderline Personality Disorder. It is a severe psychiatric condition involving profound emotion regulation deficits and interpersonal impairment. People with BPD often have other comorbid psychiatric disorders, such as PTSD. This is often associated with childhood traumatic experiences involving neglect and sexual abuse. BPD is generally regarded as a disorder of emotion regulation, though emotional regulation impairments are found in a variety of other disorders as well, such as anxiety, PTSD, depression or bipolar disorders. In diagnosing BPD, it’s been argued that the unstable relationship style would be one of the best indicators. But what causes this instability?
This article argues that impaired empathy may be the cause for dysfunctional interpersonal style in BPD.
Again, we have a two part definition of empathy. First is the cognitive component, which allows a person to infer the mental states of others. It’s also known as mentalizing, Theory of Mind or social cognition. The second aspect of empathy is the affective component which inspires an appropriate emotional reaction to another person.
Something that needs to be distinguished is that the appropriate response of emotional empathy is different from emotional contagion or personal distress.  Emotional contagion and personal distress are self-oriented responses as opposed to other-oriented responses and are seen as less mature emotional reactions. What this means is that when someone with BPD sees a scenario their response is personal and often influenced by a perceived threat to themselves as well as the others involved creating a reaction based on their own personal distress, as opposed to having an emotional response based solely on relating to the distress of how the Other person is  experiencing the situation. That’s the theory anyways.
This study attempts to quantify cognitive and emotional empathy in BPD patients with a healthy control group of individuals. This is achieved by utilizing the Multifaceted Empathy Test (MET – which I couldn’t find on-line), and a study of brain functioning through the use of brain scans taken by an fMRI machine.  
The MET consists of photographs showing people in emotionally charged situations and is intended to produce strong emotional reactions.  Cognitive empathy is assess when subjects infer the mental states of the individuals show in the pictures. To rate emotional empathy, subjects rate their level of empathic concern for the individuals portrayed. This test was performed on its own, and then again in conjunction with the fMRI machine to get an accurate interpretation of how the brain actually responds to stimuli. Questions like “What is the person feeling” (cognitive empathy; “How much are you feeling for the person?” (emotional empathy); and “How old is the person/Is this person female or male?” (higher-level baseline conditions), were asked.
Results
In the behavioral study patients with BPD showed trends toward lower scores than controls on the emotional scales. On the more objective MET patients with BPD showed significant impairments in both facets of empathy compared to healthy controls. 
fMRI main effects
Cognitive Empathy: Contrasting cognitive empathy with a higher-level baseline, revealed activations in areas that typically respond to social cognition for both groups. (Brain areas such as the superior temporal sulcus and gyrus (STS/STG) extending into the temporal parietal junction bilaterally, the orbito-frontal cortex, temporal pole, and paracinulate gyrus).
Emotional Empathy: The comparison of emotional empathy and higher-level baseline revealed similar activations for the BPD and control groups.
Group Differences
Cognitive empathy: Contrasting brain activity in cognitive empathy between patients with BPD and the healthy control group found greater changes in the left STS/STG from the control group.
Associations with level of intrustions: Correlation analysis revealed contrasting activity between the BPD and the control group during cognitive empathy. Levels of intrusions were measure din the BPD group.
Emotional empathy: There was a greater increase in the BOLD signal in the right insular cortex and the right STS in the patient group. This seems to be specific to emotional empathy. Emotional empathy responses in the right insular cortex were negatively correlated with mean arousal measured by duration of skin conductance reaction during emotional empathy in the BPD group.
Associations with skin conductance response. Changes in the BOLD signal were found in the right insular cortex ROI of contrasting activity between the BPD and control groups during emotional empathy which correlated to levels of arousal.
This is the first study reporting cognitive and emotional empathy functions and their neuronal correlates in individuals with BPD. In both cognitive and emotional empathy patients with BPD were found to have impairments. Individuals with BPD seem to have less activation than controls in the STS/STG region during cognitive empathy. Greater changes in the BOLD signal in the middle unsula region in the patients during emotional empathy were found, where this activation reflected levels of arousal.
So what does this mean? 

(I'll have the conluding results for you tomorrow in Part 2)

Wednesday, December 28, 2011

Zero Degrees of Empathy in Borderline Personality Disorder

An argument against empathy in Borderline Personality Disorder.
Author Simon Baron-Cohen in his latest work, Zero Degrees of Empathy: A New Theory of Human Cruelty, he takes a look at empathy and what a deficit of empathy can lead a person to do in terms of evil and cruelty. His work isn’t actually about traditional ideas of “evil”. It’s about redefining what we perceive as evil. He thinks his new idea of evil is explained by an absence of empathy. Empathy itself gets a new definition.  Personally, I think concepts of “good” and “evil” give a very biased and judgmental opinion which automatically creates a negative stigma without providing room for deeper explanation or hope for growth. On the other hand, I do like his definition of empathy.
Most people think of empathy as being able to understand another person’s emotional state. That’s it. Baron-Cohen has a multi-part definition of empathy: Cognitive (“Recognition”), Emotional, and Action (“Response”).
Cognitive: The drive to identify another person’s thoughts and feelings. The cognitive ability to recognize another’s emotions.
Affective: The drive to respond appropriately to another person’s thoughts and feelings. You must care.
Response: There must be an overt reaction to the cognitive and emotional recognition of emotion in another person.
It’s not enough to just see what another person is feeling. You must also feel it, and feel the need to respond to it appropriately. He believes that people with narcissistic, borderline, or psychopathic personalities are lacking in the “affective empathy” area; the ability to feel other’s feelings. They can often cognitively recognize emotions in another person, but the affective drive and emotional response are what is lacking.
Baron-Cohen believes concepts like “evil” are not necessarily accurate and should be replaced with the concept of “empathy erosion”. Disorders that involve zero-empathy, or empathy erosion, include psychopathy, narcissism, borderline personality disorder, and autism/Asperger’s spectrum disorders.
So what is empathy erosion? First, it is necessary to understand that the functioning of the empathy circuit in the brain determines how much empathy a person has. Throughout the population empathy is “normally distributed” from zero degrees at the extreme low end, to six degrees at the extreme high end. Most people are somewhere in the middle. However, for some people the specific circuit in the brain (“the empathy circuit”) can shut down. This can be temporary (like when we are stressed) or more enduring. In some people this circuit never had a chance to develop in the first place, either due to environmental  neglect and abuse and/or for genetic reasons. Attachment is key in the formation of empathy. So those that were raised in an environment that lacked a healthy attachment bond are predisposed to having impaired empathy. But that’s not the whole story. There’s also a series of genes related to empathy: MAO-A gene. There are actually multiple versions of this gene. Baron-Cohen did a study on those who presented a particular version of the gene and determined that those with the eroded gene AND those that had an unhealthy environment were most likely to have the least empathy. The key is that environment is important, because while you can be born with the eroded gene, the presentation of low empathy is supplemented by how healthy or unhealthy the environment was growing up. Whatever the reason, this circuit didn’t develop the way it would in a normal person’s brain.

There are also two kinds of empathy erosion. Zero-Negative and Zero-Positive.
A designation of “zero-negative” is correlated to a lack of affective empathy: like what Baron-Cohen considers narcissists, borderlines, and psychopaths to have. A zero amount of affective empathy being a negative condition, because the ability to self-regulate the way they treat others is significantly compromised. In short, it’s not good for the person or the people around them.
In an interview he says: I simply bring out into the open the implication that stems from the notion that, if someone who is Zero Negative is violent or abusive because of how the empathy circuit in their brain currently functions, or because of the empathy circuit in their brain did not develop in the usual way, then perhaps we should see such behavior not as a product of individual choice or responsibility, but as a product of the person’s neurology.
This is a decently objective look at his assessment. I don’t think it’s an excuse and it’s doesn’t ‘let someone off the hook’ for their behavior, but it at least attempts to understand that someone with zero-negative empathy is hard wired to think different and approaches the world in a fundamentally different way than most would think to consider.
“Zero-positive” , like zero-negatives, lack affective empathy, but in addition they score zero on “cognitive empathy” – so that they also can’t recognize another’s emotions; people with autism or Asperger’s. Baron-Cohen argues that because they also have the ability to systemize since their brain functions in a unique way, they can push human culture forward with their discoveries. In short, it may not be good for the person, but it is good for the people around them.
Frankly I think he has his own bias and is trying to avoid some very negative reactions from the general population by exalting autism spectrum disorders. They can’t feel empathy, but because they have a particular niche they are useful and therefore not negative. Ok, I don’t disagree. However, to say that it doesn’t apply to anyone else with a so called ‘zero-empathy’ is a pretty bold statement. One that does not hold any general truth. I’m not saying that specific people can’t be a pure detriment to themselves and those around them, but I know plenty of people, myself included, that systemize, and are very productive to society in a positive way.  

In an interview with Baron-Cohen one point he makes what I find as a rather astute statement: it is in the nature of empathy that people who are low in empathy are often the last people to be aware of it. This is because empathy goes hand-in-hand with self-awareness, or imagining how others see you, and it is in this very area that people with low autism struggle.
He also states: In my experience whilst even adults with Asperger Syndrome may have difficulties figuring out why someone else’s remark was considered funny, or why their own remark was considered rude, or may judge others as liars when they simply are inconsistent in not doing what they said they would do, they may nevertheless have a highly developed emotional empathy, caring about how someone feels and not wanting to hurt them. If they do hurt them it is often unintentional and they feel mortified when it is pointed out, and want to rectify this. In this respect, they do have some of the components of empathy.
My question is: Why does he not apply this to those of us that process emotions more fully? As I was reading this, I felt this was very much in line with my own experience with Borderline.
If a comment comes to mind when I’m speaking to a friend or someone I care about, something of a personal (nonpolitical) matter, and I know that it will hurt their feelings, I make a conscious effort not to say what has come into my mind. I don’t want to hurt them, I don’t want to drive them away. Sometimes that recognition doesn’t happen fast enough though and I feel bad when I’ve said something that didn’t register as being hurtful quick enough. Of course, I want to make up for it.
Personally, I can usually judge when a comment I have made, or plan to make, will be seen as rude. I know when it’s something people will take offense to. And in some instances it won’t stop me from saying it. I grew up in a very opinionated household and I hold wacky notions of absolute equality in civil rights, pro-gay marriage, pro-choice, feminist ideology, pro-science and technology, that religion has no place in government or education… these are things that I feel quite strongly about, am quite vocal about, that many people take offense to, but that have nothing to do with my physical brain chemistry. Where is the line drawn? In fact, most people would find it difficult to believe that I feel strongly about these issues, especially civil rights issues, if I didn’t have empathy. Why would I bother caring at all if I didn’t feel for the cause?
Maybe this is the problem. I have the cognitive aspect of awareness that they talk about so if I say something hurtful, then it was a choice. Someone on the autism spectrum who does not have the cognitive recognition of another’s emotional state will not even recognize the implications of their words. Someone with autism/Asperger’s may say hurtful things but they don’t know better. I think this is debatable as to whether it makes it ok, since it’s still hurtful, but I understand where he’s coming from. Whereas someone that is Borderline may say something while understanding the hurtful nature of the sentiment. This displays a lack of empathy.
However, I’ve also had plenty of scenarios where I’ve been aware that something I intended to say was hurtful, said it anyways, and still felt bad about it. How does Baron-Cohen rationalize this? As Borderline I can be very reactive, however, I’ve also been in very abusive situations where my words are not only true, but justified, while still being hurtful. I’ve been in love with my abusers before. I’ve said some cruel things when I’ve been hurt by them, in reaction to the things they’ve done. At the same time, I still loved them, still cared for them, did not want them to hurt, but was so overwhelmed by my own pain that I wasn’t going to let them step on me and treat me like a punching bag. Is this a lack of empathy or defending myself?  
I do know plenty of Borderlines that are less self-aware than I am. That blurt out hurtful statements without realizing that what they’ve said is offensive. At least not until it becomes apparent through the actions or expressions of the person that was offended. However, you will often see an immediate response from the Borderline. Borderlines, whether we admit it or not, need to be accepted, need to be loved, need to not be abandoned. We do not intentionally go out of our way to hurt those we care about or drive them away (this often happens, but the reasons are often a reaction to painfully complicated and conflicting emotions, not an intentional desire to be cruel). The thought is often paralyzing and distressing. However, because we can feel SO MUCH sometimes, because our own emotions are so overwhelming, we often cannot put the feelings of others before our own. It’s like seeing a puddle on the other side of an emotional ocean. It doesn’t mean we don’t care. It doesn’t mean we don’t empathize. It just means we have more to overcome in order to recognize what you’re going through.
Point: Emotions are complicated. Empathy is complicated. And situational. Even Baron-Cohen points out that empathy fluxuates in everyone, from situation to situation, due to our emotional states, or the groups we are currently associating with. This is particularly important to remember in regards to Borderline Personality Disorder. The emotional states of someone with BPD are often in flux, our stress responses are often compromised, and therefore our empathy responses will often fluxuate.   

I listened to a video lecture/interview he gave on Youtube. I was floored and a little angry by the stunningly abbreviated and biased summary he gave explaining Borderline Personality Disorder. I think what made me most angry was that nothing he said was untrue, but it only highlighted the most reactive and destructive aspects of the disorder while completely neglecting the complexity and normal functioning aspects. The picture he painted was one that continues to perpetuate the negative stigma and stereotype of BPD without providing any, empathy or understanding, for what the disorder actually is. If he actually believes what he is portraying then I don’t believe he has a very clear understanding of what he is trying to generalize in terms of Borderline Personality Disorder.

I think compassion for borderlines, sociopaths, psychopaths, and narcissists is going to be a hard case to sell. The havoc they wreak is so great that, as you say, there's nothing positive to be said for them (the conditions)*. And I suspect few other than potentially the borderlines in rare moments of clarity, would choose to be other than they are.  While I can almost make the reach that borderlines have a disability, I find it very hard to go that far for sociopaths and psychopaths. I confess I may be suffering from empathy erosion when it comes to feeling compassion for these individuals who create such damage to others.”
Statements like this make me wonder if he’s ever even met someone with BPD. I don’t know almost anyone with BPD that is happy about it. Even the most low functioning of us recognize that it’s painful and we’d do just about anything to stop that pain and heal. All. Of. The. Time. Not just some rare moment of clarity. Unfortunately it’s often difficult or impossible to get the treatment we need due to financial restrictions or lack of resources. It’s not that we don’t want to change, or for things to get better, but we don’t know how to go about doing it.
However the interview concludes with….
Baron-Cohen’s work is ultimately an optimistic work: the idea that empathy erosions and deficits can be turned around, that people can be taught to be empathic. He points out the need to seek treatments that will teach empathy to those who lack it, which he believes should reduce cruel behavior in the world. Baron-Cohen’s overarching topic is a serious one: why people are cruel to others, but his ultimate perspective is a hopeful one: that empathy can be learned, that the empathy muscle, so to speak, can be exercised.”

So there’s one dissenting opinion in the argument concerning whether those with BPD can feel empathy. He makes some good points. I also think he holds some rather limited opinions. Ultimately though, even if you are born with zero degrees of empathy he believes there is hope.


*DISCLAIMER: I haven’t read the book. I’ve read reviews, interviews with him, and watched videos where he has discussed his book and theories.


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