Yes, people with Borderline Personality Disorder (BPD) often have empathy, sometimes even intense empathy, but it's complicated by emotional dysregulation, leading to an "empathy paradox" where they feel deeply but struggle to express it, sometimes appearing insensitive or causing relationship issues despite their strong feelings for others' pain. They may have high affective (emotional) empathy (feeling others' emotions) but lower cognitive empathy (understanding others' perspectives), and intense emotions can shift their focus inward, making them seem lacking in empathy.
In reality, many individuals with BPD possess cognitive and emotional empathy but may experience fluctuations in their empathic abilities depending on their emotional state and the situation. The emotional volatility often seen in BPD can lead some to assume that these individuals lack empathy.
People with Borderline Personality Disorder (BPD) "split" (use black-and-white thinking) as a defense mechanism to manage overwhelming, conflicting emotions, especially fear of abandonment, by seeing people or situations as entirely "good" or "bad" rather than integrating complex realities, providing temporary relief from intense anxiety and emotional pain. It's a way to simplify a confusing world and protect themselves from perceived threats, but it often leads to unstable relationships and self-image.
Wide mood swings that last from a few hours to a few days. These mood swings can include periods of being very happy, irritable or anxious, or feeling shame. Ongoing feelings of emptiness. Inappropriate, strong anger, such as losing your temper often, being sarcastic or bitter, or physically fighting.
And here's the truth—it's more common than you think. Many people live with BPD without knowing it. They get called “too sensitive” or “too emotional.” But inside, they're just hurting.
Why BPD Symptoms Peak in Early Adulthood. In the 20s, identity formation and independence conflict with emotional vulnerability. Research shows impulsivity and mood swings occur most frequently between the ages of 18-25.
A common misdiagnosis and coexisting disorder with BPD are bipolar disorders. Both conditions have crossover traits that can be difficult to distinguish from one another. However, both disorders are conceptualised differently: BPD as a personality disorder and bipolar disorders as a brain disease.
Up to 50% of people with Borderline Personality Disorder (BPD) experience psychotic symptoms like hallucinations and paranoid thoughts. BPD-related psychosis typically differs from other psychotic disorders as symptoms are usually brief, stress-triggered, and the person often maintains some reality testing.
11 Hidden Signs of Quiet Borderline Personality Disorder
Many Autistic people are misdiagnosed with borderline/emotionally unstable personality disorder (BPD/EUPD), with most professionals preferring to accept the initial diagnosis rather than acknowledging the realities of what it means to be Autistic.
Some common types of delusions that may occur in individuals with BPD include: Persecutory delusions: Believing that one is being mistreated, harassed, or conspired against by others.
Jobs that draw on empathy, communication, and understanding, traits often strengthened by lived experience with BPD, can also be deeply rewarding. Examples include: Teaching assistant or education support worker. Counsellor, peer support, or mental health worker.
Some couples stay together for years, while others find the relationship too volatile to sustain. The BPD relationship cycle is a recurring sequence of emotional highs and lows that can repeat many times unless both partners seek support.
A person with BPD fluctuates between calm and anger, happiness and sadness, affection and coldness, and empathy and anger. Their thoughts, emotions, and behaviors can change at any time. Their powerful emotions can be provoked by any incident, regardless of its seeming insignificance.
A key example here is the empathic paradox that occurs in patients with BPD. The empathic paradox, or borderline empathy paradox, is characterized by enhanced empathy, in spite of impaired interpersonal functioning.
But there are lots of positive things you can do to support them:
Explosive anger/rage
Intense and utter rage is the bedmate of those with BPD. They swing from one extreme emotion to often ones involving anger. But not the anger most people display but the type to seem like a bomb went off (screaming as loud as they can, breaking things, stomping, physically fighting, etc.)
People with BPD may have a history of impulsive behavior and chaotic relationships. Many fear being abandoned and may tend to see the world as purely black or white, some engage in self-harm or suicidal ideation.
How can I help myself in the longer term?
While psychopathy and BPD share characteristics such as impulsivity, they are distinct disorders with unique features. Psychopathy is often associated with a lack of empathy and remorse, manipulative behavior, and a grandiose sense of self-worth.
Clinicians can be reluctant to make a diagnosis of borderline personality disorder (BPD). One reason is that BPD is a complex syndrome with symptoms that overlap many Axis I disorders. This paper will examine interfaces between BPD and depression, between BPD and bipolar disorder, and between BPD and psychoses.
Research shows that between 26% and 54% of people with BPD experience hallucinations, delusions, or other types of psychosis. They're most likely to experience auditory hallucinations of repetitive words or whole phrases. Many people say that their hallucinations are connected to previous traumatic experiences.
Psychosocial factors
Empirical studies have established a strong correlation between adverse childhood experiences such as child abuse, particularly child sexual abuse, and the onset of BPD later in life.
The symptoms of BPD are very broad, and some can be similar to or overlap with other mental health problems, such as: Bipolar disorder. Complex post-traumatic stress disorder (C-PTSD) Depression.
Common BPD medications include antidepressants (Prozac, Zoloft, Effexor, Wellbutrin), antipsychotics (Abilify, Seroquel, Risperdal, Zyprexa), mood stabilizers/anticonvulsants (Lithobid, Depakote, Lamictal, Tegretol), and anti-anxiety drugs (Ativan, Xanax, Klonopin, Buspar).