Early affective empathy, emotion contagion, and empathic concern in borderline personality disorder: A systematic review and meta-analysis

Background: Individuals with Borderline Personality Disorder (BPD) are theorized to experience lower cognitive empathy but heightened affective empathy. Despite meta-analyses addressing cognitive empathy, affective empathy remains unexplored. This pre-registered systematic review and meta-analysis investigated affective empathy in individuals with BPD or high BPD traits relative to healthy comparisons, using a multidimensional approach including, early affective empathy, emotion contagion, and empathic concern. Methods: Systematic search of SCOPUS, PubMed, Medline COMPLETE, and PsycINFO (June 27, 2022, May 14, 2023, and July 1, 2024) was completed. Included studies compared affective empathy in those with BPD/high BPD traits with healthy comparisons, utilized experimental or self-report designs, and were peer-reviewed or PhD theses. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Among 22 eligible studies identified, results revealed individuals with BPD/high BPD traits showed significantly higher emotion contagion (N-pooled = 1797, g = -1.10, 95 % CI [-1.57, -0.62]). No significant differences were found in empathic concern (N-pooled = 1545, g = 0.06, 95 % CI [-0.10, 0.22]), or early affective empathy for anger (N-pooled = 245, g = 0.28, 95 % CI [-0.0.53, 1.09]) and happiness, (N-pooled = 189, g = 0.34, 95 % CI [-0.1.50, 2.18]) Limitations: Few included studies for early affective empathy, methodological shortcomings in the broader literature and study heterogeneity suggest caution when interpreting these effects, emphasizing the need for targeted research. Conclusions: While individuals with BPD/high BPD traits are more likely to subjectively experience others' distress through emotion contagion, no differences were found in early affective empathy or ability to direct sympathy and concern towards others.