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Reduced activation in empathy core regions during observation of social interactions in patients with borderline personality disorder: an fMRI-study
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  • Published: 03 April 2026

Reduced activation in empathy core regions during observation of social interactions in patients with borderline personality disorder: an fMRI-study

  • Vera Flasbeck  ORCID: orcid.org/0000-0001-6405-45671,
  • Björn Enzi1,
  • Georg Juckel1 &
  • …
  • Martin Brüne  ORCID: orcid.org/0000-0002-2507-05611 

Translational Psychiatry , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

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  • Human behaviour
  • Neuroscience

Abstract

Patients with Borderline personality disorder (BPD) are known to exhibit aberrant empathy and heightened sensitivity to social threat. However, the neural mechanisms underlying these observations are not fully understood. In the present study, we therefore sought to assess empathy for somatic and psychological pain during a Social Interaction Empathy Task (SIET) in female patients with BPD (n = 50) and healthy participants (n = 55) during functional magnetic resonance imaging (fMRI). We further examined pain thresholds during a pain-pressure test (PPT) to the thenar muscles, self-harm behaviour, trait empathy, alexithymia and severity of BPD symptoms. Patients with BPD showed higher pain ratings for psychological pain and neutral conditions during the SIET, and higher pain ratings for psychological pain when rating from a first-person perspective, compared to a third-person perspective. The fMRI data revealed reduced activations in clusters including the right insula and hippocampus, bilateral superior and middle frontal gyri, left middle temporal gyrus, left pre-and postcentral gyri, left putamen and right anterior cingulum in patients with BPD. Activations of the left middle temporal gyrus when observing neutral scenarios correlated negatively with alexithymia and self-harm behaviour in the whole sample. In controls, middle temporal gyrus activation during viewing psychological pain was related to perspective taking (IRI), a capacity that was notably reduced in the patient group. Patients further exhibited elevated pain thresholds during the PPT and reduced pain intensity ratings for the right thenar. The findings indicated that patients with BPD showed altered processing of social interactions, speculatively due to deficits in perspective taking.

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Data availability

The data from this study are available upon request. Enquiries should be directed to the corresponding author.

References

  1. Sansone RA, Sansone LA. Personality disorders: a nation-based perspective on prevalence. Innov Clin Neurosci. 2011;8:13–8.

    Google Scholar 

  2. Volkert J, Gablonski T-C, Rabung S. Prevalence of personality disorders in the general adult population in western countries: systematic review and meta-analysis. Br J Psychiatry. 2018;213:709–15.

    Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Publishing: Washington, DC, 2013.

  4. Gunderson, JG Borderline personality disorder: a clinical guide, 2009.

  5. Fonagy P. Attachment and borderline personality disorder. J Am Psychoanal Assoc. 2000;48:1129–46. discussion 1175-87.

    Google Scholar 

  6. Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand. 2020;141:6–20.

    Google Scholar 

  7. Domes G, Schulze L, Herpertz SC. Emotion recognition in borderline personality disorder-a review of the literature. J Personality Disord. 2009;23:6–19.

    Google Scholar 

  8. Daros AR, Zakzanis KK, Ruocco AC. Facial emotion recognition in borderline personality disorder. Psychol Med. 2013;43:1953–63.

    Google Scholar 

  9. Mitchell AE, Dickens GL, Picchioni MM. Facial emotion processing in borderline personality disorder: a systematic review and meta-analysis. Neuropsychol Rev. 2014;24:166–84.

    Google Scholar 

  10. Donegan NH, Sanislow CA, Blumberg HP, Fulbright RK, Lacadie C, Skudlarski P, et al. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003;54:1284–93.

    Google Scholar 

  11. Minzenberg MJ, Fan J, New AS, Tang CY, Siever LJ. Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Res. 2007;155:231–43.

    Google Scholar 

  12. Wrege JS, Ruocco AC, Euler S, Preller KH, Busmann M, Meya L, et al. Negative affect moderates the effect of social rejection on frontal and anterior cingulate cortex activation in borderline personality disorder. Cogn Affect Behav Neurosci. 2019;19:1273–85.

    Google Scholar 

  13. Domsalla M, Koppe G, Niedtfeld I, Vollstädt-Klein S, Schmahl C, Bohus M, et al. Cerebral processing of social rejection in patients with borderline personality disorder. Soc Cognit Affect Neurosci. 2014;9:1789–97.

    Google Scholar 

  14. Jeung H, Herpertz SC. Impairments of interpersonal functioning: empathy and intimacy in borderline personality disorder. Psychopathology. 2014;47:220–34.

    Google Scholar 

  15. Lazarus SA, Cheavens JS, Festa F, Zachary Rosenthal M. Interpersonal functioning in borderline personality disorder: a systematic review of behavioral and laboratory-based assessments. Clin Psychol Rev. 2014;34:193–205.

    Google Scholar 

  16. Jackson PL, Meltzoff AN, Decety J. How do we perceive the pain of others? A window into the neural processes involved in empathy. NeuroImage. 2005;24:771–79.

    Google Scholar 

  17. Lamm C, Decety J, Singer T. Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. NeuroImage. 2011;54:2492–502.

    Google Scholar 

  18. Jackson PL, Brunet E, Meltzoff AN, Decety J. Empathy examined through the neural mechanisms involved in imagining how I feel versus how you feel pain. Neuropsychologia. 2006;44:752–61.

    Google Scholar 

  19. Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983;44:113–26.

    Google Scholar 

  20. Salgado RM, Pedrosa R, Bastos-Leite AJ. Dysfunction of empathy and related processes in borderline personality disorder: a systematic review. Harv Rev Psychiatry. 2020;28:238–54.

    Google Scholar 

  21. Blunden AG, Henry JD, Pilkington PD, Pizarro-Campagna E. Early affective empathy, emotion contagion, and empathic concern in borderline personality disorder: a systematic review and meta-analysis. J Affect Disord. 2024;367:462–78.

    Google Scholar 

  22. Dinsdale N, Crespi BJ. The borderline empathy paradox: evidence and conceptual models for empathic enhancements in borderline personality disorder. J Pers Disord. 2013;27:172–95.

    Google Scholar 

  23. Flasbeck V, Enzi B, Brüne M. Enhanced processing of painful emotions in patients with borderline personality disorder: a functional magnetic resonance imaging study. Front Psychiatry. 2019;10:357.

    Google Scholar 

  24. Flasbeck V, Enzi B, Brüne M. Altered empathy for psychological and physical pain in borderline personality disorder. J Pers Disord. 2017;31:689–708.

    Google Scholar 

  25. Bohus M, Limberger M, Ebner U, Glocker FX, Schwarz B, Wernz M, et al. Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res. 2000;95:251–60.

    Google Scholar 

  26. Schmahl C, Baumgärtner U. Pain in borderline personality disorder. Mod Probl Pharmacopsychiatry. 2015;30:166–75.

    Google Scholar 

  27. Bechi M, Brüne M, Agostoni G, Bortolla R, Bongiorno MV, Spada G, et al. Disentangling empathy for psychological and physical pain in borderline personality disorder: the interplay with clinical features and emotional competence. Eur J Psychiatry. 2026;40:100339.

    Google Scholar 

  28. Simmons JP, Nelson LD, Simonsohn U A 21 word solution. SSRN Journal 2012;26.

  29. Margraf J, Cwik JC, Pflug V, Schneider S. Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne. Z für Klinische Psychologie und Psychotherapie. 2017;46:176–86.

    Google Scholar 

  30. Turner BO, Paul EJ, Miller MB, Barbey AK. Small sample sizes reduce the replicability of task-based fMRI studies. Commun Biol. 2018;1:62.

    Google Scholar 

  31. Oldfield RC PsycTESTS Dataset. American Psychological Association (APA), 1971.

  32. Lehrl S Mehrfachwahl-wortschatz-intelligenztest: MWT-B. Spitta: Balingen, 1999.

  33. Ruscheweyh R, Marziniak M, Stumpenhorst F, Reinholz J, Knecht S. Pain sensitivity can be assessed by self-rating: development and validation of the pain sensitivity questionnaire. Pain. 2009;146:65–74.

    Google Scholar 

  34. Paulus C Saarbrücker Persönlichkeits-Fragebogen (SPF)[Saarbrücken personality questionnaire]: Based on the interpersonal reactivity index (IRI) including new items (V3. 0): Saabrücken, 2006.

  35. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto alexithymia scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38:23–32.

    Google Scholar 

  36. Bach M, Bach D, De Zwaan M, Serim M, Böhmer F. Validation of the German version of the 20-item Toronto alexithymia scale in normal persons and psychiatric patients. Psychother Psychosom Med Psychol. 1996;46:23–28.

    Google Scholar 

  37. Klinitzke G, Romppel M, Häuser W, Brähler E, Glaesmer H. Die deutsche version des childhood trauma questionnaire (CTQ) - psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe. Psychother Psychosom Med Psychol. 2012;62:47–51.

    Google Scholar 

  38. Bohus M, Kleindienst N, Limberger MF, Stieglitz R-D, Domsalla M, Chapman AL, et al. The short version of the borderline symptom list (BSL-23): development and initial data on psychometric properties. Psychopathology. 2009;42:32–39.

    Google Scholar 

  39. Gratz KL. Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. J Psychopathol Behav Assess. 2001;23:253–63.

    Google Scholar 

  40. Fliege H, Kocalevent R-D, Walter OB, Beck S, Gratz KL, Gutierrez PM, et al. Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates. J Psychosom Res. 2006;61:113–21.

    Google Scholar 

  41. Beck AT, Steer RA, Brown G PsycTESTS Dataset. American Psychological Association (APA), 1996.

  42. Kühner C, Bürger C, Keller F, Hautzinger M. Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Befunde aus deutschsprachigen Stichproben. Der Nervenarzt. 2007;78:651–56.

    Google Scholar 

  43. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. J Strength Cond Res. 2009;23:312–14.

    Google Scholar 

  44. Rolke R, Baron R, Maier C, Tölle TR, Treede -DR, Beyer A, et al. Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain. 2006;123:231–43.

    Google Scholar 

  45. Flasbeck V, Brüne M. Neural correlates of empathy for physical and psychological pain. J Psychophysiol. 2019;33:54–63.

    Google Scholar 

  46. Flasbeck V, Enzi B, Brüne M. Childhood trauma affects processing of social interactions in borderline personality disorder: An event-related potential study investigating empathy for pain. World J Biol Psychiatry. 2019;20:278–88.

    Google Scholar 

  47. Flasbeck V, Matthiessen A, Alabowitz A, Rusu AC, Brüne M. Is your pain my pain? A study exploring the relation between pain sensitivity, pain thresholds and empathy for somatic and psychological pain. Br J Clin Psychol. 2023;62:748–61.

    Google Scholar 

  48. Friston KJ, Holmes AP, Worsley KJ, Poline J-P, Frith CD, Frackowiak RSJ. Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp. 1994;2:189–210.

    Google Scholar 

  49. Friston KJ, Fletcher P, Josephs O, Holmes A, Rugg MD, Turner R. Event-related fMRI: characterizing differential responses. NeuroImage. 1998;7:30–40.

    Google Scholar 

  50. Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N, et al. Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage. 2002;15:273–89.

    Google Scholar 

  51. Maldjian JA, Laurienti PJ, Kraft RA, Burdette JH. An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets. NeuroImage. 2003;19:1233–39.

    Google Scholar 

  52. Brett. 8th international conference on functional mapping of the human brain. Region of interest analysis using an SPM toolbox 2002: 497.

  53. de Meulemeester C, Lowyck B, Luyten P. The role of impairments in self-other distinction in borderline personality disorder: a narrative review of recent evidence. Neurosci Biobehav Rev. 2021;127:242–54.

    Google Scholar 

  54. Martin F, Flasbeck V, Brown EC, Brüne M. Altered mu-rhythm suppression in borderline personality disorder. Brain Res. 2017;1659:64–70.

    Google Scholar 

  55. Arioli M, Cattaneo Z, Ricciardi E, Canessa N. Overlapping and specific neural correlates for empathizing, affective mentalizing, and cognitive mentalizing: a coordinate-based meta-analytic study. Hum Brain Mapp. 2021;42:4777–804.

    Google Scholar 

  56. Molenberghs P, Johnson H, Henry JD, Mattingley JB. Understanding the minds of others: a neuroimaging meta-analysis. Neurosci Biobehav Rev. 2016;65:276–91.

    Google Scholar 

  57. Fallon N, Roberts C, Stancak A. Shared and distinct functional networks for empathy and pain processing: a systematic review and meta-analysis of fMRI studies. Soc Cognit Affect Neurosci. 2020;15:709–23.

    Google Scholar 

  58. van Zutphen L, Siep N, Jacob GA, Goebel R, Arntz A. Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: a critical review of fMRI studies. Neurosci Biobehav Rev. 2015;51:64–76.

    Google Scholar 

  59. van der Heiden L, Scherpiet S, Konicar L, Birbaumer N, Veit R. Inter-individual differences in successful perspective taking during pain perception mediates emotional responsiveness in self and others: an fMRI study. NeuroImage. 2013;65:387–94.

    Google Scholar 

  60. Fales JL, Schmaling KB, Culbertson MA. Acute pain sensitivity in individuals with borderline personality disorder: a systematic review and meta-analysis. Clin Psychology: Sci Pract. 2021;28:341–57.

    Google Scholar 

  61. Schmahl C, Greffrath W, Baumgärtner U, Schlereth T, Magerl W, Philipsen A, et al. Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain. 2004;110:470–79.

    Google Scholar 

  62. Niedtfeld I, Schulze L, Kirsch P, Herpertz SC, Bohus M, Schmahl C. Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biol Psychiatry. 2010;68:383–91.

    Google Scholar 

  63. Dusi N, Bracco L, Bressi C, Delvecchio G, Brambilla P. Imaging associations of self-injurious behaviours amongst patients with borderline personality disorder: a mini-review. J Affect Disord. 2021;295:781–87.

    Google Scholar 

  64. Nance M, Stetsiv K, McNamara IA, Carpenter RW, Hepp J. Acute, chronic, and everyday physical pain in borderline personality disorder. Curr Psychiatry Rep. 2024;26:240–48.

    Google Scholar 

  65. Ducasse D, Courtet P, Olié E. Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review. Curr Psychiatry Rep. 2014;16:443.

    Google Scholar 

  66. Stellar JE, Manzo VM, Kraus MW, Keltner D. Class and compassion: socioeconomic factors predict responses to suffering. Emotion. 2012;12:449–59.

    Google Scholar 

  67. Piff PK, Kraus MW, Côté S, Cheng BH, Keltner D. Having less, giving more: the influence of social class on prosocial behavior. J Personality Soc Psychol. 2010;99:771–84.

    Google Scholar 

  68. Button KS, Ioannidis JPA, Mokrysz C, Nosek BA, Flint J, Robinson ESJ, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14:365–76.

    Google Scholar 

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Acknowledgements

This work was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Project number 497230718.

Funding

Open Access funding enabled and organized by Projekt DEAL.

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Authors and Affiliations

  1. LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany

    Vera Flasbeck, Björn Enzi, Georg Juckel & Martin Brüne

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  1. Vera Flasbeck
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  2. Björn Enzi
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  3. Georg Juckel
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Contributions

VF: Conceptualization; Investigation; Data Curation; Methodology; Software; Formal Analysis; Visualization; Funding Acquisition; Writing – Original Draft Preparation. BE: Data Curation; Methodology; Software; Formal Analysis; Validation; Writing – Review & Editing. GJ: Resources; Project Administration; Supervision; Writing – Review & Editing. MB: Conceptualization; Funding Acquisition; Project Administration; Resources; Writing – Review & Editing. All authors have approved the final article.

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Correspondence to Vera Flasbeck.

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Flasbeck, V., Enzi, B., Juckel, G. et al. Reduced activation in empathy core regions during observation of social interactions in patients with borderline personality disorder: an fMRI-study. Transl Psychiatry (2026). https://doi.org/10.1038/s41398-026-03989-5

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  • Received: 03 September 2025

  • Revised: 25 February 2026

  • Accepted: 16 March 2026

  • Published: 03 April 2026

  • DOI: https://doi.org/10.1038/s41398-026-03989-5

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