Is empathy is mental illness?

It is increasingly being recognised that many individuals who receive the diagnosis of BPD are naturally highly intuitive and perceptive. What was previously thought of as a genetic vulnerability may actually reflect an innate talent." 

People who were born emotionally intense, sensitive and are gifted with heightened perceptivity are like powerful sports cars. It is as if they have an extremely powerful engine that requires a special fuel and a specific kind of care. In the right condition and with the right keeping, they can be one of the most high-performing machines in the world and win many races. The problem is, however, that they may not have been taught how to run this powerful machine. To borrow a metaphor from psychologist Dr Hallowell, it is like having a Ferrari with bicycle brakes, and these brakes are simply not strong enough to control such a powerful engine.

Many emotionally intense people are diagnosed or misdiagnosed with various mental disorders throughout their lives, some of the most common ones are mood disorders, including bipolar disorder, attention deficit hyperactivity disorder (ADHD), eating disorders and personality disorders. Whilst these conditions are real and extremely painful, we should not immediately assume that they are signs of a defect.

A ‘diagnosis’ in psychiatry simply represents a cluster of symptoms, which are manifestations of internal conflicts and disease. In reality, the distinction from one disorder to another is unclear. The purpose of having these arbitrary categories is so that clinicians can fall back on a standardised framework to do research and to prescribe medication. Plus, they serve a purpose for the insurance industry. With the dominance of the medical model, we tend to pathologize and overlook the possibility that the distress may be a result of us not honouring our utterly unique make-up as individuals.  

In this article, we consider how this might be the case with BPD. It is increasingly being recognised that many individuals who receive the diagnosis of BPD are endowed with heightened sensitivity and perceptivity, and what was previously thought of as a genetic vulnerability may actually be a form of giftedness. Drawing on psychological research and theories, we see that many people who struggle with BPD do so as a result of two combing factors: 

A) their innate intuitive talents, and the specific developmental requirements that go along with it, and 

B) a childhood environment that fails to meet their emotions needs.

What does it mean to be 'hyper-empathic'?

BPD is also known as emotional dysregulation disorder or emotionally unstable personality disorder (World Health Organization, 1992). Despite being referred to as a ‘personality disorder’, it is not a character flaw but is best understood as a limitation in a person’s capacity to regulate emotions. This means that the person with BPD often experiences emotions as rapidly changing, or spiralling out of control. These symptoms go alongside impulsive self-soothing behaviours and a chronic sense of internal hollowness.

Although the link between BPD and empathy remains controversial, many people with BPD identify with the traits of being an “empath” or being hyper-empathic.

Empathy is broadly defined as the way we react to one another (Davis, 1983), and it defines how we conduct ourselves in this world. An empath is extremely sensitive to the emotions and energy of other people, animals and places (Orloff, 2011). Although the term ‘empath’ has not been used very much within the academia, psychologists have extensively studied what it is like to have high empathy, and they have found the following phenomenon:

• Individual differences in empathy level affect the way people recognise facial expressions (Besel and Yuille, 2010) and react to social cues (Eisenberg and Miller, 1987). 
• People with high empathy are better at recognising emotions in others. However, they also have a ‘bias’ towards negative emotional expressions, meaning that they are more sensitive and alert to negative feelings in others. Perhaps due to these propensities, they are also more likely to experience ‘empathic distress’ (Chikovani, Babuadze, Tamar Gvalia, Surguladze, 2015).  
• Interestingly, it was found that women with high empathy are better than their male counterparts in noticing and recognising sadness.
• Excessive empathy - an intense sharing of other’s negative emotions - is linked to emotional disorders in health professionals and caregivers. Their empathic distress is often framed as compassion fatigue or burnout. (Batson et al., 1987, Eisenberg et al., 1989, Gleichgerrcht and Decety, 2012). 

It is important that naturally empathic people learn to hone their empathic skills, such as emotional regulation, perspective taking, empathic accuracy (the ability to accurately identify and understand emotional states and intentions in yourself and others) (McLaren, 2013). Without these skills, many empaths ended up ‘absorbing’ the emotions of others to the point of being burned out. 

The 'borderline empathy paradox'

It has long been recognised that individuals with BPD seem to possess an uncanny sensitivity to other people’s subconscious mental content - thoughts, feelings and even physical sensations. They also seem to have a talent in involving and influencing others (Park, Imboden, Park, Hulse, and Unger, 1992, p. 227).

In the first study that explicitly investigates this observation, Frank and Hoffman (1986) found that individuals with BPD showed a heightened sensitivity to non-verbal cues when compared with people without BPD. This finding has been validated through other follow-up research (Domes, Schulze, and Herpertz, 2009). A well-known study, for instance, compared the way people with BPD react to photographs of people’s eyes to those without BPD. The researchers found that the BPD group was more able to correctly guess what emotions these eyes expressed, which showed their enhanced sensitivity to the mental states of others (Fertuck et al., 2012). 

At their best, these highly intuitive individuals’ ability would constitute what giftedness psychologists call 'personal intelligence' (Gardner,1985). This kind of giftedness consists of two components: ‘interpersonal intelligence’ - the capacity to understand the intentions, motivations and desires of other people, and ‘intra-personal intelligence’ - the capacity to understand oneself, to appreciate one’s feelings, fears and motivations.  

Despite their enhanced empathic ability, many people with BPD have difficulties navigating social and interpersonal situations. Without the ability to regulate their emotions and manage attachment relationships, their hypersensitivity may end up showing up as emotional storms and mood swings (Fonagy, Luyten, & Strathearn, 2011), being easily triggered by stressful situations, and a constant fear abandonment and rejection (Fertuck et al., 2009). This phenomenon is known as the ‘borderline empathy paradox’ (Franzen et al., 2011; Krohn, 1974). 

Why do I feel and see so much?

It is true that high empathy may be an outcome of growing up in a traumatic and unpredictable childhood environment. Indeed, many people with BPD have a history of abuse, neglect or prolonged separation as children. Some studies show that as many as 70% of the people with the disorder reported being sexually abused. 

As a response to confusing or neglectful parenting, these children had to ‘amp up’ their empathic functioning in order to protect themselves. They were trained by their environment to become highly attuned to the subconscious cues given out by their parents so that they can be prepared for their unpredictable behaviours.

Environmental factors alone, however, do not explain why many siblings who grow up in the same household are not affected in the same way. Thus, we must also consider the biological and innate temperament-based factors that affect people’s distinctive reactions to traumatic events. As psychologist Bockian (2002) suggested: “It is extremely unlikely that someone with a placid, passive, unengaged, aloof temperament would ever develop borderline personality disorder.”

Child psychologists have found that there is a subset of children who has ‘heightened sensitivity to the social world’, whose developmental and emotional outcomes are critically dependent upon their early childhood conditions. (Boyce, Chesney, Kaiser, Alkon-Leonard and Tschann, 1991)

In most cases, serious difficulties in emotional regulation, or BPD, is a result of two combing factors:

A) Being born with heightened sensitivity and a gift in perceptivity, and

B) a deficient or vicarious childhood environment that fails to meet these children’s emotions needs.

If it is a gift, why do I suffer so much?

Under favourable, 'good enough' circumstances, a child who is born with a gift in perceptivity would not grow up to have serious emotional regulation issues or BPD. However, if the primary caretakers did not have the capacity to attune to their child, or even resented or were threatened by their unusually perceptive child, they may consciously or subconsciously sabotage the child’s healthy development. The nature of psychological abuse may differ, but it always includes an assault on the child’s perceptions and the development of their autonomy.

For gifted children, ongoing negative feedback towards their intuitive perception is ‘particularly damaging’ (Park et al., 1992, p.228). 

Attachment theories have us know that children will do all they can in order to preserve a good image of their parents. Even when their parents are incompetent, abusive or neglectful, children naturally blame themselves because it is not safe to think of the people they depend on as ‘bad’ (Winnicott, 1960).  This scenario is complex if the child is naturally intuitive; many emotionally gifted children have strong feelings of love and responsibility for their parents and often feel compelled by a need or desire to take care of them. 

If the parents either explicitly or implicitly reject the child - he or she will internalise the shame of being rejected, and experience him/herself as being profoundly bad (toxic shame). As a result of their negative experience of themselves and those around them, these children’s natural gifts in perceptivity become ‘hijacked’ by negative bias and negative projections.

Without an environment where they can learn to set healthy boundaries and experience secure attachment without exploitation, these children develop ’symptoms’ such as an inability to self-soothe and regulate emotions, a fear of rejection, and a deep sense of internal hollowness. 

Many emotionally intense adults have struggled all their lives feeling lonely, misunderstood, with the belief that there is something deeply wrong with them. If you are one of them, I hope that you can reconsider the potential gifts that are within you. 

Whilst the history cannot be changed, you can re-write the story that you have been telling yourself. You are in no way ‘bad’. You are not ‘too much’. What you are, is a sensitive, intuitive, gifted individual, who were deprived of the right kind of nourishment as you were growing up. Your high level of awareness and acuity to subtleties is not only unusual but also extremely precious.

Because of your innate perceptivity, you cannot ‘un-see’ or ‘un-feel’ things. Perhaps like a poppy that has outgrown his peers, you were being shamed and ‘chopped down’. Your struggles are not your fault, and the shame that you carry is a natural reaction to a childhood environment that has failed to support you. 

Perhaps there is a little voice within you that have always known you were not fundamentally wrong. If you can begin to listen to that voice, you can liberate yourself to retrieve the long-forgotten gifts inside you.

Your psyche wants to heal. Once you can begin to recognise and trust your own fundamental goodness, restoration and integration would naturally happen.