Oxytocin May Promote Empathy in BPD Patients

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Oxytocin is a natural hormone that facilitates social bonding in mammals, particularly after childbirth to promote mother-infant bonding. A study published December 4, 2019, in Translational Psychiatry suggests that a single dose of oxytocin delivered intranasally may help to improve empathy in people with borderline personality disorder (BPD).

According to DSM-5, people with BPD exhibit behaviors such as mistrust, anxiety, and fear of abandonment that result in unstable and even hostile personal relationships. Some researchers believe that impaired empathy may be a significant cause of these interpersonal problems.

A team led by Gregor Domes, Ph.D., a professor of biological and clinical psychology at the University of Trier in Germany, recruited 51 adult women with BPD and 51 age-matched women without BPD to participate in a multifaceted empathy assessment after receiving one dose of intranasal oxytocin. Studies have suggested that intranasal oxytocin promotes different feelings in the sexes. This work focused on women, who are more likely to receive a BPD diagnosis than men.

Forty-five minutes prior to the empathy test, each woman received a single dose of intranasal oxytocin or placebo. To minimize the potential influence of oxytocin that is naturally produced in the body, none of the participants was pregnant, breastfeeding, or taking hormonal contraception (which elevates oxytocin levels); the women were also all tested at around the same time in their menstrual cycle.

For the empathy assessment, the women looked at a series of pictures showing people in emotional situations, both positive (pride, joy) and negative (sorrow, anger). The women were asked to identify the emotional state of the person pictured on the screen and rate their level of concern for that person. This measured both cognitive empathy (intellectually understanding someone else’s feelings) and emotional empathy (emotionally sharing another person’s feelings). The participants were also asked to rate their approach motivation—that is, how strongly they desired to be socially close to the person in the picture.

Among the women who received placebo, those with BPD scored lower on all three domains—cognitive empathy, affective empathy, and approach motivation—than women who did not have BPD. Domes and colleagues found that women with BPD were far less responsive to positive emotions than negative ones.

“It appears that BPD patients more easily empathize with people in aversive situations or in distress, while it is difficult for them to be empathic with people in positive social situations,” Domes and colleagues wrote. “This pattern is plausible, as negative emotions and situations are much more familiar to patients with BPD and thus negative emotions might be more easily accessible for BPD patients.”

Though intranasal oxytocin appeared to have no effect on cognitive empathy scores, both groups of women receiving oxytocin showed higher scores in emotional empathy and approach motivation than those who received placebo. In fact, the women with BPD who received oxytocin had similar scores on assessments of emotional empathy and approach motivation as the women without BPD who received placebo.

The authors cautioned that since this study only enrolled women, the findings may not apply to men with BPD.

“These results could provide the starting point for designing controlled clinical trials, focusing on treatment efficiency using [oxytocin] as an add-on treatment to cognitive behavioral psychotherapy in BPD,” Domes and colleagues wrote.

This study was supported by the German Research Foundation, the FAZIT Foundation, and the Research Innovation Fund of the Albert-Ludwigs-University of Freiburg. ■