Dissociated empathy and utilitarian moral judgment in borderline personality disorder

Borderline personality disorder (BPD) is characterized by affective instability, disrupted empathy, and self-processing. In this study, we aimed to investigate moral decision-making and its association with empathy in BPD compared to Control group (CG). 112 participants, 45 BPD, and 67 CG were recruited. They filled out a demographic questionnaire and completed the moral scenarios and Interpersonal Reactivity Index. We mainly used regression-based t-test, linear discriminant analysis, and canonical correlation analysis to analyze the data. Patients with BPD made more utilitarian decisions in all the moral scenarios (P-value < 0.05) and showed poorer perspective-taking , greater personal distress and fantasy (P-value < 0.05) with preserved empathic concern compared to CG. Morality, Empathy, and a combined Morality Empathy score had classification accuracies of 73%, 79%, and 84%, respectively, between BPD and CG groups.Canonical correlation analysis showed a significant association between moral and empathy scores’ spaces only in the BPD group. Most of empathy dimensions were significantly correlated only in the CG [empathic concern and personal distrress, and fantasy (P-value = 0.002 and < 0.001)]. The a typical structure of empathy in BPD may be related to differences in moral decision-making, reflected in increased utilitarian responses.