Compassion, empathy and altruism in the context of borderline personality disorder: a conceptual narrative review

This narrative review examines compassion, empathy and altruism in the context of borderline personality disorder (BPD), arguing that difficulties in these domains, often described in clinical literature as empathic or relational ‘deficits’, are better understood as psychosocial responses to trauma, invalidation and relational adversity. Drawing from personality psychology, clinical research and lived-experience scholarship, the review explores how prosocial capacities are shaped by emotional dysregulation, relational trauma and systemic invalidation within social contexts. Rather than framing impairments in compassion, empathy or altruism as fixed intrapsychic traits, the review reconceptualises them as context-dependent adaptations to adversity. Particular attention is given to fear of compassion, disruptions in cognitive and affective empathy, and altruistic behaviours motivated by insecurity. Examining how these constructs interact and contribute to relational functioning and recovery, this review builds a conceptual foundation for more person-centred, trauma-informed care. By situating empathy and compassion within lived social contexts rather than within presumed personality deficits, the article reframes BPD as a psychosocial condition shaped by relational experience.