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Personality disorders
Atypical empathy is a trait of some personality disorders, including psychopathy, narcissistic personality disorder, borderline personality disorder, schizophrenia and schizoid personality disorder, depersonalization, bipolar disorder, and schizoid personality disorder. Recent evidence points to two separate systems for empathy: an emotional system that guides our ability to empathize in an emotional level and a cognitive system that guides our cognitive understanding of another person's perspective. This may explain why some individuals may show damage or deterioration at an emotional level yet exhibit no deficiencies at a cognitive level and vice versa.

Borderline Personality Disorder
Borderline personality disorder is characterized by extensive behavioral and interpersonal difficulties that arise from emotional and cognitive dysfunction. Dysfunctional social and interpersonal behavior has been shown to play a crucial role in the way people with borderline personality disorder react to stimuli in such an emotionally intense way. While borderline personality disorder individuals may show their emotions too much, several authors have suggested that they might have a compromised ability to reflect upon mental states (cognitive empathy), as well as an impaired Theory of mind.

Previous reports have shown that people with borderline personality disorder are very good at recognizing emotions in people's faces, suggesting increased empathic capacities. It is, therefore, possible that impaired cognitive empathy (the capacity for understanding another person's experience and perspective) may account for borderline personality disorder individuals' tendency for interpersonal dysfunction, while 'hyper-emotional empathy' (the ability to share the emotional state of another person) may account for the emotional over-reactivity observed in these individuals.

In a study done by Hagai Harari et. al, it was shown that patients with borderline personality disorder were significantly impaired in cognitive empathy, yet there was no sign of impairment in affective empathy. .

Compared with controls, atypical patterns of empathy are a trait of people with borderline personality disorder, with decreased cognitive empathy and increased affective empathy.

Psychopathy
Psychopaths exhibit antisocial and aggressive behavior, as well as some emotional and interpersonal traits in the form of shallow emotions, manipulation of others, and lack of guilt and empathy for victims.

It has been suggested that adult psychopaths and children with psychopathic traits have particular impairments in recognizing distress cues (e.g. facial and vocal expressions of fear and sadness), yet are match control groups at recognizing other facial and vocal expressions of emotions like happiness. Individuals with psychopathy don't process signals of distress as unpleasant, which results in a lack of empathy which then fails to prevent behavior that creates distress in others.

Individuals with psychopathy have biological differences from controls when they implicitly process facial emotions. The underlying biological surfaces for processing facial expressions of happiness are functionally intact, although less responsive than those of controls. In contrast, individuals with psychopathy display an atypical pattern of response to fearful faces compared with neutral faces, including decreased activation of the fusiform and extrastriate cortical regions. This may partly account for impaired recognition of and reduced autonomic responsiveness to expressions of fear, and impairments of empathy.