Understanding chronic feelings of emptiness in borderline personality disorder: a qualitative study

Caitlin E Miller,Brin F S Grenyer,Michelle L Townsend

doi:10.1186/s40479-021-00164-8

Abstract

BackgroundChronic feelings of emptiness are significant in the lives of people with Borderline Personality Disorder (BPD). Feelings of emptiness have been linked to impulsivity, self-harm, suicidal behaviour and impaired psychosocial function. This study aimed to understand the experience of chronic emptiness, the cognitions, emotions and behaviours linked to emptiness, and clarify the differences between chronic emptiness and hopelessness, loneliness and depression.MethodsThis study interviewed people (n = 15) with BPD and used a template analysis qualitative approach to understand their experiences of chronic feelings of emptiness.ResultsChronic feelings of emptiness were experienced as a feeling of disconnection from both self and others, and a sense of numbness and nothingness which was frequent and reduced functional capacity. Feelings of purposelessness and unfulfillment were closely associated with emptiness, and most participants experienced emptiness as distressing. Responses to feelings of emptiness varied, with participants largely engaging in either impulsive strategies to tolerate feelings of emptiness or distracting by using adaptive behaviours. Most participants distinguished chronic feelings of emptiness from loneliness, hopelessness, dissociation, and depression.ConclusionsFeelings of chronic emptiness are an important and challenging symptom of BPD which require clinical intervention. Strengthening identity, sense of purpose and vocational and relationship functioning may reduce the intensity of emptiness.

Highlights

Chronic feelings of emptiness are significant in the lives of people with Borderline Personality Disorder (BPD)
While participants in this study provided a range of short-term measures to prevent, tolerate and alleviate chronic feelings of emptiness, the field may benefit from studies trying to understand how to reduce the severity and impact of chronic emptiness over the longer-term for people with BPD
Investigation Data curation Formal analysis Writing – original draft Writing – reviewing and editing Conceptualisation Methodology Formal Analysis Validation Writing – reviewing and editing Supervision Conceptualisation Methodology Resources Writing – reviewing and editing Supervision. This novel study found that for people with BPD, chronic emptiness is experienced as a sense of nothingness and numbness that reflects a feeling of disconnection from both self and others

Summary

Introduction

Chronic feelings of emptiness are significant in the lives of people with Borderline Personality Disorder (BPD). Borderline personality disorder (BPD) is characterised by pervasive distress and dysfunction in self and interpersonal spheres [1, 2] Within both categorical and dimensional models of classification, chronic feelings of emptiness is included as a symptom of BPD. There have been recent efforts to increase the understanding of chronic emptiness, with researchers defining it as comprising a Miller et al Borderline Personality Disorder and Emotion Dysregulation (2021) 8:24 feeling of detachment and disconnection from both self and other people [4]. Chronic emptiness has been considered one of twelve temperamental symptoms of BPD (alongside other predominant symptoms e.g. chronic depression, feelings of helplessness and hopelessness, abandonment fears), which compared to more acute symptoms (e.g. affective instability, self-injury, unstable relationships) are slow to resolve over time with low remission and high recurrence rates over 16 years [16]

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