Une analyse qualitative du sentiment chronique de vide

Abstract

ObjectiveThe chronic feeling of emptiness is an affective disturbance experienced by patients suffering from borderline personality disorder, and is poorly described in the literature. It is often assimilated to other feelings like boredom, hopelessness, helplessness, or aloneness. It is difficult to describe and to assess. It is, however, a persistent symptom of borderline personality disorder. Thus, the objective of this qualitative study is to provide a detailed description of chronic emptiness. MethodWe carried out a thematic analysis of the descriptions of the chronic feeling of emptiness given by 37 patients clinically diagnosed with borderline personality disorder (including 33 women), mean age of 33.8±10.5 years. The data were collected during a diagnostic interview. All participants also had at least one comorbid psychiatric disorder; especially depression or anxiety was highly prevalent in our sample. ResultsEmptiness was described by means of 13 categories. Five categories referring to the theme of absence (of content, of feeling, of finality, of loss, and death), three categories related to the content of emptiness (negative affect, fear, and bodily sensations) and five categories evoking experiences closely associated with the feeling of emptiness (aloneness, confusion, autopilot mode, distancing, and physical descriptions). The most frequently used categories to describe the emptiness feeling were the absence of finality, death, the absence of feeling and the absence of content. ConclusionsWe discussed and confronted our categories to the existing literature on chronic emptiness in patients suffering from borderline personality disorder. Absence seems to represent the essence of this experience, with several nuances evoking a multidimensional concept. The frequent occurrence of descriptions of death by patients is evocative of a close relation between chronic emptiness and suicide. The emptiness feeling may also include a particular feeling, composed of negative affect (the most reported one in our study was fear), and bodily sensations. Aloneness was described as a kind of intolerance of being alone and the description of confusion could vary along a continuum; from confused feelings to an altered self-image. Finally, some experiences closely associated with emptiness such as autopilot and distancing could appear to be protective. Surprisingly, boredom was not reported by our sample of patients. The categories revealed in this thematic analysis are mirrored in the literature. It is however important to remind the strong comorbidity of borderline personality disorder in our sample with comorbid psychiatric disorders, especially unipolar mood disorders. And, it is likely that the feeling of emptiness might also be dependent on the psychological context in which it occurs. It is however not possible to disentangle the subjective feeling of emptiness of borderline personality disorder from that of depressive mood. Moreover, emptiness being a vague and an evolving feeling, this transversal study does not allow marking out its contours. Actually, many descriptions may seem similar to clinical concepts such as; anhedonia, avolition, apathy or dissociation. Another limitation of this study is that our analysis is predominantly based on a feminine sample and our results cannot be generalized to men. Finally, we based our analysis on the spontaneous responses of participants asked to describe their experience of emptiness; we did not deepen the questioning in order to not influence the answers’ content; however, this strategy may have limited the richness of the descriptions. Nevertheless, this study is a first qualitative analysis of emptiness in French language and it allows a better understanding of this diagnostic criterion, which is often not well assessed and explained.