How Do Patients With Borderline Personality Disorder Describe the Symptom of Chronic Emptiness?

Chronic emptiness in people with borderline personality disorder (BPD) is linked with feeling a lack of purpose, researchers found in a qualitative study published in Borderline Personality Disorder and Emotion Dysregulation.

Researchers included 15 patients (mean age 37.42 years, 12 women) from an ongoing longitudinal study who reported in an interview that they felt chronically empty at least “a good bit of the time” in the prior two weeks on a 0-6-point scale. The patients completed the BPD component of the Structured Clinical Interview for DSM-5 (SCID-II) and an interview regarding experiences of chronic emptiness. The investigators analyzed responses through template and critical realism ontological approaches.

Past two-week average chronic emptiness was 3.4 (SD 1.68). A total of 14 participants experienced abandonment fears and affective dysregulation, and 12 experienced identify disturbance and chronic emptiness. The four individuals who had chronic emptiness most or all the time were single, unemployed and aged a mean 50 years. Those with the least severe emptiness were married or in a relationships, were employed or caregiving, and were aged a mean 31 years.

Individuals typically described chronic emptiness as numbness, as in feeling disconnected from themselves and, less frequently, from others. Some said it occurred when they were experiencing interpersonal distress, when they were not busy or distracted, when they were not striving to connect with loved ones, or when they were preparing to go to sleep. It was associated with a feeling of a lack of purpose, such as low agency and self-direction, and unfulfillment. Emptiness was difficult to treat and frequent but not constant. Individuals reported that it led to less ability to function.

Individuals said chronic emptiness was disconnection from self and other people, not solely feeling a lack of relationships. Some linked it with hopelessness, with one person saying it was the same experience while others said emptiness is lack of feeling and hopelessness is distressing. A total of four participants said disconnection felt like a lack of being in tune with surroundings.

Individuals said that when they experienced emptiness, they tried to create feelings, avoid the experience, or chose it to inhibit intense emotions. They used certain strategies to prevent, cope with, and alleviate the symptom, such as: rumination, impulsive behaviors such as self-harm, behavioral activation skills (eg choosing to engage in alternative behaviors), sleeping, ignoring the emotions, or becoming aware of the emotion and choosing a coping strategy.

“Clinicians may benefit from looking beyond impulsive or self-destructive behaviors and exploring what experience spurs these behaviors,” the researchers said.

 “This may increase awareness, reflective capacity and mindfulness of emotion. Secondly, when clients are experiencing difficulty with chronic feelings of emptiness, clinicians may work collaboratively with clients to determine adaptive coping strategies. Specifically, it seems that engagement in vocation and relationships may serve as both a protective buffer against disconnection from self and others and subsequent emptiness. While strategies including behavioral activation may be helpful in replacing maladaptive strategies for coping with chronic emptiness, most participants noted that they are a short-term strategy.”

Reference

Miller CE, Townsend ML, Grenyer BFS. Understanding chronic feelings of emptiness in borderline personality disorder: a qualitative study. Bord Personal Disord Emot Dysregul. 8, 24 (2021). doi: 10.1186/s40479-021-00164-8