What does it mean to feel empty?

What is the feeling of emptiness?

Chronic feelings of emptiness in borderline personality disorder

If we had to sum up borderline personality disorder (BPD) in one word, it would be instability. BPD has a relatively high prevalence in the general population. It is characterised by unstable interpersonal relationships, emotional dysregulation, feelings of abandonment and a negative self-image. It can also involve self-harm, suicidal ideation and suicide attempts, and other impulsive behaviour.

Chronic feelings of emptiness are one of the diagnostic criteria in the DSM-5. In BPD, this can be one of the most persistent symptoms and one of the hardest to treat. It is also among the least studied, with limited evidence about its treatment. One reason may be how subjective and difficult to define the experience is. The article describes three aspects: a bodily or physical experience, social disconnection, and a lack of purpose and personal fulfilment.

What should therapy take into account when addressing feelings of emptiness?

Feelings of emptiness are closely linked to several important areas. Therapy may therefore consider identity, social belonging and interpersonal connection, dissociation, a sense of purpose and impulsive behaviour.

How can therapy address feelings of emptiness?

• Address the impulsive behaviour and experiential avoidance that can follow feelings of emptiness.
• Develop greater acceptance of the feeling and encourage a less negative view of it.
• Develop a coherent life story and a stable identity by integrating experiences, patterns of thinking and emotions from which we feel disconnected.
• Build a greater sense of social belonging and connection through interpersonal effectiveness skills.
• Develop a flexible and realistic self-concept.
• Address dissociation.
• Explore a sense of purpose and the values that guide our behaviour.

Feelings of emptiness can also occur in people with psychological difficulties other than personality disorders, and in people without a clinical diagnosis. Acknowledging this does not diminish the experience or make it a disorder in itself. The same is true of impulsive behaviour that may follow feelings of emptiness. In some cases the behaviour carries less risk than substance misuse or suicide attempts.

Feelings of emptiness are closely tied to our identity and sense of purpose, and to our experience of being human. A broader understanding can draw on philosophy, anthropology and spirituality alongside psychology, while retaining the psychological perspective.

REFERENCES

Klonsky, E. D. (2008). What is emptiness? Clarifying the 7th criterion for borderline personality disorder. Journal of Personality Disorders, 22(4), 418–426. https://doi.org/10.1521/pedi.2008.22.4.418

Lind, M., Vanwoerden, S., Bo, S., & Sharp, C. (2022). Borderline personality disorder in adolescence: The role of narrative identity in the intrapsychic reasoning system. Personality Disorders: Theory, Research, and Treatment, 13(5), 451–459. https://doi.org/10.1037/per0000517

Miller, C. E., Townsend, M. L., & Grenyer, B. F. S. (2021). Understanding chronic feelings of emptiness in borderline personality disorder: a qualitative study. Borderline Personality Disorder And Emotion Dysregulation, 8(1). https://doi.org/10.1186/s40479-021-00164-8