Measuring the shadows: Chronic feelings of emptiness in borderline personality disorder

Chronic feelings of emptiness is a symptom of Borderline Personality Disorder (BPD) which has not undergone rigorous examination, despite theoretical and empirical indications supporting its significance. This thesis comprises three studies which explore the importance, influence, and nature of chronic feelings of emptiness for people with BPD. Study One investigated previous work on the importance of chronic feelings of emptiness using a PRISMA guided systematic review. Findings from 99 empirical studies indicated a difficulty defining and quantifying chronic emptiness. It was proposed that chronic emptiness may be conceptualised as a sense of disconnection from both self and others. Emptiness appeared to have a chronic course with low remission, and was associated with distress (i.e., impulsivity, self-harm, suicide) and dysfunction (i.e., reduced social and vocational function). Chronic feelings of emptiness were found to be distinct from hopelessness, loneliness and intolerance of aloneness, and may be related to a unique ‘borderline depression’. Study Two investigated longitudinally 199 individuals presenting for treatment of BPD. Severity of chronic emptiness at intake was associated with impaired vocational ability at twelve-month follow-up, mediated by severity of impulsivity and frequency of self-harm. These findings suggest that chronic emptiness may underlie more acute and impulsive behaviours for people with BPD resulting in difficulties engaging meaningfully in psychosocial pursuits. Study Three qualitatively analysed the verbal accounts of 15 participants to understand the nature of chronic emptiness for people with a lived experience of BPD. Chronic feelings of emptiness were experienced as a sense of numbness and nothingness representing a feeling of disconnection with self and others which resulted in feelings of unfulfillment and purposelessness. Participants largely experienced chronic feelings of emptiness as distressing, and some engaged in adap