Say the words “Borderline Personality Disorder” (BPD) to someone who is unfamiliar with personality disorders and you’ll likely get a response that highlights “anger issues,” suicidality, impulsivity, and fear of abandonment. Borderline Personality Disorder (BPD) is a complex condition characterized by instability of one’s self-concept, emotions, and behavior. What many people don’t know is that that BPD exists on a spectrum, where the various combinations of symptoms are broken down into sub-types, resulting in a variety of presentations. While the general populations’ understanding of BPD isn’t necessarily wrong, it is certainly a surface level conceptualization that doesn’t take into account the many nuances and presentations that make up the full spectrum of BPD.

BPD CRITERIA

Of the nine criteria for a BPD diagnosis listed in the DSM-5, the concept of “chronic emptiness“ recently caught my attention. While this criterion has always been included in the diagnostic picture of BPD, it is one that is transdiagnostic, meaning that it is a criterion for other mood and personality disorders, and is thus, difficult to define as well as to treat.The research around chronic emptiness has often been vague and contradictory, perhaps owing to it’s presence in multiple disorders. Science has often conflated chronic emptiness with similar, but different concerns: hopelessness, boredom, or loneliness.

Early theory suggested that those who experience chronic emptiness lack an ability to “experience themselves, others, or the world fully,” also described as “an absence of self- feeling,” while attachment theories look to signs of invalidation from early caregivers. Biosocial theories suggest that chronic emptiness are indicated by a “dysregulation of identity,” not understanding one’s own personal experience. The commonality across different theories points to emptiness being the result of a disconnection from self and others.

WHAT DOES CHRONIC EMPTINESS FEEL LIKE?

Chronic emptiness has been likened by patients as having the facade of an actor without the emotional depth needed to capture the role, a “chameleon-like quality” that masks one’s internal emptiness. It has also been described as “woodenness,” “numbness,” and “isolation.” Other clients report attempting to fill their emptiness through accumulation of knowledge or experience, perhaps in an effort to better relate to others. And still others try to fill the void through impulsive behavior, including self-harm.

A recent study by Miller et. al found correlation between chronic emptiness and “lower meaning in life, heightened detachment, separation insecurity, intimacy avoidance, anhedonia, and withdrawal,” while another study that looked at intakes of BPD patients found links between those who endorse chronic emptiness and high level of sick days/poor performance at work as well as lowest social functioning.

It’s important to have an appreciation for the unique characteristics of chronic emptiness, and to refrain from treating it as a synonym for sadness. This is where misdiagnosis tends to occur: chronic emptiness may be a symptom of BPD, but can also look like dysphoria, MDD, or Avoidant Personality Disorder. Further study and targeted treatment are clearly needed, as chronic emptiness seems to be one of the most difficult feelings to alleviate over the course of one’s lifetime, whereas other symptoms (i.e. suicidality/self-harm) can “mature out” during adulthood.

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