Borderline personality disorder (BPD) is an often misunderstood mental health condition. I was first diagnosis’d with the condition back in 2003, and I’m still learning more about it. One of the most important traits of BPD is chronic feelings of emptiness. A void most people with BPD have that they can be driven to fill, often from all the wrong places.
What Are Chronic Feelings Of Emptiness In BPD?
For the longest time, I’ve always defined my BPD by my poor ability to form and maintain attachments. That’s because I didn’t have a healthy attachment with my primary caregiver, my mum. But after taking a deeper look into the criteria of chronic feelings of emptiness, I’m starting to see this as my primary issue that hasn’t improved much since my childhood.
In the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV), chronic feelings of emptiness are listed as one of the nine criteria for a BPD diagnosis (Klonsky, 2008). This was the manual in use at the time of my BPD diagnosis. The criteria for chronic feelings of emptiness are still listed in the DSM-V for BPD, under the alternative diagnostic model which is associated with identity disturbance (Miller, Townsend, Day, and Grenyer, 2020).
For those of you that don’t know what the alternative diagnostic model is, then you’re not the only one, because neither did I. According to Skodol, Morey, Bender, and Oldham (2015), the Alternative Model describes pathological personality based on five personality traits. These five traits (negative affectivity, detachment, antagonism, disinhibition, and psychoticism), which are well-known and widely validated, consist of three to six other specific personality traits, called facets. Basically, five parent traits that have three to six child traits each, which are used to diagnosis personality disorders.
Simply put, both categorical and dimensional models of classification for BPD see chronic feelings of emptiness as a criterion (Miller, Townsend, and Grenyer, 2021).
People often talk about having a feeling of emptiness, but that can be confused with other feelings. What sets chronic feelings of emptiness apart in BPD is that it is distinguishable from feelings and experiences of depression and loneliness (Miller, Townsend, and Grenyer, 2021).
Chronic feelings of emptiness in BPD are less associated with boredom as well (Good Therapy; and Klonsky, 2008), which is another state it can often be confused with. This is why you can get people with BPD who could be on holiday or doing something that should be fun, but don’t feel anything. They don’t feel sad, but they don’t feel happy either; rather than the melancholy that is typical of depression, which has a similar observable effect.
In a study by Miller, Townsend, and Grenyer (2021), the participants said that feelings like depression came with feelings of distress. Whereas chronic feelings of emptiness came with an absence of everything. It’s a numbness that creates a feeling of disconnection from ourselves and others. The results of which are a feeling of unfulfilment and purposelessness.
Why Are Chronic Feelings Of Emptiness Harmful?
Where to start with this? Chronic feelings of emptiness might be the foundation of all the negative effects of having BPD. The chronic feelings of emptiness that might will define BPD, has been linked to impulsivity, self-harm, suicidal behaviour, and impaired psychosocial function, according to Miller, Townsend, and Grenyer (2021).
This is supported by Brickman, Ammerman, Look, Berman, and McCloskey (2014). Their study found that people with BPD and chronic feelings of emptiness were significantly positively associated with a lifetime of self-injury.
A study by Klonsky (2008) also found something interesting regarding chronic feelings of emptiness. This study found that there was an overlap with hopelessness. But that’s not the interesting part. The study also found that chronic feelings of emptiness were strongly related to suicidal ideation, but not suicide attempts. The link to suicide attempts was small.
However, Grilo and Udo (2021) found a different relationship between chronic feelings of emptiness and suicide attempts. Using a nationally representative sample of 36,309 US adult participants, they found that chronic feelings of emptiness were associated with an increased risk of suicide attempts. They also argued that risk assessments should consider chronic feelings of emptiness when assessing suicide risk.
Their argument to include chronic feelings of emptiness in risk assessments is supported by Yen et al. (2021). They conducted a longitudinal study over 10 years using semi-structured diagnostic interviews and a variety of self-report measure. Their study found that chronic feelings of emptiness may be a clinically overlooked feature of BPD regarding suicide risk.
This feels like it explains a lot about my own suicidal ideation, because I’ve lived with suicidal ideation since the age of eight, and I turned 41 yesterday. But although I still have suicidal thoughts, I haven’t attempted to take my life since 2003. Although I came close a few years ago while at university.
Another problem with chronic feelings of emptiness is how it affects our representations of ourselves and others, which can create an unstable identity and disconnection from people (Miller, Townsend, and Grenyer, 2021). A common problem for people like me of mixed ethnicity is you struggle with trying to find out where you fit in. You’re not quite one or the other, which can result in feeling like you’re unwanted by everyone. Which is what happened to me.
I grow up in a White family in an all White town, but my hometown made it very clear I wasn’t wanted by the White side of my ethnicity. But because I didn’t grow up anywhere near anything resembling Black culture, I didn’t feel Black either.
At different stages in my childhood, I wished I was fully White or fully Black, leaving me with a chaotic sense of identity. Ironically, it was the overwhelmingly White music alt subculture of metal that stabilised my identity. Not because it was White, but because it connected with me on an emotional level. The culture didn’t really care what my ethnicity was, so it meant I didn’t need to care about it either.
Long live METAL🤘🏽!
According to Miller, Townsend, Day, and Grenyer (2020), they found that both quantitative and qualitative studies supported chronic feelings of emptiness preceding impulsive behaviours in BPD. They suggested that when the void of emptiness becomes distressing, people tolerate that distress with impulsive behaviours. If true, this could explain how I developed a devil may care attitude to risk tasking and impulsivity in my late teens, rather than earlier when my BPD manifested in primary school.
When impulsivity and chronic feelings of emptiness work in tandem, they can cause people to skip work more often than someone without BPD (Ellison, Rosenstein, Chelminski, Dalrymple, and Zimmerman, 2016). But it can get worse than just missing work. Impulsivity and BPD can cause rapid and unplanned actions, as well as a preference for avoiding delayed gratification for instant rewards and pleasure (Lawrence, Allen, and Chanen, 2010).
Thus, people with BPD can easily develop unhealthy behaviours to help fill their void of chronic emptiness (Miller, Townsend, and Grenyer, 2021), which can lead to addiction. Although only 2.7% of adults have BPD, they make up 78% of adults with a substance-related disorder or addiction (Kienast, Stoffers, Bermpohl, and Lieb, 2014).
Because a lack of purpose is associated with the chronic feeling of emptiness in BPD and the negative effects that brings, I stabilised my BPD with several purposes. Having something that gave me a reason to stay alive kept me alive for years until I was able to stabilise my lack of identity for good. I went from my unhealthy reason for staying alive – to do more drugs, to having children, and to helping people avoid ending up like me and maybe having children. Each of these stages helped to manage my desire to die.
Although there appears to be a link between chronic feelings of emptiness and impulsive behaviour, Miller, Townsend, and Grenyer (2021) found that their participants hadn’t noticed the connection until it was brought up in the study. They hadn’t pieced together that they’re alleviating those feelings through their impulsive behaviours. And to be fair to them, I hadn’t either until just now. But it would explain my love of randomness and chaos when I was at my worst.
Miller, Townsend, Day, and Grenyer (2020) proposed suicidal ideation and suicide attempts would arise when self-harm and impulsive behaviours no longer relieve the distress of chronic feelings of emptiness. If this is true, then this would further dispute Klonsky (2008) findings. I know I used self-harm and drug binges to avoid taking my own life, so I can see this as something that could be true.
Rather bizarrely, Miller, Townsend, and Grenyer (2021) study found that some of their participants intentionally brought on their feelings of emptiness as a coping strategy. They would use this state to regulate other emotions and behaviours. Which I believe is something I did. My nihilism approach to life helps manage emotions and trauma I used to find problematic.
Furthermore, individuals with the BPD criterion of chronic feelings of emptiness had lower levels of social functioning (Ellison, Rosenstein, Chelminski, Dalrymple, and Zimmerman, 2016). Therefore, people who experience this will become further isolated, which will probably affect their feelings of emptiness. Our social circles help give us meaning, after all.
The Good Therapy also suggested that chronic feelings of empty and impulsivity are linked to not only an unstable sense of self, hopelessness, loneliness, and suicidal ideation, but also to infidelity. Not long ago I wrote an article about self-esteem and promiscuity, but the association Good Therapy suggests also makes sense for my BPD. When you have a void to fill, you’re impulsive, and you have an awful sense of self. Being promiscuous is something that could happen, and it won’t matter if you’re in a relationship or not. But that could just be my experience, as I was really messed up when I was younger. I was so desperate to feel wanted.
How To Manage Chronic Feelings Of Emptiness
In Miller, Townsend, and Grenyer (2021) study, they found that chronic feelings of emptiness arose from issues around participants’ identities. Thus, it stands to reason that working on your identity issues will not only help with your chronic feelings of emptiness, but your overall BPD as well.
I created reasons that were suitable for me at the time I thought of them, to manage my BPD and to give myself a reason to live, starting with wanting to try more drugs before I died. It’s not something any therapist would likely suggest (the drugs part), but it helped create some stability. I had created a goal for myself that worked for me on an individual level. It filled the emptiness in me long enough to get my shit together, eventually.
Therefore, finding goals to pursue (or a hobby) can help give you a sense of purpose and identity, like it did for me. Spending time to find out who you are and/or who you want to be could also be useful. A great way to do this might be to start a journal. The best go to for all your wellbeing needs.
Another approach to giving yourself a sense of purpose is to find a vocation and create relationships (Miller, Townsend, and Grenyer, 2021). Which is a lot easier said than done. I’m 41 and I still don’t think I’ve found my true vocation, but I have, nonetheless, found one that gives me a sense of fulfilment.
You could try doing evenings classes to help find something you might enjoy or something you’d like to pursue further. Many people get put off by trying a lot of different things, but that’s ok. We’re all different and there’s nothing wrong with continuing the search, as long as you’re not putting yourself at risk.
Also, building up relationships with people can help give you meaning and purpose, but make sure you don’t overcompensate and become a people-pleaser. I’ve been there. Websites like Meetup.com can be a great way to meet people who share your interests.
Because chronic feelings of emptiness are an important, yet challenging symptom of BPD, a clinical intervention could be the best course of action (Miller, Townsend, and Grenyer, 2021). Annoyingly, however, chronic feelings of emptiness have been an under-researched symptom of BPD, even though it’s likely central to the conceptualisation, course, and outcome of BPD treatment (Miller, Townsend, Day, and Grenyer, 2020; and Miller, Townsend, and Grenyer, 2021). Therefore, you may have to bring up this BPD trait yourself, if you have it, to make sure they give your chronic feelings of emptiness the time it needs to be worked on.
Chronic feelings of emptiness cause those with BPD to walk around feeling nothing. A lack of purpose and meaning that can cause our emotions to become numb. The research suggests that this criterion for BPD, more than any other, could influence all the negative things someone with BPD might do, such as acting impulsively and struggling with suicidal ideation and self-harm.
In short, chronic feelings of emptiness may very well be the central experience of those with BPD and treatment should focus on the self and how to healthily alleviate that emptiness (Miller, Townsend, Day, and Grenyer, 2020).
As always, leave your feedback in the comments section below. Also, please share your experiences with chronic feelings of emptiness and BPD in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
Brickman, L. J., Ammerman, B. A., Look, A. E., Berman, M. E., & McCloskey, M. S. (2014). The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Borderline personality disorder and emotion dysregulation, 1(1), 1-8. Retrieved from https://bpded.biomedcentral.com/articles/10.1186/2051-6673-1-14.
Ellison, W. D., Rosenstein, L., Chelminski, I., Dalrymple, K., & Zimmerman, M. (2016). The clinical significance of single features of borderline personality disorder: Anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients. Retrieved from https://digitalcommons.trinity.edu/cgi/viewcontent.cgi?article=1087&context=psych_faculty and https://digitalcommons.trinity.edu/psych_faculty/87.
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Lawrence, K. A., Allen, J. S., & Chanen, A. M. (2010). Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress. Journal of personality disorders, 24(6), 786–799. Retrieved from https://doi.org/10.1521/pedi.2010.24.6.785 and https://pubmed.ncbi.nlm.nih.gov/21158600.
Miller, C. E., Townsend, M. L., Day, N., & Grenyer, B. (2020). Measuring the shadows: A systematic review of chronic emptiness in borderline personality disorder. PloS one, 15(7), e0233970. Retrieved from https://doi.org/10.1371/journal.pone.0233970, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233970, and https://pubmed.ncbi.nlm.nih.gov/32609777.
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Skodol, A. E., Morey, L. C., Bender, D. S., & Oldham, J. M. (2015). The alternative DSM-5 model for personality disorders: A clinical application. American Journal of Psychiatry, 172(7), 606-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.14101220 and https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2015.14101220.
Yen, S., Peters, J. R., Nishar, S., Grilo, C. M., Sanislow, C. A., Shea, M. T., Zanarini, M. C., McGlashan, T. H, Morey, L. C., & Skodol, A. E. (2021). Association of borderline personality disorder criteria with suicide attempts: Findings from the collaborative longitudinal study of personality disorders over 10 years of follow-up. JAMA psychiatry, 78(2), 187-194. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2772883.