Feeling hollow: examining the presence and emotional correlates of emptiness in borderline personality disorder

Feelings of emptiness represent a common experience among individuals with borderline personality disorder (BPD) that are not well understood. Theoretical literature suggests that emptiness functions to downregulate intense emotional experiences in BPD, but this has not been tested. This study examines whether (1) emptiness at baseline and emptiness in response to stressors (i.e. emptiness reactivity) is elevated in BPD relative to clinical and healthy controls (HCs), and whether (2) emptiness reactivity predicts emotion reactivity across self-report, skin conductance response (SCR), and respiratory sinus arrhythmia (RSA) indices of emotion. Participants (<i>N</i> = 120) with BPD, generalised anxiety disorder (GAD), or HCs provided measurements of emptiness, self-reported emotion, SCR, and RSA at baseline and following a rejection-themed stressor. Results revealed that baseline emptiness was highest in the BPD group compared to the HC group and the GAD group. There were no significant group differences for emptiness reactivity. Overall, increases in emptiness predicted increases and decreases in emotional reactivity via self-report and RSA, respectively. These results suggest that higher baseline emptiness rather than emptiness reactivity is characteristic of BPD. Future research using longitudinal and ecological momentary assessment designs is needed to examine the causes of emptiness and how it can be effectively reduced.