From inner void to harmful action: a controlled study of emptiness, self-destructive behaviors, and mentalizing in borderline personality disorder

Emptiness, a diagnostic criterion of borderline personality disorder (BPD) characterized by inner void, disconnection, and lack of fulfillment, is linked to self-destructive behaviors. This study examined associations between emptiness and self-destructive behaviors, focusing on the moderating role of mentalizing. Adults with BPD, psychiatric controls, and healthy controls ( n = 51 per group) completed the Subjective Emptiness Scale and a novel self-destructive behavior following emptiness inventory. General and emptiness-specific mentalizing were assessed in separate interviews, including a novel emptiness-focused interview, both coded with the Reflective Functioning Scale. ANOVAs and multiple regressions revealed that individuals with BPD reported greater emptiness and self-destructive behaviors but did not differ in general or emptiness-specific mentalizing. Across groups, emptiness predicted self-destructive behaviors; however, neither group nor mentalizing moderated this association. Findings underscore the clinical significance of emptiness in BPD and its broader association with self-destructive behaviors, while suggesting that retrospective mentalizing may not buffer this association.