Price, S.L. & Mahler, H. IM. (2016, November). Subjective emptiness among adults with borderline personality disorder: An in-depth interview study. Poster at the Student Poster Showcase, California State University San Marcos, San Marcos, CA.

1. Introduction
• Chronic emptiness is a core feature of borderline personality
disorder (Kernberg, 1975 ; Stoffers et al., 2010) .
• Associated with depression (Trull & Widiger, 1991), self-
harm (Ahktar, 1984), substance use (Bockian & Villagran,
2011), and suicidal urges.
• Few empirical studies of emptiness exist among the
personality disorder literature.
• Methodological challenges related to defining the emptiness
construct have hindered empirical investigation (Didonna &
Gonzalez, 2009).
• Descriptions of the construct have remained ambiguous due
to conceptual disagreements among clinicians (Klonsky,
2008), discrepancies among patient descriptions (Didonna &
Gonzalez, 2009; Lamprell, 1994), and lexical constraints on
articulating the experience.
• Aim: The purpose of the present study was to inform
construct definition refinement and item generation for
developing a subjective emptiness self-report instrument by
exploring experiences of emptiness among adults living with
borderline personality disorder.
Procedure
Sampling and recruitment
• Purposive sampling with the aim of reaching saturation
• Blogs (e.g. WordPress) and YouTube channels
Interview
• In-depth semi-structured interviews conducted by one
interviewer via telephone and Skype (audio)
• Completion time ranged from 45- 180 minutes
• Written notes were taken during interview
• Consent and demographic information were first collected
• A series of increasingly close-ended questions were asked:
Recall past experiences of emptiness
Emotions
Thoughts
Perception of world/environment
Feeling versus fact
Interpersonal context
Presence of others
Social interaction
Manifestation in relationships
Latent meaning of conceptual metaphor
Associated feelings (see Figure 2)
Depression versus emptiness
Coding and Analysis
• Interview notes were used to develop exemplar quotes
• Respondents validated exemplar quotes and made
corrections, if applicable (i.e. member checking)
• Exemplar quotes were then thematically analyzed
In line with the Ego Defect and Defensive Theories of
emptiness, participant accounts predominantly reflected
feelings of disconnection from one’s internal experience,
particularly emotionally charged psychological material.
Overall, emptiness was described as a feeling that the
true self is absent, leaving in its place an artificial shell of
the person, devoid of affect and meaningful connection
with the world, life, and other people. One feels deeply
misunderstood and social interactions exacerbate this
sense of alienation. Moreover, social interaction proves
difficult given the artificial and anxiety-provoking nature
of these encounters. Feelings of disconnection are
augmented by changes in sensory intensity (e.g.
numbing), difficulty recognizing familiar people and
places, and perceptions of transcendence produced by
the slowing of present time and merging of past, present,
and future.
Future studies should be conducted to utilize exemplar
quotes and themes to refine the emptiness construct
definition and generate scale items which more
accurately reflect patient experiences.
Subjective Emptiness Among Adults with Borderline
Personality Disorder: An In-Depth Interview Study.
Stephanie L. Price, Heike I.M. Mahler
Participants
• Adults from the United States, Canada, and the United
Kingdom diagnosed with borderline personality disorder
(n = 18; M = 32.59 years; SD = 10.65; 16 female, 1
male, 1 other).
• Ethnicity: 17 Caucasian, 1 African-American
• 77.58% Taking medication; 72.22% In therapy
Method (cont.)
Method
Results (cont.) Results (cont.)
Disturbed sense of self
• Poor sense of self
• Disembodiment
• Disownment of memories and experiences
• Identification with false self
• Delicate existence
• Hollowness
Affective impoverishment
• Aimlessness
• Going through the motions of life
• Reduced access to thoughts and feelings
Altered experience of reality
• Changes in perceptions of time and space
• Altered intensity of sensation
• Distorted experience of past and future
• Difficulty recognizing familiar people and places
• Overwhelmed by environmental stimuli
Existential crises
• Meaninglessness
• Missing something important yet unidentifiable
• Chronic lack of fulfillment
• Futility
• Perceptions of the world as hostile
Social deficits
• Artificiality
• Reclusion
• Difficulty interacting with others
• Heightened self-consciousness
• Reticence
• Meaningless interactions
Disconnection
• Profound alienation augmented by social interaction
• Lack of belonging
• Sense of being misunderstood
• Involuntary and pervasive detachment
• Mental withdrawal
• Perceived isolation
Figure 1. Mood and anxiety disorders were the most prevalent
comorbid diagnoses among participants.
Table 1. Six major themes were extracted from interview notes.
0
2
4
6
8
10
12
14
16
Participants
Associated Feelings
Figure 2. Disconnection was most commonly associated
with feelings of emptiness.
Conclusion
• Participants largely perceived emptiness as a feeling within
themselves rather than an external reality.
• Internalization of the experience varied as a function of
insight such that greater levels of self awareness were
associated with perceptions of emptiness as an internal
feeling.
Results
Mood Disorders
37%
Anxiety
26%
PTSD
14%
ADHD/ADD
8%
Personality
Disorders
6%
OCD
3%
Psychosis
3%
Gender Dysphoria
3%