Emptiness in patients with borderline personality disorder: Severity and predictors of outcome over 24 years of prospective follow-up.

Patients with borderline personality disorder (BPD) suffer from a variety of affective symptoms, including emptiness. Emptiness has received less attention, yet causes severe suffering and impairment. This study's primary aim was to compare the severity of emptiness over time in 290 patients with BPD to 72 patients with other personality disorders (OPD), and its secondary aim was to identify clinical and psychosocial predictors of severity of feelings of emptiness over 24 years of prospective follow-up. Inpatients meeting rigorous criteria for BPD or meeting DSM criteria for OPD were assessed at baseline, then reassessed every two years for 24 years. Severity of feelings of emptiness was assessed via self-report. Severity of emptiness was significantly higher at baseline for patients with BPD than with OPD, but declined at a similar rate over time in both groups. Five variables individually predicted the severity of emptiness in those with BPD. In multivariate models controlling for time, two variables significantly predicted the severity of emptiness over 24 years; a baseline history of PTSD and the number of childhood competencies. Results suggest emptiness is a common but declining symptom of BPD. Severity and course of emptiness in patients with BPD are related to co-occurring PTSD and number of childhood competencies.