Subjective Emptiness: A Clinically Significant Trans-diagnostic Psychopathology Construct

Abstract

Subjective emptiness is a pervasive transdiagnostic construct. The aim of this series of studies was to use construct validation procedures to better understand the nature and correlates of subjective emptiness. A literature review led to 88 items which were then trimmed to 53 via qualitative interviews with patients and experts. This preliminary scale was administered to 543 university students and 1,067 clinical participants along with measures of depression, meaning in life, borderline personality disorder, and impulsivity. The scale was reduced to 17 items following item analysis, factor and item response theory analyses, extreme groups comparisons, and examinations of criterion validity. This 17-item scale, along with measures of identity disturbance and maladaptive personality traits, was then administered to 1,016 clinical participants. The scale was trimmed to 7 items based on results from these data. Results strongly supported the unidimensionality of subjective emptiness and its transdiagnostic clinical value.

Investigating the Transdiagnostic Value of Subjective Emptiness

“…These findings matched the results of other studies, stating that emptiness is a distinctive criterion for BPD, with higher intensity than in other disorders (Elsner et al, 2018;Meares et al, 2011;Miller et al, 2018;Richman & Sokolove, 1992). Although emptiness is a diagnostic criterion for BPD and is included in the category of impairments in self-functioning (American Psychiatric Association, 2013), it is absent from the DSM-5 model of maladaptive personality traits (Bach & Sellbom, 2016;Price et al, 2020). Our findings highlight the importance of including emptiness in the diagnostic criteria for personality pathology.…”

“…These findings coincide with the numerous descriptions of the feeling of emptiness made in recent decades. However, in contrast to the other BPD criteria, emptiness does not appear in the DSM-5 model of maladaptive personality traits (Bach & Sellbom, 2016;Price et al, 2020).…”

“…However, the general relation of emptiness with a broad range of diagnostic constructs remains poorly understood. Price et al (2020) found that subjective emptiness was moderately to strongly correlated with BPD (with the emptiness criterion removed), depressivity, anhedonia, withdrawal, identity problems, and low meaning or purpose in life.…”

“…The respondent is questioned to rate each item on a 4-point Likert scale from 0 = Not at all true to 3 = Very true. Cronbach's alpha of the total score was  = .88 and  = .89 (Price et al, 2020). The German version of the SES was translated independently by two authors of this study (AK and JZ) and the backtranslation was approved by one of the original authors (CH).…”

Boredom in Borderline Personality Disorder: A Lost Criterion Reconsidered

“…Despite these barriers to conceptualization, a comprehensive view of existing literature on emptiness suggests that the experience generally includes a sense of disconnection from self and between self and others [78] which is distinct from, but not entirely unrelated to, feelings of hopelessness, loneliness, intolerance of aloneness, and isolation [78, 80]. Other descriptions of emptiness include the feeling of being “without meaning, purpose, or substance” [6, p. 99], or a “pervasive and visceral sense of detachment spanning intrapersonal, interpersonal, and existential domains of existence” [81, p. 18]. Miller et al [78] found that, across the literature, chronic emptiness is described as an experience similar to having an internal hole or vacuum, aloneness [82]; feeling swallowed [83]; the feeling of vagueness [84]; a sense of internal absence [85]; woodenness [86]; and numbness or alienation [87].…”