The Urge to Fill the Void: Emptiness, Impulsivity, and Mentalizing in the Daily Life of Individuals With Borderline Personality Disorder

Emptiness is central to borderline personality disorder (BPD), significantly impacts quality of life, and is associated with increased impulsivity. Nevertheless, studies of emptiness in daily life are scarce and little is known about factors that may mitigate the emptiness–impulsivity association in BPD, such as mentalizing (Mz), the capacity to understand mental states. The current study examined whether emptiness predicts impulsive behaviors in daily life and whether this association is moderated by disorder or by Mz. The study utilized data from an existing data set (Berenson et al., 2011) of 153 participants (57 with a BPD diagnosis, 43 with avoidant personality disorder [APD], and 53 serving as healthy controls [HC]). Following a baseline lab assessment of Mz (Baron-Cohen et al., 2001), participants completed 3 weeks of ecological momentary assessment (EMA) with five daily prompts, including self-reported measures of emptiness and impulsivity. EMA data were analyzed using multilevel modeling. Both the BPD and APD groups reported higher levels of momentary emptiness compared to the HC group. The BPD group exhibited higher levels of impulsivity in daily life compared to the HC and APD groups. There were no group differences in Mz. Interestingly, emptiness significantly predicted impulsivity and was positively associated with impulsivity in both the BPD and HC groups but not in the APD group. Finally, Mz did not moderate the emptiness–impulsivity association. Emptiness seems central to impulsivity in daily life. More ecological and emptiness-specific measures of Mz may have better potential to mitigate the negative consequences of emptiness.