The clinical significance of single features of borderline personality disorder: anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients
Abstract
Although dimensional models of borderline personality disorder (BPD) are consistent with findings showing that minimal levels of pathology are associated with substantial increases in psychosocial impairment, it is still unclear whether different individual BPD criteria are each clinically significant on their own. The current study uses semistructured interview data from 1,870 adults presenting for outpatient psychiatric treatment to investigate whether the BPD criteria of impulsivity, affective instability, emptiness, and anger are each related to psychosocial morbidity when met in the absence of the other eight criteria. Analyses showed that each of these criteria was associated with dysfunction in comparison with a control group meeting zero BPD criteria, but only the emptiness criterion was a marker of impairment on all indices of psychosocial morbidity: suicidality, history of suicide attempts and psychiatric hospitalizations, social and work dysfunction, Axis I comorbidity, and global functioning. Implications for the study of borderline pathology are discussed.
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Marital dissatisfaction and discord are strongly related to depressive symptoms, with an average correlation between marital dissatisfaction and depressive symptoms of approximately r = 0·4 across studies and very similar patterns for men and women.
“Marital dissatisfaction and discord are strongly related to depressive symptoms, 238,239 with an average correlation between marital dissatisfaction and depressive symptoms of approximately r = 0·4 across studies and very similar patterns for men and women. 240”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [240]
Cites
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Carter, M. J. (2014) · Therapeutic Recreation Journal · Cited by 15,154 · see citing works
Endicott, J. (1978) · Archives of General Psychiatry · doi:10.1001/archpsyc.1978.01770310043002 · Cited by 5,686 · see citing works
Structured Clinical Interview for DSM-IV Axis I Disorders
Spitzer, R. L., First, M. B., & Gibbon, M. (1997) · Medical Entomology and Zoology · Cited by 3,582 · see citing works
Initial construction of a maladaptive personality trait model and inventory for DSM-5
Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012) · Psychological Medicine · doi:10.1017/s0033291711002674 · Cited by 1,908 · see citing works
Clark, L. A. (2006) · Annual Review of Psychology · doi:10.1146/annurev.psych.57.102904.190200 · Cited by 808 · see citing works
Widiger, T. A. (1994) · Medical Entomology and Zoology · Cited by 444 · see citing works
The hierarchical structure of DSM-5 pathological personality traits.
Wright, A. G. C., Thomas, K. M., Hopwood, C. J., Markon, K. E., Pincus, A. L., & Krueger, R. F. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0027669 · Cited by 423 · see citing works
Classification of Personality Disorder
Tyrer, P., & Alexander, J. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.135.2.163 · Cited by 319 · see citing works
Characteristics of Borderline Personality Disorder Associated With Suicidal Behavior
Brodsky, B. S., Malone, K. M., Ellis, S. P., Dulit, R. A., & Mann, J. J. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.12.1715 · Cited by 297 · see citing works
Borderline Personality Disorder Criteria Associated With Prospectively Observed Suicidal Behavior
Yen, S., Shea, M. T., Sanislow, C. A., Grilo, C. M., Skodol, A. E., Gunderson, J. G., McGlashan, T. H., Zanarini, M. C., & Morey, L. C. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.7.1296 · Cited by 259 · see citing works
Personality Disorder Types Proposed for DSM-5
Skodol, A. E., Bender, D. S., Morey, L. C., Clark, L. A., Oldham, J. M., Alarcon, R. D., Krueger, R. F., Verheul, R., Bell, C. C., & Siever, L. J. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.2.136 · Cited by 241 · see citing works
Morey, L. C., Skodol, A. E., & Oldham, J. M. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0036481 · Cited by 184 · see citing works
Borderline personality disorder features predict negative outcomes 2 years later.
Bagge, C. L., Nickell, A. D., Stepp, S. D., Durrett, C. A., Jackson, K. M., & Trull, T. J. (2004) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.113.2.279 · Cited by 159 · see citing works
Daley, S. E., Burge, D., & Hammen, C. L. (2000) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.109.3.451 · Cited by 157 · see citing works
Wedig, M. M., Silverman, M. H., Frankenburg, F. R., Reich, D. B., Fitzmaurice, G., & Zanarini, M. C. (2012) · Psychological Medicine · doi:10.1017/s0033291712000517 · Cited by 137 · see citing works
Clinicians' judgments of clinical utility: A comparison of the DSM-IV and five-factor models.
Samuel, D. B., & Widiger, T. A. (2006) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.115.2.298 · Cited by 131 · see citing works
What is Emptiness? Clarifying the 7th Criterion for Borderline Personality Disorder
Klonsky, E. D. (2008) · Journal of Personality Disorders · doi:10.1521/pedi.2008.22.4.418 · Cited by 129 · see citing works
Grilo, C. M., McGlashan, T. H., Morey, L. C., Gunderson, J. G., Skodol, A. E., Shea, M. T., Sanislow, C. A., Zanarini, M. C., Bender, D. S., Oldham, J. M., et al. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00436.x · Cited by 111 · see citing works
Does the Presence of One Feature of Borderline Personality Disorder Have Clinical Significance?
Zimmerman, M., Chelminski, I., Young, D., Dalrymple, K. L., & Martinez, J. H. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06784 · Cited by 96 · see citing works
Self-citationPowers, A. D., & Oltmanns, T. F. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.4.524 · Cited by 93 · see citing works
A Taxometric Study of Borderline Personality Disorder.
Rothschild, L., Cleland, C. M., Haslam, N., & Zimmerman, M. (2003) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.112.4.657 · Cited by 91 · see citing works
Self-citationThe hierarchical structure of clinician ratings of proposed DSM–5 pathological personality traits.
Morey, L. C., Krueger, R. F., & Skodol, A. E. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0034003 · Cited by 90 · see citing works
Whisman, M. A., & Schonbrun, Y. C. (2009) · Journal of Personality Disorders · doi:10.1521/pedi.2009.23.4.410 · Cited by 85 · see citing works
Dimensional Diagnosis of Personality--Not Whether, but When and Which
FRANCES, A. J. (1993) · Psychological Inquiry · doi:10.1207/s15327965pli0402_7 · Cited by 76 · see citing works
Arntz, A. R., Bernstein, D. P., Gielen, D., van Nieuwenhuyzen, M., Penders, K. A. P., Haslam, N., & Ruscio, J. (2009) · Journal of Personality Disorders · doi:10.1521/pedi.2009.23.6.606 · Cited by 75 · see citing works
Selby, E. A., Braithwaite, R. S., Joiner, T. E., & Fincham, F. D. (2008) · Journal of Family Psychology · doi:10.1037/a0013673 · Cited by 68 · see citing works
Oltmanns, T. F., Melley, A. H., & Turkheimer, E. N. (2002) · Journal of Personality Disorders · doi:10.1521/pedi.16.5.437.22123 · Cited by 62 · see citing works
Powers, A. D., Gleason, M. E. J., & Oltmanns, T. F. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0032363 · Cited by 60 · see citing works
Attachment, Borderline Personality, and Romantic Relationship Dysfunction
Hill, J., Stepp, S. D., Wan, M. W., Hope, H. F., Morse, J. Q., Steele, M., Steele, H., & Pilkonis, P. A. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.6.789 · Cited by 56 · see citing works
Conway, C., Hammen, C., & Brennan, P. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.5.793 · Cited by 54 · see citing works
Edens, J. F., Marcus, D. K., & Ruiz, M. A. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.3.705 · Cited by 53 · see citing works
Widiger, T. A., & Simonsen, E. H. (2005) · Journal of Personality Disorders · doi:10.1521/pedi.19.2.103.62626 · Cited by 51 · see citing works
Blais, M. A., Hilsenroth, M. J., & Fowler, J. C. (1999) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199903000-00006 · Cited by 43 · see citing works
Cooper, L. D., Balsis, S. M., & Zimmerman, M. A. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0021078 · Cited by 43 · see citing works
Self-citationGlenn, C. R., Bagge, C. L., & Osman, A. (2013) · Journal of Personality Disorders · doi:10.1521/pedi_2013_27_102 · Cited by 39 · see citing works
The clinical utility of the Five Factor Model of personality disorder.
Glover, N. G., Crego, C., & Widiger, T. A. (2011) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0024030 · Cited by 34 · see citing works
Grilo, C. M., Sanislow, C. A., Skodol, A. E., Gunderson, J. G., Stout, R. L., Bender, D. S., Yen, S., Shea, M. T., Morey, L. C., Zanarini, M. C., et al. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/070674370705200604 · Cited by 32 · see citing works
When less is more: How fewer diagnostic criteria can indicate greater severity.
Cooper, L. D., & Balsis, S. M. (2009) · Psychological Assessment · doi:10.1037/a0016698 · Cited by 30 · see citing works
Borderline Personality Disorder Features and Utilization of Treatment Over Two Years
Bagge, C. L., Stepp, S. D., & Trull, T. J. (2005) · Journal of Personality Disorders · doi:10.1521/pedi.2005.19.4.420 · Cited by 26 · see citing works
Mullins‐Sweatt, S. N., & Widiger, T. A. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.4.463 · Cited by 25 · see citing works
Losing a job on purpose: relationships with borderline personality symptomatology
Sansone, R. A., & Wiederman, M. W. (2013) · Early Intervention in Psychiatry · doi:10.1111/eip.12014 · Cited by 17 · see citing works
Determinants of Diagnostic Prototypicality Judgments of the Personality Disorders
Evans, D. L., Herbert, J. D., Nelson-Gray, R. O., & Gaudiano, B. A. (2002) · Journal of Personality Disorders · doi:10.1521/pedi.16.1.95.22554 · Cited by 13 · see citing works
Employment histories among patients with borderline personality disorder symptomatology
Sansone, R. A., Leung, J. S., & Wiederman, M. W. (2012) · Journal of Vocational Rehabilitation · doi:10.3233/jvr-2012-0606 · Cited by 8 · see citing works
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Borderline personality disorder
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S. O., & Zanarini, M. C. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.29 · Cited by 480 · see citing works
Diagnosis and Treatment of Borderline Personality Disorder in Young People
Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-01144-5 · Cited by 115 · see citing works
Borderline Personality Disorder: Risk Factors and Early Detection
Bozzatello, P., Garbarini, C., Rocca, P., & Bellino, S. (2021) · Diagnostics · doi:10.3390/diagnostics11112142 · Cited by 95 · see citing works
“…- Dimensional scoring of BPD more important for subthreshold levels of pathology, less critical once a patient meets the diagnostic threshold Ellison et al., 2016 [133] Cross-sectional study; clinical population 1870 adult psychiatric outpatients - BPD criteria of impulsivity, affective…”
BackgroundInfluentialCloos, L., Ceulemans, E., & Kuppens, P. (2022) · Psychological Assessment · doi:10.1037/pas0001200 · Cited by 97 · see citing works
Association of Borderline Personality Disorder Criteria With Suicide Attempts
Yen, S., Peters, J. R., Nishar, S., Grilo, C. M., Sanislow, C. A., Shea, M. T., Zanarini, M. C., McGlashan, T. H., Morey, L. C., & Skodol, A. E. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.3598 · Cited by 84 · see citing works
Thompson, K. N., Jackson, H. J., Cavelti, M., Betts, J. K., McCutcheon, L., Jovev, M., & Chanen, A. M. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_330 · Cited by 80 · see citing works
Measuring the shadows: A systematic review of chronic emptiness in borderline personality disorder
Miller, C. E., Townsend, M. L., Day, N. J. S., & Grenyer, B. F. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0233970 · Cited by 84 · see citing works
“, 2016 [37] The clinical significance of single features of borderline personality disorder: Anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients Understand which DSM-5 BPD criteria are associated with psychosocial morbidity in outpatients.”
BackgroundInfluentialMiller, C. E., Lewis, K. L., Huxley, E., Townsend, M. L., & Grenyer, B. F. S. (2018) · Personality and Mental Health · doi:10.1002/pmh.1432 · Cited by 61 · see citing works
Understanding chronic feelings of emptiness in borderline personality disorder: a qualitative study
Miller, C. E., Townsend, M. L., & Grenyer, B. F. S. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00164-8 · Cited by 60 · see citing works
Association of Borderline Personality Disorder Criteria With Suicide Attempts Among US Adults
Grilo, C. M., & Udo, T. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.9389 · Cited by 57 · see citing works
The Feeling of Emptiness: A Review of a Complex Subjective Experience
D’Agostino, A., Pepi, R., Monti, M. R., & Starčević, V. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000269 · Cited by 54 · see citing works
Personality and impulsive buying behaviors. A necessary condition analysis
Shahjehan, A., & Qureshi, J. A. (2019) · Economic Research-Ekonomska Istraživanja · doi:10.1080/1331677x.2019.1585268 · Cited by 53 · see citing works
Grandiose and Vulnerable Narcissism in Borderline Personality Disorder
Euler, S., Stöbi, D., Sowislo, J., Ritzler, F., Huber, C. G., Lang, U. E., Wrege, J., & Walter, M. (2018) · Psychopathology · doi:10.1159/000486601 · Cited by 47 · see citing works
Vega, D., Torrúbia, R., Soto, À., Ribas, J., Soler, J., Pascual, J. C., Rodríguez‐Fornells, A., & Marco‐Pallarés, J. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.07.008 · Cited by 38 · see citing works
“The DSM-IV BPD criteria include diverse symptoms that differ in terms of their implications for an individual's level of borderline personality pathology and level of functioning (Ellison et al., 2016; Skodol et al., 2002a, 2002b).”
BackgroundConstruction and Validation of a Self-report Subjective Emptiness Scale
Price, A. L., Mahler, H. I. M., & Hopwood, C. J. (2020) · Assessment · doi:10.1177/1073191120968275 · Cited by 40 · see citing works
“…dysregulation (Hayes et al., 1996; LaFarge, 1989), social dysfunction (Ellison et al., 2016; Klonsky, 2008; Lamprell, 1994; Peteet, 2011; Richman & Sokolove, 1992), psychiatric hospitalization, absenteeism at work, and reliance on disability benefits (Ellison et al., 2016; Miller et al., 2018).”
BackgroundMethodInfluentialAdolescent suicide risk and experiences of dissociation in daily life
Vine, V., Victor, S. E., Mohr, H., Byrd, A. L., & Stepp, S. D. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112870 · Cited by 36 · see citing works
What is the clinical significance of chronic emptiness in borderline personality disorder?
Elsner, D., Broadbear, J. H., & Rao, S. (2017) · Australasian Psychiatry · doi:10.1177/1039856217734674 · Cited by 36 · see citing works
The Age of Onset of Personality Disorders
Chanen, A. M., & Thompson, K. N. (2018) · Springer eBooks · doi:10.1007/978-3-319-72619-9_10 · Cited by 39 · see citing works
Snoek, A., Beekman, A. T. F., Dekker, J., Aarts, I., van Grootheest, G., Blankers, M., Vriend, C., van den Heuvel, O., & Thomaes, K. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02713-x · Cited by 44 · see citing works
“This is also true for patients with subclinical BPD, who are diagnosed with a higher number of DSM 5 disorders, have higher marginal levels of suicide attempts and experience more social and professional problems compared to healthy controls [20].”
BackgroundThompson, K. N., Jackson, H. J., Cavelti, M., Betts, J. K., McCutcheon, L., Jovev, M., & Chanen, A. M. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_411 · Cited by 36 · see citing works
Borderline Personality Disorder and Violence Toward Self and Others: A National Study
Harford, T. C., Chen, C. M., Kerridge, B. T., & Grant, B. F. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_361 · Cited by 34 · see citing works
Dunn, A., Cartwright‐Hatton, S., Startup, H. M., & Papamichail, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01913 · Cited by 32 · see citing works
Busch, A., Balsis, S. M., Morey, L. C., & Oltmanns, T. F. (2015) · Journal of Personality Disorders · doi:10.1521/pedi_2015_29_202 · Cited by 31 · see citing works
Seow, L. L., Page, A. C., & Hooke, G. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1720931 · Cited by 21 · see citing works
Prasad, D., Kuhathasan, N., Cardoso, T. D. A., Suh, J. S., & Frey, B. N. (2022) · Archives of Women s Mental Health · doi:10.1007/s00737-022-01218-8 · Cited by 23 · see citing works
Keefe, J. R., Huque, Z. M., DeRubeis, R. J., Barber, J. P., Milrod, B. L., & Chambless, D. L. (2019) · Psychotherapy · doi:10.1037/pst0000215 · Cited by 23 · see citing works
Chronic feelings of emptiness in a large undergraduate sample: Starting to fill the void
Martin, J. A., & Levy, K. N. (2021) · Personality and Mental Health · doi:10.1002/pmh.1531 · Cited by 20 · see citing works
Benson, K. T., Donnellan, M. B., & Morey, L. C. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000166 · Cited by 19 · see citing works
Crow, T. M., & Levy, K. N. (2019) · Personality and Mental Health · doi:10.1002/pmh.1468 · Cited by 19 · see citing works
“When measured dimensionally (rather than with a yes/no diagnosis), even a few subthreshold features of BPD can cause clinically significant impairment.(8,9) Notably, measuring BPD this way may be more reliable and valid,(10) and dimensional measurements may be especially useful in non-clinical populations because some…”
BackgroundEmptiness Mediates the Association Between Pathological Narcissism and Problematic Smartphone Use
Zerach, G. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09803-9 · Cited by 21 · see citing works
“Moreover, emptiness have been found to predict impairment on psychosocial functioning, as compared to other BPD characteristics [43].”
Harpøth, T. S. D., Hepp, J., Trull, T. J., BATEMAN, A. W., Kongerslev, M., & Simonsen, E. H. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_453 · Cited by 17 · see citing works
Paul, S. E., Boudreaux, M. J., Bondy, E., Tackett, J. L., Oltmanns, T. F., & Bogdan, R. (2019) · Development and Psychopathology · doi:10.1017/s095457941900066x · Cited by 16 · see citing works
Unemployment and the relationship between borderline personality pathology and health
Cruitt, P. J., & Oltmanns, T. F. (2019) · Journal of Research in Personality · doi:10.1016/j.jrp.2019.103863 · Cited by 16 · see citing works
Investigating the Transdiagnostic Value of Subjective Emptiness
Konjusha, A., Hopwood, C. J., Price, A. L., Masuhr, O., & Zimmermann, J. (2021) · Journal of Personality Disorders · doi:10.1521/pedi_2021_35_510 · Cited by 14 · see citing works
Fulham, L., Forsythe, J., & Fitzpatrick, S. (2023) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12949 · Cited by 14 · see citing works
Drews‐Windeck, E., Greenwood, K., & Cavanagh, K. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23523 · Cited by 15 · see citing works
Borderline personality disorder and ageing: myths and realities
D’Agostino, A., Pepi, R., & Starcevic, V. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000764 · Cited by 11 · see citing works
A general inductive approach to characterize transdiagnostic experiences of emptiness
Hudson, C. C., Ferguson, I., Fan, K., Björgvinsson, Þ., & Beard, C. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23689 · Cited by 11 · see citing works
Integrated treatment for patients with comorbid depression and personality disorders
Van, H. L., & Kool, M. (2019) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000557 · Cited by 11 · see citing works
Generalizable Links Between Borderline Personality Traits and Functional Connectivity
Shafiei, G., Keller, A. S., Bertolero, M. A., Shanmugan, S., Bassett, D. S., Chen, A. A., Covitz, S. C., Houghton, A., Luo, A. C., Mehta, K. P., et al. (2024) · Biological Psychiatry · doi:10.1016/j.biopsych.2024.02.1016 · Cited by 10 · see citing works
Shaker, N. M., Azzam, L. A., Zahran, R. M., & Hashem, R. E. (2022) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-022-01358-x · Cited by 10 · see citing works
“This finding appears to be in line with previous studies which stated that women with BPD are more likely to seek treatment than men [32].”
ResultInvestigating the Transdiagnostic Value of Subjective Emptiness
Konjusha, A., Hopwood, C. J., Price, A. L., Masuhr, O., & Zimmermann, J. (2021) · Journal of Personality Disorders · doi:10.1521/pedi.2021.35.5.788 · Cited by 10 · see citing works
Integrated treatment for personality disorders: A commentary.
Levy, K. N., & Scala, J. W. (2015) · Journal of Psychotherapy Integration · doi:10.1037/a0038771 · Cited by 9 · see citing works
Howard, J., Jesús-Romero, R. D., Peipert, A., Riley, T. N., Rutter, L. A., & Lorenzo‐Luaces, L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245099 · Cited by 9 · see citing works
“BPD traits are associated with lower work and social functioning [11, 12], and there is evidence to suggest that BPD is more impairing than other PDs.”
BackgroundPersonality: Distraction or driver in the diagnosis of depression
Berk, M., Boyce, P. M., Hamilton, A., Morris, G., Outhred, T., Das, P., Bassett, D. L., Baune, B. T., Lyndon, B., Mulder, R., et al. (2018) · Personality and Mental Health · doi:10.1002/pmh.1411 · Cited by 9 · see citing works
D’Agostino, A., Pepi, R., Monti, M. R., Starčević, V., & Price, A. L. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100226 · Cited by 9 · see citing works
Solomonov, N., Doorn, K. A., Lipner, L. M., Gorman, B. S., Milrod, B. L., Rudden, M. G., Chambless, D. L., & Barber, J. P. (2019) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-019-09434-7 · Cited by 8 · see citing works
“This is in line with existing literature that has demonstrated that both in general and clinical populations, qualifying for even one DSM-defined BPD criterion is prognostic of significant interpersonal dysfunction and psychosocial disability and that even non-diagnostic BPD traits may negatively affect patients’ func…”
Lee, H., Jang, J., Kang, H. S., Lee, J., Lee, D., Yu, H., Ha, T. H., Park, J., & Myung, W. (2023) · Medicina · doi:10.3390/medicina60010032 · Cited by 7 · see citing works
López‐Pérez, B., & McCagh, J. (2019) · British Journal of Clinical Psychology · doi:10.1111/bjc.12235 · Cited by 7 · see citing works
Borderline Personality Disorder: Diagnosis and Common Comorbidities
Hall, M. A., & Riedford, K. M. (2017) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2017.07.012 · Cited by 7 · see citing works
Zalewski, M., Musser, N., Binion, G., Lewis, J., & O’Brien, J. R. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_412 · Cited by 7 · see citing works
Symptom domains and psychosocial functioning in borderline personality disorder
Culina, I., Ranjbar, S., Maillard, P., Martin-Söelch, C., Berney, S., Kolly, S., André, J., Conus, P., & Kramer, U. (2024) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-024-00255-2 · Cited by 6 · see citing works
Hein, K. E., Glass, I. V., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.075 · Cited by 5 · see citing works
The place of subjective emptiness in the structure of personality
Hopwood, C. J., & Gjorgjieva, J. (2024) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-024-00274-z · Cited by 5 · see citing works
“Subjective emptiness is linked to other clinically significant behaviors as well, including substance abuse and problematic sexual behavior [7, 9, 19, 25, 28, 31, 33], emotion dysregulation [14, 22] social dysfunction [9, 19, 29, 32], psychiatric hospitalization, and absenteeism at work [9, 27].”
Calati, R., Romano, D., López‐Castromán, J., Turolla, F., Zimmermann, J., Madeddu, F., Courtet, P., & Preti, E. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056492 · Cited by 4 · see citing works
Posttraumatic anger in a national Sample: Demographic and clinical correlates
Patel, T. A., Sala, M. C., Dillon, K. H., & Cougle, J. R. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.06.006 · Cited by 3 · see citing works
Ahn, C.-Y., Kim, J., Kim, S., Kim, J.-W., Na, J., Seo, D. G., & Lee, J.-S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0320104 · Cited by 3 · see citing works
Watt-McMahon, K., Mildred, H., King, R. M., Craigie, G., Hyder, S., & Hall, K. (2023) · Clinical Psychologist · doi:10.1080/13284207.2023.2190879 · Cited by 3 · see citing works
Xie, W.-Y., Emery, C. R., Liu, A. Y., Ng, S., Choi, A., & Chui, C. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001098 · Cited by 1 · see citing works
“When measured continuously rather than categori-cally (yes/no diagnosis), even a single BP trait can cause clinically significant impairment in functioning (Ellison et al., 2016; Zimmerman et al., 2013).”
Kippe, Y. D., Gutwinski, S., Adam, M., Finck, A., Schouler‐Ocak, M., & Goldschmidt, T. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06366-y · Cited by 2 · see citing works
“This may give an explanation to our results indicating an elevated risk for SA in this patient group, since chronic emptiness is the BPD feature most strongly associated with psychosocial morbidity, acute suicidality and a history of SA [21–24].”
Identity Pathology and Emptiness as Novel Predictors of Suicidal Ideation
Meddaoui, B., Stewart, J. G., & Kaufman, E. A. (2025) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.13164 · Cited by 2 · see citing works
Seifert, N. J., Lübke, L., Zimmermann, J., Hopwood, C. J., Brähler, E., Volz, M., Benecke, C., & Spitzer, C. (2025) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/a-2703-2617 · Cited by 2 · see citing works
Fulham, L., & Fitzpatrick, S. (2025) · Cognition & Emotion · doi:10.1080/02699931.2025.2608120 · Cited by 2 · see citing works
“Research suggests that chronic emptiness is associated with greater psychosocial morbidity compared to other symptoms of BPD such as affective instability and impulsivity (Ellison et al., 2016).”
Hoțoiu, M., Tavella, F., & Jan Treur, A. (2018) · IFIP advances in information and communication technology · doi:10.1007/978-3-319-92007-8_31 · Cited by 2 · see citing works
“The primary criteria for assessing the diagnosis of BPD according to (Ellison et al ., 2016; American Psychiatric Association, 2013) are (1) behavioral dysregulation, including impulsivity, excessive and inappropriate anger, self-harming and suicidality, (2) a history of failed relationships and…”
BackgroundPersonality Disorders and Disordered Aging: Personality Pathology as Risk Factor for Unhealthy Aging
Cruitt, P. J. (2020) · International perspectives on aging · doi:10.1007/978-3-030-32053-9_4 · Cited by 2 · see citing works
Любов, Е. Б., & Zotov, P. B. (2023) · Суицидология · doi:10.32878/suiciderus.23-14-04(53)-39-56 · Cited by 2 · see citing works
Une analyse qualitative du sentiment chronique de vide
Salamin, V., Regamey, L., Terrapon, E., Fasseur, F., Gothuey, I., & Guenot, F. (2018) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2018.06.012 · Cited by 2 · see citing works
Fleck, L., Fuchs, A., Lerch, S., Möhler, E., Koenig, J., Resch, F., & Kaess, M. (2023) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-023-00218-z · Cited by 2 · see citing works
“Whereas even single BPD traits have been shown to be of clinical significance [54, 55], and their potential impact on physiological regulation is also supported by the current study, we cannot be sure that results generalize to clinical populations.”
ResultGeneralizable links between symptoms of borderline personality disorder and functional connectivityPreprint
Shafiei, G., Keller, A. S., Bertolero, M. A., Shanmugan, S., Bassett, D. S., Chen, A. A., Covitz, S. C., Houghton, A., Luo, A. C., Mehta, K. P., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.08.03.551534 · Cited by 2 · see citing works
“Furthermore, this perspective accords with overwhelming evidence that BPD symptoms vary dimensionally, with functional impairment scaling with symptom severity (23-27).”
BackgroundLack of Identity and Suicidality
Russolillo, A., Spidel, A. L., & Kealy, D. (2024) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001731 · Cited by 1 · see citing works
Ramstad, C. G., Graff, C., Bo, S., Sharp, C., Jørgensen, M. S., Beck, E., Simonsen, E. H., & Storebø, O. J. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.10.051 · Cited by 1 · see citing works
Martinez, B. S., Rowland, J. A., Shura, R. D., Magnante, A. T., Morey, R. A., & Martindale, S. L. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.02.058 · Cited by 1 · see citing works
The Functional Domain of Identity
Schmeck, K., Schlüter-Müller, S., & Valdés, N. (2021) · Depression and personality · doi:10.1007/978-3-030-70699-9_2 · Cited by 1 · see citing works
Diiorio, C., Norton, S. A., Boudreaux, M. J., Chang, K. K., Michalski, L. J., Cruitt, P. J., Winstone, J. M. A., Oltmanns, T. F., & Bogdan, R. (2021) · doi:10.31234/osf.io/mg7ve · Cited by 2 · see citing works
Ahn, C.-Y., Kim, J., Kim, S., Kim, J.-W., Na, J.-J., Seo, D. G., & Lee, J.-S. (2025) · medRxiv · doi:10.1101/2025.02.15.25322355 · Cited by 1 · see citing works
Construction and Validation of a Self-report Subjective Emptiness ScalePreprint
Price, A. L., Mahler, H. I. M., & Hopwood, C. J. (2020) · doi:10.31234/osf.io/ndztv
Charbon, P., Kramer, U., & Kolly, S. (2019) · Elsevier eBooks · doi:10.1016/b978-2-294-76266-6.00009-4
Filling the void: Is emptiness an emotional flashback?
Spencer, C., & Brunton, I. (2019) · Clinical Psychology Forum · doi:10.53841/bpscpf.2019.1.322.33
Mehrotra, K., Bhola, P., & Desai, G. (2023) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2023.675
Snoek, A. (2024) · doi:10.5463/thesis.960
Miller, C. E., Townsend, M. L., & Grenyer, B. F. S. (2021) · Figshare · doi:10.6084/m9.figshare.15132739
Additional file 1 of Symptom domains and psychosocial functioning in borderline personality disorder
Culina, I., Ranjbar, S., Maillard, P., Martin-Soelch, C., Berney, S., Kolly, S., André, J., Conus, P., & Kramer, U. (2024) · Figshare · doi:10.6084/m9.figshare.25971695
Fleck, L., Fuchs, A., Lerch, S., Möhler, E., Koenig, J., The Bella Study Group, & Kaess, M. (2024) · Figshare · doi:10.6084/m9.figshare.26581622
Iorio, C., Norton, S. A., Boudreaux, M. J., Chang, K. K., Michalski, L. J., Cruitt, P. J., Winstone, J. M. A., Oltmanns, T. F., & Bogdan, R. (2025) · Research in Human Development · doi:10.1080/15427609.2025.2602867
“…personality pathology symptoms (Oltmanns et al., 2014), and that subthreshold borderline personality disorder symptoms are associated with psychosocial impairment (Ellison et al., 2016; Zimmerman et al., 2013), scores were treated continuously to retainvariationat subthres-hold diagnostic levels.”
Zhong, Y., Fan, J., Li, Y., Chen, R., Li, Y., Chen, J., & Cong, E. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07972-8
Is Chronic Emptiness a Transdiagnostic Suicide Risk Factor?
Arnold, M., & Zimmerman, M. (2026) · Journal of Personality Disorders · doi:10.1521/pedi.2026.40.3.225
Self-citationMoselli, M., Quassoni, A., & D’Agostino, A. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1748134
Cholakians, E., Chen, L., Jenkins, L. M., Thomas, E. H. X., & Gurvich, C. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117334
Internal Processes of a Person with a Borderline Personality Disorder: A Computational Analysis
Hoțoiu, M., Tavella, F., & Jan Treur, A. (2026) · Studies in systems, decision and control · doi:10.1007/978-3-032-16544-2_11
Sarıçam, H. (2026) · Journal of Psychometric Research · doi:10.62425/jopres.1824233
- Authors
- Ellison, W. D., Rosenstein, L., Chelminski, I., Dalrymple, K., & Zimmerman, M.
- Affiliations
- Rhode Island Hospital (US)
- Brown University (US)
- Venue
- Journal of Personality Disorders
- Publisher
- Guilford Publications
- Published
- 2016-04
- Volume
- 30
- Issue
- 2
- Pages
- 261-270
- ISSN
- 0885-579X (ISSN-L)
- OpenAlex
- W1980529171
- Cited by
- 93
- References
- 43
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 5 · 2021: 12 · 2020: 12 · 2019: 14 · 2018: 9 · 2017: 3 · 2015: 3
- FWCI
- 6.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Personality Disorders (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons - Trinity University (Trinity University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- borderline personality disorder, anger, neuroticism, impulsivity, psychosocial impairment, suicidality, suicide attempts, psychiatric hospitalization, social dysfunction, Axis I comorbidity, global functioning, psychiatric outpatients
- MeSH terms
- Adult, Affect, Anger, Borderline Personality Disorder, Female, Humans, Impulsive Behavior, Male, Outpatients, Case-Control Studies
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