(PS2-B29) The Relationship Between Emptiness and Suicide and Self-injury Urges in Borderline Personality Disorder

Borderline personality disorder (BPD) is a chronic and debilitating personality disorder associated with an elevated risk of suicide and self-injury (SSI) such that approximately 84% of individuals with BPD cause bodily harm to themselves and over 70% will have three or more lifetime suicide attempts (Soloff et al., 2000; 2002). A common symptom of BPD linked to SSI are chronic feelings of emptiness (Klonsky, 2008). Among individuals with BPD, chronic emptiness is reported to predict both lifetime and past year suicide attempts over and above all other symptoms of BPD (Grilo & Udo, 2021). Considering that SSI urges typically precede SSI behaviours (Ammerman et al., 2017), emptiness may be associated with SSI urges as well, but this has not been explored. Furthermore, it is unknown whether emptiness predicts SSI urges at baseline (i.e., prior to an emotional stressor) and SSI urge reactivity (i.e., rises in SSI urges from baseline to stressor). Given the conceptual overlap between emptiness and other negative emotions (Miller et al., 2020), it is also important to examine these relationships while controlling for general negative emotion in order to identify whether emptiness influences SSI above and beyond the general influence of negative emotion and distress. Thus, the purpose of this study was to examine whether baseline emptiness predicts 1) baseline SSI urges and 2) SSI urge reactivity in BPD with and without controlling for general negative emotion.

            A secondary analysis was conducted on data obtained in a previous study that examined whether BPD is characterized by a range of emotion processes (see Fitzpatrick et al., 2020). In this study, individuals with BPD (N = 40) provided measures of emptiness, negative emotions (e.g., shame, guilt, sadness), suicide urges, and self-harm urges using a visual analogue scale at baseline and following a rejection-themed emotional stressor. Scores on each negative emotion were summed together to create a global negative emotion composite variable, which was entered into analyses as a covariate. A series of generalized estimating equations (GEE) were conducted to examine whether baseline emptiness predicts baseline SSI urges and SSI urge reactivity both with and without controlling for general negative emotion. Results revealed that higher baseline emptiness significantly predicted higher baseline suicide urges, χ²(1, N = 40) = 13.274, p < .001, but not baseline self-harm urges or SSI urge reactivity. When controlling for general negative emotion, higher baseline emptiness significantly predicted higher self-harm urge reactivity χ²(1, N = 40) = 4.223, p = .040. However, baseline emptiness did not predict baseline SSI nor suicide urge reactivity when controlling for general negative emotion. These results suggest that baseline emptiness is associated with baseline suicide urges but not over and above general negative emotion. In addition, baseline emptiness on its own is associated with greater self-harm urge reactivity, which is not accounted for by general negative emotion. A clinical implication of these findings is that clinicians should assess and target baseline emptiness among individuals with BPD in order to prevent or attenuate self-harm urges in response to stress.