The Feeling of Emptiness: A Review of a Complex Subjective Experience.

A feeling of emptiness is commonly encountered in clinical practice, but it is poorly understood, with incongruent approaches to its definition and possible role in various disorders. This review examines the conceptualization of the feeling of emptiness and its place in psychopathology. We found an imbalance between theoretical approaches to this phenomenon and empirical research, and argue that more studies using adequate assessment tools are needed. Based on our literature review, we propose that a feeling of emptiness is a complex, negative emotional state that is experienced in different ways by different individuals. This feeling includes a physical or bodily component, a component of aloneness or social disconnectedness, and a component of a deep sense of personal unfulfillment or lack of purpose. The feeling of emptiness is related to other emotional states (dysphoria, boredom, loneliness, and numbness) and overlaps to some extent with them. Although the feeling of emptiness is most often considered in the context of borderline personality disorder, it is also encountered in depression, narcissistic personality disorder, and schizophrenia spectrum disorders, with its features potentially varying between different conditions. The feeling of emptiness may lead to nonsuicidal self-injury and may also have an important relationship with suicidality. We conclude by offering suggestions for further research, emphasizing a need to refine the multidimensional conceptualization of the feeling of emptiness and to better understand its manifestations and relationships with other emotions within various forms of psychopathology.

Phenomenology in Psychoanalysis: Still an Open Debate?

In a recent book Cristopher Bollas, one of the greatest contemporary psychoanalysts, tells about how he began to bring together phenomenology and psychoanalysis in the clinical setting at the beginning of his career. Working with psychotic patients, he realized that it was first necessary to "absorb" their view of reality before being able to reflect on the mad scenarios of psychosis. In what world did they live? How did they perceive it? Only by "mirroring" this back to the patients was it possible to offer them the experience of being in front of someone trying to understand their world view. Today, phenomenology has been spreading over psychoanalysis more than one can think it did in the past. The aim of this paper is to review and discuss the most relevant theoretical-clinical areas characterizing contemporary psychoanalysis in which phenomenology can claim a legitimate (or still illegitimate for someone) position. The main areas that will be discussed are: (a) the larger relational system or field in which human experience is continually shaped, i.e., the intersubjective matrix in which we are embedded; (b) the capacity to think about the "what" of the patients' experience, rather than the "why" (especially with the most severely disturbed ones); and (c) the crisis of the primacy of interpretation in the analytical technique. Obviously, this review does not have the ambition to be exhaustive. Rather, it just wants to (re)open the discussion on a still controversial but very current topic.

Psychotic symptoms in borderline personality disorder: an update.

PURPOSE OF REVIEW: The purpose of this article is to review the most recent literature on psychotic symptoms in borderline personality disorder (BPD). RECENT FINDINGS: Both auditory hallucinations and delusional ideation (especially paranoid delusions) are relatively common in individuals with BPD. It is still difficult to distinguish these and related phenomena in BPD from the corresponding experiences in psychotic disorders and schizophrenia, despite numerous attempts to do so. The terminology introduced to help with this effort has not been particularly useful. The presence of auditory hallucinations may affect the course of BPD negatively. Psychotic symptoms in BPD seem to be significantly related to the context (usually stressful events) and appear or intensify in response to situational crisis. The role of certain co-occurring disorders in increasing the risk of psychotic symptoms in BPD remains uncertain. SUMMARY: Psychotic symptoms in BPD continue to be poorly understood. Further research should try to ascertain the relationships between hallucinations and delusions on one hand and the processing of trauma, emotion regulation, distress tolerance and interpersonal sensitivity on the other. Ultimately, such endeavor will contribute to developing more effective treatments for BPD.

Diagnosis or Diagnosing? From Symptoms to a Phenomenological-Psychoanalytic Stance on the Patient's World.

While on the one hand therapists can count on a number of codified and standardized diagnostic procedures, on the other hand it is hard to believe that in their daily work therapists slavishly follow these standardized procedures. In a clinical assessment, the diagnosis seems to be the outcome of a naïve and fuzzy process that is strongly influenced by personal training, by, theoretical models, and by one's masters as well as the experience gained in the field. What happens inside the no man's land of the clinical encounter? Can we identify some landmarks in these "amoeboid" exploratory moves? This paper addresses diagnosis not only as a noun or name ("diagnosis"), but also as a verb ("diagnosing"), arguing that a diagnostic space opens up thanks to an oscillatory state of mind that emerges at the intersection of different ways of looking "through" the symptom.

Models of borderline personality disorder: recent advances and new perspectives.

PURPOSE OF REVIEW: The purpose of this article is to review the most relevant conceptual models of borderline personality disorder (BPD), with a focus on recent developments in this area. RECENT FINDINGS: Several conceptual models have been proposed with the aim of better understanding BPD: the borderline personality organization, emotion dysregulation, reflective (mentalization) dysfunction, interpersonal hypersensitivity and hyperbolic temperament models. These models have all been supported to some extent and their common components include disorganized attachment and traumatic early experiences, emotion dysregulation, interpersonal sensitivity and difficulties with social cognition. An attempt to integrate some components of the conceptual models of BPD has resulted in an emerging new perspective, the interpersonal dysphoria model, which emphasizes dysphoria as an overarching phenomenon that connects the dispositional and situational aspects of BPD. SUMMARY: Various conceptual models have expanded our understanding of BPD, but it appears that further development entails theoretical integration. More research is needed to better understand interactions between various components of BPD, including the situational factors that activate symptoms of BPD. This will help develop therapeutic approaches that are more tailored to the heterogeneous psychopathology of BPD.

Preliminary Validation of the Interpersonal Dysphoria Model of Borderline Personality Disorder.

BACKGROUND: Borderline personality disorder (BPD) is one of the most puzzling psychiatric disorders. In order to improve its understanding and management, we have recently proposed an interpersonal dysphoria model that emphasizes the key role of the complex emotional state of dysphoria in BPD. The purpose of this study was to test the interpersonal dysphoria model using a structural equation modeling analysis. SAMPLING AND METHODS: The sample consisted of 105 patients with BPD and 105 healthy controls. A total of five self-report instruments and three semistructured interviews were administered to the participants. RESULTS: The best-fitting structural model fit the data well in the BPD sample. Background dysphoria and negative interpersonal disposition were significant predictors of situational dysphoria, which in turn was a significant predictor of various symptoms of BPD. This model differs from the originally proposed one in terms of impaired empathy not being a component of negative interpersonal disposition and organizing and disorganizing BPD symptoms being replaced by interpersonal (abandonment fears, angry outbursts, and stormy relations) and affective (affective shifts and emptiness) symptoms. CONCLUSIONS: Although some revision was needed, the findings provide support to the proposed model, which needs to be further tested in a larger sample of individuals with BPD.

Reconsidering Emotion Dysregulation.

This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.

Psychoanalysis and art: artistic representations in patients' dreams.

The authors explore the psychic passages that were opened up within a patient, Ada, thanks to her contact with two works of art, Signorelli's frescoes in Orvieto and Picasso's painting La Nageuse--their themes, formal structures, and the conventions governing their creation. A work of art can be considered as a kind of window that allows one to look upon the imaginary world created by the artist. One can peer out of this window from the other side, permitting a look at the viewer (the patient), who is caught in a web of associations that are yet to be explored.

New interpretative styles: progress or contamination?: psychoanalysis and phenomenological psychopathology.

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specific form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological 'temptation' has been spreading over psychoanalysis, so too has a psychoanalytical 'temptation' always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being-in-the-world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specific technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic 'temptation' and phenomenological 'temptation' can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.