Journal of Personality Disorders, 6(4), 382-393, 1992 & 1992 The Guilford Press QUALITY OF DEPRESSIVE EXPERIENCE IN BORDERLINE PERSONALITY DISORDER AND MAJOR DEPRESSION: WHEN DEPRESSION IS NOT JUST DEPRESSION Drew Westen, PhD, M. Jay Moses, BA, Kenneth R. Silk, MD, Naomi E. Lohr, PhD, Robert Cohen, MA, and Harry Segal, PhD Clinicians and theorists have argued that the depression characteristic of borderline patients is phenomenologically distinct from that of other unipolar depressives. In the present study, the quality of depressive experience was examined in borderline patients with (n = 16) and without (n = 17) major depression as compared with nonborderline major depressives (n = 14). In support of the hypothesis, borderlines with and without major depression evidenced a qualitatively distinct, interpersonally focused "borderline depression," even controlling for severity of depression. Phenomenologically, this borderline depression is characterized by emptiness, loneliness, desperation in relation to attachment figures, and labile, diffuse negative affectivity. The relationship between borderline personality disorder (BPD) and mood disorders continues to vex clinicians and researchers (Gunderson & Elliott, 1985; Gunderson 6k Phillips, 1991; Kroll & Ogata, 1987). Whereas some have viewed borderline symptomatology as derivative of an underlying affec tive dysregulation common to major depression, others have suggested that depression in borderline patients is qualitatively different (Gunderson, 1984; Kernberg, 1975; Masterson, 1976). Clinical experience suggests that the phenomenology of depression is distinct in borderline patients, center ing on concerns about abandonment and rejection, a sense of emptiness and meaninglessness, and a view of the self as fundamentally evil or despic able. Blatt (1974; Blatt & Zuroff, 1992) has distinguished between a de pendent, empty, interpersonally oriented "anaclitic" depression and a self- critical "introjective" depression. He and his colleagues have developed a From the Department of Psychiatry, Cambridge Hospital and Harvard University (D.W.); and from the Department of Psychiatry (M.J.M., K.R.S., and N.E.L.) and the Department of Psy chology, University of Michigan (N.E.L.. R.C.. and H.S.) Address correspondence to Dr. Westen at the Department of Psychiatry, Cambridge Hospital, Macht Building, 1483 Cambridge Street, Cambridge, MA 02139. The authors would like to thank Dr. Christopher Peterson and Dr. Jean Wixom for their comments on a draft of this paper. 382