Chronic feelings of emptiness is an under-researched symptom of borderline personality disorder (BPD), despite indications it may be central to the conceptualisation, course, and outcome of BPD treatment. A systematic review aimed to provide a comprehensive overview of chronic feelings of emptiness in BPD, identify key findings, and clarify differences between chronic feelings of emptiness and related constructs like depression, hopelessness, and loneliness. A PRISMA guided systematic search of the literature identified empirical studies with a focus on BPD or BPD symptoms that discussed chronic feelings of emptiness or a related construct. Ninety-nine studies met criteria for inclusion in the review. Key themes were identified and thematically synthesised. Most studies conceptualised chronic emptiness as a manifestation of identity disturbance which when experienced at frequent and severe levels, is associated with low remission for people with BPD. Emptiness as a construct can be separated from hopelessness, loneliness and aloneness, however there are significant difficulties with defining and measuring emptiness itself. Chronic emptiness may be related to depressive experiences unique to people with BPD, and is associated with self-harm, suicidality, and lower social and vocational function. We conclude that studies point to how treatment focusing on integration of self may help alleviate a sense of emptiness, and that understanding chronic feelings of emptiness may be central to the experience of people with BPD. Further research is required to provide a better understanding of the nature of chronic emptiness in BPD in order to develop ways to quantify the experience and target treatment.