Out of Sight, Out of Mind: Understanding Emotional Permanence in Mental Health

Contributors: Cailyn White, Scarlett Sparks, and Nialynn Cueto

“Will I ever feel happy again?”
“Do they still care about me?”
“Did I ever matter, or was that all in my head?”

For many people, these are passing thoughts. But for those living with certain mental illnesses, these questions reveal a deeper psychological reality—one shaped by a disrupted sense of emotional permanence.

What Is Emotional Permanence?

Emotional permanence is the ability to believe that emotions—both your own and others’—continue to exist even when they are not actively felt, expressed, or observed. It is what allows us to:

• Trust that a loved one still cares, even when they’re distant.

• Remember that happiness is possible, even in moments of despair.

• Know that sadness will pass, and love doesn’t disappear simply because it’s unspoken.

From Peekaboo to People

To understand emotional permanence, it helps to start with a well-known psychological milestone: object permanence.

The Swiss developmental psychologist Jean Piaget observed that infants gradually learn to understand that objects continue to exist even when out of sight. This milestone typically develops between 8 and 12 months of age and marks a child’s growing awareness that the world is stable and predictable.

For example, an infant who hasn’t yet developed object permanence may cry when a parent leaves the room, perceiving that person as having disappeared. The game of peekaboo reflects this early stage perfectly, where the surprise and joy come from the “disappearing” and “reappearing” of people or objects.

While Piaget focused on physical objects, his work laid the foundation for applying this principle to emotions—the idea that feelings and relationships persist even when they aren’t immediately visible or expressed.

Building on this, psychoanalyst Melanie Klein expanded the concept into the emotional realm through her work in object relations theory. Klein proposed that infants initially experience the world as divided into “good” and “bad” objects—mental representations of caregivers as sources of comfort or frustration. A critical developmental task is integrating these polarized views into a more realistic understanding that others are complex, enduring beings capable of both love and imperfection.

This integration is known as emotional object constancy. It enables a child to feel secure in relationships even when caregivers are not physically present or when feelings of anger or disappointment arise. Failure to develop this emotional permanence can lead to emotional instability, fear of abandonment, and difficulties maintaining internal emotional security—issues commonly observed in personality disorders such as Borderline Personality Disorder.

Just as infants learn that “out of sight” does not mean “gone,” many individuals living with mood or personality disorders must learn—or relearn—that “out of expression” does not mean “no longer true.” When emotional permanence is disrupted:

• A missed call or delayed reply can feel like total rejection.

• A moment of sadness may feel endless.

• The absence of praise can feel like the absence of worth.

This emotional instability is not a personal failure. It often arises from trauma, emotional neglect, attachment disruptions, or neurobiological factors that undermine a stable emotional core.

Emotional Permanence in Personality Disorders

Personality disorders often involve profound disruptions in emotional permanence, but the nature of these disruptions can vary widely.

Borderline Personality Disorder (BPD) is perhaps the most well-known example of impaired emotional permanence. Individuals with BPD experience intense emotional dysregulation and difficulty maintaining stable emotional truths. A friend’s temporary silence may feel like abandonment; affection can vanish from memory as soon as it’s no longer expressed; and a positive self-image or trust can collapse over minor conflicts. This instability causes relationships and emotions to feel fragmented and fleeting, as the immediate emotional moment overshadows past and future context.

Narcissistic Personality Disorder (NPD) presents a different dynamic. Though individuals with NPD may appear confident or emotionally detached, this often masks profound emotional instability and unmet developmental needs. They frequently struggle to sustain feelings of self-worth without constant external affirmation. Praise and love must be repeatedly received or else feel invalidated. Emotional constancy in relationships is weak, with others quickly idealized or devalued depending on how well they support the fragile self-image. Without internalized emotional support, people with NPD continually seek reassurance to regulate their unstable sense of self.

In Antisocial Personality Disorder (ASPD), emotional permanence is often impaired not through dysregulation but through an absence or shallowness of emotions like empathy, guilt, and love. Individuals with ASPD may see others’ feelings as transient, exploitable, or irrelevant, undermining the stability of relationships. This lack of emotional depth contributes to manipulative, impulsive, or callous behaviors and a fractured understanding of personal and social consequences.

Bipolar Disorder

In bipolar I and II, mood states profoundly influence emotional continuity.

• During depressive episodes, joy feels emotionally inaccessible, no matter how clearly one remembers feeling it before.
  
  
• In mania or hypomania, prior vulnerability is often forgotten or dismissed, replaced by unrealistic optimism or invincibility.
  
  
• Each mood state feels all-encompassing, distorting emotional memory and continuity.
  
  

The fragmentation between emotional states can leave individuals feeling like different versions of themselves with no clear thread tying them together.

Major Depressive Disorder (MDD)

Depression doesn’t just suppress mood—it distorts memory and perception:

• Hope, joy, and connection feel like distant concepts.
  
  
• Even when intellectually recalled, positive emotional experiences no longer feel real.
  
  
• This inability to reconnect emotionally with prior states can deepen hopelessness and suicidal ideation.
  
  

In short: when emotional permanence is impaired by depression, it becomes difficult to believe that any emotion other than despair is valid or possible.

Complex PTSD (CPTSD)

For individuals with complex trauma, emotional permanence is often underdeveloped due to inconsistent caregiving and relational harm:

• A lack of secure attachment makes emotional security feel foreign or untrustworthy.
  
  
• Feelings of safety, joy, or love are difficult to retain when they aren’t actively reinforced.
  
  
• Emotional memory may be fragmented or distorted due to trauma.
  
  

As a result, emotional impermanence can feel like a lifelong state of being—never truly secure, never truly grounded.

ADHD & Emotional Dysregulation

Though ADHD is not a mood disorder, emotional impulsivity and Rejection Sensitive Dysphoria (RSD) often reflect disrupted emotional permanence:

• Emotional reactions are intense in the moment but may disappear quickly, leaving little emotional continuity.
  
  
• Feelings of rejection can feel permanent even when unsupported by facts.
  
  
• Impaired self-regulation contributes to unstable self-esteem and frequent interpersonal misunderstandings.
  
  

The Cost of Emotional Impermanence

When emotional permanence is impaired, individuals often experience:

• Fragile relationships and difficulty trusting others.
  
  
• Difficulty soothing themselves during distress.
  
  
• Impulsivity driven by “now” feelings.
  
  
• A fragmented sense of identity across time and context.
  
  
• Shame, guilt, and emotional exhaustion from not understanding their own reactions.
  
  

It is not a question of knowing better—it is a question of feeling unable to hold onto emotional truth across time.

Rebuilding Permanence: Therapeutic Tools

While emotional impermanence can be deeply rooted, it is not irreversible.

• Dialectical Behavior Therapy (DBT) offers mindfulness and emotional regulation skills to build awareness and control.
  
  
• Mentalization-Based Therapy (MBT) helps clients better understand their own and others’ emotions, enhancing emotional continuity.
  
  
• Trauma-informed care helps rebuild inner models of safety and trust.
  
  
• Medication may assist in stabilizing mood and improving emotional accessibility in disorders like MDD or bipolar disorder.
  
  

Just as a child learns object permanence through consistent presence and caregiving, individuals can rebuild emotional permanence through steady, supportive relationships and therapeutic practice.

Restoring the Thread of Emotional Permanence

To live with impaired emotional permanence is to constantly forget how it felt to be safe, loved, or whole. It’s to question every silence, doubt every connection, and fear that happiness was never real to begin with.

But permanence is a skill. A process. A remembering.

Through connection, reflection, and compassionate care, emotional permanence can be rebuilt—brick by brick—until the inner self is strong enough to hold love even in silence, and hope even in pain.