Intensive research on borderline personality has played a key role in the development of object relations theory in the United States during the past two decades. Borderline personality presents the topic of several complex periodic crises (Mahler 1971, Kernberg 1975, Mastcrson and Rinsley 1975, Adler 1985).
In the past decade, “borderline” has come to refer to a group of cases with concurrent or recurrent psychotic and schizophrenic symptoms, as classified by Wong (1980). borderline schizophrenia (Stern1938), transient schizophrenia (Ambulatory Schizophrenia, Zilborg1941), hidden schizophrenia (Occult Schizophrenia, Stern1945), schizophrenic personality (Schizophrenia Character, Schafer1948), pseudo-psychotic schizophrenia (Pseudoneurotic Schizophrenia, Hoch and Polatin1949), developmentally incomplete schizophrenia (Abortive Schizophrenia. Mayer1950), clinical prodromal schizophrenia (Subclincal Schizophrenia, Peterson1954), and psychoticCharacter (Frosch1964). It was not until Grinker et al. (1968) that empirical studies on this group of cases began clinically. Later, Kolb and Gunderson (1980) cited diagnostic talks of borderline cases, which further led to future research.
Kernberg (1967, 1975) provided the most complete psychoanalytically oriented understanding of what he called the Borderline Personality Organization. As he described, this group of cases had specific symptoms, personality structures, and developmental characteristics. In addition, he claims that the borderline personalities, although dysfunctional in some areas, are specific and stable. They are not just a temporary state that oscillates between psychosis and psychopathy. As Kernberg describes, these cases are often impulsive, angry, addictive, sexually promiscuous or sexually inappropriate, psychopathic, fearful, and chronically afflicted with generalized anxiety. They are also prone to dissociative states, paranoid thinking, and obsessive thoughts.
Structurally, borderline cases have ego weaknesses, specific defense mechanisms (splitting, projective identification, idealization, devaluation), and split internal objects. The weaknesses of the ego are problems similar to those first identified by Knight (1953). These dysfunctions include an inability to regulate anxiety or other emotions, a lack of impulse control, and a poor ability to sublimate (meaning transferring sexual and aggressive impulses to other socially appropriate activities). Sublimation requires the use of the ego’s functions to integrate the needs presented by various impulses and the benefits derived from conformity to more complex social standards.
According to Kernberg’s account, character development accelerates the increase in aggression drive. If not because they are innately inclined to aggression, or because they are overly frustrated, these individuals need to turn and over-project bad (aggressive) objects through the splitting machine in order to secure good internal objects. This combination of splitting and projection leads to the inability of the case to reconcile the good and bad self and object images during the compounding period.
Understanding the borderline personality combination from the psychoanalytic theory of personality will expand this classification system. It includes most other severe personality disorders such as schizotypy, delusional, antisocial, passive-aggressive, and infantile personality, because all of these disorders exhibit similar internal object relations. Diagnosis in terms of internal psychiatric topics casts a wide net, as all individuals still have more or less the vestiges of each developmental stage they have traversed. Thus, each person, whether more unified or more disintegrated, has some signs of ego weakness and primitive defensive mechanisms, such as splitting, projective identification, idealization, and depreciation.
The diagnostic criteria that are carried out have become less broad than Kernberg’s concept. The narrowing of definitions occurred not to discard Kernberg’s ideas, but to translate them from psychoanalytic abstractions into more narrative and behavioral wording. Intensive experimental work contributed to this evolution.
”The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) includes impulsivity, intense unstable relationships, uncomfortable anger, identity disorders, unstable affect, intolerance of solitude, self-injurious behavior, and chronic feelings of emptiness and boredom. All of the above symptoms can find their source in Kernberg’s concept, which can be understood in terms of split internal object relations and failure to achieve object constancy. This splitting, accompanied by poor object constancy, is characteristic of children in the composite stage. Before I begin to look at the possible causes of borderline personality, I must point out that in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, each of the diagnostic criteria for borderline personality reflects a failure of integration that results in poor object constancy and split internal object relations.
Many borderline cases in adolescence and adulthood have impulses similar to those of toddlers. They rush toward what appears to be a satisfying object without considering the consequences, forgetting about the present frustrating object. Cases often turn to drugs or alcohol as satisfying objects. When drugs cause pain or damage self-esteem, they abruptly quit using them, but always use them again. This is much like the behavior of a child running near and away from his mother during the compounding period. This back-and-forth behavior extends to treatment as well. Hospital staff find it particularly troubling that borderline cases are admitted one day but discharged the next.
The case is unable to maintain a stable object image of a relationship that is basically fine. When something is frustrating, it quickly becomes as if everything is bad, at which point the thing to be avoided out of fear can make the self bad as well. When drugs or a new relationship is experienced as good, they temporarily seem to be all good and pursued, only to be thrown away soon. The impulse in borderline cases comes from these wandering splits between all-good and all-bad, their inability to see things as a stable image with good but also bad parts.
The same excursions in the self and object worlds can lead to impulsive behavior in relationships. Because borderline cases may experience new relationships as satisfying, this is when obsessions can reach euphoric levels, like an all-good, symbiotic attachment. This all-good self-other experience with blurred boundaries can quickly turn into an all-bad self-other resentment because of the lack of object constancy. That is, the inability to remember the presence of the good object in the face of frustration.
When these cases feel alone or unloved, they try to manipulate others to change their feelings. Through projective identification, they believe that if others can do it, they will feel good. When they are not satisfied, they lose their temper, threaten, cajole – even attempt suicide – in an effort to recall the all-good object and punish the all-bad object. They are incapable of forming the notion that the person who ignored them at some point is the same person they felt loved by earlier. Such strong emotions often lead to sexual promiscuity or other relationships as described in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition.
The anger in borderline cases also stems from an internal split and a tendency to go into a full-blown self-object state when they forget their love for certain objects. They are prone to become involved in negative projective identification because of poorly developed self-other boundaries.
Borderline personality identity disorders arise from poor object constancy and a splitting mechanism along the all-good, all-bad axis. Some cases will literally say that they themselves have a good self and a bad self. Although borderline cases do not have multiple identities, they often seem like completely different people depending on whether they feel accepted or abandoned.
Borderline cases are so emotionally dependent on the external environment that they are always wandering. Because of the lack of good object permanence, these people are unable to maintain a sense of well-being if the relationship is temporarily frustrating. They have no way of remembering that life is mostly satisfying and that someone has taken care of them when they were deprived of affection or alone. Yet they feel great to be with someone who is graceful and kind and supportive. Then, the extreme all-good, all-bad autotelic state of the borderline case creates emotional instability.
These cases rely on satisfying external objects in order to be internally happy. They do not tolerate loneliness well, unlike most people who can enjoy being alone or doing something by themselves without feeling abandoned; instead, they feel as if they have a large, caring object in their mind. Borderline cases lack a constant, satisfying inner object to accompany them when they are alone. They do not have that “calm, small” voice in their ears telling them that everything is okay. When they are lonely, they forget all the people who have been with them. This is the lack of object constancy, where good objects have to be physically present to remind them that they are useful, resulting in what the DSM-III calls the inability to tolerate loneliness.
An all-but-bad self-object state can lead to severely irritating self-harm behaviors. The case lends itself to harming the self to remove stress and release the body is boundaries.
Chronic emptiness and boredom are also associated with the tendency to enter into a state of total dis-ease and the inability to remember the good self and object. To feel empty is to feel that the self is depleted. The external equivalent of emptiness is boredom, i.e., the feeling that the world is depleted and uninteresting. In contrast, some cases with fully established object constancy do not feel bored even in a state of extreme deprivation. Borderline personality disorders are cases that do not have the ability to recall various internal resources. They are always looking for a symbiotic mother in the external world to eliminate emptiness and boredom.
All of the DSM-III criteria for borderline personality disorder can be viewed as a lack of object constancy and split internal object relations. Because the characteristics of these borderline cases are typical of children in the complex stage, borderline personality disorders are on the object relations spectrum in a complex position, and the cause of these problems is most often related to an inherent excess of aggression, a relative deficit of affectionate impulses, or a lack of consistent, approved, and conciliatory parental care.
If his aggressive impulses are excessive or his loving impulses are deficient, the child in the complex period must use more projective mechanisms to protect the vulnerable internal object from being overwhelmed by hostility. Children of this age are unable to integrate good and bad self and object images and to build stable, good enough internal object images; children of this age must constantly look for sources of warmth and concern in the external environment.
Children internalize what they feel, but that is not necessarily the true quality of the external object, and even if their parents are in fact good, they may still project their own excess aggression onto the external object and then project that first object back in. Later, they must split off and project these newly re-injected hostile objects. Thus, according to this theory, children with excess aggressive impulses enter a vicious cycle of projecting hostility, which results in the need to split and project more hostility.
Another view is that borderline defiance is often due to a deficit in the mother’s comforting ability. As (Adler 1985) suggests, parents who are unable to provide empathy, comfort, and approval have no opportunity for their children to internalize these abilities. Masterson and Rinsley (1975) have described mothers who have to cling to their children in order to meet their previously unmet dependency needs. These mothers provide affirmation, support, and affection for symbiotic, codependent behaviors. However, they feel threatened by separation and “become aggressive, critical, angry, and withdraw supply and affirmation in the face of any ability of the child to separate and individuate.” This reinforces the infant’s all-good and all-bad dissociative object relations. This makes the child feel abandoned as he matures in his behavior and thus continues to search for good symbiotic objects.
For borderline cases, the splitting and lack of object constancy is not necessarily the result of increased hostility and decreased love in the internal or external object world, but can also be the result of imperfectly integrated ego functioning. Split object and bad object constancy will persist if the ego is unable to cognitively integrate, compare and contrast images of good and bad selves and objects. This factor leads to a hitherto under-explored clinical phenomenon: intelligence deficits are associated with microscopic brain function abnormalities and borderline personality aberrations.
Adults who have developed a unified and fairly intact personality in the past may have an altered personality due to impaired integrative self-functioning after brain injury. This personality resulting from organic injury may be indistinguishable from borderline personality with impulsivity, chronic anger, intense and unstable relationships, unstable moods, and even self-injurious behavior. As mentioned earlier, these cases can often remember their past relationships in a detailed and integrated manner because their long-term memory is not impaired. Their current relationships, however, reflect their split all-good and all-bad objects and their inability to integrate their experiences.
Brain injury is not the only thing that can return a person to a compound-phase type of functioning; extreme experiences that occur at some point in life can cause similar degradation. For example, Vietnam War veterans with post-traumatic stress disorder are often indistinguishable from borderline disorders. Many of the soldiers involved in the Vietnam War were 18 – 22 years old at the time. During this late adolescent stage of life, adult identities have been solidified and new intimacies have been established. The subject of compounding separation is revived and reworked as part of this process. This is the time when adolescents leave their parents and begin to work and socialize independently. And the early separation issues come up again. Late college-age adolescents are often able to revise these separation and attachment issues by repeatedly moving in and out of their parents’ homes. They are still sometimes dependent on their families.