Borderline Personality Organization

In this paper Otto Kernberg argues that the patients loosely called "borderline" do not occupy an unstable zone between neurosis and psychosis but share a specific and remarkably stable pathological organization of the personality, which he names borderline personality organization. He examines it from three angles. Descriptively, he lists symptoms that should raise the suspicion of it: chronic diffuse anxiety, polysymptomatic neuroses, polymorphous perverse sexual trends, prepsychotic (paranoid, schizoid, hypomanic) personalities, impulse neuroses and addictions, and lower-level character disorders such as the infantile, narcissistic, "as if" and antisocial personalities. He insists, however, that no symptom is decisive. The diagnosis is made structurally, from nonspecific ego weakness, a shift toward primary-process thinking seen mainly in unstructured psychological testing, a characteristic constellation of primitive defenses centred on splitting, and a pathology of internalized object relations in which good and bad images of the self and of others remain unintegrated, while reality testing is largely preserved. Genetically and dynamically, he traces the organization to an excess of pregenital, especially oral, aggression, constitutional or the result of early frustration, which drives a premature and distorted oedipal development. By joining Melanie Klein's ideas on splitting and projective identification to Edith Jacobson's ego psychology of self and object representations, the paper became the founding statement of Kernberg's structural approach to borderline and narcissistic pathology and the ground of his later work on its treatment.