Article
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.
Main ideas
- Borderline personality organization is a specific, stable and lasting pathological structure, not a transitional state that fluctuates between neurosis and psychosis.
- Certain presenting symptoms are only presumptive signs of it: chronic free-floating anxiety, polysymptomatic neurosis, polymorphous perverse sexuality, prepsychotic personalities, impulse neuroses and addictions, and lower-level character disorders such as infantile, narcissistic, "as if" and antisocial personalities.
- The diagnosis rests on a structural analysis of the ego, its defenses and its internalized object relations, not on descriptive symptoms.
- Nonspecific ego weakness shows in a lack of anxiety tolerance, poor impulse control and poorly developed channels of sublimation.
- These patients shift toward primary-process thinking, seen mainly on unstructured projective tests, while their formal thinking in structured situations stays intact.
- Splitting is the central defense: contradictory ego states and introjections are actively kept apart, so that aggression does not contaminate good images. It differs from the repression that dominates neurotic organization, and it feeds ego weakness in a vicious circle.
- Splitting is supported by related primitive defenses: primitive idealization, early forms of projection (above all projective identification), denial, and omnipotence with devaluation.
- Libidinally and aggressively charged images of self and objects fail to integrate. The result is the lack of an integrated self-concept and of realistic, whole perceptions of others, which Kernberg links to identity diffusion and to a poorly integrated superego.
- Unlike in psychosis, reality testing is preserved, although brief psychotic episodes can occur under severe stress or under the influence of alcohol or drugs.
- The organization arises from excessive pregenital, especially oral, aggression, whether constitutional or due to severe early frustration. This aggression distorts the parental images and drives a premature oedipal development, in which pregenital and genital aims are condensed under the pressure of aggression.
What it shows
- 1967
Otto F. Kernberg introduced Borderline personality organization
Kernberg set out borderline personality organization in his 1967 paper as a stable structure between neurosis and psychosis, defined by identity diffusion, primitive defences and preserved reality testing, and expanded it in Borderline Conditions and Pathological Narcissism (1975).
- 1967
Otto F. Kernberg reworked Identity diffusion
Kernberg took Erikson's notion of identity diffusion, which Erikson tied to the identity crisis of adolescence, and made it a defining structural feature of borderline organization, extending it from the concept of oneself to the concept of one's significant others.
- 1967
Otto F. Kernberg developed Splitting
Kernberg made splitting, the active keeping apart of all-good and all-bad images of self and others, the central defence of borderline organization, and tied it to a failure to integrate early object relations.
Borderline personality organization derives from Identity diffusion
Kernberg built borderline personality organization on Erikson's identity diffusion, which he made the first of its three defining structural features.
Erik Erikson influenced Otto F. Kernberg
Kernberg took Erikson's notion of identity diffusion into his account of borderline personality organization (1967), where it became one of the structural criteria of the diagnosis.