Borderline Personality Organization

Introduction. Borderline Personality Organization

The psychoanalytical concept of Borderline Personality Organization forms the common base allowing to categorize different variations of abnormal personality structures.

Borderline Personality Organization defines the characteristics common for all abnormal personalities.

Dissociating emotions from cognition

Patients with Borderline Personality Organization undergo intense emotions, which are not internally connected. As a result, any emotion feels at a given moment and dominates the patient’s subjective experience influencing their thinking and acting. Such overwhelming emotions hamper patient’s rational ability to evaluate the situation. Although the patient is aware of the thoughts associated with emotions, he is not able to adapt his reaction to the external environment. So, the problems of BPO patient consist of two elements: 1.) inability to control emotions and 2.) detachment of emotions from rational judgment. BPO individuals are unable to “translate” their emotion into socially adequate behaviour.

In the analytical language strong, incoherent emotions experienced by BPO patients, are called “primitive emotions”. The description doesn’t relate to the intellectual status of the patient. Such unbounded primitive emotions can overwhelm even highly intelligent individual. Due to the emotional instability, patients struggle with establishing and maintaining interpersonal relationships. Furthermore, this emotional instability can lead to self-destructive behaviour, such as substance abuse or self-harm.

Overall, BPO patients experience profound cognitive and emotional dysregulation, which can lead to significant interpersonal, social, and personal difficulties. Therefore, the focus of the treatment is helping the patients to regain the cognitive control over their emotions and to develop healthy coping strategies to manage life’s challenges.

Elements of Borderline Personality Organization

BPO patients exhibit a range of characteristics that reflect the disorder’s constituent elements. These include:

• fragmented sense of identity
• reliance on primitive defence mechanisms
• fragile but generally intact reality testing
• difficulty regulating emotions
• challenges with sexual and aggressive expression

Additionally, patients may struggle with internalized values that are inconsistent or unclear and cause poor quality relationships with others.

The pathological structure of BPO is rooted in the lack of integration of positive and negative segments of early object relations. The early object relations are formed during in the early childhood trough intense emotional experiences. This lack of integration leads to identity diffusion, characterized by a fragmented sense of self and others. This lack of coherence is evident in the patient’s experience of self and others, which may be chaotic or contradictory. Patients may also struggle to recognize or integrate these contradictions.

Borderline Personality Organization presents significant challenges for the affected individuals. They struggle to establish a coherent sense of self and to navigate relationships with others. Effective treatment focuses on helping patients integrate these internal representations of self and others. By achieving such integration, the BPO individuals can develop healthy coping strategies to manage their emotions and relationships. By doing so, patients can work towards achieving a greater sense of coherence and stability in their lives.

Moral Values in patients with Borderline Personality Organization

The development of moral values is a complex process that occurs in successive layers.

• The first layer represents the primitive morality experienced in childhood when caregivers impose demands that inhibit certain impulses.

• The second layer is composed of ideal representations of self and objects based on early childhood experiences.

• The third layer of the Super-Ego evolves from the earliest persecutory level to a more realistic, integrated level that allows for deeper commitments to values and others.

The internalized value system allows individuals to be less dependent on external validation and behaviour control. By late adolescence, the third layer is typically completed through processes of abstraction, generalization, and individualization.

Implications of the Super-Ego pathology

Superego pathology, particularly the presence of antisocial traits, has negative prognostic implications for psychotherapeutic approaches to personality disorders. On the other hand, severe personality disorders with maintained interpersonal behaviour and the absence of antisocial features can present a positive prognosis for psychotherapy. It is also essential to consider the presence or absence of intense relationships with significant others, regardless of their chaotic or disturbed nature.

Overall, the development of moral values is a critical aspect of personality development that can greatly impact an individual’s prognosis for psychotherapy.

Aggression

The earliest motivators of human behaviour are libido and aggression. Libido evolves from early experiences of sensual pleasures. Aggression is more related to differentiated affects like irritability, anger, rage, envy, and hatred.

Affects are primary psychological motivators, and an abnormal development of positive and negative affective systems can lead to pleasure in aggression. Negative affect, whether constitutional or environmentally mediated, has a significant impact on an individual’s feelings and perceptions.

Low-level versus high-level Borderline Personality Disorder

Patients with low-level Borderline Personality Disorder (BPD) suffer from more overt aggression and have more serious lacunae in superego development than those with high-level BPD. Those with low-level BPD are more difficult to treat and may approach the limits of treatability.

The integration of positive and negative affective systems is a complex process, and abnormal development can lead to serious psychological disturbances. Understanding the role of aggression in personality development is essential for effective psychotherapeutic interventions.

In terms of DSM diagnoses, patients with low-level BPD are likely to have comorbid narcissistic, paranoid, and antisocial personality disorder or traits. The impact of aggression can invade object relations, leading to nonspecific manifestations of Ego weakness.

Patients in the less severe group (high-level BPD patients) have a greater proportion of frustrated libidinal affect, a greater capacity for dependent relationships, and more capacity for investing in work and social relations.

Primitive defences in patients with Borderline Personality Organization

The use of primitive defences is a defining feature of individuals with Borderline Personality Organization (BPO). The primitive defence manifests in behaviours that interfere with patients functioning and distort their interactions with others, particularly in the context of therapy.

Defense mechanisms are Ego-protective measures, and mature defences minimize anxiety and increase adaptability. By understanding the use of primitive defences, such as splitting, projective identification, and omnipotent control, is crucial for therapists working with individuals with BPO. Recognizing these defences and their manifestations is crucial in therapy. Such insights provide therapists with valuable information about what the patient has difficulty integrating within themselves.

Splitting

Primitive defences, are rigid and inflexible. They emerge in early childhood and do not allow for successful adaptation to life. These defences are organized around:

• splitting, which separates good and bad affect and
• objects as a way to protect an idealized segment of the psyche from an aggressive segment.

The split organization of the psyche results in a categorical experience of the world, where things are either completely good or bad, and opinions are strong but not stable. This rigidity provides little flexibility for dealing with the complexity of the world. It also contributes to the emotional and interpersonal chaos in individuals with BPO.

In individuals where splitting predominates, each part of the split has access to consciousness and expression, resulting in contradictory thinking, affects, and behaviours. The split internal organization of the psyche imposes itself on the individual’s perception of the world. This results in poor fit with reality, and a lack of appreciation for the subtleties of situations and ambiguity. Typical for BPO individuals are distortions in perception. His external reality is filtered through the rigid and primitive internal structure of self and object representations.

Projective identification

Projective identification is an unconscious tendency to induce affect states in another person. The process is closely linked with splitting and omnipotent control, where the individual tries to maintain control over their environment.

Primitive idealization, devaluation, and denial

These are other dominant primitive mechanisms that complement or reinforce splitting, projective identification, and omnipotent control.

Denial

Primitive denial is characteristic for early childhood development. It is the refusal to accept reality or fact, thought or feeling perceived as painful, as they wouldn’t exist.

Idealization and devaluation

Idealization and devaluation help manage anxiety and external stresses, serving as defence mechanisms within the process of splitting. They are typical for borderline personality disorder (BPD). Splitting reflects difficulties in maintaining a balanced view of others, encompassing their positive and negative aspects.

Idealization

Idealization is a process where positive qualities are attributed excessively to someone or something. It serves as a coping mechanism for anxiety, perceiving an ambivalent object or person as flawless or possessing exaggerated positive traits. By idealizing, individuals protect themselves from potential emotional conflicts that may arise in relationships. Rather than facing the fear of imperfection or the possibility of a failed relationship, idealization allows them to preserve the illusion of perfection. However, idealization can swiftly shift to intense anger, referred to as devaluation, towards the once idealized individual.

Devaluation

In patients with Borderline Personality Disorder (BPD) idealization can quickly turn into devaluation because of patient’s incapability to have a differentiate perception of an object (another person). Devaluation is just the opposite of idealization. It happens when the patient characterizes an object as completely worthless, or by exaggerating its negative qualities. Feeling challenged, or disappointed he quickly turns to devalue the formerly idealized object, instead of coping with the stress of ambiguity.

People interacting with individuals suffering of BPD and being exposed to such cycles are confused by the sudden shift from being idealized to being devalued. Shifting between these two states makes it difficult for people with BPD to maintain stable relationships with others.

Object Relations Classification and DSM-5

The DSM diagnostic criteria for personality disorders can be limited by relying on observable behaviours. Behaviours may have different functions and meanings depending on underlying personality organization. DSM-5 Section III provides a refined assessment of core personality disorder aspects and treatment outcomes.

Treatment for personality disorder has focused on reducing symptoms, but core issues of self-functioning and interpersonal functioning have received less attention. The alternative DSM-5 model balances attention to personality disorder types with dimensional traits.

Understanding both personality traits and processes can lead to a fuller picture of personality functioning and better clinical assessment. After trait ratings the assessment of specific context follows.

Borderline Personality Organization. Conclusion

The psychoanalytical theory of Borderline Personality Organization (BPO) is the biggest achievement in the field of psychology in the past 50 years. This theory created a formative concept helping to categorize different types of personality disorders.

Characteristic for Borderline Personality Organization are various elements such as fragmented sense of identity, reliance on primitive defence mechanisms, fragile but generally intact reality testing, difficulty in regulating emotions, including aggressive and inadequate sexual behaviours.

Individuals with BPO use so called primitive defences such as splitting, projective identification, primitive idealization, devaluation, and denial. These primitive defences hinder successful cognitive processing and lead to behavioral manifestations of distress, rather than internal mastery of it.

The development of moral values plays a crucial role in personality development. BPO individuals often have internalized values that are inconsistent or unclear causing poor-quality relationships with others.

The undeveloped social values have significant impact on individual’s prognosis for psychotherapy. The presence of antisocial traits has negative implications for psychotherapeutic approaches to personality disorders.

The main problems faced by individuals with BPO are their inability to control emotions and detachment of emotions from rational judgment. Therefore, the focus of treatment is helping them to regain control over their emotions and to develop healthy coping strategies to manage life’s challenges.