Identity Disturbance in BPD: cause, effect & treatments

Borderline Personality Disorder and the Inconsistent Sense of Self

How is identity diffusion established in borderline patients?

In order to examine the theory behind the principals of this internal separation of the self, wherein the BPD afflicted are left without a clear foundation of who they are, we must examine a few things:
1. Development of Ego, especially in its various defence mechanisms
2. Object relations theory and how that misshapes the developing ego by way of these defences.
3. Childhood abuses and their affects on identity perception.
4. Fragmentation, projection and transference as a result of an inconsistent self object view.
5. Differences between borderline identity diffusion and dissociative identity disorder.
6. Enter into clinical studies and research about borderline identity issues and their effects on the disordered.
i. Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation; Tess Wilkinson-Ryan, A.B., and Drew Westen, Ph.D.
7. Examine treatment methods and their applied theories to BPD’s suffering from issues of identity.

Ego Development:
In order to examine the development of ego, I think it best to look at it through the eyes of the pioneering expertise of Sigmund Freud himself. Let us go back to the earliest stages of infantile development in the first 2 years of life wherein the original drive of the id is our soul means of communication, based upon an impulse of needs and desires.
According to Freud, we are born with our Id. The id is an important part of our personality because as newborns, it allows us to get our basic needs met. Freud believed that the id is based on our pleasure principle. In other words, the id wants whatever feels good at the time, with no consideration for the reality of the situation. When a child is hungry, the id wants food, and therefore the child cries, etc...
The id doesn't care about reality, about the needs of anyone else, only its own satisfaction. If you think about it, babies are not real considerate of their parents' wishes. When the id wants something, nothing else is important.

During the laps between the time the id we are born with and the forthcoming ego we will develop, other stages of development are taking place (according to Freud) in the psychosexual development of the infant. Although these things greatly contribute sexuality, they also hold strong roots in personality and identity overall.

Take for example the oral stage of development from birth to 18 months. During the oral stage, the child is focused on oral pleasures (sucking). Too much or too little gratification can result in an Oral Fixation or Oral Personality which is evidenced by a preoccupation with oral activities. This type of personality may have a stronger tendency to smoke, drink alcohol, over eat, or bite his or her nails. Personality wise, these individuals may become overly dependent upon others, gullible, and perpetual followers. On the other hand, they may also fight these urges and develop pessimism and aggression toward others.

Following the oral stage of development is the anal Stage (18 months to three years) where Freud believes the child’s focus of pleasure in this stage is on eliminating and retaining feces. Through society’s pressure, mainly via parents, the child has to learn to control anal stimulation. In terms of personality, after effects of an anal fixation during this stage can result in an obsession with cleanliness, perfection, and control (anal retentive). On the opposite end of the spectrum, they may become messy and disorganized (anal expulsive).

The development of the ego is thought to occur at 3 years old, alongside the phallic stage of psychosexual development (three to six). The pleasure zone switches from the anus to the genitals.
Freud believed that during this stage boy develop unconscious sexual desires for their mother. Because of this, he becomes rivals with his father and sees him as competition for the mother’s affection. During this time, boys also develop a fear that their father will punish them for these feelings, such as by castrating them. This group of feelings is known as Oedipus Complex. Though Freud disagreed with other theorists who believed the same development was in female children towards their fathers, the female equivalent of this process, called the Electra Complex, was established.

It is at the same time, as the child interacts more and more with the world, the second part of the personality begins to develop- the Ego. The ego is based on the reality principle. The ego understands that other people have needs and desires and that sometimes being impulsive or selfish can hurt us in the long run. Its the ego's job to meet the needs of the id, while taking into consideration the reality of the situation.

The development of ego is a crucial part in the development of ones own identity as well. Without well established boundaries of self vs. others many malfunctions in ego defences can take over the underdeveloped ego resulting in a splitting in object relations and an internal splitting of the self.
Thought the ego is something which we develop as a healthy environment and interactions are surrounding us there are standard defences in the ego, which without that stable environment can become destructive to the self and the overall development of ego.

Ego Defences:
Freud recognized 10 facets of ego defences and how they play a part in protective mechanisms for the developing mind:
DEFENSE DESCRIPTION EXAMPLE
denial arguing against an anxiety provoking stimuli by stating it doesn't exist denying that your physician's diagnosis of cancer is correct and seeking a second opinion
displacement taking out impulses on a less threatening target slamming a door instead of hitting as person, yelling at your spouse after an argument with your boss
intellectualization avoiding unacceptable emotions by focusing on the intellectual aspects focusing on the details of a funeral as opposed to the sadness and grief

projection placing unacceptable impulses in yourself onto someone else when losing an argument, you state "You're just Stupid;" homophobia
rationalization supplying a logical or rational reason as opposed to the real reason stating that you were fired because you didn't kiss up the the boss, when the real reason was your poor performance
reaction formation taking the opposite belief because the true belief causes anxiety having a bias against a particular race or culture and then embracing that race or culture to the extreme
regression returning to a previous stage of development sitting in a corner and crying after hearing bad news; throwing a temper tantrum when you don't get your way
repression pulling into the unconscious forgetting sexual abuse from your childhood due to the trauma and anxiety
sublimation acting out unacceptable impulses in a socially acceptable way sublimating your aggressive impulses toward a career as a boxer; becoming a surgeon because of your desire to cut; lifting weights to release 'pent up' energy
suppression pushing into the unconscious trying to forget something that causes you anxiety
(25)
When we look at these defences as compared to the mentality and behaviours of an adult borderline, it becomes very obvious to see where these ego defences are largely being used, abused in fact to the point of severe malfunction within the borderline’s interactions with others and with self.
Ego defences and their usage are not unhealthy; however, if consistently used at the wrong time or used too frequently they can become a destructive pattern of malbehaviour, and also have devastating impact on the patients sense of self.

Object Relations:
Freud’s next stage of personality development takes to the creation of the superego; but I think important to pause at the formation of ego and examine the principal factors of Kernberg’s theory of object relations before we move forward to the next phase of Freudian developmental stage.

Otto F. Kernberg, remains faithful the Freudian theory believing primary inner struggles lead to emotional projection which are largely centered around love (sex) and aggression. Kernberg’s main focus is on Axis II of the DSM, (personality disorders) more particularly the Cluster B grouping, which includes both narcissistic and borderline personalities. His excellent work in taking Freud’s theories beyond the phallic description into more sustainable/understandable objects (persons) is paramount in the understanding of personality disorders and malfunctions identity disturbances as a whole.

For the moment I’d like to examine two components of Kernberg’s object relations internalization, and structuralization; which theoretically stands by the principal that what a developing mind internalizes as its true self, reflected by actions of another ‘object’ (person), it then restructures internally on an unconscious level to become what the mind perceives as it’s true identity, and this external perception of self is what’s shown to the world.

Kernberg describes this in greater detail here, “Internalization of object relations refers to the concept that, in all interactions of the infant and child with the significant parental figures, what the infant internalizes is not an image or representation of the other ("the object"), but the relationship between the self and the other, in the form of a self image or self representation interacting with an object image or object representation. This internal structure replicates in the intrapsychic world both real and fantasized relationships with significant others... Object relations theories explore primitive defensive operations and object relations both in cases of severe psychopathology and at points of severe regression with all patients... Perhaps the most important practical implication of object relations theory is the conception of identification as a series of internalization processes ranging from earliest introjection to identification per se, to the development of complex identity formation. Each step includes the internalizing of both self and object representations and their affective interactions under the conditions of different developmental levels.”(26)

Taking the ego defences found by Freud and applying them to Kernberg’s object relations and their schematic development, we can clearly see the correlation between the external object perceived as ‘bad’ and the inner defences which protect the immature mind from negative emotional impact. What’s fascinating and important to note is the internalizing of this perception from the exterior ‘bad object’ into the developing internal self.

Use of ego defences like denial, regression, repression, suppression and intellectualization could be considered major component behaviours (internal [unseen] defensive factors) for reforming the natural creation of self image, and also a marked precursor to other protective strategies such as reaction formation, displacement, projection, rationalization and sublimation (exterior [exhibited] defensive factors).

Therefore what the developing mind sees as an undesirable person or behaviour it then internalizes into the still maturing ego and its own self image/identity.
Considering all the environmental factors are in favour of the developing child, these things happen and are quickly corrected by the assurance of love, attention, acceptance and support of nurturing parents; however if the child’s environment does not favour these positive interactions and reassurances the delicate mind is forced to compensate for these factors on its own.
Suffice it to say, a young ,unsupported subconscious (either by the child’s direct neglect, control or mistreatment by the primary caregiver[s]) cannot comprehend these changes on its own, and it is there where these persons run into malformed perceptions of their exterior world and internalize that negativity into themselves. Without a stable sense of the world around them, the child is also lacking in internal stability, thereby fractioning off pieces of that negative reality into a fantasy world of objectivity and goodness that it doesn’t have in its own natural environment.
The mind and identity become split from reality in order to protect itself from negativity by use of the primitive defences of the ego. What the mind is trying to do is keep the ego protected and intact, but the repetitive use of these protective factors force the ego to become ‘unsure and unsupported’ leading to chaos and self confusion.

It is theorized by Freud and Kernberg alike, that this is the definitive factor in determining ones sense of self and sense of others, for reference and reflection throughout the course of ones life. If this does not happen successfully, the ‘essential identity” is then lost.
A concept captured beautifully here, “At birth the human infant has no sense of self. He is Being. He is his being without knowledge or self-consciousness. There is no mental functioning yet. Slowly, through experiences of pleasure and pain, memory traces are retained, forming the first self-impressions (self-representations). As the infant starts taking himself to be this or that (this or that self-image) he separates from his sense of Being, because an image is not his being. As the ego-identity and sense of self develop and become stable, the contact with Being in its various aspects and qualities is mostly lost. The extent of the loss also depends on the adequacy of the environment and the infant's relation to it. The process of loss of contact with Being leaves a sense of deficiency, a state of deficient emptiness, as if the Being is left with many holes in it. The deficient emptiness is the state of the absence of contact with or awareness of Being. Space, which is the open dimension of Being, is lost in the formation of the self-image. This self-image includes the unconscious body image of having a genital hole. For the normal individual, the development of the personality happens relatively smoothly. The self is highly integrated and stays stable throughout most of one's life. In those with mental disorders, for reasons already known in depth psychology, the development of the personality and its sense of self is incomplete, or happens with various distortions, malformations, or inadequacies.” By A. H. Almaas (27)

After examining the root of self identity in the development of the ego through object relations and primitive defences, it’s easy to see how things could have gone wrong in this all important developmental stage of life. Because these things occur at such an early stage in life and development they are usually buried deeply in the unconscious memory of the individual, who therefore has no recollection or memorable association to the events which caused this malformation of identity and its corresponding maladaptive behaviours. In essence it’s fair to say that the malfunction happened so far back in development, that the afflicted person has no idea that there is any kind of malfunction present in the mind at all; because their life and themselves have always been this way.

Moving on from the phallic stage and ego development into the supported creation of one’s super ego, it can be easily understood why the super ego would not be formed appropriately if the ego has been damaged beforehand.

Ideally, the super ego is formed to keep a balance between the desires of the id and the understanding of others needs; derived from proper development of the ego by adding another layer of self control through means of morality and ethics. The super ego is formed primarily by our environment the rules, regulations, religions and direct reflections of our family unit and social structure. However, if the ego has malformed itself, during its most integral stages of development, the super ego will in turn be affected by the internalized instability. Therefore, proper morals, personal boundaries, self regulation of inhibitions and a hierarchy of core values/ethics, does not take a firm hold on the psyche and it instead becomes flux to both external and internal variables and drives.

So much determines who we are and who we will become, in the formative years of life (aside from any memorable, recollective, emotional trauma) that if additional trauma occurs to the now fragile sense of self, it holds all the more impact and damage to the individual.

Childhood Abuse:
If we turn our focus from theory to clinical research and studies, we can examine the many aspects of contributing abuse factors which commonly occur in patients diagnosed with BPD and how they affect the varied aspects of the disorder, more importantly though for this project, how they affect the concept of self identity.

A 1997 study, in the pathological childhood experiences of patients with borderline personality disorder, as compared to patients diagnosed with other personality disorders, 91% of the borderline patients reported have been abused by means of physical, emotional or sexual means at some point during their life. Of that 91%; 92% reported that the abuse occurred before the age of 18 years old. The varied types of abuse remained higher in borderline patients across the abuse spectrum, as compared to patients who suffered from different forms of personality disorder. In fact the instances of childhood sexual abuse were nearly doubled in borderline patients at 61.5% compared to 32.1% in the non borderline group. It was also noted in this study that sexual abuse by non caretakers seemed to be an important factor in the etiology of BPD especially when coupled with other factors of emotional abuse (particularly neglect) by care takers of both genders, in some combined/opposable form on to the child directly. However important the role of childhood sexual abuse seems to be in the development of BPD in many patients, it is by no means a necessity nor sufficient for the development of borderline personality disorder in and of itself. This study instead suggests that the sexual abuse only indicates the instability and atmosphere of general chaos/neglect by the parents, and that other forms of abuse in conjunction with various forms of neglect probably play a more central etiological role. (28)

Numerous studies in the area of childhood abuse have been examined in correlation with borderline personality disorder, to enter into such a wide realm of research would be a massive undertaking on its own; I think it fair enough to say, for the purpose of this paper, that childhood abuse of all sorts runs ramped throughout the youth and developmental stages of nearly all those diagnosed with BPD.

Abuse in childhood, as we’ve thus seen, has a major impact on the development of core values, stable self image, objective views and feelings towards others, and is in turn a major component of life and living with personality disorders of all types, most notably borderline. If we probe this area of self inconsistency in more depth in borderline personality disorders, we can see that manifestations of false self can often replace the lacking self image of one who is so internally fragmented.

Fragmentation, Projection and Transference:
What has happened here is the emotional child who was not allowed or encouraged to be who they originally are inside themselves, who also did not receive a stable sense of their core self due to conflict and chaos in their surrounding environment, has now physically grown with age while their developmental emotional maturity remains un nurtured and undefined. Realizing (unconsciously) that something must take the foreground and be displayed in order to attain and maintain a sense of normality, the intellectually and physically maturing child replaces their own depleted and warped self reflection with a facade. Usually this is the face that the child would have been praised for displaying/becoming in the home; the attitude which gained love, support and positive attention, and is a complete conformity into something created by the child in order to achieve approval and a sense of self worth. The fragmentation of the child’s self image is pressed upon them by the demanding of ‘appropriate behaviour’ by constant infliction of shame, guilt, and abandonment should they not conform, by the parents.
The parts of ourselves with which we have lost touch in the fragmented state are aspects of our innate drives which cannot be accommodated by the person we have grown up to be. These clusters of feeling also embody part of our self-awareness. When we are angry, for example, we are in touch with the part of ourselves which can feel anger, and if we have had to cut off anger in childhood we also cut off that part of ourselves. In serious cases practically the whole personality can be lost to fragmentation, then we have an accumulation of defence mechanisms instead of a personality, and our personality is a ‘False Self’ (29) lacking in true substance and continuity. A barrage of faces clouds the lack of identity to the external world and a constant sense of emptiness is left within the individual.

Because fragmentation has occurred so implicitly through the individual, the emotionality and roller coaster of reactions is all that’s left as an expression of self intent/desire. This volatile instable sense of self and negativity implied to the ‘bad self’ (the one who was unworthy of love and attention as a child) comes through future behaviours in borderline relationships by means of splitting (believing that a person is either all good or all bad, depending on their perception of/reaction to the BPD person), projection (divulging their own self loathing onto another object [person] and attacking themselves unconsciously by consciously attacking another who unknowingly drenched in their own self shame and deeply seeded self worthlessness), and transference* (where external objects of the past and their encompassing emotions, are displaced/directed onto another object in the present). In essence, it’s that whole ‘ego defences’ principal being acted out on a routine basis throughout all relationships and ordeals in a borderlines life.
*it is important to remember the term transference as it will come up again in the area discussing treatment methods.

The constant battle is draining and becomes self defeating as the individual matures with age. Though the physical body develops into adulthood, and the intellectual development is at par with the course (or better in some cases) the borderline patient remains forever suspended in time in regards to emotional maturity, which causes long standing issues with emotional regulation, impulse control, often chaotic relationships, inability to manage stress, and instability in their identity as well.


BPD vs. DID:
Considering that identity is comprised of stability, continuity, understanding and acceptance of ones self over time, it is painfully obvious to see why this doesn’t happen in the self identity of a borderline patient. Nothing is stable, everything is changing and totally reactive; all that is left is a fragmented self left with a chronic feeling of inner emptiness caused by the inability to integrate into a coherent sense of self identity. As this empty feeling and loss of inner self becomes more problematic and chronic (in some cases) a refuge world or fantasy self can at times take the stage by means of dissociation from the painful reality the BPD is forced to live in if they remain in their current state consciousness/awareness.
This disruption of the normal integrative processes of consciousness, perception, memory, and identity can form deeper issues over time which can manifests with an emergence of 2 or more personality states including auditory hallucinations, severe depression and suicidality, phobic anxiety, somatization, substance abuse, and borderline features that partially or fully predominate the psychologic function of the individual for a period. Various degrees of dissociative disorders are recognized, ranging from passive disengagement and withdrawal from the active environment to multiple personality disorder (MPD), a severe dissociative disorder characterized by disturbances in both identity and memory and best understood as a posttraumatic, adaptive dissociative response to the fear and pain of overwhelming trauma, most commonly abuse. The effects of exposure to situations of extreme ambivalence and abuse in early childhood may be coped with in a psychodynamic formulation by an elaborate form of denial so that the child believes the event to be happening to someone else. This process may be facilitated in childhood, a time with a rich fantasy life that often includes imaginary companions. Because most abuse cases occur during the preschool years, children may be particularly vulnerable to dissociation during those years. In 1991, the National Child Abuse and Neglect Data System indicated that 24% of 838,232 reports were for physical abuse and that 7% of children who were abused were younger than 1 year, 27% were younger than 4 years, and 28% were aged 4-8 years. The rate of reports decreases for older children. Early age at onset was also correlated with a higher degree of dissociation. (30)

Although the case of dissociative identity disorder (formally known as MPD, or multiple personality disorder) is far more extreme than what is usually experienced with borderline patients, the onset process and contributing factors toward identity diffusion and dissociation from any kind of core foundation of self, are indeed identical.

Key points of difference though are that those whom suffer DID (dissociative identity disorder) usually remain unaware of their other fragmented selves (referred to as alters) which are more concrete, unique individuals, accompanied by blacked out memories/loss of time, whereas BPD’s remain more coherent through their changes in persona, and it’s often such a slight change that they are unable to recognize the shift in behaviour or perception at all. The only self telling is a lack of self identity and a constant feeling that they don’t quite measure up to the ‘norm’ followed by the emptiness and fierce method of replacement/compensation for this inner loss.

Clinical Research:
There’s not a lot of accessible research out there on Identity Disturbance/Diffusion in BPD as a topic base, but it is often referred to in many other case studies as a contributing factor and an examinable feature of the disorder. In an article based on previous research(2) on youth development in potential adolescent BPD’s and their development of commonly recognized Borderline contributing features, identity disturbance was included research and clearly showed that “in adolescents, the symptoms with the highest likelihood of leading to a correct diagnosis with respect to borderline personality disorder were identity disturbance and two criteria that involve aspects of affective dysregulation. That identity disturbance has specific value in discriminating the diagnosis of borderline personality disorder is of interest,”(1) in contrast; we can see for other involving older BPD patients which shows that although impulsivity in older BPD’s ‘naturally’ decreases with age (thought to be an aspect of maturity in patients) the identity disturbances remain if un treated.

“In this study(3) of 123 participants with borderline personality disorder, younger participants showed significantly more impulsive behavior than older participants. Age did not predict interpersonal disturbance, cognitive disturbance, or affective disturbance. This finding suggests that a putative “maturing out” or burning out with age in borderline personality disorder is only partial and that, although impulsivity declines, the less behaviorally salient but equally disabling features of affective disturbance, interpersonal difficulties, and cognitive disturbance may not ameliorate.
The findings are consistent with those of Stone (4), who, in an extensive review observed that whereas impulsive features are less pronounced in later life, identity disturbance persists.”

So it appears that Identity confusion is very much a part of borderline personality disorder; but what is it?

Kernberg’s theories include that identity diffusion in patients with borderline personality reflects an inability to integrate positive and negative representations of the self, the patient also has difficulty integrating positive and negative representations of others.
The result is a shifting view of the self, with sharp discontinuities, rapidly shifting roles (e.g., victim and victimizer, dominant and submissive), and a sense of inner emptiness.
He theorizes these defenses allow patients with borderline personality disorder to remain comfortable (with remarkable inconsistencies which inhibit the capacity to form a coherent view of themselves) in their environment and their mentality. (5,6)

Adler and Buie (7,8) described patients with borderline personality disorder as suffering from a sense of incoherence and disjointed thinking, feelings of loss of integration, concerns about “falling apart,” and a subjective sense of losing functional control over the self and other forms of “self-fragmentation.” From a self-psychological perspective, these patients lack an ability to internalize many aspects of their primary caregivers that would allow them to develop a cohesive sense of self.

Fonagy and colleagues (9) emphasize the failure of patients with borderline personality disorder to develop the capacity to step inside the mind of another and to imagine the way the other experiences the patient. To the extent that patients with borderline personality disorder have difficulty seeing themselves in the mind’s eye of another, and logically they have difficulty in developing coherent self identities.

Westen and Cohen (10) believe identity disturbance to be central to borderline personality disorder. Theorising a lack of consistently invested goals, values, ideals, and relationships; a tendency to make temporary hyperinvestments in roles, value systems, world views, and relationships that ultimately break down and lead to a sense of emptiness and meaninglessness; gross inconsistencies in behavior over time and across situations that lead to a relatively accurate perception of the self as lacking coherence; difficulty integrating multiple representations of self at any given time; a lack of a coherent life narrative or sense of continuity over time; and a lack of continuity of relationships over time that leaves significant parts of the patient’s past “deposited” with people who are no longer part of the individual’s life, and hence the loss of shared memories that help define the self over time.

The clinical literature on identity disturbance in borderline personality disorder provides a rich conceptual foundation for understanding identity disturbance, sexual abuse history and dissociative experiences are either common in, or diagnostic of, both borderline personality disorder and dissociative identity disorder (11,12). Research suggests that 30%–75% of adult and adolescent patients with borderline personality disorder have reported histories of sexual abuse (13-16).

Researchers have found a strong relationship between a history of sexual abuse and dissociative symptoms (17-19). The patient’s painful concern about identity incoherence is not only the result of trauma; it appears to be integral to the nature of borderline personality disorder, whether or not the patient has an abuse history.


(As an exploratory analysis, we followed up on findings of two recent studies that isolated two distinct types of patients currently diagnosed with borderline personality disorder [20,21], one with more dysphoric features and the other with more histrionic features. The first type [emotionally dysregulated] includes patients who have intense, painful, and poorly regulated emotions that they attempt to escape by using various maladaptive affect-regulatory strategies. The second [histrionic] type have emotions that are intense and dramatic but not very troubling to them; for these patients, dramatic emotions may even be self-defining.)

Result: some elements of identity disturbance appear more closely associated with histrionic than with borderline features, particularly role absorption, and, secondarily, inconsistency. (For the first factor, role absorption, the partial correlation with the histrionic rating was significant [r=0.24, df=82, p=0.03]. Strikingly, the second factor, which correlated so strongly with borderline personality disorder, showed a slightly negative correlation with histrionic ratings [r=–0.07, df=82, p=0.50]. The last two factors correlated slightly positively with the histrionic rating [r=0.19, df=82, p=0.08; and r=0.13, df=82, p=0.28], respectively.)
Four factors emerged from the factor analysis, each encompassing a distinct facet of identity disturbance.
• First factor, role absorption, describes overidentification with a specific role or group membership, such that a limited role or label defines the person’s whole identity.
• The second factor, painful incoherence, deals with patients’ subjective experience of their own identity. This factor conveys distress or concern about identity incoherence or lack of a coherence sense of self.
• The third factor, inconsistency, includes items such as “beliefs and actions often seem grossly contradictory.”
• The final factor, lack of commitment, is a fundamental element of Marcia’s conception of identity (22,23). This factor includes patients’ difficulties in committing to goals or maintaining a constant set of values.

The weakest of the four factors in predicting borderline personality disorder was the fourth, lack of commitment. This may be an important finding, given the heavy emphasis most identity research (as well as DSM-IV) has placed on this construct. For example, DSM-IV describes identity disturbance in borderline personality disorder as being “characterized by shifting goals, values, and vocational aspirations” Data from this study however indicates that while this factor is a central component of identity disturbance and is somewhat elevated in patients with borderline personality disorder, it does not distinguish borderline personality disorder from other types of psychopathology. Lack of commitment may thus be a less specific index of identity disturbance that is related to multiple forms of psychopathology and not specifically to borderline personality disorder.

Patients’ experience of their own identity incoherence is central to identity disturbance in borderline personality disorder; identity disturbance may manifest itself clinically in different ways depending on whether the patient is more emotionally dysregulated or more histrionic.

The secondary analyses in this study provide suggestive data on differences in the types of identity disturbance characteristic of each subtype. When borderline features held constant, the role absorption factor was significantly associated with histrionic ratings. The inconsistency factor appears to be associated with both kinds of patients, but particularly with the histrionic.

CONCLUSIONS
The data from this study suggest that identity disturbance is multifaceted, and that each of these facets is associated with borderline personality disorder. Identity disturbance in borderline personality disorder is characterized by a painful sense of incoherence, objective inconsistencies in beliefs and behaviors, overidentification with groups or roles, etc... These factors are all related to borderline personality disorder regardless of abuse history, although history of trauma can contribute substantially to the sense of painful incoherence associated with dissociative tendencies. Identity disturbance may manifest itself clinically in different ways depending on whether the patient is more emotionally dysregulated or more histrionic.

Treatment Methods and Theories:
If we look back on Otto F. Kernbergs theory of object relations, we can revisit the subconscious phenomena of transference more in depth. It is important that we investigate and understand how this happens on the maladaptive end of BPD, because it is an integral part of treating diffused identity issues within a clinical setting.

In his base theory behind object relations, Kernberg suggests, “patients with severe identity diffusion lack sufficient linkage of self representations into an integrated self. They tend to alternate rapidly between projection of self and object representations in the transference, so that the analytic situation seems chaotic. Systematic interpretation of how the same internalized object relation is enacted again and again with rapid role reversals makes it possible to clarify the nature of the unconscious object relation, and the double splitting of (a) self representation from object representation and (b) idealized from persecutory object relations. This process promotes integration of the split representations which characterize the object relations of severe psychopathology.” (26)

As we’ve already explored this splitting of both self and external object into ‘all good’ when the individuals needs are being met, or ‘all bad’ when an external or internal force apposes their desires; the internal conflict remains within the subconscious memory as an underlying trigger for either love or hate like relations in future relationships. The subconscious memory remains and when the new love or hate emotion is triggered within the BPD towards any new object, the combined emotional reaction to this new feeling is steeped in all the same intense emotions that where present in the original object of the past. In fact, what you get could be referred to as a classic ‘double whammy’ effect.
The patient is essentially compartmentalizing the love of the primary object into themselves, which leads to intensified feelings of love for the new object. Anger and aggression follow the same pattern; and a new happening is made all the more hurtful and frustrating for a BPD when combined with the original pain, because it’s still buried deep within the psyche.

If this pattern persists over the course of a life time, you end up with subsequent compounding of these emotions on top of the triggers which inevitably set them off. What you end up with up is a family tree of destruction:
Love for the father figure, compounded by love of mother, compounded by love of close friends and extended family, compounded by love for romantic interests, multiplied by the number of romantic interests, compounded on top of the previous emotional loves, and it continues to branch out into a full blown all consuming kind of love that it is overwhelming to both the BPD and their partner.

A time bomb of rage builds on the opposite side of the spectrum:
Hatred towards the father, compounded by resentment towards the mother, compounded by refusal/neglect from close friends and extended family, compounded by infidelity and conflict by romantic interests, multiplied by the number of romantic interests, compounded on top of the previous emotions of hurt and repressed anger, until the internalized negative emotions explode in a transference of rage filled destruction on to some poor unsuspecting soul.

Therein lies the compounded interest of both negative and positive emotions, their course of action and the way in which they become self defeating/self damaging in the BPD mindset. This entire process happens under the radar of awareness, deep within the subconscious, behind the scenes. The use of psychodynamic therapies such as TFP (transference focused therapy) is used to bring these underlying object relations (relation of the new object towards the primary source of the emotion), the transferred reaction of the emotions (the compounding and misdirecting of old emotions on to a new object when triggered), mindfulness of the triggered transference indicators (recognizing) the stimulating factors that causes the transference of inner emotions onto an external source), and working through the original emotions (more focusing on the negative) to purge the pool of negativity and gain some sense of self worth by working through the external negatives which were internalized through the developmental stages of the BPD’s life.

It could be theoretically argued that CBT (cognitive behavioural therapy) and DBT (dialectical behavioural therapy) do much the same thing, and in the behavioural approach of the TFP process this is true; however the process of TFP does not plateau at the level of cognition, it is here where the real work begins.
A page on the Cornell University website describes the TFP process as such, “The treatment focuses on the transference [the patient's moment-to-moment experience of the therapist] because it is believed that the patient lives out his/her predominant object relations dyads in the transference. Once the treatment frame is in place, the core task in TFP is to identify these internal object relations dyads that act as the "lenses" which determine the patient's experience of the self and the world. It is believed that the information that unfolds within the patient's relation with the therapist provides the most direct access to understanding the make-up of the patient's internal world for two reasons. First, it has immediacy and is observable by both therapist and patient simultaneously so that differing perceptions of the shared reality can be discussed in the moment. Second, it includes the affect (feelings) that accompanies the perceptions, in contrast to discussion of historical material that can have an intellectualized quality.”(31)

As we take a brief look into the process of transference, as described as dual model process encompassing the Displacement Model (the foundation to the process of the transferred emotion [negative output]) and the Organisation Model (the restructuring of these variously displayed malfunctions) as described by J Fosshage’s, “Toward Reconceptualising Transference” we see that transference goes beyond cognition (stated as #1; the ‘Core Process’ in his comparison) and it also deals heavily in other areas such as 2) The Nature of Reality, 3) Scientific Paradigm, 4) Structural Features, 5) Motivational Model, 6) The Analysts Contribution, 7) Illuminating The Transference, and The Nature of Change.
I’d like to examine the Displacement and Organisation Models of several sub headings for a moment, as they relate to the factor of identity directly or indirectly:
2) The Nature of Reality:
Displacement Model: through displacements the patient distorts the reality of the analyst based on the proposition that there is an object reality.
Organization Model: through organizing principals the patient (as well as the analyst) perceives and organizes the experience of the analytical relationship that becomes his/her subjective reality, based on the proposition that ‘reality’ is relative to and always partially determined by the perceiver. (cite)
4) Structural Features:
Displacement Model: transference is a temporarily and structurally regressive process.
Organization Model: primary organizing principals are always potentially operative and subject to change more or less through accommodation to new experiences; more structurally- regressed schemas (that is, less complex and more immature psychological organizations) are often triggered in analysis.
5) Motivational Model:
Displacement Model: transference is fuelled by the libidinal and aggressive drives and, specifically, by drive- derivatives related to infantile wishes and fears and conflicts around the same; the repetition (compulsion) of the childhood conflict in relation to the analyst serves as a resistance to remembering, and, as Freud conceived it, is, principally, biologically- driven by aggression (and, ultimately the death instinct).
Organization Model: perpetual- affective- cognitive organization of experience and its maintenance is fundamental human striving. A striving to organize or create meaning experientially validatible but, in my view, is not sufficient for the various and complex strivings in our lives. To capture these strivings Lichtenberg (1989) had posited a comprehensive motivational theory involving 5 motivational systems; the physiological, attachment- affiliation, exploratory assertive, aversive, and sensual- sexual systems. These motivational systems are integral to the overall development, maintenance, and restoration of a vital cohesive sense of self. Each system effects, developmentally, as well as from moment- to moment, the emergence and dominance of a particular schema.
7) Illuminating the Transference:
Displacement Model: to illuminate the transference, the analyst, through providing a blank screen, reflects, understands and explains how the patient experiences and organizes the analytic relationship with particular emphasis on primary problematic schemas. (Self psychologists also emphasise the self object or vitalizing organizations, to be discussed.) The contribution of the analyst is frequently acknowledged.
The Nature of Change:
Displacement Model: resolution of the transference entails renunciation of infantile wishes and fears, which enables less distorted and more realistic perceptions.
Organization Model: the primary problematic schemas gradually become less dominant, either through modification (that is, through a process of accommodation) and/or through the establishment of additional organizing principals, increasing the rage and complexity of experience (decreasing the frequency of use of primary problematic schemas).


It is important to note that transference is not inappropriate, but is an aspect of every relationship- a fundamental feature of the organization model, the displacement of transferred emotions is a base principal based on all primary schematics; only when the schematics have been distorted (as is the case with BPD) does transference become negatively impacting to self and external objects (other people).

Transference encompasses a vast field of projection as well, the emotions and self attitudes we hold for ourselves is constantly placed outwardly on others in the process of transference. The way a disordered mind ‘displaces’ the negative or provocative subconscious views onto others it the source of transferred self truth, and where the examination for core issues and malformed schematics takes place. Once the source of the outward projection has been identified, the therapist and patient examine the core issue (the root of the problem) and deal with the emotions (usually surrounded in vast amounts negativity and shame) theoretically purging the original triggered incident of its ‘power’ over the patient, and build upon the newly established truth, the foundation for better established views of self and others by means of correcting the primary problematic schema.

In essence, TFP goes past the point of cognition and into the rebuilding of the schematics; it penetrates deeper into the psyche and by that methodology reaches the patient on a deeper level of self awareness. Therefore; forming the supportive groundwork and true self comprehension to establish a firm grounding for identity, morality and healthy schematics to be founded, TFP is an integral part of dealing with identity issues in the BPD patient.

References:
(not yet orginaized)

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AliceWonders wrote:
there's a great amount of contributing factors that make us the way we are, that can at timebe self defeating and overwhelming to know; keep in mind, you don't have to 'own' this trauma on your own, you're not a bad person and it's not your fault- you're NOT HOPLELESS!!!!

there is a great hope in reversing the effects your environment nad traumas have played in your life- see treatment section for more details and find someone to talk to about your issues should you ever feel ovewhelmed.

Never give up on yourself, always strive for self betterment and if you fall (which we all do from time to time) take the lesson and carry on towards your goal- YOU!

You are your goal and your life is the reward!

Peace, Love and Happiness 2 ALL!
~Alice

cboxpalace wrote:I swear to God that I have got to be the biggest A$$hole in existence to man, but I think all of the above is non sense. It's this rationale that if you think positive than positive will happen. #######4! I can be nice (positive), and get no rewards in friendship or I can be a real jerk (negative), and get no rewards of having friends. It's far easier to be an ass and have understanding as to why I have no friends then to be nice, have no friends, and be confused as to why not, left with the assumption I must be a bad person.

It sounds as if this is written by someone who doesn't have bpd or any other mental illness.