key symptom is the phenomenon known as ‘splitting’ – in fact, Kernberg (1975)
argued that the majority of all borderline pathology was based around this
phenomenon. He defined splitting as ‘the failure to integrate representations
of good and bad in self and others’, and it can essentially be seen as a coping
mechanism where ‘good’ and ‘bad’ memories of people or situations are stored
separately, leaving the patient unable to draw on both sets of memories at one
time (and as such seeing others as entirely ‘good’ or entirely ‘bad’ depending on their actions at that
particular point in time). Kernberg argued that this was due to possible
emotional ramifications (e.g. a patient wanting to see an abusive mother as
nurturing, or not wanting to see flaws in an idealised parent who failed to
protect them from an abusive other parent).
on from this, we can see how a difficulty integrating self-representations with
different qualities (e.g. angry vs. loving or good vs. evil) can lead to
another major symptom of BPD: identity disturbance. This, along with the
defensive use of splitting in relation to others (e.g. seeing oneself as
‘unlovable’ to avoid seeing an idealised significant other as ‘unloving’), will
clearly lead to instability in sense as self, as patients will define
themselves solely in terms of how the situation they are in causes them to view
themselves. This unstable sense of self in turn leads to a deficit in ‘ego
strength’ (defined as “a
person’s capacity to maintain his/her own identity despite psychological pain,
distress, turmoil and conflict between internal forces as well as the demands
of reality”). This deficit, also known as ‘ego weakness’, is characterized by impulsivity,
unstable emotions and excessive vulnerability, so it is highly likely to be
linked with many of the symptoms of BPD.
we will look at relationship instability, which can be seen as an amalgamation
of several of the symptoms of BPD (e.g. emotional regulation and impulsivity
leading to frequent lashing out at others, abandonment fears causing patients
to push others away to avoid being pushed away themselves, etc.). Despite the
many contributing causes, this instability is largely due to splitting:
patients will rapidly switch between idealisation and devaluation of
significant others, leading to extreme tension in interpersonal relationships. In addition, relationship instability
may be due to a deficit in understanding of social causality (and thus a
difficulty predicting, understanding and adapting to others). This again is
often due to unpredictable or abusive caregiving which results in an inability
to form healthy, coherent models of relationships.
Of course, there are undoubtedly
limitations in a psychoanalytic approach to BPD. Firstly, looking into single
causes (such as sexual, physical or emotional abuse) does not take into account
the context in which these causes occur: the majority of these events will only
take place in an unstable, non-nurturing family environment, which (as we’ve
seen) can be a cause of BPD in itself. Secondly, like any personality disorder,
BPD is developed over time so it is impossible to pinpoint a single developmental
era or event in the patient’s life. For example, difficulties caused by a poor
relationship with the maternal object can already be observed by the end of
infancy, while the sexual abuse often seen in patients with BPD generally
occurs long after this. Finally, there are several possible biological causes
of the disorder: a 2002 study by Caspi et al. found that a polymorphism in the
promoter region of a serotonin transporter gene moderated the influence of
stressful life events in childhood and adulthood, while a similar study in 2003
found that a polymorphism in a monoamine oxidase regulating gene moderated the
relationship between childhood abuse and antisocial behavior in adulthood.
Markstrom, C. and Marshall,
S. (2007). The psychosocial inventory of ego strengths: Examination of theory
and psychometric properties. Journal of Adolescence, 30(1), pp.63-79.
Howell, E. (2002). Back to
the “States” Victim and Abuser States in Borderline Personality Disorder. Psychoanalytic Dialogues, 12(6), pp.921-957.
BRADLEY, R. and WESTEN, D.
(2005). The psychodynamics of borderline personality disorder: A view from
developmental psychopathology. Development and Psychopathology, 17(04).
(2016). My subdued ego: A psychodynamic case study of borderline personality
disorder following relational trauma. Psychodynamic Practice, 22(3), pp.223-235.