LEVEL OF DEFENSIVE OPERATIONS IN BORDERLINE PERSONALITY

In contrast to neurotic personality organization, in which the patient's defensive organization centers on repression and other advanced or high-level defensive operations, borderline and psychotic levels of organization manifest predominately primitive defenses centering on the mechanism of splitting. Splitting and other mechanisms related to it (for example, primitive idealization, projective identification, denial, omnipotent control, and devaluation) protect the ego from conflict by dissociating contradictory experiences of the self and of significant others.

The presence of splitting and its related primitive defense mechanisms may be elicited in the analysis of the patient's personality, as reflected in interactions both with significant others and with an interviewer.

-Splitting. The division of self and external objects into "all good" and "all bad" results in sudden and complete reversals of all feelings and conceptualizations about one's self or views about a particular person.

-Primitive Idealization. This mechanism exaggerates the tendency to see all external objects as good. The qualities of goodness in others are exaggerated in a pathological way, to the exclusion of commonplace human defects. The patient does not tolerate any imperfection in the idealized person. The counterpart of idealization is the complete devaluation of others, or the perception of others as persecutory and dangerous.

-Early forms of Projection; Projective Identification. In contrast to higher levels of projection, characterized by attributing to other persons an impulse that the patient has repressed, projective identification is characterized by: (1) the tendency to continue to experience the impulse, which is at the same time projected onto the other person; (2) fear of the other person, who is viewed as being characterized by or under the sway of that projected impulse; and (3) the need to control that person, often done in such a way as to elicit behaviour in the person that seemingly validates the projection. Thus, whereas projection is based on an ego structure centered on repression as a defense, projective identification is based on a structure centered on splitting, or primitive dissiciation.

-Denial. In borderline patients denial is exemplified by the presence of emotionally independent areas of consciousness. These patients are aware that their perceptions, thoughts, and feelings about themselves or others at some times are completely opposite those entertained at other times, but this recognition has no emotional relevance and cannot influence their current state of mind.

-Omnipotence and Devaluation. Both omnipotence and devaluation are derivatives of splitting and are represented by the activation of ego states that reflect a highly inflated grandiose, omnipotent self and that relate to depreciated and devaluated representations of others, including the projection of devalued aspects of the self. A corollary of the omnipotence fantasy is the devaluation of other people, the patient's conviction of his superiority over them, including the therapist.

-The Subjective Experience of Emptiness. There are patients who describe a painful and disturbing subjective experience which they frequently refer to as a feeling of emptiness. In typical cases, it is as if this emptiness were their basic modality of subjective experience from which they attempt to escape by engagement in many activities or in frantic social interaction, by the ingestion of drugs or alchohol, or by attempts to obtain instinctual gratifications through sex, aggression, food, or compulsive activities that reduce their focusing on their inner experience. Other patients, in contrast, seem to succumb to this experience of emptiness and to aquire what might be described as a mechanical style of life -going through the motions of daily activities with a deadening sense of unreality or a blurring of any subjective experience, so that they seem to merge, so to speak, with whatever immediate inanimate or human environment surrounds them… This experience becomes particularly strong when active mechanisms of primitive dissociation or splitting constitute a predominant defense against intrapsychic conflict.

-Self Harm/Mutilation. Some patients have tendencies toward self-mutilation, and tend to relieve tension of any origin by inducing pain in themselves (by cutting themselves, burning their skin, etc.). One [may even] observe a real pleasure or pride in the power of self-destruction.

[From 'Borderline Conditions and Pathological Narcissism', and 'Psychodynamic Psychotherapy of Borderline Patients' by Otto Kernberg]