IIC 125: Borderline Personality According to the Conventional Secular Experts



Summary

This episode focuses on the internal experience of borderline personality dynamics, what it feels like.  Next, I share how “borderline” is a relatively new diagnosis, and previously indicated a range of personality development, rather than a specific disorder. I then discuss the standard diagnostic criteria from the DSM-5 and the Psychodynamic Diagnostic Manual, 2nd Ed., summarizing the symptoms in plain English. I explore the etiology or the origin of “borderline personality” and the underlying unmet attachment needs that fuel borderline dynamics. I describe different subtypes of borderline presentations and explore the types of partners to whom those with borderline dynamics are romantically attracted. From there, I describe five major treatment approaches and briefly discuss an outcome study. In closing, I review some suggestions for living with someone who presents with borderline characteristics.

Transcript

Borderline personality disorder. What does that bring up for you? Borderline personality disorder–the word borderline.
I’d like to lead in with some quotes from those who have struggled with borderline dynamics. These are direct quotes. The first set is from an article called “Borderline Personality Disorder” by Mind.org.uk.

  1. “My experience is that I have to keep my emotions inside because I get told I’m overreacting, so I end up feeling like I’m trapped inside my body screaming while no one can hear me.”
  2. “My borderline personality disorder affects every part of my life–relationships, identity, career choices, moods. I changed my name twice by deed poll. It’s a terrible, painful feeling not knowing who you are. A real struggle some days to battle everything.”
  3. “It’s like there’s something missing inside me. And no one understands when I try to explain how I feel.”
  4. “Borderline personality disorder can be exhausting. My mind is a constant roller coaster of emotions. When the emotions are happy and exhilarating, it’s the best feeling in the world.”

[00:01:35] The following ten quotes are from Christian Moltu and colleagues from their journal article, “How People Diagnosed with Borderline Personality Disorder Experience Relationships to Oneself and to Others. A Qualitative, In-Depth Study.”

  1. “I can wake up feeling depressed, and then three days goes by and I’m high up. I have no middle, either I’m down or I’m up. Either I’m happy and blue eyed and the world is really nice and everything is just ‘YES,’ or it’s death, destruction, war. Kill me. I’m like that.”
  2. “I did not have any words to describe my feelings, my head and body did not connect, I felt separated, my head was just chaos, I did not know how to put things into words, I didn’t know, I knew anger though, if I felt angry.
  3. “The pain I feel inside can be so intolerable to bear that my initial reaction is to harm myself.”
  4. “I’m thinking that when it gets too scary, there are two options for me. One is to get really ill with my eating disorder again, that life just, you almost die, or I could kill myself. If life gets too scary, then those two options are something I know that I’ll have, almost comforting.”
  5. “I would feel insecure a lot; I still do. I need confirmation several times a day, to confirm that I do things right, because I will judge myself a lot. I have this perfectionist in me; if it’s not perfect, then it’s not good.”
  6. “When I am really high up, I can feel invincible. No one can defeat me; what I did was fantastic, you know. But, when I come down from that high, this thought is suddenly there: ‘How could you think that way about yourself?!’ Then I feel the urge to punish myself for being positive.”
  7. “I don’t deserve anything good in this life. I deserve the mud on the bottom of the sea. I am the mud, I am mud! That’s how I felt about myself for years! I don’t deserve any joy, I don’t deserve anything good! I deserve all the bad things happening to me.”
  8. “I struggle a lot with the fact that I lose myself when I’m alone. Life can become hopeless and I can’t seem to do anything, even if I would like to draw or something, I rarely manage to do anything when I’m home. It’s just about passing the time until it’s time to go to bed.”
  9. “It might be what this personality disorder entails, because all I wanted was that someone would take me home with them, you know. Take me home and take care of me. That’s what I wanted and still want, but that’s not good, or what I want does not go together with what is actually good for me.
  10. My challenge is that I become so wrapped up in other people. I’m very lonely and can grab on to people, you know. I’m very lonely. I feel very lonely. I just want to be with other people, so I become too much. So then it’s a big thing when people reject me, you know?

[00:04:45] And these quotes are from Kelly Jo Holly’s article, ‘Borderline Personality Disorder Quotes.’

  1. “You know you’re borderline when you fluctuate between fearing abandonment and encouraging it.
  2. “I despise my own hypersensitiveness, which requires so much reassurance. It’s certainly abnormal to crave so much to be loved and understood.”
  3. “One second I’m perfectly fine, and the next it’s like a volcano erupts inside me, leaving me miserable.”
  4. “Having borderline feels like eternal hell. Never knowing how I am going to feel from one minute to the next. Hurting because I hurt those I love.”
  5. “I don’t know what living a balanced life feels like. When I’m sad, I don’t cry, I pour. When I’m happy, I don’t smile, I glow. When I’m angry, I don’t yell, I burn. The good thing about feeling in extremes is that when I love, I give them wings, but perhaps that isn’t such a good thing because they always tend to leave, and you should see me when my heart is broken, I don’t grieve, I shatter.”
  6. “My skin is so thin that the innocent words of others burns holes right through me.”
  7. “Living with BPD is pure confusion. It’s always like: ‘Am I allowed to be upset about this thing or am I being oversensitive?'”
  8. “It’s as if my life were magically run by two electric currents: joyous positive and despairing negative–whichever is running at the moment dominates my life, floods it.”
  9. “I couldn’t trust my own emotions. Which emotional reactions were justified, if any? And which ones were tainted by the mental illness of BPD? I found myself fiercely guarding and limiting my emotional reactions, chastising myself for possible distortions and motivations.”
  10. “I keep so much pain inside myself. I grasp my anger and loneliness and hold it in my chest. It has changed me into something I was never meant to be. It has transformed me into a person I do not recognize. But I don’t know how to let it go.”

[00:07:19] I am Dr. Peter Malinoski, clinical psychologist, trauma therapist, podcaster, blogger, co-founder and president of Souls and Hearts. I’m your host and guide in this Interior Integration for Catholics podcast. It is an honor. It is a pleasure to be with you. Thank you for listening in.

My goal for you is that you be able to more completely taste and see the height and depth and breadth and warmth and the light of the love of God, especially God the Father and Mary our mother, our spiritual parents, our primary parents. I am here to help you embrace your identity as a beloved little son or daughter of God. That’s what this podcast is all about. That is what Souls and Hearts is all about. And to bring that about, to live out this mission, I bring you new ways of understanding yourself, new ways of understanding people.

And as we continue our series on personality throughout the remaining months of 2023 and throughout 2024, we are starting a new series–a series on borderline personalities. This is episode 125 of the Interior Integration for Catholics podcast. It’s titled ‘Borderline Personality According to the Conventional Secular Experts.’ This will be released on November 6th, 2023.

In this episode, I’m going to bring you the best of the conventional understandings of borderline personalities, borderline dynamics. We are going to explore the what of borderline, the who of borderline, the why of borderline, and the how of borderline. We’re going to be looking at all those different dynamics in this episode today. This will be the first of a four episode series on this topic, and let’s get right into it.

[00:09:30] Let’s start by exploring what is borderline. What are borderline dynamics? And one of our RCC members framed the question this way.

“Hi, Dr. Peter. I have a question about borderline. When I was younger, someone in my family was diagnosed with borderline personality disorder, and when the adults shared the results with us, they said, you know, ‘borderline, there’s a borderline.’ And it sounded like not really a sure diagnosis, but just somewhere on a scale of a personality disorder. What is it with the name of this condition? And why is it so nebulous? Thank you.”

Why is it so nebulous? That’s a really good question. Now I’m going to invite you to go back to episode 116, which is called ‘Why a Single Personality Isn’t Enough.’ In that episode, I really argue against this whole idea of personality disorders in single, unified, homogeneous personalities.

I’m going to give you this quote from Linnea Butler, who said, “Borderline personality disorder has been called a ‘trash can diagnosis,’ meaning that it was originally a catch-all for problems that didn’t fit well within other diagnoses. It has long been pathologized by the mental health community as something inherent to a person’s personality, and therefore untreatable. This is not accurate and is harmful to people given that diagnosis and to the people who love them.”

[00:11:17] I want to get into the history a little bit about how the whole diagnosis of borderline personality disorder came to be. First of all, I’m going to say it didn’t exist before 1980. Before 1980, you won’t find borderline personality disorder in any of the statistical manuals and any of the standard nomenclatures for diagnosis. It was in the Diagnostic and Statistical Manual, III, that you saw it for the first time.

Originally going all the way back decades and decades, borderline was not a personality style. It wasn’t a personality style, it was actually a zone. It was a region. It was the space between being neurotic and being psychotic. Those that have looked at the history of personality assessment or personality diagnosis will know that Freud categorized people as being neurotic or being psychotic. But what happened was that there began to be this growing awareness that there was this zone–there was a wide space between the developmental level of neurosis and the developmental level of psychosis.

Grant Hilary Brenner in the March 5th, 2023 Psychology Today article, “There May Be Three Types of Borderline Personality Disorders,” said, “The term ‘borderline’ relating to personality has its origins in psychoanalysis, not as a diagnosis per se, but as a description of personality organization–in the borderland between higher-functioning neurosis and more profound psychosis.”

[00:13:16] Borderline personality disorder was not included as a diagnosis in the original Psychodynamic Diagnostic Manual in 2006. Instead, the PDM, the original version, continued the traditional understanding of borderline as exactly what it says: the borderline, the border zone.

Let me flesh this out a little bit. According to the second edition of the Psychodynamic Diagnostic Manual, there are four levels of personality organization. These are on a developmental continuum–this is how personality develops or where you might look at personality as a whole being arrested.

So there’s the healthy personality where there’s good functioning in all or at least most domains–they’re satisfying relationships, people are in touch with their feelings, they’re self-aware, they’re flexible and adaptive, and they’re coping even when there’s a lot of stress. Even when there’s internal conflicts, they’re able to maintain this coherent sense of identity, of who I am. Over time, people are able to express impulses appropriately in this healthy level of personality organization. They behave in ways that are congruent with their internalized code of conduct, their moral compass. They’re not suffering undue distress, and they’re not imposing undue distress on anybody else. And they have a flavor, if you will, of personality. But there’s flexibility. There’s alternate ways to cope. There’s not rigidity. There’s not chaos. That’s a healthy level of personality organization.

[00:15:01] But if we take it down to the neurotic level of personality organization, here we start to see internal psychological rigidity that’s present. It’s noticeable. There’s a restricted range of coping strategies. The pattern of suffering is usually restricted to a single area of focus, maybe two. And outside of that difficulty, the person is doing fairly well. There’s a good work history, there’s good relationships with others, good behavioral regulation. And the person who is in that neurotic range is managing impulsivity fairly well. They can handle unpleasant emotions. So it’s not as fully healthy, not as fully mature as a person at the healthy range of personality organization, but it is still doing relatively well.

The psychotic level of personality organization, though, here the characteristic is there’s a break with reality. There’s some type of psychosis. There’s overgeneralized, bizarre, or overly concrete thinking. There can be this unshakable conviction that one’s own assessment of others is correct. You can harden into that position regardless of what anybody else says or does. One might attribute one’s own emotions and thoughts to others and assume they’re thinking the exact same thing–that reality testing is compromised and this can harden into delusions or hallucinations. Identity gets fragmented. There’s identity diffusion, a lack of cohesiveness in the way I understand myself. And usually there’s socially inappropriate behaviors. There can be really deep fear of annihilation. Annihilation in a physical way, in an emotional way, in a spiritual way, a fear of a loss of existence. These folks are really frightened. So that’s the psychotic level of organization.

[00:17:04] And the borderline level of organization is in between that psychotic level and the neurotic level. And this is characterized by people who have difficulties with emotional regulation. They’re vulnerable to extremes of overwhelming emotion, being flooded with emotions of different kinds–depression, anxiety, rage, shame. They have recurrent relational difficulties, chronic problems with emotional intimacy, problems with work, difficulties with impulse regulation. They might be prone to substance abuse, addictive behaviors. They may be at greater risk for intentional self harm behaviors, especially when their primary relationships are not going well.

This is the level in which most “personality disorders” are diagnosed. This is a broad range, and you can be closer to the neurotic or closer to the psychotic side. But the whole idea is that this can encompass all personality disorders. All personality disorders are characterized by these elements of being in this range between neurosis where there’s no personality disorder, and psychosis.

What’s happened, though, is that this range of functioning, including this sort of instability, this unpredictability, has taken on a life of its own, and a few theorists began to think of it as a discrete personality disorder on its own borderline personality disorder.

[00:18:40] So we’re now going to get into what does that look like? And here’s a question from Susan to kind of lead us off on that.

“Hi, Dr. Peter. Susan here. Is there a distinct trait that you think distinguishes borderlines from, say, NPD or other mental illnesses? Thank you.”

Okay, so when Susan refers to NPD, she’s referring to narcissistic personality disorder. And we spent six episodes on narcissistic personality disorder, from episode 118 to episode 124. But let’s get into the markers and the characteristics and the symptoms that identify how the profession of psychology and the profession of psychiatry understand borderline personality disorder.

According to the American Psychiatric Association’s DSM-5, borderline personality disorder is diagnosed on the basis of a pervasive pattern of instability of personal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Okay, that’s really the core of it. A pervasive pattern of instability in interpersonal relationships, self-image, and affects or emotions, and marked impulsivity beginning by early adulthood and present in a lot of different contexts. At least five of the following nine symptoms–and then we’ll go through those symptoms in a minute. But that’s the core of it, this pervasive pattern of instability.

[00:20:32] But this is one of my arguments about why borderline is not a personality disorder. Because the DSM-5 defines personality as composed of “enduring patterns of perceiving, relating to, and thinking about the environment and oneself,” but the definition is that those patterns don’t exist, that they’re unstable. So this is a self-refuting definition. This is one of my concerns about how we understand “personality.”

I got into that in episode 116 in greater depth, but I just want to highlight it here–the consistent, enduring pattern is one of inconsistency and instability. That’s what is supposed to be consistent and stable about borderline personality disorder.

This marked impulsivity, according to the DSM-5, you need at least five of nine symptoms.

  1. Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging, such as spending, sex, substance abuse, reckless driving, binge eating.
  5. Recurrent suicidal behavior, gestures or threats or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood. That could be dysphoria, irritability, anxiety.
  7. Chronic feelings of emptiness.
  8. Inappropriate intense anger or difficulty controlling anger. For example, frequent displays of temper, constant anger, or recurrent physical fights.
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

[00:22:34] So those are the nine symptoms that the DSM-5 gives us. You need five of them. Right. So imagine, you know, the first person that gets diagnosed has number one through five. And the second one could have number five through nine, right? They could overlap with only one common symptom of market impulsivity.

So this is why I go back to that idea that this is a trash can diagnosis. As Linnea Butler said, this isn’t something that’s very coherent or consistent. Again, because what it grew out of was actually a whole level of personality organization, as I mentioned before.

Now, another way to understand this, according to the DSM-5, is through their alternative criteria. And the DSM-5 says that “typical features of borderline personality disorder are instability of self-image, personal goals, interpersonal relationships, and affects or emotions accompanied by impulsivity, risk taking, and/or hostility. Characteristic difficulties our appearance in identity, self-direction, empathy, and or intimacy as described below, along with specific maladaptive traits in the domain of negative affectivity and also antagonism and or disinhibition.”

[00:23:54] So problems with identity. Identity being markedly impoverished and poorly developed. There’s this unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness, and dissociative states under stress. Self-direction is just instability in goals, instability in aspirations, values or career plans. Empathy, a compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity. You know, for example, the feeling slighted or feeling disregarded by others and perceptions of others that are selectively biased toward negative attributes or vulnerabilities. And then again, the difficulties with intimacy–this intense, unstable, conflicted, close relationships marked by mistrust, neediness, anxious preoccupation with real or imagined abandonment. Close relationships are often viewed in extremes of idealization and devaluation, and alternating between overinvolvement and withdrawal. There’s just this chronic interpersonal instability, this unpredictable, polarizing way of interacting with other people.

[00:25:10] And then four of the following seven pathological personality traits. Emotional lability–that is unstable emotional experiences, mood swings, these frequent mood changes. Anxiousness–this tension, even panic. Separation insecurity–fears of rejection and separation from significant others. They fear their own excessive dependency. They fear the loss of autonomy. Depressivity–the sense of being depressed, miserable, hopeless. Impulsivity–acting on the spur of the moment, being reactive to what’s going on in the environment around you, acting on a momentary basis without plans or forethought, considering the possible outcomes or consequences, difficulty with following plans. And it could be driven by the sense of urgency. Risk-taking is another one. Could be dangerous activities, risky activities. And then hostility–persistent or frequent angry feelings. Anger or irritability in response to minor slights or insults.

So that’s the DSM take on it. They have they have their main criteria. They have their alternative criteria.

But I think a better diagnostic system, if you’re going to look at borderline personality as a disorder or as a real thing, is to take a look at the Psychodynamic Diagnostic Manual, II. In the second edition, the authors decided that they were going to recognize borderline personality disorder. They did this back in like 2016.

[00:27:04] Again, they define personality in the PDM-2 as “relatively stable ways of thinking, feeling, behaving and relating to others.” And when they look at borderline personality disorder, they see the basic constitutional or maturational pattern as having these difficulties with affect regulation, that is, emotional regulation, intensity of emotion, aggression, and a limited capacity to be soothed. These difficulties with emotional regulation, with intensity, there’s not much modulation. There’s these difficulties in tolerating and regulating the intense emotions. Emotions very readily ramp up. They spin out of control. There’s a lot of interpersonal reactivity.

Marsha Linehan said that, “People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” They often have a fairly high degree of aggressive drive, and as I mentioned before, that capacity to be soothed, that primary attachment need to be soothed, comforted and reassured, they really struggle with that.

Their central tension or preoccupation is twofold. One is self-cohesion vs. fragmentation. They are in fear of falling apart–of emotionally the wheels coming off the wagon, psychologically things collapsing in. Self-cohesion, being able to hold it together, is a constant issue for folks that are activated who have these dynamics.

The second major tension or preoccupation is engulfing attachment vs. abandonment or despair. There’s no good place for those with borderline dynamics to be in the relationship. They don’t want the abandonment. They don’t want the rejection, they don’t want the alienation. But if they get close to somebody else, they fear that they’re going to be engulfed by them, that they’re going to be consumed by them, that others are going to take them over and control them. And Kimberlee Roth said, “Owing to a poorly defined sense of self, people with BPD rely on others for their feelings of worth and emotional caretaking. So fearful are they of feeling alone that they may act in desperate ways that quite frequently bring about the very abandonment and rejection they are trying to avoid.”

[00:29:53] So what is the emotional experience of folks with these dynamics? We talked about them at the very beginning. At that lead in, you heard some of those quotes, but they experience emotions very intensely and their emotions vacillate. They cycle. They change very rapidly. They have mood swings, and they are highly emotionally conflicted about their unmet dependency needs. So we see rage. We see shame. We see fear. We see these abrupt outbursts of emotion that have great intensity and that others don’t expect. They can also feel guilty about asserting themselves, and I also think they struggle with despair. What about their thinking? Well, their thinking, their cognition, is compromised because of the intensity of their emotions. They struggle with misperceptions of others that are driven by their fear of abandonment, that are driven by their fear of engulfment their cognitions, their thoughts can change very rapidly. They can hold multiple thoughts that are incompatible with each other at the same time, that are contradictory, and they are very prone to misunderstand the attitudes, emotions, and behaviors of others–to interpret those attitudes, emotions, and behaviors of others to mean current or future rejection and abandonment. They often think that others think or feel the way that they do. That’s, in a nutshell, how individuals with these borderline dynamics think.

[00:31:32] Now, the characteristic pathogenic belief about the self, according to the PDM-2 is “I don’t know who I am; I inhabit dissociated self-states rather than having a sense of continuity.” I don’t know who I am. This is such a central concept for those struggling with borderline dynamics–this diffusion of identity, this lack of self-cohesion, this internal fragmentation. I don’t know who I am. And it’s often driven by this deep sense that there’s a void inside, an inner emptiness, feelings of deep uncertainty about the self. They lead to a lack of consistent identity. My identity can seem to change so much.

And Jerold Kreisman and Hal Straus said,

“Central to the borderline syndrome is the lack of a core sense of identity. When describing themselves, borderlines typically paint a confused or contradictory self-portrait, in contrast to other patients who generally have a much clearer sense of who they are. To overcome their indistinct and mostly negative self image, borderlines, like actors, are constantly searching for ‘good roles,’ complete ‘characters’ they can use to fill their identity void. So they often adapt like chameleons to the environment, to the situation, or to companions of the moment. Much like the title character in Woody Allen’s film Zelig, who literally assumes the personality, identity and appearance of people around him.”

[00:33:12] Moreover, folks that struggle with these borderline dynamics have a lack of self-awareness and a lack of consistent self-governance. They have difficulty managing themselves. They have difficulty managing the intensity of their internal experience. So often their integrity needs are not met. They are not accurately seen through the eyes of others. They are frequently misunderstood.

What’s the characteristic pathogenic belief about others that these folks have? Well, according to the PDM, they believe that, “Others are one-dimensional and defined by their effects on me, rather than by a sense of their complex individual psychology.” People with these dynamics tend to see others in orbit around them. They have this insecure attachment style. They have this separation anxiety. They need so much protection and reassurance and encouragement from others that they have difficulty understanding that others have their own internal experience–they have their own emotions, desires, attitudes, thoughts, and impulses.

People with borderline dynamics have difficulty putting themselves in another’s shoes, and they tend to see others in black and white terms, this dichotomous and often rapidly changing ways.

[00:34:36] Theodore Millon, the great personality theorist, believes that people with borderline personality characteristics are “interpersonally paradoxical.” I really like that description. Interpersonally paradoxical. On the one hand, they have great need for others’ attention and affection, but they can be very contrary, even combative, at times–very volatile. So on the one hand, you here you have this tearful neediness, you have this contrition, you have this dependency. And on the other hand, you have this angry, vindictive approach to interpersonal relationships. And this pattern being so inconsistent, being so paradoxical, being unpredictable is likely to invite or even encourage others rejection. Theodore Millon said,

“Borderlines create the vicious cycles they fear the most. They become angry and drive their relationship to the breaking point, then switch to a posture of helplessness and contrition, beg for reconciliation. If both parties are equally enmeshed, chaos and conflict become the soul of the relationship.”

According to the PDM-2, the central ways of defending, the central protective mechanisms, the coping strategies, are splitting, projective identification, denial, dissociation, and acting out.

[00:36:05] Well, what is splitting? Splitting, according to the American Psychological Association Dictionary of Psychology, is in Kleinian analysis and Fairbairnian theory–you don’t need to know about that–splitting is a primitive defense mechanism used to protect oneself from conflict, in which important others who provoke anxiety and ambivalence are dichotomized into extreme representations (or part objects) with either positive or negative qualities, resulting in polarized viewpoints that fluctuate in extremes of seeing the self or others as either all good or all bad.

All right, so let me break this down into a little more easily understandable language. Splitting is making somebody either all good or all bad. They’re either angels or devils, right? This is not an integrated understanding of a person. It is a split understanding of the person.

The APA Dictionary of Psychology goes on to say that this splitting mechanism is used not only by infants and young children who are not yet capable of integrating these polarized viewpoints, but also by adults with dysfunctional patterns of dealing with ambivalence; it is often associated with the borderline personality disorder.

When you split another person and you make them either all good or all bad, you wind up having to alternate between those two because it’s not a complete representation of the other person. If you split, though, you can at least preserve the good dynamic. Sometimes what happens is that children are raised in environments in which if they integrated mommy, or if they integrated their representation of daddy, mommy and daddy wouldn’t be good enough. They wouldn’t be good enough. So there’s this attempt to hold on to the goodness by splitting off the badness. That can happen with splitting, and it’s one of the ways that people with borderline dynamics cope with life.

[00:38:11] The second one is projective identification, and Ogden in 1982 said,

“In projective identification, not only does the patient view the therapist in a distorted way that is determined by the patient’s past object relationships; in addition, pressure is exerted onto the therapist to experience himself in a way that is congruent with the patient’s unconscious fantasy.”

All right. So this is a little more difficult to understand, but it is important. What happens in projective identification is that the person with the borderline dynamics projects onto the other person what he or she thinks that person is feeling. And then they engineer the social relationships, the interpersonal relationships, to induce that feeling in the person.

Bertram Cohen calls this a self-fulfilling prophecy. It reenacts the old dynamics, right? And according to Nancy McWilliams, Person A feels less crazy if Person A can induce in Person B the feelings and experiences that Person A is convinced that Person B already has.

Projective identification is an unconscious process. Person A has no awareness that she’s doing it. Projective identification can feel crazy-making in Person B, leading Person B to set very strong boundaries. It can evoke a very strong countertransference in therapists, right?

[00:40:05] So denial. This is a lot simpler. This is a defense mechanism in which unpleasant thoughts and feelings and wishes and events are ignored. They’re excluded from conscious awareness. It can take such forms as refusal to acknowledge the reality of of really unpleasant facts, like a terminal illness, or a divorce, or the death of another person. That’s denial.

Dissociation. That’s the defense mechanism in which conflicting impulses are kept apart, or threatening ideas and feelings are separated from the rest of the psyche. All right, that’s basically enacting something. It’s expressing unconscious emotional conflicts or feelings or desires without being aware of where that behavior is coming from or what the impulses are that drive that behavior. Acting out.

And then Theodore Millon would add regression as a defense to the borderline dynamic. This is a return to a prior, lower state of cognitive, emotional, or behavioral functioning. The term is associated particularly with psychoanalytic theory, and it’s regressing into an earlier pattern of coping, a younger pattern, a more immature pattern of coping. If you want to understand the internal experience of someone with these borderline dynamics at the intrapsychic level, Theodore Millon says that there is a “split organization.” These folks are fragmented. They’re split inside. They have “inner structures that exist in a sharply segmented and conflictual configuration in which a marked lack of consistency and congruency is seen among the elements.” Right? Things don’t hang together well inside. Their “levels of consciousness often shift and result in rapid movements across boundaries that usually separate contrasting percepts, memories, and affects; this leads to periodic schisms in what limited psychic order and cohesion may otherwise be present, resulting in transient stress-related psychotic episodes.” So when these folks get really distressed, they start to look more psychotic. Remember, this is originally a term that described a range, a zone, the borderline.

[00:42:47] So that’s the ‘what’ of borderline personality. That’s what it is described as in the major reference works in the profession of psychology and the profession of psychiatry.

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