Monday, August 5, 2013

Disturbed Sense of Identity in Borderline Personality Disorder: Part 4

Here’s the part that I get really interested in. Psychological Causes for Identity Diffusion. I know many of you are probably more interested in how to strengthen a flexible and weakened identity. We’ll get to that when I’m done with this series (Hint: Tomorrow is the last day).

Carsten Rene´ Jørgensen, PhD

PSYCHOLOGICAL CAUSES OF IDENTITY DIFFUSION




Apart from the primarily descriptive conception given above, identity diffusion can be viewed from at least two other perspectives: namely a developmental and a dynamic perspective (Akhtar, 1992). Developmentally, identity diffusion is often related to problems in the growth and maturation of basic trust(Erikson, 1968) and insecure attachment(Bowlby, 1988). Identity diffusion has been conceptualized as the result of problems in the separation-individuation process, especially the rapprochement sub-phase of early childhood (Mahler, Pine, & Bergman, 1975) and the second individuation process in adolescence (Blos, 1979). The common psychological tasks of these two critical periods in human development, characterized by a heightened vulnerability of the personality organization, are centered round an endeavor to disengage and separate from inner (internalized) and outer objects. Adaptive transformation and maturation of the personality organization occurs as the result of a normal separation-individuation process. If the process fails, separation, individuation and disengagement from internal and external objects is replaced by a maladaptive polarization of them (Blos, 1979), or alternatively a complete detachment from inner and outer objects. Masterson (2000) has speculated that the significant others of the future borderline patient are unable to support the child’s emerging self during the rapprochement stage of individuation. Malignant interactions with significant others are internalized and give rise to separation anxiety and abandonment depression, which will inhibit self-activation and development of personal identity. Similarly, insecure attachment and deficits in the development of basic trust inevitably inhibit the establishment of a stable and mature identity.


As described by Blos (1979, p. 148), “the incapacity to separate from internal objects except by detachment, rejection, and debasement is subjectively experienced as a sense of alienation” and emptiness. During the normal separation-individuation process, attachments to significant inner and outer objects are maintained at increasingly mature levels. Up to adolescence, parental egos will normally be available to the child and—in assistance with social structures—give organization and structure to its ego.

Normally things should happen this way, as we know though, this isn’t how things typically go for us.

In adolescence this alliance is disrupted and “ego regression lays bare the intactness or defectiveness of early ego organization” (Blos, 1979, p. 157).

Adolescents with problems in the first separation-individuation process and resulting deficits in personality structure will be more vulnerable to problems in the second individuation process and more prone to develop a maladaptive, diffused identity. Identity diffusion can manifest itself throughout childhood but because childhood normally occurs in a relatively structured and protective environment, the symptoms of identity diffusion usually become evident when, in the course of adolescent development, the structure of the parental home environment decreases (Kernberg, 2004) and demands from the environment increase.

So parents may notice things in their smaller children that could indicate something off or unusual behaviorally, but odds are it won’t be until adolescence, when things become a little more unstructured, a little more unpredictable, that it becomes very apparent that something is actually wrong.

The development of severe and persistent identity problems in adolescence is the result of several interacting factors, including genetically determined traits and behavioral dispositions, individual vulnerabilities (structural deficits, etc.), immediate strains, and insufficient support from the environment. Similarly, problems in attachment relations must be understood in their social and interactional context. The strains of modern life affect the family and significant other’s ability to contain and react appropriately to the patient’s behavior. Parents who are under great stress, unemployed, socially excluded, divorced, etc. are often disadvantaged when it comes to taking care of children and adolescents. Moreover, “development is determined by the dynamic interaction between the child’s individual temperament and the environmental experiences and demands which the child encounters” (Thomas & Chess, 1977, p. 35). Healthy development depends upon a ‘goodness of fit’ between temperament and environment. ‘Goodness of fit’ describes the degree to which “the properties of the environment and its expectations and demands are in accord with the organism’s own capacities, characteristics, and style of behaving” (Thomas & Chess, 1977, p. 11). From an interactional perspective, environment and temperament are not independent entities. Temperament or constitution and environment are not necessarily constant over time, they constantly interact and can modify each other in a dialectical process. Especially in infancy, parental responses are significantly influenced by whether the child has the temperamental constellation of what Thomas, Chess, and Birch (1968, p. 75ff) has called the ‘difficult’ or ‘easy’ child.

It is reasonable to hypothesize, that biologically based deficits in self and affect-regulation and biologically determined temperamental dimensions like high harm avoidance and, especially, high novelty seeking (including impulsiveness, disorderliness and easily being bored), which have been related to borderline personality disorder (Svrakic et al., 1993, 2002), in many cases destabilizes attachment relationships in childhood and adolescence and—secondarily—contributes to disturbances in identity development. The environment will often experience children with temperamental traits like these as difficult and react in ways that are negative and have adverse effects on the psychological development of the child. Similarly, character dimensions such as low self-directedness and low cooperativeness, often found in borderline patients (Svrakic et al., 2002), are likely to compromise social relations in adolescence and adulthood and destabilize personal identity. Additionally, parents under great stress are less likely to be able to handle ‘the difficult child’ in ways that are ‘good enough.’

No chance to turn out well. Sorry. 

As I’ve said over and over ad nauseum… nature AND nurture. Yes there is a biological element that predisposes us to a certain temperament, however, that temperament can be abated or exacerbated depending on the environment and how we are encouraged by our environments.

Start this next paragraph thinking about lack of object constancy and consistent sense of self and sense of others (the jargon is confusing).

Psychoanalytic theory has related identity diffusion to the presence of un-metabolized introjection and an insufficient integration of contradictory identifications and representations of self and others. Deficits in evocative memory imply that the BPO-patient does not have the access to memories of good objects, which is required for self-soothing and continuous stabilization of the self. Absence of a good, reliable and caring other, or an accessible representation of one, precipitates the loss of a coherent sense of identity (Westen & Cohen, 1993). In addition to this, cognitive development has an impact on the level of differentiation and integration of personal identity (Harter, 1999) and one could speculate that splitting and incoherent identity sometimes are related to not only dynamic processes but also cognitive immaturity. Cognitive development is also related to factors in interpersonal relationships and contemporary culture. As argued by Harter (1999), developmental changes in cognitive processes during adolescence “typically require greater scaffolding by the social environment in the form of support, experience, instruction, as so on, for individuals to function at their optimal level.”

A diffuse sense of personal identity can be related to deficits in the ability to mentalize (Fonagy, Gregely, Jurist, & Target, 2002). The ability to mentalize represents a capacity to understand one’s own and others’ mental states, that is to say thoughts, needs, feelings, wishes, and intentions.

Furthermore, it is the ability to attribute mental states to the self and others and thereby gain a valid understanding of one’s own character and behavior and the behavior and personal character of others. Competent mentalization enables the person to predict behavior and reactions of the self and others. This capacity for symbolic representation and valid understanding of one’s own mental states (and the mental states of others) is an essential pre-requisite for a sense of identity (Bateman & Fonagy, 2004, p. 85). Those who lack this ability “will lack an authentic, organic self-image built around internalized representations of mental states”(p. 85) and they are unable to predict and understand reactions and behaviors of the self and others. Failures in the capacity to mentalize is manifested in several ways, including “poor organization of self-states leading to a breakdown in the sense of identity that is rooted in the appropriate interpretation of subjectivity” (Fonagy, Target, Gregely, Allen, & Bateman, 2003, p. 442).


What this means is that it being able to understand how others perceive us, helps us understand ourselves. So if we don’t have a clear understanding of how to interpret others reactions consistently, our own perceptions will feel unfamiliar and even vaguely hostile. Everything will always be up for interpretation and nothing will feel firmly implanted or steady.

The capacity to mentalize is developed in early attachment relations. In order to develop a coherent and stable sense of identity, people need to feel understood, validated, accepted and mirrored by significant others in their subjective experiences. Accurate, consistent and clearly ‘marked’ (Bateman & Fonagy, 2004) mirroring of the constitutional self contributes to the development of a coherent and stable sense of identity. Conversely, inaccurate, inconsistent and insufficiently marked mirroring from significant others impedes the development of a sense of identity that is coherent, consistent and clearly differentiated from others. One could assume, that identity diffusion also is related to what Fonagy and colleagues (2002) has called the pretend mode of experiencing in which fantasy and conceptions of the self is fragmented and cut off from the real world and the ability to mentalize is compromized. Pretend mode is marked by simultaneously held contradictory beliefs (Bateman & Fonagy, 2006, p. 8).

Individuals with an insufficiently developed capacity for mentalization will experience interpersonal relationships and find the world in general as unpredictable and frightening. They will often need to use controlling and manipulative strategies to establish a coherent sense of self (Bateman & Fonagy, 2004). Through projective identification and other primitive defense mechanisms, parts of the self are evacuated and attempts to control these parts of the self ‘in the other’ are initiated. Transactional defense mechanisms, like these, inevitably jeopardize interpersonal relationships.

Genuine intimacy is only possible if issues of identity are reasonably well resolved and interpersonal relationships are not dominated by attempts to construct or stabilize one’s own identity or ward off parts of the self.

In some cases identity diffusion can be related to the development of a ‘false self.’ In an attempt to survive defective self-object experiences, repetitively experienced empathic failures, lack of validation, and the insufficient attunement of significant others to the needs of the self, the borderline patient submits to expectations from the environment and his or her self-concept becomes dominated by projective and invalid representations of the self, internalized in interactions with significant others. When this false self is weakened, as often happens in successful psychotherapy, it is revealed how the false self has been part of a (pathological) defensive strategy, established in an attempt to organize and stabilize the self and to protect the ‘true’ or constitutional self. Typically, what is found ‘behind’ the false self or foreclosed identity (an identity chosen and imprinted on the self by significant others) is for the most case emptiness and a profound inability to answer psychologically important questions like: ‘Who am I really, if I am not the person others have always told me that I am?’ ‘What do I really want and need?’ ‘What are my personal boundaries?’

Deeply seated identity diffusion has been masked by a false self and when this false self is peeled off, in the course of psychotherapy, the underlying identity problems are revealed.

So the ‘false self’ is either meant to be a protector or is a projection developed because the real self is so weakened that that the person just subverts the ‘real self’ and adopts the identities that they think others need them to be.

For me, most of my flexible sense of self issues have been more of sense of protection, protection from abandonment. Structure, stability, these things I’ve reached for and tried to cling to until I was practically choking the life out of myself!

So what do you think? One last installment in this series…. 

5 comments:

  1. Hey there Haven. The third criterion in BPD diagnosis deals with identity disturbance and an instability in the sense of self. Does this necessarily mean identity diffusion or could it also mean identity foreclosure? From what I know they are two different kinds of identity problems.

    And to be frank I've always wondered about the range of effect of "lack of object constancy" on people who suffer from it. To what degree can one really be impacted by it? If a sufferer has an online friendship with a person they've never met in real life, can their behavior with that person be impaired and unpredictable because they never saw that person as a "real" entity in life, instead just visualizing him/her as a passive entity which has no direct effect on them?

    I know I sound really confusing but I just wanted to know if these things are possible x)

    ReplyDelete
    Replies
    1. It can definitely mean identity foreclosure. It can mean mirroring, projection, moratorium, or just being flexible in general. Identity issues are actually very complicated.

      As to the on-line person, yes certainly. You can develop a strong bond with someone on-line in this virtual world of ours, especially if you are in contact with them often. And then subsequently when you lose contact with them the loss of that persons contact can be very destabilizing, maybe more so, because then they are only a void where no body is at all.


      Lack of Object Constancy

      Delete
  2. Hi Haven; I came across your blog thru a google search that led me to this entry. Six months ago I was diagnosed with BPD, but I've dealt with strong feelings of emptiness and a lack of self-identity for a long time. I've tried so hard over the past several years to figure out who I really am, only to find myself more confused & frustrated. It seems like who I *used* to be, who I *want* to be & who I *feel* like I am, are in such conflict. I go through so many cycles of impulsive actions, emotions, & reactions. And feeling so lost & empty inside doesn't make dealing with it any easier.
    Well, I just wanted to let you know that I found the information in your blog entry intriguing... even though I had to read a few of the sentences more than once to understand it. I'm just not sure how I feel about the sentence: "They will often need to use controlling and manipulative strategies to establish a coherent sense of self". I sincerely hope I'm not like that.

    ReplyDelete
    Replies
    1. ::hugs:: I know the feeling. I struggled with it for years, more like over a decade. I'm just now kind of starting to find myself, but it's still a slow process. It takes time. Don't give up though. As long as you keep trying, you will get there.

      I don't always thing that people understand what Borderline manipulation is. Everyone manipulates, just like everyone lies. Check out the links below and see if that helps you.

      BPD acting “Normal” and Manipulation

      Borderline "Manipulation"

      Delete
    2. Thank you. Your posts helped me understand it much better. I appreciate it!

      Delete

Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

Related Posts Plugin for WordPress, Blogger...