Friday, July 19, 2013

Disturbed Sense of Identity in Borderline Personality Disorder: Part 1

Sorry everyone. I got bit by a spider. Well, we think it was probably a spider. I was asleep at the time and woke up to something terribly, terribly wrong.  My left arm has been a swollen mass of pain and fever. I’m on antibiotics.  Bleh. It’s been a really bad month for me between my computer dying, the stalker, and now the spider. I need a vacation. Fortunately, I’m going on a short one next Friday for 5 days. ::head desk::.  

Anyways. Here is the article I’ve found that I really wanted to share with you. I was going to break it down for you as it’s exceptionally long, but it’s also exceptionally fascinating and very well written so what I’ll do is break it down into easily digestible chunks per day and highlight/underline important bits and whatnot.  


Carsten Rene´ Jørgensen, PhD

Traditionally, personal identity is considered to be important for psychological health and adaptive functioning. Identity diffusion and other more severe forms of disturbance associated with personal identity are regarded as being essential parts of the borderline personality disorder. Moreover, disturbances in identity are seen as being part of the dynamic background for many of the symptoms and maladaptive behaviors found in borderline patients. It is argued, that the development of personal identity is intimately related to, and indeed dependent on, elements of modern culture, with significant cultural changes having affected the conditions under which human identity develops. Therefore, the identity diffusion seen in patients with borderline disorders must be understood in relation to not only the individual patient’s personal history and inner structures but also contemporary late modern culture and social organization.

In the famous chapter entitled ‘Of identity and diversity’ in ‘An Essay Concerning Human Understanding’ by John Locke (1690) the author writes “to find wherein personal identity consists, we must consider what person stands for.” According to Locke ‘person’ refers to a “thinking, intelligent being that has reason and reflection, and can consider itself as itself, the same thinking thing, in different times and places” (p. 67). He further claims that “since consciousness always accompanies thinking, and it is that which makes everyone to be what he calls self, and thereby distinguishes himself from all other thinking beings, in this alone consists personal identity” (p. 67). Locke’s solution to the problem of personal identity is then, one that is based on a continuity of self-consciousness.

There is no definition of human or personal identity that is universally agreed upon. Depending on the context, personal identity has been understood as being a substance, a subjective experience or personal ‘sense of self,’ an inner structure, a personal construction, an existential project and a (never ending) process. Moreover, theorists often use terms such as ego-, self-, and personal identity more or less interchangeably. “On the one hand, identity is a feature of the individual, reflecting an internal process of self-definition. One the other hand, identity emerges in a social context and is shaped by the immediate circumstances as well as the broader culture” (Deaux, 2000, p. 225). Additionally, one often differentiates between social identity, that part of a person’s identity or self-concept which derives from his or her membership of a particular social group, culture or society, and personal identity, the person’s more or less conscious concept of humor herself as a unique individual with particular traits, needs,  defining characteristics, and a particular history.

As Erikson (1959) has pointed out, the term ‘identity’ has several different, but intimately connected meanings. Sometimes it refers to “a conscious sense of individual identity; at another to an unconscious striving for continuity of personal character”(p. 102). In a third situation, it is used as “a criterion for the silent doings of ego synthesis; and finally, it is used in connection with the maintenance of an inner solidarity with a group’s ideals and identity” (p. 102). Marcia, one of the successors of Erikson, understands (ego) identity as a personality structure that makes its first appearance in adolescence. This structure “consists of an individual’s organization of drives (needs, wishes) and abilities (skills, competence) in the context of his or her particular culture’s demands (requirements) and rewards (gratifications)”(Marcia, 1994, p. 64). Greenacre (1958) argued that the term identity has two significant faces, an inner and an outer one. On the one hand, identity means an individual person “whose component parts are sufficiently well integrated in the organization of the whole that the effect is of genuine oneness, a unit” (Greenacre, 1958, p. 612). On the other hand, identity refers to the unique characteristics of the individual person,“whereby it can be distinguished from other somewhat similar persons”(p. 612). Psychoanalytic theory (Kernberg, 1976) has related the primarily phenomenological or ‘subjective’ sense of identity to inner structures and the organization of personality. It is assumed that both level of organization of personality or integration, and the structural level of development of identity are manifest in the individual’s subjective sense of identity. I suggest that the term ‘identity’ is primarily used as a phenomenological concept which denotes a subjective representation or sense of the self as agent, person and object of perception and reflection.

Varying conceptualizations of identity, self, and personality has led to confusion regarding the interpretation and differentiation of the terms. ‘The self’ has a long and complex history in psychology and philosophy. From William James (1890) onward, the term ‘self’ has been used to denote both the human subject (the knower, actor, or ‘I-self’) and an object of perception and reflection (the known, or ‘me-self’). Especially in classical psychoanalytic theory these two conceptualizations of the self are used more or less interchangeably which has caused some confusion. The self as object, the self as ‘the known,’ is intimately related to the social identity and, more loosely to personal identity.

In everyday discourse ‘the self’ is often used as a rough synonym for ‘the person’ or personality; primarily the self as ‘the known’. As pointed out by Leary and Tangney (2003, p. 7), in scholarly writing ‘the self’ typically refer to an “inner psychological entity that is the center or subject of a person’s experience.” Here the self is conceptualized as a mental capacity which allows the individual “to take itself as the object of its own attention and to think consciously about itself” (p. 8), an executive agency of the mind related to ‘the ego’ in classical psychoanalytic theory (the self as actor and knower). Similarly, we find multiple conceptions of personality. In 1937 Allport argued that hundreds of different definitions of personality were available, and the clarity has not improved substantially since then. Historically, the term personality (derived from the Greek ‘persona’) has changed from external illusion, to, primarily, a surface reality, and finally inner traits. Some researchers mainly use the term to refer to objective and observable traits. Others acknowledge that the personality is deeply embedded in the individual’s interpersonal relationships and is inseparable from the social context. In Allport’s (1937, p. 28) classical conceptualization, personality is defined as “the dynamic organizations within the individual of those psychophysical systems that determine his characteristic behaviour and thought.” As a heuristic construct, ‘personality’ integrates, organizes and adds coherence to the individual’s experience and behavior across time and in different contexts, it refers to regularities and consistencies in behavior and experience. In people with personality disorders these integrative processes have failed.

Especially modern psychodynamic theory has emphasized the importance of identity for personality functioning. Clarkin, Yeomans, and Kernberg (2006, p.11) have argued that identity “provides the psychological structure that determines the dynamic organization of character.” Individuals with a consolidated identity are more able to adapt to different contexts, modulate their behavior without losing a core sense of inner coherence and stability and act in ways that are relatively coherent and predictable. A diffuse (scattered/fluid) sense of identity and one self as object will compromise the individual as a competent (autonomous) subject and actor.

Personal identity is an important part of human psychology and has substantial implications for psychological health. The development of identity is essential for self-acceptance and self-esteem and is “the cornerstone of the capacity to do well” (Crawford, Cohen, Johnson, Sneed, & Brook, 2004, p. 374). A stable and integrated sense of identity is viewed as a prerequisite for a balanced experience of internal locus of control, sense of personal agency and autonomous functioning. In psychoanalytic theory, mature personal identity is regarded as an important resource, when it comes to the regulation of cognitive, affective and interpersonal functions.  Conversely, some cognitive theories (Linehan, 1993) assume that emotional consistency and predictability over time and across similar situations are a prerequisite for the development of a stable sense of identity. It is assumed that “people form a sense of self-identity through their own observations of themselves, as well as through the reactions of others to them” (p. 61‘). Gross inconsistencies in behavior over time and across different situations will therefore make it difficult to create a coherent self-narrative, as well as establish a sense of personal continuity. Whatever the direction of causality, identity is (at least in part) socially constructed—it is based upon socially shared meanings which are constantly negotiated in dialogue with others—and failure to establish and sustain intimate relationships gives rise to a fragile sense of identity. A stable identity provide people with an important source of coherence, it gives structure to their experience and guide their behavior in social interactions. Identity has organizational significance, providing the individual with a sense of ‘self’ and guidelines for navigation that allow him or her to regulate behavior. Moreover, by stabilizing behaviour in social interactions, a stable identity makes the individual more predictable and understandable to others which stabilize the way others respond to him or her. Generally, a stable identity contributes to a stable and coherent social environment, which, in turn, further stabilizes the identity of the individual. Cultural changes and weakening of social communities implies that it has become more difficult to construct a stable and coherent social environment which, in some cases, compromises the development of a stable identity.

This is why having unstable home lives growing up and unstable environments in general so detrimental to those of us with BPD.  

A subjective sense of identity is neither gained, nor gained once and for all, it is constantly being lost and regained (Erikson, 1959). According to Erikson (1959), the phenomenological experience of personal identity is a preconscious sense of personal well-being and the “most obvious concomitants are a feeling of being at home in one’s body, a sense of knowing where one is going and an inner assuredness of anticipated recognition from those who count”(p. 118). An important part of the subjective experience of having an identity is that “one has a core, a center that is oneself, to which experience and action can be referred” (Marcia, 1993, p. 7), a feeling of personal agency.

The many essential experiences and psychological functions that have been related to personal identity include (Westen & Heim, 2003; Akhtar, 1992; Erikson, 1959):

(1)    a subjective sense of personal sameness or continuity over time and across different situations and contexts;

(2)   the display of roughly similar character traits and forms of behavior to a variety of others;

(3)   an experience of personal invariance and coherence within a process of perpetual change;

(4)   a commitment to certain self-representations and social roles as might be deemed self- defining;

(5)   temporal continuity in self-experience;

(6)   genuineness and authenticity of personal character and behavior;

(7)   a realistic and adaptive sense of one’s own body or body image; including

(8)   a subjective clarity regarding ones gender and gender-identity. Moreover, individuals with a mature identity are characterized by

(9)   a commitment to a coherent set of values, standards and a table and valid worldview that gives meaning to life,

(10)            inner solidarity with or commitment to one’s social group, and finally

(11)  a subjective confidence that one’s self, identity and self-representations are acknowledged and recognized by others of significance.
Disturbances in these areas of psychological functioning comprise the syndrome of identity diffusion (Akhtar, 1992, 1984), which is characteristic for borderline personality disorder (BPD) patients and patients with borderline personality organization (BPO). One could argue that some of those characteristics (e.g., display of roughly similar character traits and forms of behavior to a variety of others) are intimately related to what personality theorists have conceptualized as manifestations of a stable personality structure.

Psychoanalytic theory has analyzed the development of personal identity through internalization and gradual integration of early object relationships. The development has three intimately related phases:

In the first (1), and most primitive phase, traces of memories of self-images, images of others and affective colorings ofthe interaction between self and object are introjected.

The second (2) phase is dominated by the individual’s identification with significant others and a more role-oriented internalization of others of significance who have a relationship with the self.

Finally (3), in the third phase, during which mature identity is formed, earlier introjections and identifications are synthesized into more stable and integrated representations of self, other, and interactions between self and other.

In accordance with personal talents, values and constitutional character, individuals ‘select’ some of their earlier introjections and identifications and gradually synthesize or assimilate them into new configurations while discarding others. During this process, individual identifications are depersonalized, the attachment to significant others and the use of self-objects is transformed into more mature forms and the person becomes emancipated from the objects of childhood.

The normal separation and individuation process implies that the self is differentiated from important objects of childhood and their internal mental representations. This results in a personal identity being created or realized. In this way, human identity is not only a sense of who one is, but also a sense of who one isn’t and doesn’t wish to become. Furthermore, the mature and adaptive identity is based upon a sense of continuity with one’s past, as opposed to the total disavowal of past objects and experiences. The later being something that one often sees in borderline patients and people with, what Erikson (1959) has called, a negative identity; “an identity perversely based on all those identifications and roles which, at critical stages of development, has been presented to the individual as most undesirable or dangerous”(p. 131). It is a prerequisite for the normal individuation process and development of identity that others of significance respect recognize and validate the young person’s developing individuality and identity. Significant others must be able to contain and support the adolescent’s attempts to separate and individuate and avoid reacting in ways that could be interpreted as punishment for individuating behavior.
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