Shapeshifting Borderline, Morphing Narcissist Identity Disturbance

Uploaded 6/14/2022, approx. 33 minute read

Anyone with borderline will tell you that she switches between whole identities. She doesn't feel herself in various states.

And before I proceed, borderline personality disorder is equally diagnosed nowadays in women as in men. I'm using the female pronouns because the vast majority of scholarly literature hitherto had focused on the manifestations of borderline personality disorder in women. And yes, I think this is a form of gender bias and sexism in psychiatry and psychology.

Having dispensed with this disclaimer, this woke politically correct disclaimer, let us proceed.

Borderlines switch between what looks to be completely different personalities and identities.

It is eerily reminiscent of multiple personality disorder today called dissociative identity disorder, but there are of course very important differences.

Anyone living with borderline will attest that borderlines switch, especially when they feel rejected, humiliated, abandoned or on the very contrary, engulfed, assimilated, merged and fused with a love object. They tend to switch.

I described all this in terms of self states.

And no, I regret that I'm not the one who came up with this idea. It was Philip Bromberg. Philip Bromberg was the first to conceptualize and propose the idea of self states rather than a coherent unitary self.

Borderlines, like everyone else, have self states, but there is something very important, about borderlines. In addition to self states, they have identity disturbance and internal emptiness.

And today, in this video lecture, I'm going to discuss both of these concepts.

This lecture is a CIAPS, Center for International Advanced and Professional Studies lecture, part of the new syllabus on human sexuality and personality disorders that I have spent three years compiling.

My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited. I'm also a professor of psychology and very well acquainted firsthand with borderline personality disorder and narcissistic personality disorder, sometimes on the receiving end.

Okay, Shoshanim, time to delve in and plunge in and get immersed in the Sam Vaknin or show.

Until 1980, with a Diagnostic and Statistical Manual three, borderline personality disorder was considered a form of schizophrenia. It was called pseudo neurotic schizophrenia.

The ICD-8, the International Classification of Diseases, which is the world's DSM, the DSM outside North America, mainly European, so the ICD-8, edition eight, and the ICD edition nine, stated that schizophrenia, and I'm quoting, entails a fundamental disturbance of personality that involves its most basic functions.

Those that give the normal person his feeling of individuality, uniqueness, and self-direction. These experiential self-disorders were called pseudo neurotic schizophrenia.

It was Otto Kernberg who had suggested in the 1970s that some patients are on the border between neurosis and psychosis. Psychosis is a fancy term for losing it. So they were on the border between neurosis and psychosis.

That's why he called them border lines.

But people don't know that the original conceptual borderline included what today we call psychopathy and narcissistic personality disorder.

In general, delectable characters, people you want to spend the rest of your life with. Lang, who was a controversial iconoclastic psychiatrist, described the experiences of what he called schizoid schizophrenic borderline cases. He described their experiences as a lack of autonomous identity, personal consistency, and temporal continuity. They usually experience their self, he said, as disembodied, not connected to their bodies. They feel empty, unreal, dead, and differentiated from the world.

So well into the end of the 20th century, there was no real distinction between borderline personality disorder, schizophrenia, schizoid personality disorder, and schizotypal personality disorder.

Lang said, these patients are unable to sustain a sense of self as persons, which is why they are equally unable to experience neither separateness from nor relatedness to other people in a usual way. They may fear losing their identity in a relationship as well as feel dependent on the other for their very being in existence.

That's an excellent description for borderline although Lang was actually talking about schizophrenia.

In 1918, the Diagnostic and Statistical Manual Edition 3, there was a very extensive description of identity disturbance which was later mysteriously removed from consequent editions. It said, identity is manifested by uncertainty about several issues relating to identity such as self-image, gender identity, long-term goals of career choice, friendship patterns, values, and loyalties.

Example given, who am I? I feel like I am my sister when I am good.

The DSM 3 continued to elaborate. It said that identity is the sense of self providing a unity of personality over time. Prominent disturbances in identity or the sense of self are seen in schizophrenia, borderline personality disorder, and identity disorder.

And yet, not a single edition of the Diagnostic and Statistical Manual bothered to define what the heck is a self.

When the DSM 3, Edition 3 had been revised when a text revision was issued, they added this marked and persistent identity disturbance manifested by uncertainty about at least two of the following self-image, sexual orientation, long-term goals of career choice, type of friends desired, and preferred values.

Fast forward to the Diagnostic and Statistical Manual, Edition 5, published nine years ago, 2013, and they ventured a little into the territory of reforming the diagnostic criteria.

They didn't dare go all the way because of pressure from the pharmaceutical and insurance industries, but they kind of hinted at what they call the alternative model of personality disorders, page, I think, 766.

And this is what they had written.

What they have written in the Diagnostic and Statistical Manual, Edition 5.

Identity, markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness, dissociative states under stress, self-direction, instability in goals, aspirations, values, or career plans.

And then you find identity as the experience of oneself as unique with clear boundaries between self and others, stability of self-esteem and accuracy of self-appraisal, capacity for and ability to regulate a range of emotional experience.

Again, there was no definition of what is a self.

In the International Classification of Disorders, they say that there are disturbances in and uncertainty about self-image, aims, internal preferences, including, very important, sexual preferences.

When the identity, when the self, whatever they may be, when this core, immutable core, the feeling that you are the same person from one minute to another, the continuity of being you from one day to another are disturbed.

There are three types of identity disturbance to my mind.

One is cyclical, where the borderline, and to a very large extent a narcissist, actually cycle between behaviors, which are mutually exclusive behaviors, don't characterize the same type of personality.

I will take the example of promiscuity. Borderlines have stretches of unbridled self-trashing promiscuity, which is way over the top, extreme. And then suddenly they hibernate, they go into a state of celibacy and abstinence, which could last years.

Now the two behaviors are mutually exclusive. That's why we cannot say that borderlines are sex addicts, because they can go through long stretches of time without sex. But they alternate, they cycle between these modes, between these identity states or self-states, between promiscuity and abstinence.

Abstinence and promiscuity are associated with mood disorders, such as depression and with anxiety disorders. So we can't safely say that the reason for the fluctuation of the cycling is the mood, that they had acquired depression, and so consequently they became abstinent or celibate.

No, that's not the reason.

Actually, borderlines are notorious for self-medicating and soothing with rampant, unbounded, unregulated or dysregulated sex. So it's not about mood, it's simply an internal process, possibly a neurological process, we don't know, which kind of regulates these transitions between identity figments or identity elements, which are utterly incompatible.

Then we have allotropic identity disservice. It's when there are two or three variants of the same person, and there is an alternation between them, subject to stressors, to stress, anxiety and environmental and social cues.

So the borderline may switch between borderline A, borderline B, borderline C, and very frequently, borderlines give names to these self-states as if they were separate people. And this is the allotropic identity disservice.

And finally, there's object-related identity disservice. Preferences regarding friends, spouses, boyfriends, intimate partners, co-workers, role models, politicians, rock stars, etc. Preferences regarding other people. These preferences reflect underlying values, and yet there is no consistency, constancy and continuity with the borderline.

One day, she could be held bent against extramarital sex. The next day, she could see nothing wrong with it. One day, a certain politician is her role model. The next day, she detests him. One day, her spouse or intimate partner is the center of her life. The next day, he's the center of a twister.

So this is object-related identity disservice.

The problem is that autobiographical memory, memory of one's personal history, the narrative that is the glue that holds identity together is disrupted. It's disrupted because of dissociation.

There's a lot of dissociation in cluster B, especially in narcissistic and borderline personality disorder. Dissociation involves amnesia, forgetting things. It involves depersonalization, the feeling that you're not really there, and derealization, the feeling that what's happening to you is not real.

And so all these processes, dissociative processes, disrupt massively the ability to maintain continuous, smoothly flowing autobiographical memory, or even stream of consciousness.

And of course, given these conditions, it's impossible to form a core identity. It's impossible to feel that you are yourself at subsequent moments. It's like you're a different person every now and then.

This is intimately connected to splitting and other primitive defenses where you can't see other people as a single unitary entity, where you divide people in dichotomous thinking into black and white, good and bad, as if they were fragments of people, split of people, not real people.

And there is self-splitting, the application of the splitting defense mechanism to yourself, splitting yourself, breaking yourself apart, unable to connect the parts.

This is very reminiscent, as I said, to other dissociative disorders. I'm going to read to you from the DSM Edition 5. I'm going to read to you what they say about other specified dissociative disorder.

They say, chronic and recurrent syndromes of mixed dissociative symptoms. This category, they say, includes identity disturbance associated with less than marked discontinuities in sense of self and agency or alterations of identity or episodes of possession in an individual who reports non-dissociative amnesia.

And the alternative is identity disturbance due to prolonged and intense coercive persuasion.

Individuals who have been subjected to intense coercive persuasion, brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects and cults, or by terror organizations.

These individuals may present with prolonged changes in or conscious questioning of their identity. I think they forgot one thing, abusive families. Children who are subjected to abuse in early childhood usually find themselves in a cult-like setting with a dead parent, a parent who is narcissistic, self-centered. These children are subjected to what they perceive to be torture.

And so they're likely to show an identity disturbance due to prolonged and intense coercive persuasion, which is an integral hallmark and part of what today we call complex trauma, complex post-traumatic stress disorder.

In borderline personality disorder, the DSM has this to say, diagnostic criterion number three, identity disturbance, markedly and persistently unstable self-image or sense of self.

They elaborate in the DSM. There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self.

They are sudden and dramatic shifts in self-image. I call it switching, characterized by shifting goals, shifting values, and vocational aspirations.

There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to that of a righteous avenger for past mistreatment.

Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which an individual feels a lack of a meaningful relationship, nurturing, and support.

In other words, abandonment and rejection. These individuals may show worse performance in unstructured work or schooling situations.

The French philosopher Paul Ricoeur suggested a typology, or not typology, but let's say a break, a deconstruction of personal identity. He said that personal identity is a triangle.

There is what you call idem identity, sameness, ipse identity, selfhood, and interpersonal relationships. Idem identity, or sameness, refers to persisting, yet malleable personal features such as personality traits, your character, temperamental dispositions, and values which can change and do change over the span of a lifespan, and also can and do change in the throes of social interactions.

These features are expressed in linguistic, propositional terms, and when you self-reflect, you can spot them.

Now, Ericsson, the mega-master of human personal development, the guy who brought it all together, in my view, Ericsson described identity as referring to a conscious self of individual identity, an unconscious striving for a continuity of personal character, a criterion for the silent doings of ego synthesis, and an inner solidarity with a group's ideals and identity.

Koenberg is the one who introduced a self-concept. Koenberg said that it's the integration of representations of the self, but it's not clear. Did Koenberg mean to discuss a person's beliefs about himself or herself, beliefs that she can verbalize, fematize, I don't know, express, or was he referring actually to subpersonal, unconscious, dispositional structures that only occasionally became actualized as a belief about oneself, I don't know, through, for example, talking to me in therapy or treatment.

So that part remained unclear.

Go back three decades from Koenberg to Deutsch. Deutsch had written a seminal article titled Some Forms of Emotional Disturbance and Their Relationship to Schizophrenia. She published it in Psychoanalytic Quarterly, or Psychoanalysis Quarterly, in 1942. Deutsch said that there are groups of patients, and she called them as if personalities.

It became a very widespread meme, as if personalities. It's patients' readiness to mold herself according to the surroundings. The patient anticipates the widely used characteristics of everyone around her, and kind of shapeshifts and morphs.

There's a famous movie by Woody Allen, Zellig. Zellig is a chameleon, a kind of shapeshift. So the borderline patient, Deutsch described the borderline patient as having a chameleon-like adaptability to others.

Deutsch said that her patients were not aware of their as-if personality, which is very similar to the idea of persona or mask in Jungian psychoanalytic theory. It's very similar to Goffman's work in sociology or social psychology, etc.

But she preceded, Deutsch preceded Oliver. Deutsch said that the patients were not aware of this mask, of this as-if personality. They felt an inner emptiness, which they tried to overcome by an exaggerated identification with other people.

Deutsch considered these patients to belong to the schizophrenia spectrum, actually. There was no borderline conception at the time.

Ericsson described what he called identity diffusion. It's a psychoanalytic concept, actually, which preceded Ericsson. But Ericsson was the first one to suggest that identity is a mutual relation in that it connotes both a persistent sameness within oneself, self-sameness, and a persistent sharing of some kind of essential character with other people.

So there is this Deutsch mask or as-if personality, and there is a feeling that you are the same person. And if you put these two together, you get your identity.

Identity diffusion is when there is a disintegration of the sense of inner continuity and sameness.

There are difficulties in committing to occupational choices and difficulties with intimacy. And, of course, all adolescents go through identity diffusion.

But if identity diffusion persists beyond adolescence, it becomes identity disturbance.

And that is one of the main reasons we can diagnose borderline personality disorder fairly safely in puberty.

Kernberg, though, provided the main contribution to formulating identity diffusion as a key pathology in borderline personality disorder.

Kernberg took all this aforementioned information, and he said that identity diffusion is the lack of an integrated self-concept and an integrated and stable concept of total objects in relationship with the self.

So when we have a self-image or a self-concept and an image of others, a theory of mind of other people, and other people's concept, a concept which represents us and a concept which represents other people, these are essentially internal objects.

But when they contradict each other, when there is a conflict or a dissonance between our self-image and the image of others in our mind, there is a split. There is a split and inability to synthesize these two.

So it's on the unconscious level, or what Kernberg called the subpersonal level.

Klein described the mechanism of splitting and the association between excessive splitting and the disturbance in the feeling of the ego, as she called it. She believed it to be the root of some forms of schizophrenia.

What about the experience of self? How do you experience a self and how does the borderline experience her disturbed self, disturbed identity?

On the experiential level, Kernberg thought that identity diffusion is reflected in the patient's incapacity to give an integrated description of herself and who offers significant others.

These patients, these patients, said Kernberg, they are uncertain about their major interests. They don't know, they can't promulgate a consistent pattern of behaviors. They're very chaotic. Their commitments to work and to other people are very unstable.

So Kernberg's seminal, very important, crucial concept of borderline personality organization includes patients with schizoid, paranoid, narcissistic, hypomanic, anti-social personalities, impulse disorders, as if personalities, psychotic characters, inadequate personalities, patients with multiple sexual deviations, and so on and so forth. It's a kind of a basket.

In Kernberg's terms, borderline personality disorder is a basket term, actually comprising most of what we call what most of the diagnostic and statistical manual.

He put together numerous categories which at the time were considered strongly linked to schizophrenia.

What he was trying to do, he was trying to create a schizophrenia light diagnosis, which he termed borderline personality disorder, the capacity for reality testing and the relative intact ego boundaries in patients with borderline personality disorder.

He said these are the differences between borderline and schizophrenia.

Borderlines are still enmeshed and embedded in reality. They can still judge reality more or less accurately. By the way, they can judge reality better than narcissists do. And their ego boundaries are pretty much intact, which is not something I can say about narcissists.

I therefore, as opposed to Kernberg, I think that narcissists are the true borderlines.

Narcissists are the ones who are much closer to psychosis. They're much closer to a disintegrative framework of self and identity. They are very, very close to hyper-reflexivity. In other words, a blurring of the lines between external and internal objects.

So I think borderlines are less severe personality organization than narcissism or narcissistic personality disorder.

Feeling of emptiness have also been described, but they've been described not only in borderline personality disorder. They've been described in psychosis, depression, schizoid conditions, narcissistic conditions, and borderline.

So emptiness is not unique to borderline. What is called the empty inner core or the empty schizoid core characterizes all these people.

There are descriptions of a sense of being dead, deadness, an absence of inner feeling, a kind of gaping hole, a black hole, a void, which many patients describe spatially, like in space, they do this with the hands. And many patients can even describe the size of the hole, small, big, fluctuating.

Borderlines very often say that when they're in love or in a relationship, the hole, the emptiness becomes smaller. It's a very common borderline utterance or description.

So they know there's an absence of inner feelings, a feeling of being dead, unresponsiveness. There's a lot of intolerable boredom, superficiality, unhedonia, inability to enjoy anything or to find pleasure in life and depersonalization, the feeling that you are not you, that you're just an observer of what's happening to you on autopilot, so to speak.

These experiences are not permanent. They're not a fixture like, let's say, in psychosis. They're fluctuating. They're episodic. They are, but they are chronic.

In other words, these conditions are likely to recur.

The condition of identity disturbance and the attendant emptiness and void, they're lifelong. They're likely to happen again and again and again, but they don't happen all the time. They're not like permanent fixture or feature.

The feelings of emptiness in borderline patients, they are the experiential consequence of an identity disturbance or a disturbance in some sense of self.

When you don't have a core, when you don't have a self, of course, you feel empty because there's nothing there. As I keep saying, there's nobody home. There's nobody there. It's a hole of mirrors. It's empty space. There's a continuum of experiences from a sense of incompleteness, vagueness, a search for one's being to a psychotic conviction of actual personal extinction or non-existence, which is not common in borderline.

That's why borderlines keep searching for something, searching for meaning, searching for the truth. They go from one cult insect to another cult insect. They follow role models and thought leaders and public intellectuals. They try to discover themselves via numerous therapies, conventional and alternative.

They're constantly on a lookout and a search can but describe that patients with identity diffusion experience various forms of emptiness, depending on the pathological structure of the personality.

He said, for example, patients with schizoid personality experience the emptiness as an innate quality that makes them different to other people. There's a bit of grandiosity here, actually. I'm special. I'm unique. I can never be understood by other people.

The experience of emptiness is related to phenomena such as apathy and anhedonia, as I mentioned, in these patients, in schizoid patients. In patients with a narcissistic personality, the feeling of emptiness is characterized by strong feelings of boredom and restlessness. And this is a result of the potential lack of gratification from other people.

In other words, deficient narcissistic supply.

This, by the way, is also common to psychopaths.

And so the cutting edge knowledge we have, the latest thinking on the topic in contemporary phenomenology, philosophy, cognitive science, we think there's a distinction between a narrative self and a core or basic or minimal self.

The core self is the first personal manifestation of all experience. It's how you experience yourself in the world, in the world in you. This experience is never anonymous. It manifests as my experience. It's identified with a core, with a self, with a conviction of continuity and constancy across time, with what Riko called idem identity, the sameness.

Experiencing articulates itself in a first-person perspective. That's why we use the word, the pronouns, I, me, myself. Experience is always first-hand. And experience gives us a persistent feeling, a persistent sense of self presence and self sameness, to use Ericsson's term.

This is the healthy.

The healthy type of core self. It's a core self is a sense of self coincidence.

The privacy of our inner world and a kind of boundary or demarcation between me and not me.

Unity of body and mind, psychosomatic unity, or what we call embodiment in clinical terms.

An experience of being existing in a special way, a combination of being and becoming, having begun in or around birth and liable to extinction with death, but transforming in the middle in ways which never negate the core.

So the core is the foundational fundamental layer.

And on this layer, we have the narrative self.

The narrative self is an outcome of socialization and acculturation. It's largely about language. It's wholly about interacting with other people. It's story about you in the world, you with others.

The narrative self implies, to use Nicole's term, the who. Who are you?

Well, I'm introverted, I'm ambitious, I'm friendly. These are all outgoing descriptions, descriptions that have no meaning. If you were left alone in the whole world, in a post-apocalyptic world, you're the only human being, these descriptions of no meaning, you can never have a narrative self.

It's questionable whether you can have a core self.

The Object Relations School in the 1960s also believed that you cannot have any kind of self without object relations, without interactions with other people.

In normal experience, the structure and the content of experience are interwoven, they're intermingled, they're entangled. The structure of experience does not become an object of reflection or object of experience. It just happens. You're just in it. You are it in many ways.

The distinction is artificial.

But when you go to patients with borderline personalities or you observe patients with schizophrenia, there are structural disturbances of self-experience, the distortions of first-person perspective.

There's an incomplete sense of substance, substantiality, embodiment. There's a feeling of having divorced your own body sometimes. There's an ephemeral sense of self-presence.

Very often these patients describe themselves as not here, or I was just observing myself, or an out-of-body experience kind of.

So the disturbance of the structural level of selfhood, an instability of basic subject world relation, also manifests as a disturbance of narrative features, including interpersonal functioning, emotional regulation, direction in life.

What I'm trying to say to the uninitiated is that emotional dysregulation in borderline personality disorder is an outcome of identity disturbance.

Contrary to what a few scholars say, I think the opposite. I think the directionality is from problems in identity formation to problems in regulating emotionsand not vice versa.

The disturbance of the narrative level of the selfhood is not in itself a structural problem. It's not a major problem.

If you're confused about your career choice, or you're impulsive, or you're not friendly, or I don't know, you're extroverted than introverted, it indicates some identity diffusion.

But there's no problem in differentiating yourself from others. The demarcation, the boundary between self and self-presence and others is perfectly okay.

But when the core identity is disturbed, when the core identity is ruptured, and you have identity fragments, self-states, pseudo-identities, sub-personalities, ego-states, as they're called in some schools, when you're not constellated, as Jung said, when you're not integrated, there is no host, there's no center, there's no pivot, there's nobody there to regulate your emotions and cognitions, actually.

So you have cognitive distortions, and you have emotional dysregulation.

The criterion of chronic feelings of emptiness is also an outcome of identity disturbance.

Of course, if you have no identity and no core, there's no one there, and you would feel empty.

I would like to refer to a few recent articles that haveattracted my attention.

I'll start with an article titled, Autobiographical memories, identity disturbance, and brain functioning in patients with borderline personality disorder, an fMRI, functional magnetic resonance imaging study on this issue. It was authored by Buzzalle, Moesse, and others, and it was published in Helium, volume 5, March 2019.

The authors say identity disturbance is a core feature of borderline personality disorder. Autobiographical memory is a process of reflective thinking through which we form links between elements of life and elements of self. It can be considered as an indirect index of identity integration.

With reference to the condition resolved, condition of identity disturbance, when it's resolved, when it's ameliorated, they found increased cerebral activity in certain areas of the brain, an area known as ACC, the anterior cingulate cortex, and they also find enhanced activity in the right medial prefrontal cortex and the right dorsolateral prefrontal cortex and bilateral insula. All these were registered in BPD patients and not in controls.

Clearly, in borderline, there is some abnormality of functioning in the brain as we had suspected for a long time.

When the identity disturbance is not resolved, again, borderline brain differs to normal brains. There is increased brain activity in these patients in the bilateral ACC, bilateral DLPFC, and right temporal parietal junction.

Hyperactivity in ACC and DLPFC in borderline patients with both conditions, in other words, fluctuating between resolved disturbance and unresolved disturbance, is due, maybe due, to an inefficient attempt to reconstruct a coherent narrative of life events.

So this is the neurological background.

Let's proceed to another article published in Psychiatry Research volume 271, January 2019, and it's titled, Facet of Identity Disturbance Reported by Patients with Borderline Personality Disorder and Personality Disorder Comparison Subjects, over 20 years of prospective follow-up.

This longitudinal study, this kind of study, is very valuable. It was authored by Muhammad A. Gada, Hannah E. Parker, your mind is in the gutter, get it out, Catherine E. Hein and others.

And the highlights are patients with other personality disorders reported less identity disturbance over time than patients with borderline personality disorder.

The recovery status in borderline personality disorder is significantly associated with a decline in negative identity.

For three or four inner states, three out of four inner states, recovered patients had higher rates of decline in this problem of negative image or negative identity. Feeling evil or bad showed a steeper decline in the case of non-recovered patients.

So that's good news. It means negative self-image and the resulting disturbance to identity tend to decline with age in both types of patients, patients who haven't recovered and patients who have recovered.

The abstract is interesting. It says, participants were followed and reassessed every two years for a total of 20 years of follow-up.

Borderline patients reported levels of these states that were more than three times higher than personality disordered comparison subjects.

With both groups demonstrating significant declines in these states over time, the good news.

For three out of these four inner states, I feel like I'm worthless, I feel a complete failure, and I feel like I'm evil.

Recovered borderline patients had lower baseline scores and significantly different patterns of decline than non-recovered patients.

When it comes to the fourth state, I feel like I'm a bad person. Recovered patients had lower scores over time, but the groups declined at the same rate, even non-recovered borderlines.

Got rid of this perception of being a bad object, a worthless object.

These results, say the authors, suggest that borderline patients report experiencing inner states related to having a negative identity less often over time.

Additionally, recovery status is significantly associated with decreased time experiencing these states.

A very interesting article, at least intellectually and philosophically, if not clinically, was published by Maya Sanderson and Joseph Parnas, entitled Identity disturbance, feelings of emptiness, and the Boundaries of the Schizophrenia Spectral. It was published where else in the Schizophreniaunity, Volume 45, Issue 1, January 2019.

And here's what they say.

Historical and current research on borderline personality disorder reveal certain affinities with schizophrenia spectrum psychopathology. This is also the case for the borderline criteria of identity disturbance and feelings of emptiness, which reflect symptomatology frequently found in schizophrenia and schizotypal personality disorder.

Unfortunately, the diagnostic manuals offer limited insight into the nature of these criteria, including possible deviations and similarities with schizophrenia spectrum symptomatology.

In this article, say the authors, we attempt to clarify the concepts of identity disturbance and feelings of emptiness with an emphasis on the criteria's differential diagnostic significance.

Drawing on contemporary philosophy, we distinguish between a narrative self and a core self, suggesting that this distinction may assist differential diagnostic efforts and contribute to mark the psychopathological boundaries of these disorders, schizophrenia, as opposed to borderline personality disorder.

Fascinating article, which would lead you to conclude, and I think correctly, that there are very, very fuzzy and permeable boundaries between borderline and narcissistic disorders of the self, psychosis, and schizophrenia, including schizophrenia light, like schizotypal personality disorder, and schizoid personality disorder.

Onward Jewish soldiers to the Journal of Personality Disorders, Volume 35, Supplement B. The article is titled, A Dejunction of Clinical and Developmental Science, Associations of Borderline Identity Disturbance Symptoms with Identity Formation Processes in Adolescence.

Very critical topic. It's borderline and the identity disturbance attendant upon borderline, associated with borderline, and the resulting clinical features and symptoms of borderline.

All of them start in early adolescence, between the ages of 10 and 13, most commonly 12 to 14.

This article, timely article, was authored by Shona Mastro-Campo, Melanie Zimmer-Gembeck, and Amanda Duffy. It was published in June 2021, and this is what they have to say.

Developmental scientists describe the role confusion that can occur for adolescents as their forming personal identity. Clinical psychologists describe low sense of self-worth, lack of self-clarity, feelings of emptiness, and dissociation as the key elements of identity disturbance, and they link this to borderline personality disorder.

Empathy stood out as the strongest correlate of borderline symptoms. Youth young people reporting greater emptiness were nearly twice as likely to report a high borderline symptom profile.

So, it seems that emptiness and identity disturbance are the twin engines that lead later to full-fledged borderline pathology and to full-fledged narcissistic pathology.

Narcissistic pathology is a more egregious stage, a more egregious form of the borderline pathology. That's why Groschines suggested that borderlines are failed narcissists.

Borderlines are children who didn't progress with their mental illness as far as narcissists. They stopped midway, and they became borderlines.

Narcissism is extremely close to psychosis and schizophrenia. It could easily be conceived as a post-traumatic state that leads inexorably and under prolonged stress and abuse, complex trauma, and from complex trauma to a disintegration of the personality, a sense of emptiness that are indistinguishable literally from schizophrenia, schizotypal personality disorder, schizoid personality disorder, and of course psychosis.

This is all emerging in current literature and current debates, and I encourage you to read, to download, and read the articles that I've mentioned. They are all available on Schola, S-C-H-O-L-A-R dot google dot com. Just type in the titles of the articles which are available in the description of this video down, and you will be rewarded with fascinating read.

Living with a borderline personality disorder, and I have had my share of such experiences, is harrowing. It's harrowing because you constantly have to mourn and grieve the person who is not there.

This absence, this fluctuating shimmering mirage, and this process of grieving and mourning affects you.

And if you are also mentally ill, and if you also suffer from identity disturbance, there is a resonance, an amplifying resonance, between these two identity disturbances.

There is a confluence and congruence of the emptiness of your borderline partner, and your own emptiness.

It becomes the equivalent of a massive black hole at the center of an illusory galaxy, some kind of a swirling vortex that threatens to digest and assimilate and swallow you and never spit you out.

This experience could be addictive because both the borderline and her typically narcissistic partner try to appropriate the other person's identity as a sound and a medicine to their own identity disturbance and knowing emptiness, howling void.

They try to annex each other, to digest each other, to merge with each other, so as to form a complete person.

But the outcome is never a complete person. The outcome is more of the same, exponentially so.

This is the sadness. This is the frustration. This is the maddening recurrence and repetition compulsion at the core of the narcissistic borderline couple, and here I refer you to Joann Dulac's pioneering work on the topic. She's about to publish a new book in with the Rutter about this, but she has pioneered the film. It is by far the most agonizing experience imaginable because through the borderline you get annihilated, you get disintegrated, and you can't save her, you can't help her, you can't be her, you can't provide her with surrogate or vicarious or by proxy existence.

She doesn't have her own and so she can't get it from the outside of course.

And so if you have a fixer and savior type, if you have a healer type, there is no experience more horrible, even in therapy.

This inability to reach and touch something because there's nothing there is between terrifying and maddening in the sense it can drive you mad, drive you crazy. It's not for the faint hearted.

You need to be very centered and very grounded to live with the borderline or with the narcissist.

Empathy, identity disturbance, personal discontinuity, and so the show goes on. You find yourself living with a kaleidoscope of people, a circus, a panoply, a smogasbord, and every morning you get up and you're not sure who is in bed with you, who is sharing your life.

It's the closest one gets to a horror movie.

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