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Variable Sense of Reality

Like neurotics, borderlines retain contact with reality most of the time; however, under stress the borderline can regress to a brief psychotic state. Marjorie, a twenty-nine-year-old married woman, sought therapy for increasing depression and marital disharmony. An intelligent, attractive woman, Marjorie related calmly throughout her initial eight sessions. She eagerly assented to a joint interview with her husband, but during the session she turned uncharacteristically loud and belligerent. Dropping her facade of self-control, she began to berate her husband for alleged infidelities. She accused her therapist of taking her husband’s side (“You men always stick together!”) and accused both of engaging in a conspiracy against her. The sudden transformation from a relaxed, mildly depressed woman to a raging, paranoid one is quite characteristic of the kind of rapidly shifting borders of reality observed in the borderline.

Nonspecific Weaknesses in Functioning

Borderlines have great difficulty tolerating frustration and coping with anxiety. In Kernberg’s framework, impulsive behavior is an attempt to diffuse this tension. Borderlines also have defective sublimation tools; that is, they are unable to channel frustrations and discomforts in socially adaptive ways. Though borderlines may exhibit extreme empathy, warmth, and guilt, these exhibitions are often rote, more manipulative gestures for display purposes only, rather than true expressions of feeling. Indeed, the borderline may act as if he has totally forgotten a dramatic effusion that occurred only moments before, much like a child who suddenly emerges from a temper tantrum all smiles and laughter.

Primitive Thinking

Borderlines are capable of performing well in a structured work or professional environment, but below the surface linger grave self-doubts, suspicions, and fears. The internal thought processes of borderlines may be surprisingly unsophisticated and primal, camouflaged by a stable facade of learned and rehearsed platitudes. Any circumstance that pierces the protective structure shielding the borderline may unleash a flood of chaotic passions concealed within. The example of Marjorie (above) illustrates this point.

Projective psychological tests also reveal the borderline’s primitive thought processes. These tests—such as the Rorschach and Thematic Apperception Test (TAT)—elicit associations to ambiguous stimuli, such as inkblots or pictures, around which the patient creates a story. Borderline responses typically resemble those of schizophrenics and other psychotic patients. Unlike the coherent, organized responses usually observed among neurotic patients, those from borderlines often describe bizarre, primitive images—the borderline might see vicious animals cannibalizing one another, where the neurotic sees a butterfly.

Primitive Defense Mechanisms

The coping mechanism of splitting (see chapter 2) preserves the borderline’s perception of a world of extremes—a view in which people and objects are either good or bad, friendly or hostile, loved or hated—in order to escape the anxiety of ambiguity and uncertainty.

In Kernberg’s conceptualization, splitting often leads to “magical thinking”: superstitions, phobias, obsessions, and compulsions are used as talismans to ward off unconscious fears. Splitting also results in derivative defense mechanisms:

• Primitive idealization—insistently placing a person or object in the “all-good” category so as to avoid the anxiety accompanying the recognition of faults in that person.

• Devaluation—an unrelenting negative view of a person or object; the opposite of idealization. Using this mechanism, the borderline avoids the guilt of his rage—the “all-bad” person fully deserves it.

• Omnipotence—a feeling of unlimited power in which one feels incapable of failure or sometimes even of death. (Omnipotence is also a common feature in the narcissistic personality.)

• Projection—disavowing features unacceptable to the self and attributing them to