Because of distortion in the ego structure and functions, the borderline patient manifests a severely aggressive transference with acting out reactions (Ego weakness). They seem to lack any capacity for introspection, insight and ability to work through the therapeutic process. They tend to use the therapist ruthlessly as a transference object to gratify their needs, unable to achieve object constancy. They present pre-genital fixations with strong oral trends and aggression relating to psychosexual arrest.
In the neurotic person, the defensive organisation centres around regression and high-level defences such as reaction formation, isolation, and intellectualisation to protect the ego from intrapsychic conflicts. The rejection of drive derivatives and their representations from the conscious ego. The BPD uses primitive types of projective identification, denial, omnipotence and devaluation as defences, disassociating and keeping contradictive experiences and affects of the self and others apart. These defences weaken ego functions and reduce adaptive creativity, effectiveness and flexibility.
A poorly integrated concept of self and significant others.
A subjective feeling of emptiness contradicts self-concepts as they can’t emotionally integrate contradictory behaviours and feelings. Temporal continuity is lost due to splitting, with an unrealistic evaluation of others and reality. Relationships are chaotic and shallow, contaminated by genital and pre-genital conflicts. The problem is the intensity of the aggression with which the mental reps are imbued and how all the good mental reps are idealised, making integration impossible. Unable to bring together diametrically opposed loving and hating images of the self and significant others. This would trigger unbearable anxiety and guilt because of the implicit danger to internal and external object relations. Consequently, splitting is used actively during rapprochement to separate contradictory ego states whilst unconsciously sacrificing ego development.
An over-dependence (chronic) on external objects to establish some continuity in thoughts, feelings and behaviour. Superego functions of integration are missing, reinforcing the unchallenged persistence of contradictory defences and chaotic character traits. Therefore, specific aspects of ego strength, such as anxiety tolerance, impulse control and reality testing, are severely distorted and fragmented. Unable to differentiate the self from the non-self, unable to evaluate one`s own affects and thoughts in terms of ordinary norms beyond an infantile symbiotic phase. Envy expresses hatred for the withholding object (breast) and the wish to spoil or destroy it to eliminate envy.
Objects invested with libido are introjected as internal objects, infused with emotional representation, the earliest manifestation of love. Gratifying experiences reinforce basic trust and shape the expression of the libido, and influence the balance between life and death instincts. Cycles of projection and reintrojection of good objects foster psychic growth and promote ego synthesis. The bad object is experienced as devouring or controlling with oedipal fears of castration imbued within the relationship. These fears represent aggressive wishes and fantasies towards the mother and the contents of her body.
In the earliest stage of development, the paranoid-schizoid position projects all aggression outwards. This protects the ego from the awareness of its own aggression and persecutory anxiety. A subjective experience with artificial emotions and impoverished reality testing. Splitting is also linked to idealisation, an exaggeration of good qualities of internal and external objects, denying any contradictory evidence of the object’s real characteristics—fantasies of unlimited gratification from the object, which protects them against frustration and incremental aggression. Excessive projective identification manifests as believing that all power is vested in the external object, with the self-perceived as impoverished and weak. In the later depressive deposition, bad objects are tolerated, which constitutes an early persecutory superego. The child can begin to realise they harbour aggressive feelings towards the good object and recognise the good aspects of the object they attacked and perceived as bad.
Regressive anxiety or guilt is now expressed as a concern, as it’s become more important to preserve the good object and learn to tolerate the ambiguity and ambivalence within the self and the object. Awareness of love and hate towards the same object fosters a deepening of experience and understanding about self and the other. The deepening of emotions and the capacity for empathic perceptions of others. The capacity for further differentiation between objects and self.
A healthy predominance of love over hate in relation to the whole object .
Mourning
The child’s greed or destructive fantasies have lost or destroyed the good mother. The sorrow and concern over their mother in these fantasies represent an early process of grief and mourning. Mourning increases the awareness of reality and the need for a good mother to strengthen the child`s confidence and inner capacity to love. The child stuck within the grieving process may manifest a depressive psychosis, hypochondria delusions with manic defences—the use of idealisation to protect against guilt and contamination of aggression towards the good object—other defences such as omnipotence, contempt, compulsions and identification with the sadistic superego. The omnipotence is based on identifying with an all-powerful idealised good object and consists of denying bad aspects, such as weakness, vulnerability and dependency.
Identification with the sadistic superego, where aggression and depressive guilt are denied and projected onto the outside world. Hypomanic personalities tend to idealise and devalue others excessively, think in large numbers and neglect details, and neglect real objects with the denial of guilt. One must deal with their aggression and face their distorted beliefs, prejudices, unconscious envy and hatred. Increasing awareness of time passing is accelerated by accumulating losses, such as parents, siblings, and friends. The manifestation of ageing, physical effectiveness and well-being all constitute a growing awareness. The possibility of death and acceptance and working through losses establish ego strength and the capacity to mourn, accept oneself, and trust oneself to reconstitute a meaningful life.
