New Theses about the Borderline Personality Disorder
Summary: According to literature the borderline personality disorder is a severe and stigmatizing disease. Its aetiology deviates from the clinical observations that I have made in 864 psychotherapeutic patients and their 35 165 dreams. By means of the concept of symbiosis the so-called borderline personality is put into a new frame of reference.
With the diagnosis borderline personality disorder one has to handle carefully and precisely, because a diagnosis predicts about heaviness and progress of a disease. Patients also know to esteem a name of an illness. In a sense of self fulfilling prophecy this diagnosis influences the process and wins stigmatizing might over the patient. They come to the conclusions that a borderline personality is heavy and difficult to handle.
In the literature the Borderline Personality Disorder is disputed until today. The diagnosis: Borderline Personality Disorder means for patients and the doctor that the clinical picture of this illness is severe. It is to put into the borderland between psychosis and neurosis. But this conclusion is not justified after a critical review of the diagnostic and therapeutic possibilities. On the contrary: patients with fear, with disturbances of relations and other symptoms which belong to the BPD show a high degree transformational energy. By their nearness to primary thinking they are able to remember dreams and to open themselves to depth psychology. Thereby results a good prognosis if they submit psychotherapy. These patients need clear advises and a clear conduction. There are not only the deeply disordered, but also the changeable and the sensible ones who are affected by the Borderline-Symptoms.
Borderline Personality Disorder – A Questionable Diagnosis
Since years I do not need the concept of the Borderline Personality Disorder. Nevertheless I am working successfully. I only use the concept of neurosis and psychosis. Many cases of panic disorder, of fear, eating disorders and of the other neurotic disturbances belong to the "Borderline Personality Disorder". The BPD is a disputable diagnosis also because of its amorphous complexity and its name.
The Borderline Patient:
A Being of Lacks?
It is out of the question that the blemish of a severe illness adheres to this diagnosis which belongs to the nearness of mental disease. In psychoanalytic institutes, the Borderline-case is regarded as a grave disorder which should be treated by the experienced colleagues. After Kernberg, the borderline patient is a "being of lacks". Many characteristics are "deficient and primitive". The borderline patient is panneurotic, pansexual and polymorph-perverse. He appears mask-like, demoniac-dislikeable.
The literature for Borderline Personality Disorder offers indeed many justified arguments for building up their system; they do not explain the complex, multilayer symptomatic of many Patients with a BPD in a new way.
Results of research mainly derive from observations and statements which concern the adulthood of psychoanalytic or psychiatric patients. At the time, a field of scientific research is neglected, the dream analysis. This neglecting explains why these Borderline-theses and theories over the so called early preoedipal disorders and early traumatic impacts can persist so long. In the psychoanalytic literature, it is until now only casually remarked that the plurality of the so called borderline patients suffers from a persisting, infantile binding to a paternal or maternal object (31, 12, 39, 49 and 15).
It is astonishing how often patients are not only fixed to an inner almighty object, but also embraced closely by real parents in the adolescence. Theses parents influence the adult son or daughter with the unconscious aid to hinder their separation and individuation.
The Concept of Symbiosis
The results of my psychotherapeutic treatment of 861 patients and the analysis of the according 35 165 dreams show that these patients by the majority suffer from a pathological, persistent symbiosis with a parental object. In this connection it doesn't play a role if the patient was overprotected, misused or neglected (7).
The message "Don't grow up" and the state of inner stress which is caused by the contrast between the real age and the regressive infantile trait, become manifest in the symbiotic behaviour.
Symbiotic, infantile Behaviour
3. Overadaptation, uncertain identity
4. Inner agitation und strain
5. Offensiveness, anger, defiance, impatience
6. Grandiosity, narcissism
8. Unstable relationships
9 . Depressive mood
10 . Addiction
11. Suicide fantasies and self-damaging
Anxiety and depressive symptoms appear as a sign of an unsolved persisting symbiosis with parent figures, also as a sign of mental development. I have described the symptoms of symbiosis in detail in the book: Angst - Ursprung und Überwindung (7).
The theory about the Borderline-Personality-Organisation corresponds to the Concept of Symbiosis. Kernberg assumes that more than 10% of the population show a Borderline-Personality-Organisation.
Typical Symptoms of the Borderline Personality Disorder
There is postulated a certain amount of symptoms for the diagnosis of the BDP.
Fear comprises many psychic and somatic symptoms. Fear is a characteristic of each developmental stage because of feeling of guilt or symbiotic binding. Freely floating fear, typical of the Borderline Personality Disorder, frequently is to be found among some anxiety neurotic patients. Also panic attacks, suddenly rising fear of things or situations with tachycardia, vertigo, and the typical somatic equivalents of fear are symptoms of unsolved symbiosis.
The classification into different fears brings neither an advantage to the diagnosis nor to therapy. Floating fear stands for the parental call: "Come back to me. You have fear of life, fear of sexuality, fear of separation, of being autonomous, of every situation in your life! You'll feel anxiously, if you do anything that is separating you from the mother or father. Don't grow up!"
It is the fear that appears in any developmental moment of life.
The symbiotically attached man, especially the anxiety neurotic, lives within his family jail that allows him few inner and exterior freedoms. Even if a narcissistic, symbiotic person succeeds in his career and lives here out his fantasies of potency and success, he mentally stays a victim of his familiar binding power. He is not capable of expressing his aggression in adequate manner against his parents or other persons who are close to him. He has no allowance to express his wish to love someone and to start a family. So his head feels empty and dark, depressive.
He cannot hold out the ambivalence between love and hatred towards a person. Mostly he swallows his anger up, depressive mood slowly follows. The symbiotic will develop depressive traits that are variously out formed.
The depressive mood also results from the search of the lost paradise, from the search of the parental object that is finally disappeared out of reality. This all understanding and devouring parental object is only available in the fantasy. This harmonious state is vainly longed for. The non-performance of the lost paradise causes depressive pain.
The disturbance of identity is a typical symptom of the symbiotic bound men. The symbiotic has put his antennas too much on action. He has not sufficiently uttered his own opinion and wishes. His parents have constantly violated his boundaries – verbally, corporally or by other meanings. The symbiotic has adapted himself to the needs of a clinging exhausting parent so that he develops a disturbance of identity and an insufficient differentiation between the Self and the clinging object. Feelings of guilt and fear play a central role in the destruction of the identity or of the Self. Another way to confuse the child's identity is to neglect it.
Polysymptomatic Neurosis and Phobias
The classification of the abovementioned symbiotic behaviour is clear, but multiplex. It includes a broad spectrum of neurotic symptoms which also Kernberg postulates for the diagnosis of the Borderline personality Disorder.
Phobias show the same pathogenetic mechanism as they are described for the anxiety neurosis. The phobic attitude is a superficial symptom, behind which regressive wishes hide, autonomous conflicts, aggressive and sexual repression. It is characteristic for the phobias that here the aggressive and thrilling fantasies are directed on to an external object. The person fears a certain situation or thing. The aggressive impulse against devouring almighty object is oppressed. Phobias are marked by stabile and compulsive defence mechanisms. Therefore, phobias are well suited for behavioural therapy.
The development of compulsive symptoms is complex. Compulsive symptoms are on the one hand expression of infantile almighty fantasies, otherwise compulsive symptoms are internalized parental figures which act against the own Self. Compulsive symptoms hinder life, for example love, a stable relationship, sexuality. The compulsive thought is transforming into the compulsiveness which also is characteristic for the addiction. The Not Solving from a parental object, the being enclosed into the parental cage obsesses and occupies the patient. Their only ways outwards are the compulsive symptoms. The obsession of a compulsive or an addictive thought is to compare with the obsession of the almighty parent that does not allow freedom.
Development means stress. If a patient develops psychologically, symptoms like derealisation or depersonalisation can occur. They rise as equivalents of fear and feelings of guilt. The solution of symbiosis and the integration of split, until now strange personality traits is in sympathy with a loosening of the ego-functions. Feelings of guilt, a bad conscience and fear provoke the breaking down of the ego.
Hypochondriasis is a main characteristic of the anxiety neurosis. The steady occupying with the own body corresponds the low esteem which the patient gives the exterior world. The hypochondriac has no allowance to live out his wishes and impulses. Hypochondriasis mirrors the predominant engagement of the almighty object with the child. The mother has taken too much care of her baby. She has tried to save it from the "bad world". Hypochondriasis is a kind of obsessive behaviour referring the well-being of the own body. The hypochondriac thoughts are directed on the anxiety symptoms or other psychosomatic diseases which are to be found if autonomous impulses operate against the attachment power of the almighty objects (7, 45, 46, 50).
Hypochondriasis also appears in the process of psychotherapy, if feelings of guilt emerge while the patient tries to detach from the almighty object.
Paranoid symptoms are used as a defence and a projection of aggressive and oral impulses that originally are directed on to an almighty object. Paranoid fantasies appear among symbiotically attached patients who project their fears and the suppressed hatred against the destructive and persecuting object onto the external world. These patients suffer from an Ego-weakness. The transitory psychosis should be temporarily treated by a neuroleptic.
The repression of sexuality and the compensatorily exerted Don Juanism is characteristic of a dedication disturbance and fear of intimacy. The might and pull of the paternal attachment hinder the symbiotic to contract a monogamous partnership. The stringent messages of father or mother sound: "You are mine" or "You will come back to me. Therefore you doubt the love to your wife or your friend." "Because my love to you is inextricable, you can't be faithful."
Aggressive impulses are mixed to the sexuality (7). Anal intercourse has its deep origin in the unconscious search of the anal sadistic universe that is a picture for the Great Mother (5).
Addiction stands for the search of the maternal object and mirrors the simultaneous obsession by this object. The addiction points out to symbiosis between The Great Mother and the junkie. Addiction always is the search for the past, for the narcissistic primary state of which obtainment promises happiness and satisfaction. The addict wants to re establish the dual union between baby and mother. The addict tries to re-establish this infantile unit that is steadily refused by the real world (34).
The addictive striving after reanimation of the infantile unit with the mother increases more and more and serves the withdrawal from the world in which autonomy and responsibility disappear.
Accordingly to the multilayer determination of human behaviour narcissistic vulnerability and anger show a multiplicative origin. The term of the narcissistic rage mainly is understood as the revival of archaic anger because of injuries. These result from missing empathy, frustration or early loss experiences (23, 28, 39).
Narcissistic vulnerability and anger result not only by traumas rejections and oral frustrations, but also by the frustrated wish after unification with an archaic-omnipotent object. The striving after symbiotic fusion is so total that it fails because of reality. Disillusions appear.
The symbiotic bound one reacts with aggrieved behaviour and often with aggression.
The original symbiotic union shall be re-established with the help of aggressive taciturnity, a fit of anger or other aggressive behaviour. The rage of the disappointed child that misses a caring and ubiquitous mother directs in the adulthood against others or oneself. The anger originates from the impulse for revenge after a disappointing mother or reality. Narcissistic anger does not only result by early child injuries and traumas, but primarily is infantile behaviour. Rage serves the maintenance and restitution of symbiosis.
There are parents who do not prohibit aggressive behaviour of their children or they dispose themselves to fits of rage.
The child maintains the fits of anger over the phase of the little child because the parents hadn't set him enough limits. In later times, the adult believes to achieve something by his behaviour like in former times. The adult manipulates his environment after the motto: "If you don't do it like I will, I'll become angry. You will see that I will make my way!"
In its grandiosity the symbiotic has the tendency to exalt his past, his kind of thinking, feelings and acting. What the symbiotic says, does and feels, is right. The symbiotic attached one shows disappointment and violated behaviour if somebody did not live up his expectations. He is sulky, pouts one's lips for hours and days – depending how deeply he feels piqued. He is disappointed with his partner or his therapist upon whom he concentrates his expectations and wishes.
The aggrieved one retreats. He is not able to talk about the violation with his partner or to verbalize his anger. Silence is the consequence as aggressive retreat and revenge. Voicelessness is an expression of the inability to show adequately one's anger.
After enough rage has bottled up in the affronted partner, he explodes out of a little reason. He offers an infantile fit of rage.
A further source of anger consists of the fact that with the beginning of the partnership the symbiotic bound partner says good bye, takes leave from a parental object. Department and change are connected with mourning and anger. These are the stronger the more one is bound to the parents.
Because the partner cannot completely fulfil one's wishes the symbiotic is disappointed, sad and angry. This behaviour destroys intimacy and contact.
A Tantrum as an Approach of Intimacy
The aggressive inclination is fortified in periods of psychic transformation as the expression of the search of unifying symbiosis with the motherly or fatherly object. The respective step of individuation goes hand in hand with aroused sulkiness, rage and impatience. Depressive symptoms and psychosomatic signs of fear augment. Whereas the reactions of being aggrieved enlarge the distance to the other and hinder nearness, a temper tantrum can generate closeness. In an indurated partnership, loud and direct words are sometimes the last trial to create contact to the partner and to get him out of his arrogance and symbiotic grandiosity. The one shows increased vulnerability and anger, the other raised withdrawal and silence – as signs of symbiosis and infantile behaviour. The more a parent has occupied his child the greater may be the rage against the devouring parental object that does not stop violating his child's privacy. The father often takes a weak part in the family, so the symbiotic feels abandoned by his father. A typical answer of such patients is: "My father has had not much time for me." The children are disappointed about the missing educational love of the father. As adults they stay vulnerably, sulky, narcissistic and cholericly.
Character Disorders of low Structure
After Kernberg the infantile character often is to be found among the borderline personality disorder (23). This observation supports the thesis of the symbiotic attachment and involving infantility.
Self destruction is to understand as liberation-guilt and aggression against the Self during the effort to detach oneself from the enchaining parent house. Suicidal fantasies are both a regressive symptom and an auto-aggressive symptom.
The minipsychosis can be a sign of a transference psychosis that may grow by an orthodox analytic treatment. The minipsychosis is to classify as the result of a therapeutic situation that stimulates regression. The term minipsychosis does not live up to its name, but trivializes the possibility of a beginning psychosis or schizophrenia.
Not the splitting is the main factor of the ego-weakness but ego-weakness grounds on the missing possibility to develop the ego-functions in one's childhood and to exercise these. The child has not enough possibilities to exercise the perception of its Self and its exterior world.
Difficult communication, deficient differentiation between the Ego and You and the redefining of feelings are some mechanisms by which the perception of the Self and the others can be distorted. Ego-weakness is also caused by a diffuse anxiety which inhibits thinking. Unsolved symbiosis goes hand in hand with archaic aggression against the binding parental object. This elementary aggression restrains the ego functions.
Fear, feelings of guilt and a bad conscience overflow the ego and weaken it. The distortion of apperception corresponds to infantile thinking and perception patterns. These act more in accordance with the inner world of the symbiotic. For the infantile, the exterior world or the reality plays an underpart. The symbiotic perceives the world out of the perspective of the grandiose, beloved and a narcissistic cathected child that still lives in the dyad between mother and child.
Instinctive Character or missing Impulse Control
The instinctive character is induced by infantility. Children behave impulsively. Among the infantile symbiotic, the non-existence world oft the adults is manifesting in the impulsiveness.
The splitting of thinking, feeling and acting that Bleuler observed among his patients caused him to generate the term schizophrenia (2). Freud descripted the ego-splitting as a defence mechanism against an impulse (9). After Jaspers, the experience and perception of contradictions, of polarity and dialectic is a question of an universal form of thinking and all being (19).
Kernberg terms the splitting as the active separation of introjection and identification of antithetical matter. The borderline patient separates contradictory ego-states which are cathected with early, pathological object relations (23).
The term splitting that was generated by Klein is nebulous, not clear in its postulated genesis. A specify, primitive splitting mechanism as Kernberg postulates, does not play such an important and central role in my psychiatric-psychotherapeutic praxis like it should be resumed after the literature.
Where the sensation of contradictions takes too much ground, we have to do it with infantile, grandiose, primitive thinking patterns and behaviour. The simplifying glorification on the one hand and the total scornfulness on the other hand we find within the typical anxious neurotic families, in groups and peoples that are lead into a collective regression by seductive politicians and ideologists.
As psychiatrists, we see the splitting mechanism between idealisation and devaluation in the therapy. The separation into the good and the all-bad with a sudden turn over of the idealisation into the complete depreciation has the aim to destroy the contact to the partner, the therapy or professional group, if the relation becomes too tight, does not resemble to the primitive idealized image or the might of the parents gains the upper hand. The beloved person is damned or depreciated. For a certain time the complete depreciation of the worshipped men corresponds the archaic, inhibited potential of aggression that is enormous and does not permit any positive quality at the other. The symbiotic doesn't succeed to handle this big anger. Either he retires and depreciates completely his love or he idealizes it further more suppressing his archaic rage that would otherwise hit his partner.
In the course of hours, days or weeks the feelings of hatred can retreat with the aim of regaining a positive feeling.
The task of the adult is to overcome his childish aggressions, to become conscious of his inner contradictions and do integrate these.
The symbiotic person pushes forwards the search after re-establishment of the symbiotic union with the almighty object. But he doesn't succeed. Upon this disappointment he reacts with blunt declination that may lead to the end of the relation. The stronger the symbiotic partner wants to form a unit with the almighty object, the more he reacts upon the disillusion with depreciation mechanisms. The depreciation expresses the turn over from inclination to disappointment anger. After the symbiotic has divorced the infantile symbiosis under feelings of guilt and many symptoms he can live out relations without being forced to split them or to depreciate his partner.
The pronounced preference to idealize exterior objects exorbitantly is infantile. The primitive idealization derives from the identification with the almighty object. The symbiotic retains this old, infantile attitude, because he has no allowance to behave as an adult person.
The projective identification plays no part in my terminology. This expression was developed by the school of Klein that uses a nebulous language. Wurmser has critiqued this superfluous term of the psychoanalysis (52).
Grandiosity and Omnipotence
Grandiosity and omnipotence are symbiotic behaviour. Grandiosity and omnipotence are not a "direct manifestation of primitive introjection and identification with the aim of defence", but are directly connected with the infantile symbiosis. A person who sticks in the world of his infantilism will cultivate almighty fantasies. These persons were too much loved and glorified by mother or father.
The infantile simultaneously maintains feelings of inferiority, because he didn't arrive in the world of the adults. The grandiose person was disturbed in his identity by too much or too little parental love. He compensatorily feeds his powerlessness with the attitude of omnipotence and grandiosity.
In the following phrases we find grandiosity: "I shall never get married." "I will never do that." "No therapist can help me." "Nobody understands me." "I have tried everything." "Nobody loves me." These generalizations serve for maintaining the infantile symbiosis with the parental object. Sentences like: "She does not like me." or "The therapist is not sensible enough" destroy the actual relation. The grandiose person is not willing to leave the infantile pattern. The symbiotic has difficulties to engage in a momentary relation. Such people are quickly offended; they retire or react with narcissistic anger. They are snobby and highbrow. They are in love with themselves, with their ideas and endowments. He strands however in human relations.
Grandiosity can also be fed by the defence of a depressive mood. The persons, who cannot endure the process of mourning, depression and parting, may choose the defence of behaving grandiosely.
Depreciations and Doubts
The symbiotic depreciates anything if the intimacy becomes too tight for him. Depreciations have the sense to maintain the symbiosis with the real or inner parental figures, because depreciations lead back to the motherly stove. The one who depreciates does not feel well in the world, but he cavils at everything in going to hinder his membership. The symbiotic tries to preserve the world of the childhood by depreciating and interpreting the reality anew.
Depreciations are comparable with doubts. Doubts also maintain the symbiosis. All situations that require decisions can be subdued to the doubt. The doubts or depreciations often occur in the psychotherapy or in partnerships. The symbiotic doesn't tolerate the great nearness of these relations. He fears to be devoured by the almighty objects. In going to evade this feared omnipotence of the partner and his regressive sucking he is in doubt about his capacities.
The neighbourhood of the concept of the borderline personality disorder to the concept of narcissism is founded on the fact that the narcissism is a more harmless, less noisy form of symbiotic behaviour. When the narcissist accepts the process of detachment from the symbiosis a noisy and multilayer symptomatic begins.
The Scientific World of Dreams
Where a person stands in his psychic development, where its momentary problem or conflicts lie, offer its actual dreams. These dreams make contact with the healing power in this person. Look at: Dr. Flöttmann´s Scientific Encyclopedia of Dream Symbols.
Literature at the author.
This article was updated on the 23.1.2009.
Copyright 2009 Dr. H.B. Flöttmann
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