Psychoanalytic Theories of Personality
Psychoanalytic Theories of Personality
Psychoanalytic Theories of Personality
THEORIES OF PERSONALITY
Instructor: Michael J. Gerson, PhD
Copyright 1993, 1994 by the Institute of Advanced Psychological Studies. All rights reserved.
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I ntroduction
The following course is an examination of the psychoanalytic theories of
personality. In an effort to synthesize nearly 100 years of theoretical formulations,
there are some inevitable conflicts, contradictions and confusions that arise relative to
terminology. Freud, for example wrote about "character types" while today, the DSM-
IV (see American Psychiatric Association, 1952, 1968, 1980, 1987, 1994) refers to
"personality disorders;" Kohut reconstructed some of the psychoanalytic
metapsychology into a study of "self' and "disorders of self," while Kernberg
elaborated upon "borderline personality organization." While each of the above terms
demarcates justifiably different territories, it is imperative that we also recognize a
necessary unity among these terms as a goal toward an improved understanding of the
human experience. The fact that so many different terms become justified to illustrate
different areas of interest only attests to the complexity of the mind, emotions and
behavior. F or the purposes of this course I will utilize the terms "character" and
"personality" somewhat interchangeably only making differentiations where necessary
and significant. Other terms such as "ego," "self," and "identity" have well-established
differentiations in the literature that require careful consideration regarding underlying
theoretical models. Also, in an effort to make this course comprehensive, a variety of
theoretical models or paradigms will be referred to with some occasional digressions
for clarification purposes. It is our hope that this multi-modal approach will allow you
to consider the information both critically and in a manner that can best be integrated
into your clinical experience.
Along the lines of the goal of clinical integration, the DSM-IV categories of
Personality Disorders will also be incorporated into the discussion. While we
recognize that the DSM-IV is an atheoretical compendium of nosological conditions,
the rich psychoanalytic history on personality formation and pathology can offer
informative and challenging insights into an understanding of these conditions.
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What ConstitutesPersonalityFormation?
Personality formation refers to the process whereby an individual becomes an
individual; that is, the process whereby one develops stable and enduring patterns of
thinking, feeling, and behaving. These patterns are, to a large degree, adaptations both
to the internal demands of instinctual drives and tensions as well as to the external
demands for conformity and socialization. Character formation represents a resolution
to these conflicts and can therefore be seen as a person's best effort at "staying sane."
In a more technical sense, personality results from autoplastic (self-modifying)
adaptations that are ego-syntonic (subjectively congruent). Classic psychoanalytic
theories on personality formation are in many ways remarkably consistent with the
social interactionist's position in contemporary child development theory, to the extent
that psychoanalytic models have anticipated a necessary integration of innate
predispositions with environmental factors. Their major points of departure are that
the innate predispositions that psychoanalytic theories consider consist of instincts and
drives rather than temperament features. The earliest environmental factors of
psychoanalytic theories are limited almost exclusively to the qualities of and the
imaginative constructions of the parent-child interactions as experienced by the child,
rather than a more broadly based inclusion of learning theory, sociological, and
cultural factors.
With parents as the personification of external reality, the psychoanalytic
theories examine the processes by which parents serve as models for ego, ego-ideal,
and superego formations. The psychodynamics of introjection and identification serve
as the fundamental processes for this aspect of character shaping in concert with the
specific events of psychosexual and psychosocial developmental stages. This means
that when and how the parent-child conflicts arise, and when and how they are
resolved, will determine whose attitudes the child imitates and incorporates; whether
for example, the nurturing characteristics of the parents or their prohibitive attitudes
become part of the child's legacy.
Constitutional factors may also play a part in the psychoanalytic theories about
character formation to the extent that some persons may be better able or more ill-
equipped at managing the tensions caused by aggressive and sexual drives. Some
people may be better able at identifying and adjusting to the needs of the child than
others and be capable, in varying degrees, to tolerate the projections of the infant's
fantasies. This consideration leaves the door open for biological and genetic
transmission theories about personality and is consistent with findings regarding
temperament.
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The phenomena of fixation and regression are particularly illuminating to our
understanding of personality development because they suggest the importance of
different developmental stage experiences and their possibly intrusive impact upon the
personality, or the resolution of these experiences by adjusting the personality into
normalizing them. That is to say, developmental crises can be dealt with dynamically
through repression and other defensive measures possibly leading to some form of
neurotic compromise formation that may emerge episodically in the form of
psychoneurotic symptoms, or developmental crises can be resolved by adjusting or
distorting the character in a manner such that the crises are assimilated and integrated
into behavior that appears relatively normal. Thus, whether one is induced by periodic
stresses or cues to regress to previous developmental events, or whether one carries
with him or her the artifacts of these events in the formof fixations, the significance
of a person's developmental history can serve to shape the various personality traits.
The extent to which these traits are normal or pathological is usually considered a
matter of flexibility. This distinction, based on degree of flexibility is largely the
criterion used in DSM-IV to differentiate personality traits from personality
disorders.
What ConstitutesaPersonalityor Character Disorder?
As I alluded to above, there is an important distinction between neurotic
symptoms and character traits. Freud noted in 1913 that the neurotic symptoms arise
from a failure of repression, i.e., a return of the repressed that disrupts the normal and
expectable functioning of the individual. By contrast, classical theory suggests that
character traits owe their existence to the success of repression and the defensive
system that is able to achieve a pattern of relative stability through reaction formation
and sublimation. In subsequent writings that elaborated on the processes of the ego
and the id, Freud (1923) expanded upon the process of identification as a form of
adaptation. In the context of a lost object (or relationship) the process of identification
can function such that an internalized representation is constructed and the conflict
(loss/ mourning) can be minimized or resolved by a special form of internalization
called introjection. The introjection of the parental or societal attitudes in the form of
the superego likewise allows for an enduring referential base of right and wrong
against which a resolution of conflict or the restitution for misdeeds can be made. The
process of introjection accounts for the relatively enduring characteristics of the
superego structure. Thus, identification, internalization and introjection are
fundamental processes that establish the adaptive capacity of the ego system such that
conflict can be prophylactically avoided. The net result is a psychic system shaped to
the demands of the instinctual drives and the constraints of external reality.
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In the case of character disorders we are examining a heterogeneous group of
personality styles that share the common features of being habitually inflexible in
patterns of thought, affect and behavior and who also experience their being inflexible
without any apparent subjective distress. Thus, other people experience the conflicts
and contradictions of the personality styles, but not the persons who exhibit them.
Clearly these are disorders of relationship in that the pathology is recognizable only in
the context of an other and that these disorders are paradoxically inconspicuous to
their owners. As one might expect, the absence of subjective distress eliminates any
motivation for change and can severely diminish the prospects for a favorable
prognosis in treatment. While persons may be unlikely to seek treatment directly for a
personality disorder, they are likely to seek treatment for an associated condition such
as marital dissatisfaction or job-related stress. Certainly, it is also possible for persons
such as these to seek treatment for an unrelated issue such as the death of a family
member and then face the impact of this stressor upon a given rigid, inflexible over-
adapted personality organization. In either case a psychoanalytically oriented clinician
can generally expect that what distresses a patient is the initial focus of treatment,
while their character style dictates how treatment needs to be conducted. For this
reason an assessment of character style and / or character disorder is essential for a
complete understanding of the patient and treatment planning.
Otto Fenichel in his classic treatise on The Psychoanalytic Theory of Neurosis
(1945) provided one of the most thorough examinations of character disorders and
offered a basis for the classification of character traits. He noted that some character
"attitudes" (i.e., stereotyped ego reactions) demonstrate a reciprocal relationship
between character traits and neurotic symptoms. That is, a character attitude is an
attempt to "make the best of established neurotic conditions." These patients sacrifice
their developmental potential through the wasteful expenditure of energy in the form
of definitive patterns of constant counter-cathexis. The resulting limited patterns of
defense lead to a permanent deforming of the ego. For Fenichel, the character of an
individual is constituted by the ego's habitual modes of adjustment to and from the
external world and toward the superego and id. The characteristic types-of-combining
these modes with one another constitute character and what he termed "character
attitudes." These attitudes are changes that are brought about through the adaptational
re-shaping of the instinctual demands. Therefore, Fenichel was describing character as
a sub-process of the ego that essentially stylizes the operation of the various ego
functions. Character sets the distinctive stamp upon how the ego system achieves its
various purposes. In the case of pathological character, the stamp is routinized and
stereotypical - certainly not geared toward being generative and creative. The
character can be
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highly functional, but only in a limited sense given that life is reliably unpredictable.
As a basis for the classification of character traits, Fenichel chose the
distinction between whether a character trait aims at discharging an instinctual
impulse or suppressing it. The former group he referred to as Sublimation Types and
the latter group Reactive Types. F or the most part he believed that the Sublimation
Type was non-pathological since it succeeds in replacing an existing instinctual
impulse with an impulse that is compatible with the ego and one that is organized and
inhibited as to aim-- "a channel and not a dam for the instinctual stream" (Fenichel,
1945, p. 471). These character trait types are of greatest importance for the treatment
of character disorders as they represent the goal of transforming the reactive type into
the sublimation type and thereby achieving "successful repressions."
Reactive character types which are the subject of study for psychopathology
are further sub-divided into phobic attitudes and reaction formations. Phobic attitudes
reflect attitudes of avoidance and an escape from the awareness of instinctual
demands. Reaction formation attitudes reflect attitudes of opposition in the hopes of
camouflaging the instinctual demands in a sea of exaggeration and counter-cathexis.
So, for example, a phobic-type character might devote his or her life to combat
pornography as an avoidance of his or her own lustful desires; while the reaction-
formation type might pursue a career as a comedic actor to oppose feared emotions of
depression and sadness. Both of these character types reveal a fundamental conflict
between the instinctual drives and the ego system's ability to manage them. Character
serves a defensive function in protecting the integrity of the ego through its persistent
reactive style.
By examining the function of character or personality traits vis-a-vis the
instinctual drives we are also essentially examining the relationship between character
and the emotions. Fenichel noted that the defensive function of character types is not
only directed against impulses but rather against the emotions related to the impulses.
Narcissistic characters, for example, who seek out confirmation from others about
their power and prestige may do so to defend against the primitive dependency needs
and associated feelings of helplessness and powerlessness. These same individuals
may sometimes tolerate some emotions because they can be justified as reasonable
and rational thus utilizing rationalization as a defense which serves to support a sense
of narcissistic omnipotence.
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Fenichel proposed an organization of character types that afforded a distinction
between the enduring, ego-syntonic features of the character disorder and the
episodic, ego-dystonic features of the psychoneuroses. His typology addressed the
different manifestations of character types relative to the management of instinctual
drives. A more contemporary attempt at organizing our understanding of character
disorders has been put forth by Otto Kernberg (1967, 1976, 1980). While much of
Kernberg's work examines the dynamics and characteristics of the borderline
personality organization, his scholarly critiques of theory have resulted in an
understanding of personality disorders based upon the development of ego and
superego structures and their related processes. Kernberg distinguishes between
higher-level character pathology and lower-level character pathology. Higher-level
patients possess a well integrated superego structure that is relatively punitive and
severe. The ego is also well integrated to the extent that there is a stable ego-identity,
self-concept and representational world. While the defensive operations may be
extensive, they utilize repression to resolve conflict and retain ego integrity. In short,
the higher level character pathologies are quite similar to Fenichel's reactive types.
Examples of these disorders would include the hysterical (histrionic), obsessive-
compulsive and the depressive-masochistic (a depressive character capable of
experiencing guilt about anger at a lost object and able to tolerate mourning, i.e. a
dysthymic disorder). The lower-level character pathologies exhibit severe structural
deficits in the ego and superego and related developmental consequences. These
persons have minimal superego integration and a tendency toward the use of primitive
defenses such as splitting, projection, denial, projective-identification and idealization.
The resulting internal world of these patients is unintegrated and split into dissociated
ego states.
Dissociated ego states refer to an immature fixation of ego development
resulting from the predominant use of the splitting defense. In this defense, mental
representations of self and object developed through aggressive strivings are split off
from the mental representations of self and object developed through libidinal
strivings. The net effect is an unintegrated set of bad and good representations that
retain primitive, crude and simplistic distinctions between self and object and between
bad and good emotional experiences. The perception of reality is severely limited and
the tendency toward idealization and devaluation is predetermined. The development
of emotions is likewise restrained by the bad-good dichotomy such that ambivalence
is not experienced and therefore neither are the subtleties of emotional experiences.
The entire spectrum of human emotions is reduced to a simple bad-good dimension.
Examples of the lower-level character pathologies include the narcissistic, borderline
and anti-social personalities.
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What Kernberg is offering is a typology based around the development of ego
and superego. Those disorders which exhibit primitive or infantile ego and superego
development are at the lower end of the continuum, while those with more mature ego
and superego development would be at the higher end. To proceed with this
comparison we will need to identify the various structural features of the mind and
their corresponding operations.
A structural analysis of the mind corresponds to an analysis of the mental
processes from the point of view of the id, ego, and superego structures. The
predominant focus is upon the development and operation of the ego system with
regard to the management of instinctual drive derivatives; the autonomous ego
functions such as language, intelligence, motility, perception and thought; primary
and secondary thinking processes; defensive operations; and the structural derivatives
of object relationships. Another dimension of structural analysis addresses the relative
strength or weakness of the ego with regard to the capacity to tolerate frustration or
anxiety this includes the control imposed over instinctual impulses and the channels
available for the sublimation of drives. Ego weakness which would predictably
represent the lower-level character disorders would evidence a lack of anxiety
tolerance such that the ego reacts to anxiety with regression or additional symptom
formation. Impulse pressures likewise are discharged unpredictably and erratically by
the lower-level disorders while they can be specifically expressed in an ego-syntonic
episode by higher level disorders. Sublimatory channels reflect assessments of
potential versus actual performance. The lower-level disorders being inhibited with
regard to their potential performance are unable to utilize their creativity. Thus this
aspect of ego functioning is limited both in terms of the patient's capacity for creative
enjoyment and creative achievement. A similar distinction is suggested by Winnicott
(1960) in his comparison of the true and false-self. In that example, the true-self,
which represents a constitutional potential, is facilitated developmentally by the
stimulation of creative expression. The false-self represents the adaptation ally
motivated compromises to reality and a protective process for the true-selfs integrity.
What Kernberg presents in his classification of personality disorders is a means
for comparing the different types of characters relative to each other on the dimension
of structural integration. In doing so he postulates both quantitative and qualitative
distinctions that are etiologically based (i.e., he presumes the causes of the disorder,
why it appears the way it does) rather than being merely descriptively based (i.e.,
describing the manifest presentation of the symptoms in terms of how the
psychodynamics account for the appearance of the disorder). Kernberg's use of the
term "borderline personality organization" further allows for an examination of
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a spectrum of conditions along the continuum of structural development from pre-
psychotic to neurotic levels of functioning.
We will now explore some of the personalities of the DSM-IV as a referential
base of character types and discuss them in term of descriptive, structural, defensive,
and object-relational conditions. As you are probably aware, the DSM-IV is
atheoretical and descriptive such that it divides the personality disorders into three
clusters (A, B, C) based upon manifest symptoms. Cluster A represents those
disorders whose symptoms are odd and eccentric. These include the Paranoid,
Schizoid, and Schizotypal Personalities. Cluster B is characterized as being dramatic,
emotional, and erratic. This cluster includes the Borderline, Narcissistic, Histrionic,
and Anti-Social Personalities. Cluster C is described as anxious and fearful and is
constituted by the Dependent, Avoidant, and Obsessive-Compulsive. The DSM-III-R
included the Passive Aggressive Personality Disorder in Cluster C as well; the
disorder would be diagnosed as "NOS" using the DSM-IV.
Cluster A
The Paranoid Personality Disorder describes individuals characterized by
suspiciousness, mistrust, irritability, and emotional coldness. They appear hyper-
vigilant to anticipated dangers and are likely to put others on the defensive by being
accusatory and judgmental. Like all character types, these persons perceive and act
upon the environment in this manner all the time. This is in contrast to a Delusional
Disorder where a patient is likely to have evolved a delusional explanation or
justification for their views or behavior. This latter condition is also not reflective of a
lifetime pattern or a pervasive orientation to the world, but rather, is a symptomatic
condition that arose from the breakdown of repression. In paranoia the impulse and its
derivative ideational content is projected onto the environment where it can be
defended against externally. Freud (1911) in the Schreber case elucidated the process
whereby paranoia evolved from the repressed homosexual urges of the patient. In a
series of defensive transformations the thought derivative "I love him" was denied and
transformed by reaction formation into "I don't love him, I hate him." This more
consciously acceptable idea was projected in the further transform "It is not that I hate
him, he hates me!" With this version of the thought near consciousness, the patient
could modify the idea slightly with rationalization to become "I hate him because of
his hatred for me." Thus Freud accounted for the range of persecutory, erotic, and
jealous delusions as the transforms of unacceptable libidinal drive derivatives.
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For the Paranoid Personality we see a slightly different picture from that of
delusional paranoia in that there is a constant flow of aggressively determined
projections from the patient to the environment that establishes a world that is
dangerous. This world becomes the reification of the patient's intolerable feelings and
thoughts. The relationship to the world and its occupants is understandably dangerous
given that it is constantly being populated by these aggressively determined
projections. The internal world of the patient is prevented from maturing beyond the
infantile level given that the negative part-objects are being projected and are thus
unavailable for integration with the positive part-objects that are retained. A vicious
cycle ensues such that the projections are reintrojected as perceptions of hostility and
danger. An intensification of the splitting process keeps the patient's libidinally
determined part-objects (positive part-objects) from being contaminated by these
perceptions of danger and affords a false sense of objectivity and perspective. The
patient has effected an internal polarization of aggressive and libidinal part-objects
with the former being attributed to the perception of external events and the latter to
the patient's rational, objective mind. Emotional restrictiveness would be a by-product
of a process that maintains the basic simplicity of good-bad, me-not me distinctions
caused by the splitting defense. This restriction of affect is typical for this character.
With all of the above description of the psychodynamic machinations it must be
remembered that these processes are not operating independent of reality. Cameron
(1963) notes that the origin of the Paranoid Personality is likely an environment that
was . hostile, unloving, possibly abusive, but certainly not conducive for the
development of basic trust.
The Schizoid Personality can also be presumed to have originated from an
environment that was lacking in basic trust (Cameron, 1963). They differ to the extent
that the expression of rage and aggression was so stifled as to leave the individual
passive, compliant, obedient, and detached. Fairbairn (1940) stressed the role of
depersonalization, de-realization, and disturbances of the reality-sense such that these
persons sense themselves as artificial. He describes how these patients refer to a
"plate-glass" between them and others with a strange sense of unfamiliarity with the
familiar and familiarity with the unfamiliar. One gets the impression that these
patients exist in a perennial dream-like detachment. Winnicott's concept of the "false
self" personality would help to describe how the "true self" (core creative self)
remains protected and insulated by a false adaptive self. This "false self," even if
sufficiently competent to negotiate the events of life, could only, at best, achieve a
"false" ego-strength and "false" self-esteem. The "true self" always remains hidden,
impoverished, suffering and lacking in
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experience. The life and accomplishments of the individual seem, to them, inauthentic
and devoid of pride.
The interpersonal relations of the Schizoid are, as Guntrip (1952) described: "emptied
by a massive withdrawal of real libidinal self ... The attitude to the outer world is the
same: non-involvement and observation at a distance without any feeling ... "(p. 86).
Thus, we see a patient who remains in their own asocial existence whose pain,
rejection, anger, and longing, all expectable emotional scars from a childhood of
coldness and betrayal, are masked behind a shroud of apparent apathy. Whereas these
patients appear bland and deadened, they may engage in active primary process
reveries which are rarely revealed to any of the few relations they may have.
Therapists sometimes underestimate these patient's true emotional commitment and
unwittingly victimize them with premature terminations or other countertransference
rejections like falling asleep or changing their appointment times.
From an object relations perspective we could expect that the self-object
images of these patients are not clearly differentiated. Rather than projecting the
aggressively determined object representations into the environment and then
defending against them externally, as the Paranoid Personality does, these patients
regress to a pre-psychotic state of self-object undifferentiation. Their ability to remain
stable at this level prevents them from degenerating into a more classic schizophrenic
autism. The withdrawal of object libido is not reinvested in the self, as we would see
in a Narcissistic Personality, but rather is dissipated into primary process imaginings
and "protective" distractions. This latter process gives the Schizoid their detached,
dream-like appearance.
An interesting and somewhat unique description of the Schizoid patient is
presented by Bollas (1989) in what he calls the "ghostline personality." These patients
experience a failure of the "potential space" between the self and the other such that
the child cannot "live" in this intermediate or transitional area. The consequence of
this failure is a psychic death of the part of the "true self' or the potential "true self' or
the transitional object. The essence of that which dies is transferred to an inner world
Bollas refers to as the "alternative world." This "alternative world" functions as an
internal world populated by the foreclosed self states and object representations.
Unlike the conventional use of the internal world to contain representations of objects
in external reality, this "alternative world" contains ghosts of object and self
representations that could not be sustained. This realm of the mind becomes the
psychic afterlife. The patient conserves these ghosts in the "alternative world" where
they can potentially be re-incarnated through the transference. It is through the
aliveness of the analyst, who serves as
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the transitional object, that the "alternative world" can be transformed. These
alternative objects can be transformed into "true self' states and objectified objects by
the use of the transitional object (therapist) who provides life and an arena wherein to
share the experience of the "alternative world." What Bollas so poetically captures
about the Schizoid Personality is the macabre romanticizing of a death-like being state
that could easily remain unseen by a superficial symptomatic description of the
patient.
In contrast to the Schizoid Personality who withdraws passively from social
contact, is the Schizotypal Personality who withdraws erratically and is active only on
the fringes of social contact. These personalities have historically been viewed as
"stabilized schizophrenics" by Bleuler (1911), "autistic personalities" by Kraepelin
(1919), "ambulatory schizophrenics" by Zilboorg (1941), or the "schizophrenic
phenotype" (the full term from which "schizotypal" is a shortened form) by Rado
(1950). What is striking about these patients is their peculiarities of speech, behavior,
and beliefs which can give them the appearance of a psychosis. They remain,
however, connected to reality if only in the form of bizarre, eccentric, or out-of-the-
ordinary beliefs. Like the Schizoid Personality, their emotional life is deadened, but
the Schizotypal is clearly capable of explosive and aggressive outbursts (Millon,
1981).
So, if we were to extend the above discussion about the psychodynamics and object
relatedness of the Schizoid to that of the Schizotypal, we could propose that rather
than a massive withdrawal of libidinal cathexis, here we find an occasional intense
infusion of aggressive energy in some part-object representation. Given that these
patients present with the "primary symptoms" of schizophrenia (disturbed associations
of thought; splits between affect and intellect; ambivalence toward objects; and an
autistic detachment from reality (Bleuler, 1911)), their self and object representations
would be fragments of external reality. Should their detachment from society be
intruded upon in some way their internal state becomes agitated and they perceive this
as a violent aggressive act. The primitive quality of their mind is limited in its
capacity to accommodate to the intrusion and they regress to a pre-psychotic fused
self-object experience with the intrusion. Their aggressive explosions are essentially
an externalization of this internal chaos. Some stabilizing ego functions allow for a
semblance of a synthesizing of these fragmented elements by adhering to fringe
beliefs such as UFO's; clairvoyance; reincarnation; etc. The interface between their
primary process thinking and society's "twilight zone" of belief systems, gives these
patients a meeting ground that supports their ability to connect. Their odd speech and
neologisms can likewise serve as a consolidation of autistic thinking with a social
language system. They can thus retain their detachment by employing unusual or
idiosyncratic words
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while weaving them into a conventional fabric of social discourse. They are, at once,
connected, and detached hence their erratic style.
The erratic quality of the Schizotypal together with their aggressive capabilities
sometimes confuses this character with the Borderline Personality (Millon, 1981).
This similarity exists only at the level of some manifest symptoms. A more basic
difference is postulated by the various psychodynamic descriptions to follow.
Cluster B
The Cluster B disorders of DSM-IV include the Borderline, Narcissistic, Anti-Social,
and Histrionic Personality Disorders. While Kernberg describes these as varying
along a continuum of "borderline personality organization, " other psychoanalytic
descriptions can view them as relatively discrete and autonomous disorders (Knight,
1957; Schmideberg, 1947; Stem, 1938).
The Borderline Personality Disorder as presented in DSM-IV has the manifest
symptoms of: unstable interpersonal relationships; impulsive behavior; affective
instability; inappropriate intense anger or rage; recurrent suicidal threats, gestures or
behavior; marked and persistent identity disorder; chronic feelings of emptiness or
boredom; and frantic efforts to avoid real or imagined abandonment.
Historically, the Borderline Personality Disorder has referred to a condition midway
between neurotic disorders and psychotic disorders (Stem, 1938) or as a complex of
traits and symptom features of both neurotic and psychotic type that constellates in a
rather stabilized instability (Schmideberg, 1947, 1959). Knight (1957) added to the
psychodynamic understanding by highlighting ego-weakness as a critical feature of
the disorder. Kernberg's formulations (1967, 1975) about the borderline personality
organization has incorporated all the above into an object-relations model.
Kernberg (1967, 1975) attributes the symptoms to the "dissociation of ego-states"
under the impact of primitive defenses such as splitting, projection, projective
identification, and denial. The psychic stress experienced by the Borderline patient in
an effort to organize internal and external experience leads to an intensification of the
splitting process leaving the patient ultimately unable to integrate good and bad self-
object images. Aggressive instincts are not neutralized so the intensity of these drives
remains powerful and infantile. Idealization and
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devaluation are typical derivatives of the un-neutralized aggressive drive.
Unlike the Paranoid patient who actively defends against the projections of
aggressively determined object images, the Borderline patient is fixated at a level of
ambi-tendency with the world (i.e., an approach-avoidance type oscillation).
The Borderline alternately projects the aggressive images to get distance from
them, then reintrojects the object in response to feelings of estrangement and
abandonment.
Masterson (1981) offers another variation of the Borderline Personality
psychodynamics through the incorporation of developmental theory and the concept
of a "split object-relations unit." Briefly, this model focuses on the adaptive
characteristics of the mother and child during the rapprochement sub-phase of the
separation-individuation process in Mahler's theory. Significant for this sub-phase
toward the development of Self, is the child's ability to retain the newly evolved,
tenuously held experiences of separateness under the impact of individuation
autonomy and the need for periodic re-attachment to the mother. Masterson contends
that parental inconsistency during this period can result in an abandonment depression
that is fundamental to borderline psychopathology. The child can experience the
maternal part-object representation as withdrawing, angry and critical of the child's
efforts to separate. The affective link to this experience (a form of emotional memory)
is a profound abandonment panic, depression, helplessness, emptiness, or rage. The
child's part-self representation is internalized as inadequate, bad, ugly or insignificant.
The resulting personality disturbance centers around the projections and defenses
against abandonment as it emerges in interpersonal relationships. Clearly, both
Masterson and Kernberg describe personalities that meet the DSM symptoms; they
differ in terms of howand why the symptoms appear.
In turning to an examination of the Narcissistic Personality Disorder we should
begin with Freud's rather straight forward model of libidinal maturity. Freud originally
described narcissism as the mid-point between auto-erotic and object love (Freud,
1910). Therefore, the body becomes a love object as a transition from auto-erotic
sensations to the appreciation for the other. In 1914 this concept was linked to libido
theory wherein a developmental progression for libido was presented. In the
autoerotic phase, "primary narcissism" was the investment of libido into the
experience of the body. This investment is eventually made into an other who can
then be loved as the self once was. Object-love comes to replace self-love as an
elaboration and extension of loving. Complications to this sequence can occur when
the object of the person's love fails to be sufficiently gratifying or
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is abandoning and rejecting. Under these conditions, libido is withdrawn from objects
and re-invested in the self. This defensive re-cathexis of the ego (ego and self were
used interchangeably) leads to an exaggeration of self importance and power. The
megalomania, omnipotence and grandiosity of this form of narcissism was viewed as
pathological and a "secondary narcissism" (as opposed to normal "primary
narcissism"). For Freud, then, a pathological narcissist was the result of a libidinally
determined regression to a pre-object-love state. Wilhelm Reich (1926) coined the
term "phallic-narcissist" to refer to a fixation at the phallic stage of development
where arrogance and self-assurance serve as defenses against castration anxiety.
As was noted earlier, Kernberg views narcissistic pathology as a variant of the
borderline personality organization. He interprets the arrogance and grandiosity as a
defense against the projection of oral rage. This rage stems from a incapacity to
depend upon "internalized good objects" that keep the narcissist in a perpetual state of
inner emptiness and abandonment. Their anger is a revengeful resentment for their
incapacitating internal world. Kernberg notes that these patients often reveal histories
of parents who were cold, aggressive, and spiteful towards their children. He also
notes that the children were often once viewed by the parents as having special talents
or genius making them exceptional targets for the parent's idealization and eventual
devaluation.
Masterson (1981) describes the Narcissistic Personality also as a variant of
borderline pathology, but with regard to an object-relations unit of the parent and
child that is rewarding for clinging, dependent, and regressive behavior. The child is
essentially fixated by the parent-child dyad at a level of self-object fusion that
undermines the child's ability to differentiate and further guarantees the child's
inevitable disappointment with others who could never supplant the parent-child
specialness. In contrast to Kernberg who would tend to view the Narcissistic
Personality as a slightly more developed Borderline disorder, Masterson sees the
Narcissistic Personality as pre-dating the development of the Borderline Personality
given the more symbiotic character to the part-object relations fused unit.
Heinz Kohut (1971, 1977) has offered an explanation of narcissism that is
fundamentally different from any of the above. He posits that at birth two fonns of
libido exist and follow different lines of development. Object libido follows the path
elucidated by Freud and is responsible for the transformation of auto-eroticism into
object-love. This process is essential to the maturation of the ego system in
differentiating self from object representations. Another form of libido, narcissistic
libido, is responsible for the development of Self as a separate psychic structure.
14
The development of Self requires the integration of two major "spheres;" the
"grandiose self' and the "idealized parental imago." The former represents the residue
of infantile grandiosity while the latter represents the residue of dependency and
protective symbiosis. Collectively, these spheres represent the "bi-polar Self. "
The development of narcissism is facilitated by the maintenance and creation of
selfobjects which are representations of the person's Self organization. That is, they
are what the compound word itself represents, a merged self and object experience
(pure subjectivity). Selfobjects serve to maintain the child's equilibrium by adjusting
to shifts in internal emotional vulnerability. Parents function as the first selfobjects
through the provision of an empathic relationship to the child that mirrors the child's
self state. Serving as a selfobject they provide a transforming or transmuting function
for the child's painful emotional experiences (not unlike the auxiliary ego functions or
stimulus barrier functions discussed by object-relations theorists). Pathology results
from empathic failures that impede the integration of the two spheres of the Self
leaving one or the other to serve in a compensatory fashion. For instance, a failure of
grandiosity can be compensated by a symbiotic re-fusion with an idealized parental
imago selfobject, or, a disappointment by a fallen ideal can be compensated by a
grandiose inflation, seeking validation from the world.
As pathological conditions persist, the dynamic tension arc between these two
poles of Self oscillates to extreme degrees of compensation that prevent essential
integration and keep the Self fixed at an infantile level. This process may sound
similar to the reinforced splitting mechanism described by Kernberg, but is used in an
entirely different context. Kernberg was describing ego integration with self as
subsumed within those processes. Kohut is referring to the development of Self as
separate from ego such that the development of Self and ego are independent.
Interestingly, these differences prove to be quite profound when we compare how
these different theories interpret the severity of the narcissistic pathology. The
Kernberg narcissists (narcissistic-borderlines) are illustrative of more severe
borderline conditions than the Kohut narcissists. This latter group could theoretically
have higher developed ego functions than the narcissistic-borderlines would suggest
and owe their narcissistic pathology solely to a failure of Self development. In any
event, Kohut's model proposes forms of narcissistic transferences that correspond to
the selfobject representations of the grandiose and idealized parental imago spheres
that are immensely helpful in understanding the unique requirements of the
therapeutic alliance; namely the mirroring, merger, alter-ego and idealizing functions.
15
The Anti-Social Personality is an individual with a life history of aggressive,
destructive, oppositional, and defiant acts. They are often regarded as lacking a
conscience and operating without guilt or empathy. They manifest a diffuse lack of
impulse control that results in frequent irresponsible and thoughtless behaviors which,
at the time of performance (and possibly afterward as well), are ego-syntonic. The
DSM behavioral criteria for this disorder attempts to account for the long history of
anti-social conduct by requiring evidence of symptomatology before age 15 as well as
afterward. What the symptom description lacks, however, are the essential, but less
obvious, characterological features of the sociopath. DSM-III-R replaced the older
DSM-II categories of Sociopathic Personalities (Dissociative and Anti-Social Types)
with the Anti-Social Personality Disorder. The psychodynamic literature however
describes a character disorder of the sociopath whose charm, intelligence, callousness
and ability to manipulate others is lost by the contemporary description that appears
more indicative of a common criminal type. The sociopath that Fenichel (1945),
Cleckley (1959), Cameron (1963), and Kernberg (1967) describe is a person whose
basically borderline personality structure uses others and society as exploited part-
objects to compensate for structural deficiencies. The absence of conscience, for
example, which is often cited as indicative of the sociopath is compensated for by
exploiting the conscience of others. These persons project their anger, hatred, and rage
on others who are then made to feel guilty for feeling revengeful.
Prior to a recent California state execution, a condemned prisoner chastised.
society for its inhumane treatment of him and its barbaric punishments. The convicted
murderer, who shot two teenagers after stealing their car, praised the protesters of the
execution and condemned the state for failing to be empathic about his abusive
childhood. After once winning a stay of execution some years earlier, the convict
commented "oh, well" when asked about his gratitude toward the protesters. This use
of projective identification puts into the Other what the sociopath never has to
consciously feel. They are spared from developing a superego by essentially
manipulating society into serving that function. The sociopath's behavior can be
rationalized as a failure of society or the "system" in creating their personality.
Without an internal capacity for guilt there can be no empathy or compassion. The
supervising responsibility for the ego is externalized giving free reign to instinctual
drives and wishes, hence the high incidence of impulse disorders, addictions, and
sexual perversions. Collectively, these individuals come to personify the dark side of
humanity and, as such, are of an ironic necessity for civilized social values. They
provide the necessary dialectic for the good-evil dichotomy. Perhaps it is for this
reason that these patients create such powerful countertransference reactions. They tap
into the anti-social or sociopathic potential that each of us has attempted to mature out
of. Winnicott
16
(1956) notes that the "anti-social tendency" retains a sense of hope in a world that can
be nurturing. Once hope is lost, the anti-social tendency gives rise to delinquency and
criminality. I was once taught that a child would rather be a bad child in a good world
than a good child in a bad world. The sociopath, having lost all hope, depicts a bad
child in a bad world where guilt and remorse are non-existent.
To complete our discussion of Cluster B, we will now turn our attention to the
Histrionic Personality Disorder. These individuals typically present as socially
motivated, dramatic, exhibitionistic, and yet, dependent persons. Compared to the
other disorders of this Cluster, the Histrionic is clearly higher functioning in terms of
ego structure, types of defenses used, emotional development, insight into themselves,
and apparent developmental level (Kernberg, 1975). While these patients can exhibit
the impulse conflicts, fears of abandonment, hyper-emotionality, and interpersonal
manipulations which would suggest a similarity with the above disorders, the
Histrionic demonstrates these symptoms from a more reality based and mature
perspective. For example, the Histrionic Personality may be impulsive in regard to
their behavior, but this impulsivity would be more in line with spontaneity rather than
the destructive or dangerous acting-out by the Borderline or Anti-Social Personalities.
The Histrionic fears abandonment and loss out of strong dependency needs but tends
to protect from these experiences by maintaining a backlog of friendships and
acquaintances. Once faced with a loss or abandonment they can recover by utilizing
more mature ego functions like reality testing or sublimating their dependency needs
into altruistic endeavors. As the long history of the term hysterical-histrionic suggests,
these persons are highly emotional and seem to be consumed by affect over intellect.
While once thought to be a female disorder related to a "wandering womb"
(Millon, 1981), their emotional lability coupled with cultural stereotyping still tends to
suggest patients with a distinct "feminine character" (Cameron, 1963). The emotional
quality of these patients is quite different from the other Cluster B conditions as well.
While the Narcissistic Personality is likely to experience intense envy with a
corresponding wish to destroy and spoil, the Histrionic tends toward jealousy and a
wish to win over or possess. The Borderline intrudes into the psychological
boundaries of others while the Histrionic seduces and entices the crossing of
boundaries. If the Borderline needs to be contained emotionally; the Narcissist
entertained; the Anti-Social restrained; the Histrionic needs to do the entertaining.
They require recognition and are active in the pursuit of being noticed. The Narcissist
would never be content with just being noticed, they must be admired!
Developmentally, Histrionic patients are fixated at the phallic level
17
of sexual development (Cameron, 1963). They have not resolved the oedipal conflict
and seem to be in a continual re-creation of oedipal triangles. The ability to foster
rivalries serves to reinforce the patient's need for external validation as a desired
"prize" to the victor and also protects the patient from the fear of the intimacy that
might evolve should they settle into a long-term dyad. In this case, the dyad often
takes on parent-child characteristics which represent repressed incestuous conflicts
necessitating an outside relationship or extra-marital affair to displace the sexual
drives. The ensuing triangle keeps all of the relationships manageably superficial.
Under stress, these patients are prone toward regressions which resemble the
lower-level character disorders of the borderline spectrum. While they also present a
predominantly "false" self as evidenced by their being easily influenced by fads and
trends (Millon, 1981) and their tendency to market themselves as if a commodity, they
are sufficiently developed structurally (Kernberg, 1967) as to be able to capitalize on
creative talents and skills indicative of a fair degree of "true" self development
(Winnicott, 1960). Their subsequent inability to retain the narcissistic supplies
achieved by their accomplishments suggests the insufficiency of the "true" self, hence
their dependency upon others for acceptance and approval.
Cluster C
The final cluster of personality disorders is distinguished by the manifestation of
anxiety and fearfulness in their symptom pictures. This cluster is comprised of the
Dependent, Avoidant, Passive-Aggressive, and Obsessive-Compulsive Personality
Disorders. While these conditions all express varying examples of anxiety and fear
they do not appear to have other pronounced mood or thought disturbances. These
characters are more typical of neurotic conditions and seem to best be accounted for in
terms of developmental fixations and ego defense configurations.
The Dependent Personality Disorder has been alternatively called the Passive-
Dependent (Cameron, 1963), the Compliant-Type (Horney, 1945), and the
Submissive Character (Millon, 1981). Utilizing Freud's psychosexual stages as a
referent for character fixations or regressions, Abraham (1924) presented the "Oral-
Character." These individuals presumably bring with them an expectation for
continued nurturing and gratification from the world. They remain helpless child-like
persons expecting to be rescued, protected, fed, and supported. Fenichel (1945) added
that these characters become fixated to the world of oral wishes and disinclined to
care for themselves. They can identify with persons by whom they
18
wish to be cared for and therefore act as generous indulgent parents. In doing so, they
act toward others as they wish others would act toward them. Their lack of self-
protectiveness borders on masochism and self sacrifice in an obstinate, and yet naive,
refusal to move from this passive-dependent position.
The Dependent Personality uses their weakness and inadequacy to circumvent
responsibilities and can also employ self-depreciation as a manipulation of others to
gain their attention and receive their absolution. This process has to be carefully
balanced to avoid guilt which would only reinforce the vicious cycle of guilt and
forgiveness. They tend to rationalize their dependency by attributing their
helplessness to circumstances, luck or some other external source of control. The
Dependent, like the idealizing Narcissist, will ally with powerful others to cover-up
their own inadequacy. The Narcissist attempts to "psychically steal" those attributes
through their supplication to the other, while the Dependent merely desires a life of
secure passivity in the shadows of the ideal one. The Dependent willingly submerges
their independence in return for acceptance and support, they do not desire a vicarious
self-aggrandizement through this association. Predictably, these persons also
submerge or repress all expressions of anger or aggressiveness as this could be lethal
to their dependency needs. The hostile impulses, feelings or thoughts are turned
against the self in an effort to protect the relationship at all costs. Their anxiety and
fear is largely of their own individuality emerging such that it would threaten an
orientation dedicated to compliance and submission.
The Avoidant Personality Disorder is also dependent upon others for
acceptance but is consumed by fears of criticism, embarrassment, humiliation, and
shame. They represent what Fenichel (1945) called a "phobic character" as they
reactively avoid situations they originally wished for. Out of the anxiety generated by
the "what if. .. " predictions of doom, these persons built a character dedicated to
allaying chronic insecurity and fear. Their defenses against the anticipated rejection
foster defenses against defenses and a spreading of anxiety to limitless proportions.
Since this is characteristic of the person's relationship to life, the over-reactions are
not noticeable subjectively. These are worrisome individuals who always find
insecurities and ambiguities to support their concerns. Avoidant Personalities are
actively detached (Millon, 1981) and actively dependent. They withdraw in fear but
with desire, unlike the Schizoid who is apathetic. Rather than responding to the
anxiety over dependency needs with passive compliance and a repression of
aggressive impulses, the Avoidant represses libidinal as well as aggressive impulses.
The motivation for the repression of the aggressive impulses would be similar to the
Dependent while the repression or suppression of libidinal impulses protects them
from the pain of desire. Diminished sexual needs and
19
expression avoids the potential for rejection and humiliation. A retreat into fantasy
can serve as an outlet for these impulses. Given a lack of real experience, the fantasies
tend to be both aggressive and sexual which, when coupled with a punitive superego,
can justify the need for self-exile. Avoidant Personalities help perpetuate their
loneliness and isolation largely from an identification with those who were
depreciating and rejecting. They maintain a relationship with their abusers by playing
both roles in their mind, that of the belittled and condemned child, as well as the
rejecting parent. They are not beaten down into apathy like the Schizoid nor angered
into battle like the Paranoid; the Avoidant, instead, tries to hide from the persecutor
who resides within them and from whom they also hope to gain acceptance.
The Passive-Aggressive Personality Disorder has been described both as an "oral
sadistic melancholiac" by Abraham (1924) and Menninger (1940) and as the
"masochistic character" by Reich (1933) and Homey (1939). The term "passive-
aggressive personality" was also credited to the U.S. Joint Armed Services nosology
of medical classifications (cited in Millon, 1981) to describe those persons with a
unique propensity for undermining morale and proving to be corrosive to authoritative
structure.
Abraham (1924) differentiated the oral stage into a receptive, passive, sucking
stage and an aggressive, destructive, biting stage. In the late oral stage, biting becomes
as aggressively determined process of incorporation where the object is destroyed in
the process of internalization (i.e., it is cannibalized). The ego develops an attitude of
ambivalence toward the object which is now experienced under the influence of the
aggressive instinct. The formerly all-gratifying object is now at times frustrating,
depleted, or injured. Menninger (1940) notes that sadism replaces passive dependency
and gives rise to a characterological type that is the direct opposite, namely
pessimistic, blaming, contemptuous and petulant. The person becomes over-
demanding and perpetually discontented. The Passive-Aggressive character represents
a back and forth movement from oral dependency to oral sadism that keeps the
emotional and interpersonal functioning at an infantile level.
Reich (1933) describes a passive form of aggression in persons who use
suffering and a tendency to complain to inflict pain upon and debase both themselves
and others who care for them. He proposed that a deep disappointment in love lies
behind their provocation of love objects. Their "infantile spite reaction" is an attempt
to get back at those who they feel rejected them by courting love through provocation
and defiance. Homey (1939) added that the masochistic type despises their own
dependency. Their inordinate need for
20
others leads to inevitable disappointment and regressive retaliation. Given strong
inhibitions about the destructiveness of their aggressive fantasies and the guilt they
evoke, the individual regresses to a passive-dependent position where a pseudo-
aggression such as forgetfulness, procrastination, or self-demeaning behaviors can
emerge in a disguised form of unintentional hostility. The fear and anxiety over
dependency leaves these patients to view almost everyone as a potential tyrant to be
mistrusted and disobeyed.
The final character type to be discussed is the Obsessive-Compulsive Personality
Disorder. These are persons who are caught in a powerful ambivalence over
conformity and rebellion. They utilize thoughts and actions to bind the anxiety
generated by conflicting impulses under the scrutiny of a powerfully repressive
superego. Freud (1908) specified three distinct traits of the "anal character" that
provide a clear description of the Obsessive-Compulsive Personality: orderly,
parsimonious, and obstinate. The orderliness comprises bodily cleanliness, reliability,
and conscientiousness. Parsimony can be exaggerated to the point of avarice, and
obstinacy may amount to outright defiance. He clearly identified an array of
ambivalent characteristics that were subsequently elaborated upon by Abraham (1921)
to include exaggerated criticism of others, avoidance of initiative, and a preoccupation
with the control over money and time (there is never enough of either).
While the above addresses mostly the obsessive or thinking components of the
character, Reich (1933) discussed the compulsive or behavioral characteristics. These
include a pedantic sense of order typified by cataloging, indexing and organizing and
an unswerving adherence to pattern and routine. Rado (1959) described how these
persons are most critically affected by the experience of toilet training during the anal
phase of development. The mother and child engage in a "battle of the chamber pot"
wherein the child is enraged by mother's interference with the bowel clock and
responds with a defiant resistance and a fearful obedience to her punishments. The
disobedient child is made to feel guilty, undergo deserved punishment and ask for
forgiveness. The guilt comes to repress the defiant rage, and obedience overcomes
defiance. We see, here, the precursors to reaction-formation in the form of a pride in
obedience that hides the desire for rebellion, and the beginning of undoing patterns
that expiate sins with ritualized acts to "undo" evils and wrongs.
These persons become extraordinarily consistent to the point of being rigid and
unyielding. They have learned to repress all urges toward autonomy or individuality
that might challenge real or imagined authority. Secretly, they wish to subvert
authority, but instead, use these wishes to further strengthen a restrictive
21
superego structure. They vigorously defend rules and convention lest they expose
some excuse for disobedience. Since emotions are expressions of subjective truth they
may betray the cognitive conforming pattern. Thus, emotions are mistrusted and to be
defended against. Defenses such as rationalization, intellectualization, and isolation all
serve the organizing and controlling need to conform emotions to some pre-set social
standard .. These are classic bureaucrats who adhere to "the book" for protocol and
propriety. When faced with unanticipated events these persons can become paralyzed
or search frantically for the "correct" course of action. They are likely to spend an
hour looking for a lost shopping list that would take 10 minutes to re-create. While the
Obsessive-Compulsive Personality is also a procrastinator like the Passive-
Aggressive, the former is constricted by anxiety over deciding on an action while the
latter is withholding the action in order to control.
The Obsessive-Compulsive is also credited with higher functioning sublimatory
channels (Kernberg, 1967) allowing them socially acceptable channels for
aggressivity such as police work or surgery, and outlets for conformity such as for
judges and administrators. To the extreme, these tendencies can be debilitating and
restricting leaving the patient frustrated and bitter. Such conditions can lead to persons
who are fiercely moralistic or over controlling of themselves or others. It may be
interesting to contrast this character with the Histrionic who is almost the direct
opposite in many ways. The Histrionic is so emotional they can hardly think, while
the Obsessive-Compulsive is so into thinking they avoid feeling. The Histrionic is
spontaneous while the Obsessive-Compulsive rarely varies their routine. The
Histrionic is hyper-sexual while the Obsessive-Compulsive is sexually constrained
and conservative. The Histrionic sees a world of impressions and sensations while the
Obsessive-Compulsive sees a world that is precise and geometrically balanced. In
short, they are a marriage made in heaven. Each can provide a vicarious expression of
the other's repressed wishes.
Conclusion
This brings to an end this review of the psychoanalytic theory of personality.
While I have tried to be somewhat comprehensive of a broad base of available
literature, a great deal of material had to be omitted with respect to time and
practicality. Should you wish to pursue this subject more fully, I would direct you to
the reference section and other IAPS courses on psychoanalytic theory and technique.
22
References
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Abraham, K. (1925). Character formation on the genital level of the libido. In Selected
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Federn, P. (1947). Principles of psychotherapy in latent schizophrenia. American
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25
Appendix
CLASSIC PSYCHO-SEXUAL DEVELOPMENT
Borderline
ORALDEPENDENCY Narcissistic
Paranoid/Schizoid
ANAL CONTROL Obsessive-Compulsive
URETHRAL COMPETITION Anti-Social
Grandiose Narcissist
PHALLICPOWER
Hysterical
GENITAL MATURITY
KERNBERG : BORDERLINE PERSONALITY ORGANIZATION
STRUCTUAL DIFFERENTIATION : SUPEREGO DEVELOPMENT
Social Conformity
Creative Potential
FENICHEL : CHARACTER TYPES
SUBLIMATION REACTIVE
PHOBIC REACTION-FORMATION
AVOIDANT OBSESSIVE-COMPULISIVE
KOHUT : DEVELOPMENT OF SELF
POLES OF SELF
GRANDIOSE IDEALIZED PARENTAL IMAGE
MERGER TWINSHIP ALTER-EGO IDEALIZATION
27
MASTERSON : DEVELOPMENTAL OBJECT RELATIONS
RORU WORU
Rewarding Object -Relations Unit Withdrawing Object -Relations Unit
Reinforced for Clinging (Narcissistic) Abandoned for Independence (Borderline)
Pre-Ambivalent Ambitendant/Ambivalent
BOLLAS : GHOSTLINE PERSONALITY
28
External
Object
Internal
World
Alternative
World
GHOSTLINE
Transitional
Space