PSYCHOANALYTIC THEORIES OF PERSONALITY

Instructor: Michael J. Gerson, PhD

Copyright 1993, 1994 by the Institute of Advanced Psychological Studies. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher.

Introduction

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 DSMIV (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.

What Constitutes Personality Formation?

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 illequipped 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 form of 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 Constitutes a Personality or 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 overadapted 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 reactionformation 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.

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), obsessivecompulsive 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 prepsychotic 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 hypervigilant 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.

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-theordinary 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 selfobject 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 how and 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.
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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 partobjects 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 PassiveDependent (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 "OralCharacter." 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 selfprotectiveness 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 "passiveaggressive 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 overdemanding 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 pseudoaggression 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 PassiveAggressive, 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.

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References
Abraham, K. (1921). Contributions to the theory of the anal character. In Selected Papers on Psychoanalysis. London: Hogarth. Abraham, K. (1924). The influence of oral eroticism on character formation. In Selected Papers on Psychoanalysis. London: Hogarth. Abraham, K. (1925). Character formation on the genital level of the libido. In Selected Papers on Psychoanalysis. London: Hogarth. American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders (DSM-I) (1st ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (DSM-II) (2nd ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (DSM-III) (3rd ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (DSM-III-R) (3rd ed. revised). Washington, DC: American Psychiatric Association. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association. Bollas, C. (1989). Forces of Destiny. London: Free Association Books. Cameron, N. (1963). Personality Development and Psychopathology: A Dynamic Approach. Boston: Houghton, Mifflin Co. Cleckley, H. (1941). The Mask of Sanity. St. Louis: Mosby. Cleckley, H. (1959). Psychopathic states. In S. Arieti (Ed.), American Handbook of Psychiatry. New York: Basic Books.

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Federn, P. (1947). Principles of psychotherapy in latent schizophrenia. American Journal of Psychotherapy, 1, 129-139. Fenichel, O. (1945). The Psychoanalytic Theory of Neurosis. New York: Norton. Freud, S. (1908) Character and anal eroticism. In Collected Papers. London: Hogarth. Freud, S. (1911). Psychoanalytic notes upon an autobiographical account of a case of paranoia. In Collected Papers. London: Hogarth. Freud, S. (1914). On narcissism: an introduction. In Collected Papers. London: Hogarth. Freud, S. (1915). Some character types met with in psycho-analytic work. In Collected Papers. London: Hogarth. Freud, S. (1925). Libidinal types. In Collected Papers. London: Hogarth. Horney, K. (1939). New Ways in Psychoanalysis. New York: Norton. Kernberg, O. (1967). Borderline personality organization. Journal of American Psychoanalytic Association, 15, 641-685. Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism. New York: Jason Aronson. Kernberg, O. (1980). Internal World and External Reality. New York: Jason Aronson. Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press. Kohut, H. (1977) The Restoration of the Self. New York: International Universities Press. Masterson, J. (1981). The Narcissistic and Borderline Disorders: An Integrated Approach. New York: Brunner/Mazel.

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Menninger, K. (1940). Character disorders. In J.F. Brown (Ed.), The Psychodynamics of Abnormal Behavior, pp. 384-403. New York: McGraw-Hill. Millon, T. (1981). Disorders of Personality. New York: John Wiley and Sons. Rado, S. (1959). Obsessive behavior. In S. Arieti (Ed.), American Handbook of Psychiatry, Vol. 1. New York: Basic Books. Reich, W. (1933). Charakteranalyse. Leipsig: Sexpol Verlag. Reich, W. (1949). Character Analysis (3rd Ed.). New York: Farrar, Straus, and Giroux. Schmideberg, M. (1947). The treatment of psychopaths and borderline patients. American Journal of Psychotherapy, 1, 45-55. Winnicott, D.W. (1956). The antisocial tendency. In Through Pediatrics to PsychoAnalysis. New York: Basic Books. Winnicott, D.W. (1960). Ego distortion in terms of the true and false self. In The Maturation Processes and the Facilitating Environment. London: Hogarth.

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Appendix
CLASSIC PSYCHO-SEXUAL DEVELOPMENT Borderline ORAL DEPENDENCY Narcissistic Paranoid/Schizoid ANAL CONTROL Obsessive-Compulsive Anti-Social

URETHRAL COMPETITION

Grandiose Narcissist PHALLIC POWER Hysterical GENITAL MATURITY

KERNBERG : BORDERLINE PERSONALITY ORGANIZATION STRUCTUAL DIFFERENTIATION : SUPEREGO DEVELOPMENT Infantile Narcissistic Histrionic
(Borderline)

WINNICOTT : TRUE/FALSE SELF

False Self

Social Conformity

True Self

Creative Potential

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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

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MASTERSON : DEVELOPMENTAL OBJECT RELATIONS RORU Rewarding Object -Relations Unit Reinforced for Clinging (Narcissistic) Pre-Ambivalent WORU Withdrawing Object -Relations Unit Abandoned for Independence (Borderline) Ambitendant/Ambivalent

BOLLAS : GHOSTLINE PERSONALITY

GHOSTLINE

Internal World External Object Transitional Space Alternative World

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