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Disturbed identity is one of the defining characteristics of borderline personality disorder (Jrgensen, 2006a,b). In line with Plutchik (1980), who
described the development of a coherent sense of identity as one of four
universal tasks in personality development, Livesley has suggested that
personality disorder in general should be defined as the failure to achieve
adaptive solutions to essential life tasks, and that this involves three main
areas: (1) interpersonal dysfunction, (2) failure to function in social
groups, and (3) failure to establish stable and integrated representations
of self and others (Livesley, 2003, p.19). Hurt, Clarkin, Munroe-Blum,
and Marziali (1992, p. 201f) have described three clusters or core problems presented by individuals with BPD: problems relating to identity, affect, and impulse. Whereas the affect and impulse clusters refer to overt
behaviors that are easily observed and measured, the identity cluster involves inner states that are quite dependent upon the reporting of the subject and therefore less accessible to observation and careful measurement. But, as Hurt et al. (1992, p. 213f) argue, this does not mean that
they are less important. Similarly, Linehan has reorganized the diagnostic
From University of Aarhus, Denmark and Psychiatric Hospital, Central Jutland Region, Denmark.
Address correspondence to Prof. Carsten Rene Jrgensen, PhD, Department of Psychology,
University of Aarhus, Nobelparken, Jens Chr.Skous Vej 4, DK-8000 Aarhus C, Denmark; Email: carsten@psy.au.dk
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criteria for BPD into five domains: emotional, behavioral, cognitive, and
interpersonal dysregulation, and dysregulation of the sense of self, including not knowing who one is, having no sense of self, and feeling empty
(Linehan, 1993, p. 11ff; Linehan & Dexter-Mazza, 2008, p. 366).
Most of the existing models of BPD point in one way or another to some
form of identity disturbance or identity diffusion as an essential characteristic of BDP, or, more specifically, to a total or partial failure to integrate
essential elements of identity. In Kernbergs concept of borderline personality organization, failure to integrate positive and negative representations of the self and others, or deficits in the integration of ego-identity,
are presented as one of three defining elements of BPO and, in effect, BPD,
the other two being the use of immature defenses and compromised reality
testing under stress (Kernberg, 1984). In some cases the use of immature
defenses (dissociation, projective identification, etc.) can be understood as
maladaptive attempts to establish a more coherent and stable identity (by
evacuating nonintegrated identity elements), and immature defenses often
affect the patients identity. Self-psychology (Kohut, 1971, 1977) assumes
that all forms of personality pathology are related to deficits in the development of personality structures involving the failure to establish a coherent
sense of self or identity. In Bateman and Fonagys mentalization model
(Bateman & Fonagy, 2004, 2006) BPD is related to deficits in mentalization, or the ability to understand oneself and others, and to the establishment of a false or alien self inside the self, creating a constant need
to evacuate or expel this alien self in an effort to establish and stabilize a
more coherent sense of self. Ryles (1997) multiple states model of BPD
argues that abrupt switches between mutually dissociated self-states is
part of the core of borderline pathology, leading to deep-seated confusion
in both the patient and others. This confusion in the BPD patient is intimately related to identity diffusion. Similarly, Young, Klosko, and Weishaar (2003) have related BPD to continuous switches between different
maladaptive cognitive schemas or schema modes in response to life events
and subjective experiences, switches leading to confusion in the BPD patients self-concept and to incoherent behavior.
Emotional dysregulation and identity disturbance are intimately related
in Linehans cognitive-behavioral model. Emotional lability, unpredictable
behavior, cognitive inconsistency, and failures in identity development, or
the inability to establish a stable sense of identity, are understood as connected problem areas in BPD (Linehan, 1993, p. 61). Emotional lability
and unpredictable emotional reactions [lead] to unpredictable behaviour
and cognitive inconsistency and a stable self-concept, or sense of identity, fails to develop (Linehan, 1993, p. 61).
According to the DSM system, identity disturbance is manifested in a
markedly and persistently unstable self-image or sense of self, sudden
and dramatic shifts in self-image, characterized by shifting goals, values,
and vocational aspirations, and possibly sudden changes in opinions
and plans about career, sexual identity, and types of friends (DSM-IV-TR,
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p. 707). As I have argued elsewhere (Jrgensen, 2006b), basing my analysis on empirical studies of the predictive power of each of the nine diagnostic criteria, identity disturbance and unstable relationships are at the core
of borderline pathology and should be imperative in diagnosing BPD.
In the Risskov-I-study, an ongoing study that compares the outcome of
mentalization-based and supportive treatment for SCID-II-diagnosed BPD
patients in a randomized design (Jrgensen et al., 2009a,b), 86% of the
patients with borderline personality disorder (88 of 102 patients) met the
BPD diagnostic criteria for identity disturbance at intake. The only diagnostic criterion for BPD with a higher incidence in the participating group
of BPD patients was affective instability, met by 95% of the patients.
IDENTITY DEFINED
Contemporary psychology and sociology offer a broad range of perspectives onand conceptualizations ofhuman identity. Thus, identity has
been variously understood as: (1) a subjective sense of identity (Who I am;
Erikson, 1968); (2) an inner psychic structure seen as an essential part of
the mature personality, related to what Erikson (1959, p. 102) has termed
an unconscious striving for continuity of personal character developed
through the silent doings of ego-synthesis; (3) an inner core (individuality) that the individual must engage in an ongoing struggle to realize (Waterman, 1984), and which has been related to separation and individuation processes (Mahler, Pne, & Bergman, 1975; Blos, 1979); (4) a social
construction, determined by social discourse and elements of (possible)
identities that circulate in contemporary culture (Gergen, 1991); (5) an inner connection and identification with the values, ideas, and (self-) images
of a social group (Erikson, 1968); (6) a performance or dramaturgic effect
(Goffman, 1959); (7) a set of individual traits, talents, and abilities; (8) a
personal construction related to cognitive schemas and information processing strategies (Berzonsky, 1989); (9) an existential project rooted in
the free choices of the individual (Bilsker, 1992); and, finally, (10) a personal self-narrative or narrative construction (McAdams, 1996, 2008).
From a psychodynamic perspective (Kernberg & Caligor, 2005) human
identity is primarily an inner psychic structure manifested in conscious
representations of the self, others, and the world in general, and in identification with social groups, cultural norms, ideals, and values. One could
argue that Kernbergs concept of ego-identity is not able to capture all aspects of human identity but conceptualizes the inner structural foundation of identity, and that an integrated ego-identity is an inner structural
precondition for the realization of the many aspects of identity conceptualized by others.
Phenomenologically, identity is manifested in my more or less conscious, more or less elaborated, and more or less realistic subjective experience of who I am, my basic needs, how I differ from real (specific) or
imagined/fantasized others, and how my past, present, and future consti-
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347
tute a more or less meaningful whole. Normally we are only partially able
to verbalize and report our identity. Substantial parts of our identity exist
outside our immediate consciousness and are lived rather than chosen;
they are manifested in our interpretations of the world, the choices we
make, and our behavior.
Preliminarily, one can define human identity as a sense of the self as a
relatively delimited, coherent, and stable center of behavior or autonomous acts (i.e., acts that are volitional and self-regulated, as opposed to
forced, alien, or disowned); and as a delimited person, subject or individual with specific, distinct, and stable traits, boundaries, needs, and characteristics, and a unique life-story (self-narrative)an individual who belongs to, and identifies with, one or more social groups and their norms,
values, ideals, and worldview, and differs from others in more or less specific ways. More specifically, human identity in its normally developed
form involves (1) a sense of personal sameness, coherence, and continuity
over time and across different contexts; (2) a sense of personal agency and
experience of the self as a coherent unit that thinks its own thoughts and
feels its own feelings; (3) identification with a social group and a stable set
of norms, values, and ideals; (4) emotional commitment to long-term goals,
relationships, and certain successfully integrated self-representations and
social roles which are seen as self-defining; (5) subjective confidence and
certainty concerning ones own gender and differentiation from others (individuation); and (6) identification with a worldview that gives life meaning
and is recognized by others. Many or all of these aspects of identity are
more or less disturbed in BPD patients.
LEVELS OF IDENTITY
One can distinguish at least four levels of identity: (1) ego identity, which
is related to basic personality structure, continuity, and the integration of
personal character, and to stable and firmly integrated images of the self
and others; (2) personal identity, rooted in the personal goals, values, beliefs, unique personal traits, and preferences that the individual shows
to the world; (3) social identity, which springs from the individuals inner
solidarity with specific social groups and elements of identity, and results
from personal choices, constructions, and impression management and
from the enactment of social roles; and finally, (4), collective or large-group
identity, grounded in the individuals membership of larger social groups,
internalization of cultural norms, ideals, and values, and personal commitment to religious beliefs, an ethnic group, a nation, or a specific community. The attainment of a mature identity, thus, involves not just development of individuality (personal identity) but also relatedness and
integration of individuality with an identification with common goals, values, and standard (collective identity; Blatt, 2008, p. 110). The four levels
of identity are intimately related and dysfunctions on one level can give
rise to problems on one or more of the other three levels. In particular,
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349
identities and ways of life) and (2) commitment (the possession of a firm
and stable set of convictions, values, and goals that are either self-initiated
or adapted from others), Marcia (1966) has described four widely used categories of identity or identity statuses: (a) achieved identity, characterized
by a high level of commitment after a period of exploration; (b) identity
moratorium, where the individual lacks deep and stable commitments but
is currently engaged in the process of exploring and attempting to make
commitments; (c) foreclosed identity, seen in individuals who have made
premature commitments to a pre-given set of values, goals, and ideals
without any foregoing exploration, and who have uncritically adopted the
standards, rules, choices, and beliefs of significant others (typically parents) without questioning, modifying, or exploring alternatives; and finally
(d) diffused identity, in which both exploration and commitment are lacking and the individual is more or less unable to engage in adaptive exploration.
Although identity status was originally (and sometimes still is) referred
to as ego identity status and taken to index ego identity, the model primarily maps onto Eriksons concept of personal identity (Schwartz & Pantin,
2006, p. 51). One could argue that the content domains on the basis of
which identity status is measured; e.g., religious beliefs, occupational
choices, gender roles, and political preferences, are indicative of a persons
goals, values, and beliefs, which are core elements of personal identity
rather than ego-identity. As Schwartz argues (2001, p. 24), it is also questionable whether the identity status approach is valid for use with adult
populations. The identity style model developed by Berzonsky has been
demonstrated to be effective with adults (p. 24) and has been able to show
significant differences between BPD patients and normal controls (Jrgensen, 2009).
Berzonsky (1989) views identity as a kind of self-theory; i.e., as the individuals self-constructed theory of him- or herself. On the basis of this
theoretical analysis he distinguishes between three different identity styles
or identity processing orientations: (1) information-oriented, (2) normative,
and (3) diffuse-avoidant . Berzonskys hypothesis is that identity style determines how the individual processes self-relevant information, solves
problems, and more or less continuously constructs or reconstructs his or
her sense of identity (on the basis of new information, new experiences,
etc.). People with an information-oriented style actively seek out, process,
and evaluate information (Berzonsky, 1989, p. 269) before making identity-related decisions. Individuals who rely on a normative style are primarily concerned with conforming to normative standards and prescriptions from significant others, whereas the diffuse-avoidant style involves
the tendency to delay and procrastinate until situational consequences
and rewards dictate a course of action (p. 269). Berzonskys identity style
categories reflect important manifestations of ego-identity, focusing on underlying processes rather than on more static structures or outcomes of
identity development. Compared with the idea of identity status, the con-
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351
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and coherent identity is developed and sustained only in so far as we continuously experience self-verifying feedback from significant others. Severe
deficits in the ability to mentalize and make sense of the behavior of others, which have been related to BPD (Bateman & Fonagy, 2004), make it
difficult to see oneself from the point of view of others, contributing to
difficulties in developing a stable and coherent identity.
Implicit mentalization of ones own actions is an emotional state characterized by a sense of oneself as an autonomous agent. In general, awareness of our behaviour as driven by mental states gives us the sense of
continuity and control that generates the subjective experience of agency
or I-ness which is at the very core of a sense of identity (Bateman &
Fonagy, 2006, p. 4). Most of us to some degree fail to integrate certain
parts of the self. It seems that states of mind that are not felt to fit coherently into a self-structure are nevertheless integrated into it by the capacity for mentalization. We smooth the discontinuities by creating an intentional narrative (Bateman & Fonagy, 2006, p. 15).
On the other hand a prementalistic mode of functioning, such as one
often seen in BPD patients, particularly when under stress, has the power
to disorganize relationships and destroy the coherence of self-experience
that the narrative provided by normal mentalization generates (Bateman
& Fonagy, 2008, p. 183). The loss or insufficient development of the capacity to mentalize will destabilize the self, provoke a deeply felt sense of uncertainty (p. 184) and lead to confusion regarding essential questions
relating to identity, such as Who am I?. Discontinuity in a persons selfstructure (a sense of having wishes, beliefs, feelings, etc., which do not feel
like ones own) leads to a sense of discontinuity in identity (Bateman &
Fonagy, 2006, p. 16), and discontinuity/incoherence in behavior, including interpersonal behavior. Unstable and unpredictable behavior will often
evoke unpredictable, alienating/distancing and shifting reactions from
FIGURE 1. Interrelationship between disturbed identity and disturbed interpersonal relations in BPD patients.
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353
others, leading to unstable and more or less incomprehensible interpersonal feedback and further destabilization of identity. A self-perpetuating
process is thus established with aggravating identity dysfunction and maladaptive interpersonal relationships. The ability to negotiate ones identity
(Swann & Bosson 2008)a precondition for having it recognized and
nourished by othersis compromised.
In BPD patients the experience of the self as agent is often disrupted by
impulsive behavior arising from a more general impulsivity that may be
temperamental or may be a consequence of early trauma, insufficiently
developed mentalization, biologically-determined emotional dysregulation,
or other factors. Impulses are acted upon with such a sense of immediacy
that the self is not experienced as the agent of the act (Bradley & Westen,
2005, p. 937) and interpersonal relationships are compromised. Especially
when the attachment system is activated, the patients reactions are often
so irrational and unpredictable, dictated by intense emotions and impulses, that she feels unable to make sense of, understand or explain her
own behavior: an experience that contributes to the incoherent self and
identity diffusion characteristic of BPD patients.
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identity) is resolved she has no stable preferences as to which of her desires should be her will and become a stable guide of her behavior (Frankfurt, 1988, p. 21). Her behavior will be incoherent, changing over time and
across different contexts. In line with Frankfurts account (p. 84), one
could argue that the BPD patient who is moved by immediate impulses is
not in any proper sense guiding or directing herself at all.
According to Frankfurt (1999, p. 100), ambivalence is a disease of the
will, whereas the health of the will is to be unified, making the person
wholehearted in her behavior and being in the world. The motives of the
wholehearted person are in concert or integrated, rather than in conflict
with one another, so that the individual is not divided against herself. That
a person is ambivalent, in Frankfurts sense, means that he is indecisive
concerning whether to be for or against a certain psychic position (Frankfurt, 1999, p. 99). This disunity in the ambivalent BPD patients will prevents her from effectively pursuing and satisfactorily attaining her goals.
She will be caught in a volitional conflict or deficit that ultimately leads to
self-defeat. The BPD patients identity diffusion means that she is unable
to be and act wholeheartedly in Frankfurts sense, and that she is in danger of being divided against herself in ways that undermine the autonomous, coherent behavior that is necessary if one is to realize long-term
goals.
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troversy is related to the classical discussion of conflict and deficit pathology (Killingmo, 1989) and of how to understand the clinical phenomenon
variously conceptualized as splitting (initiated by the conflicted ego) or dissociation (the weak ego being overwhelmed by shifting states of mind, etc.).
Bromberg (1998, p. 200f) has suggested that personality disorders in
general represent the characterological outcome of ego-syntonic dissociation. In BPD the sense of identity as coherent and continuous across time
and space is interrupted by dissociative experiences (Bradley & Westen,
2005, p. 937). Dissociation interferes with the ability to process and integrate emotions, sensations, and information and can, over time, lead to a
severe lack of coherence and continuity in the sense of identity. Traumatized individuals who are unable to integrate the trauma they have experienced into their self-concept or develop a self-narrative that includes these
traumatic experiences, as is often the case with BPD patients, will develop
self-narratives marked by gaps in the history of the self, and the person
will be left with a fragmented and discontinuous sense of identity.
Ryle (1997) has conceptualized BPD as rooted in rapid and uncontrollable shifts between mutually dissociated self-states. The patients difficulties in understanding and moderating or controlling the processes involved in shifting between different states of mind is related to some form
of dissociation between these states. BPD is thus understood in terms of
damage that affects three levels of development (Ryle, 1997, p. 34f): (1)
Restriction or distortion of the patients role repertoire, leading to an identity based on restricting and distorted elements; (2) incomplete development or disruption of higher order or meta-procedures responsible for
mobilizing, linking, and coordinating different elements of the role repertoireor second order integration of the elements of identity (related to
the integration of ego-identity, as conceptualized by Kernberg, 1984); and
(3) incomplete development or disruption of self-reflection resulting in deficits in the capacity for self-reflectionor the ability to mentalize, as conceptualized by Bateman and Fonagy, 2004. As Ryle (1997) has emphasized
(p. 41) level 2 damage is probably the most characteristic of patients diagnosed as borderline. According to Ryle, identity disturbance should be
seen as the manifestation of switching between different self-states and
the alternating dominance of a relatively small number of roles and selfstates (Ryle, 1997, p. 39) where each self-state is characterized by specific
emotions, conceptions of the self and others, behavior patterns, levels of
self-esteem, and strategies to protect and comfort the self. The rigid separation/lack of integration of different self-states is thus understood as a
manifestation of partial dissociation from different parts of the self.
As the person moves between different, mutually dissociated, self-states,
the roles of both the self and others are altered (Ryle, 1997, p. 37). Rapid
and abrupt switches between self-states, such as are often seen in BPD
patients, can have substantial implications for the persons interpersonal
functioning (and identity, see Figure 1). As Ryle argues, disturbed relationships and traumatic experiences compromise the BPD patients ability to
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DYSFUNCTIONAL NARRATIVES
Narrative conceptualizations of psychopathology focus on incoherence,
disintegration, instability, and other forms of incompleteness in the patients life story and sense of self. The human self is understood as a
narrative construction, an ordering of inchoate experiences into a durable
sense of identity (Niemeyer, 2000, p. 208) and the adaptive narrative establishes a continuity of meaning in the lived experience and a stable un-
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359
derstanding of self, others, and the world in general. As one of the founding fathers of narrative psychology, Jerome Bruner (2002, p. 86), has
argued, if we lacked the capacity to make stories about ourselves, there
would be no such thing as selfhood. In a sense it is exactly this capacity
to make coherent and stable narratives that is lacking or at least severely
deficient in patients with BPD.
Dimaggio and his colleagues in Italy have developed a narrative and constructivist, cognitive model of personality disorder (Dimaggio & Semerari,
2007). They hypothesize that PD involves dysfunctions in the structure of
the stories told about the self, the stories that manifests identity (Salvatore, Dimaggio, & Semerari, 2004, p. 233). The narrative is seen as a form
of reasoning that combines significant quantities of information and puts
it into structures (stories) that a person can quickly draw on to solve identity problems (Semerari et al., 2007, p. 111). From a psychodynamic perspective, deep-seated confusion regarding ones own identityrooted in
insufficient integration of the structural ego-identitymay be manifested
in what Dimaggio and Semerari (2001) have described as the overproduction of narratives. The patient is caught up by an infinite number of things
and sees everything from an uncontrollable multitude of perspectives, resulting in incoherence and a sense of meaninglessness.
Semerari et al. (2007, p. 111) hypothesize the existence of an integration
function, giving a subjective feeling of consistency and guaranteeing consistency in self-narrative and behavior. It is a function by which individuals are able to arrive at super-ordinate points of view about themselves,
hierarchies ranking multiple goals by importance, and the continuity of
action necessary for adaptation. Integration is defined as the ability to
reflect on states and mental contents with a view to giving them an order
or ranking them by importance (p. 112), and is thus related to Frankfurts
(1988) concept of second order volitions. Descriptively, this integration
function is intimately related to what follows from a well-integrated egoidentity, as conceptualized by Kernberg. Semerari et al. (2003, p. 243) distinguish between two types of integration deficit: one form involving incoherent mental states containing contradictory representations of the self
or a multitude of emotionally significant thoughts that follow one another
in an apparently random and chaotic manner with no order or hierarchy;
and another form primarily characterized by an inability to understand
changes in ones own mental states over time and to describe these in a
coherent narrative form.
Findings by Semerari et al. (2005) suggest that the main dysfunction in
PD-patients capacity to mentalize is not primarily related to difficulty in
identifying, monitoring, and labelling emotions, as Bateman and Fonagy
(2004) suggest, but to difficulty in integrating, reflecting on, and ordering
different mental states. Both forms of difficulty in the integrative function
are intimately related to identity dysfunction and one might argue that the
findings of Semerari et al. support the idea that identity diffusion is an
essential element in BDP.
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361
Strong commitments and a stable identity help to structure our deliberations. These are matters of necessity and help us overcome painful ambivalences and doubt.
One might argue that elements of our late-modern Western culture contribute to an increased risk of developing the kinds of identity disturbances seen in BPD patients (and others). At the same time, it is more
difficult than ever for people with severe identity disturbancesincluding
BPD patientsto navigate and find ways to behave in socially adaptive
ways in a culture characterized by weakened social structures and extensive individual freedom (Jrgensen 2006b, 2008).
As Frankfurt (1999, p. 102) has argued, unless a person is capable of
a considerable degree of volitional unity, he cannot make coherent use of
freedom. This volitional unity is often severely compromised in individuals with BPD. What good is it for someone to be free to make significant
choices if he does not know what he wants?. This summarizes some of
the consequences of severe identity disturbance for BPD patients living in
late modern societies.
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