PSYCHOANALYTICTHEORIES 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 ofpersonality. In an effort to synthesize nearly 100 years of theoretical formulations,there are some inevitable conflicts, contradictions and confusions that arise relative toterminology. Freud, for example wrote about "character types" while today, the DSM-IV (see American Psychiatric Association, 1952, 1968, 1980, 1987, 1994) refers to"personality disorders;" Kohut reconstructed some of the psychoanalyticmetapsychology into a study of "self' and "disorders of self," while Kernbergelaborated upon "borderline personality organization." While each of the above termsdemarcates justifiably different territories, it is imperative that we also recognize anecessary unity among these terms as a goal toward an improved understanding of thehuman experience. The fact that so many different terms become justified to illustratedifferent areas of interest only attests to the complexity of the mind, emotions andbehavior. F or the purposes of this course I will utilize the terms "character" and"personality" somewhat interchangeably only making differentiations where necessaryand significant. Other terms such as "ego," "self," and "identity" have well-establisheddifferentiations in the literature that require careful consideration regarding underlyingtheoretical models. Also, in an effort to make this course comprehensive, a variety oftheoretical models or paradigms will be referred to with some occasional digressionsfor clarification purposes. It is our hope that this multi-modal approach will allow youto consider the information both critically and in a manner that can best be integratedinto your clinical experience.

Along the lines of the goal of clinical integration, the DSM-IV categories ofPersonality Disorders will also be incorporated into the discussion. While werecognize that the DSM-IV is an atheoretical compendium of nosological conditions,the rich psychoanalytic history on personality formation and pathology can offerinformative and challenging insights into an understanding of these conditions.

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What Constitutes Personality Formation?

Personality formation refers to the process whereby an individual becomes anindividual; that is, the process whereby one develops stable and enduring patterns ofthinking, feeling, and behaving. These patterns are, to a large degree, adaptations bothto the internal demands of instinctual drives and tensions as well as to the externaldemands for conformity and socialization. Character formation represents a resolutionto 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 psychoanalytictheories on personality formation are in many ways remarkably consistent with thesocial interactionist's position in contemporary child development theory, to the extentthat psychoanalytic models have anticipated a necessary integration of innatepredispositions with environmental factors. Their major points of departure are thatthe innate predispositions that psychoanalytic theories consider consist of instincts anddrives rather than temperament features. The earliest environmental factors ofpsychoanalytic theories are limited almost exclusively to the qualities of and theimaginative constructions of the parent-child interactions as experienced by the child,rather than a more broadly based inclusion of learning theory, sociological, andcultural factors.

With parents as the personification of external reality, the psychoanalytictheories examine the processes by which parents serve as models for ego, ego-ideal,and superego formations. The psychodynamics of introjection and identification serveas the fundamental processes for this aspect of character shaping in concert with thespecific events of psychosexual and psychosocial developmental stages. This meansthat when and how the parent-child conflicts arise, and when and how they areresolved, will determine whose attitudes the child imitates and incorporates; whetherfor example, the nurturing characteristics of the parents or their prohibitive attitudesbecome part of the child's legacy.

Constitutional factors may also play a part in the psychoanalytic theories aboutcharacter formation to the extent that some persons may be better able or more ill-equipped at managing the tensions caused by aggressive and sexual drives. Somepeople may be better able at identifying and adjusting to the needs of the child thanothers and be capable, in varying degrees, to tolerate the projections of the infant'sfantasies. This consideration leaves the door open for biological and genetictransmission theories about personality and is consistent with findings regardingtemperament.

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The phenomena of fixation and regression are particularly illuminating to ourunderstanding of personality development because they suggest the importance ofdifferent developmental stage experiences and their possibly intrusive impact upon thepersonality, or the resolution of these experiences by adjusting the personality intonormalizing them. That is to say, developmental crises can be dealt with dynamicallythrough repression and other defensive measures possibly leading to some form ofneurotic compromise formation that may emerge episodically in the form ofpsychoneurotic symptoms, or developmental crises can be resolved by adjusting ordistorting the character in a manner such that the crises are assimilated and integratedinto behavior that appears relatively normal. Thus, whether one is induced by periodicstresses or cues to regress to previous developmental events, or whether one carrieswith him or her the artifacts of these events in the form of fixations, the significanceof 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 amatter of flexibility. This distinction, based on degree of flexibility is largely thecriterion used in DSM-IV to differentiate personality traits from personalitydisorders.

What Constitutes a Personality or Character Disorder?

As I alluded to above, there is an important distinction between neuroticsymptoms and character traits. Freud noted in 1913 that the neurotic symptoms arisefrom a failure of repression, i.e., a return of the repressed that disrupts the normal andexpectable functioning of the individual. By contrast, classical theory suggests thatcharacter traits owe their existence to the success of repression and the defensivesystem that is able to achieve a pattern of relative stability through reaction formationand sublimation. In subsequent writings that elaborated on the processes of the egoand the id, Freud (1923) expanded upon the process of identification as a form ofadaptation. In the context of a lost object (or relationship) the process of identificationcan function such that an internalized representation is constructed and the conflict(loss/ mourning) can be minimized or resolved by a special form of internalizationcalled introjection. The introjection of the parental or societal attitudes in the form ofthe superego likewise allows for an enduring referential base of right and wrongagainst which a resolution of conflict or the restitution for misdeeds can be made. Theprocess of introjection accounts for the relatively enduring characteristics of thesuperego structure. Thus, identification, internalization and introjection arefundamental processes that establish the adaptive capacity of the ego system such thatconflict can be prophylactically avoided. The net result is a psychic system shaped tothe 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 ofpersonality styles that share the common features of being habitually inflexible inpatterns of thought, affect and behavior and who also experience their being inflexiblewithout any apparent subjective distress. Thus, other people experience the conflictsand 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 inthe context of an other and that these disorders are paradoxically inconspicuous totheir owners. As one might expect, the absence of subjective distress eliminates anymotivation for change and can severely diminish the prospects for a favorableprognosis in treatment. While persons may be unlikely to seek treatment directly for apersonality disorder, they are likely to seek treatment for an associated condition suchas marital dissatisfaction or job-related stress. Certainly, it is also possible for personssuch as these to seek treatment for an unrelated issue such as the death of a familymember and then face the impact of this stressor upon a given rigid, inflexible over-adapted personality organization. In either case a psychoanalytically oriented cliniciancan 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 thisreason an assessment of character style and / or character disorder is essential for acomplete 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 andoffered a basis for the classification of character traits. He noted that some character"attitudes" (i.e., stereotyped ego reactions) demonstrate a reciprocal relationshipbetween character traits and neurotic symptoms. That is, a character attitude is anattempt to "make the best of established neurotic conditions." These patients sacrificetheir developmental potential through the wasteful expenditure of energy in the formof definitive patterns of constant counter-cathexis. The resulting limited patterns ofdefense lead to a permanent deforming of the ego. For Fenichel, the character of anindividual is constituted by the ego's habitual modes of adjustment to and from theexternal world and toward the superego and id. The characteristic types-of-combiningthese modes with one another constitute character and what he termed "characterattitudes." These attitudes are changes that are brought about through the adaptationalre-shaping of the instinctual demands. Therefore, Fenichel was describing character asa sub-process of the ego that essentially stylizes the operation of the various egofunctions. Character sets the distinctive stamp upon how the ego system achieves itsvarious purposes. In the case of pathological character, the stamp is routinized andstereotypical - certainly not geared toward being generative and creative. Thecharacter 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 thedistinction between whether a character trait aims at discharging an instinctualimpulse or suppressing it. The former group he referred to as Sublimation Types andthe latter group Reactive Types. F or the most part he believed that the SublimationType was non-pathological since it succeeds in replacing an existing instinctualimpulse with an impulse that is compatible with the ego and one that is organized andinhibited 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 treatmentof character disorders as they represent the goal of transforming the reactive type intothe sublimation type and thereby achieving "successful repressions."

Reactive character types which are the subject of study for psychopathologyare further sub-divided into phobic attitudes and reaction formations. Phobic attitudesreflect attitudes of avoidance and an escape from the awareness of instinctualdemands. Reaction formation attitudes reflect attitudes of opposition in the hopes ofcamouflaging 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 combatpornography as an avoidance of his or her own lustful desires; while the reaction-formation type might pursue a career as a comedic actor to oppose feared emotions ofdepression and sadness. Both of these character types reveal a fundamental conflictbetween the instinctual drives and the ego system's ability to manage them. Characterserves a defensive function in protecting the integrity of the ego through its persistentreactive style.

By examining the function of character or personality traits vis-a-vis theinstinctual drives we are also essentially examining the relationship between characterand the emotions. Fenichel noted that the defensive function of character types is notonly directed against impulses but rather against the emotions related to the impulses.Narcissistic characters, for example, who seek out confirmation from others abouttheir power and prestige may do so to defend against the primitive dependency needsand associated feelings of helplessness and powerlessness. These same individualsmay sometimes tolerate some emotions because they can be justified as reasonableand rational thus utilizing rationalization as a defense which serves to support a senseof narcissistic omnipotence.

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Fenichel proposed an organization of character types that afforded a distinctionbetween the enduring, ego-syntonic features of the character disorder and theepisodic, ego-dystonic features of the psychoneuroses. His typology addressed thedifferent manifestations of character types relative to the management of instinctualdrives. A more contemporary attempt at organizing our understanding of characterdisorders has been put forth by Otto Kernberg (1967, 1976, 1980). While much ofKernberg's work examines the dynamics and characteristics of the borderlinepersonality organization, his scholarly critiques of theory have resulted in anunderstanding of personality disorders based upon the development of ego andsuperego structures and their related processes. Kernberg distinguishes betweenhigher-level character pathology and lower-level character pathology. Higher-levelpatients possess a well integrated superego structure that is relatively punitive andsevere. 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 beextensive, they utilize repression to resolve conflict and retain ego integrity. In short,the higher level character pathologies are quite similar to Fenichel's reactive types.Examples of these disorders would include the hysterical (histrionic), obsessive-compulsive and the depressive-masochistic (a depressive character capable ofexperiencing guilt about anger at a lost object and able to tolerate mourning, i.e. adysthymic disorder). The lower-level character pathologies exhibit severe structuraldeficits in the ego and superego and related developmental consequences. Thesepersons have minimal superego integration and a tendency toward the use of primitivedefenses such as splitting, projection, denial, projective-identification and idealization.The resulting internal world of these patients is unintegrated and split into dissociatedego states.

Dissociated ego states refer to an immature fixation of ego developmentresulting from the predominant use of the splitting defense. In this defense, mentalrepresentations of self and object developed through aggressive strivings are split offfrom the mental representations of self and object developed through libidinalstrivings. The net effect is an unintegrated set of bad and good representations thatretain primitive, crude and simplistic distinctions between self and object and betweenbad and good emotional experiences. The perception of reality is severely limited andthe tendency toward idealization and devaluation is predetermined. The developmentof emotions is likewise restrained by the bad-good dichotomy such that ambivalenceis 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, borderlineand anti-social personalities.

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What Kernberg is offering is a typology based around the development of egoand superego. Those disorders which exhibit primitive or infantile ego and superegodevelopment are at the lower end of the continuum, while those with more mature egoand superego development would be at the higher end. To proceed with thiscomparison we will need to identify the various structural features of the mind andtheir corresponding operations.

A structural analysis of the mind corresponds to an analysis of the mentalprocesses from the point of view of the id, ego, and superego structures. Thepredominant focus is upon the development and operation of the ego system withregard to the management of instinctual drive derivatives; the autonomous egofunctions such as language, intelligence, motility, perception and thought; primaryand secondary thinking processes; defensive operations; and the structural derivativesof object relationships. Another dimension of structural analysis addresses the relativestrength or weakness of the ego with regard to the capacity to tolerate frustration oranxiety this includes the control imposed over instinctual impulses and the channelsavailable for the sublimation of drives. Ego weakness which would predictablyrepresent the lower-level character disorders would evidence a lack of anxietytolerance such that the ego reacts to anxiety with regression or additional symptomformation. Impulse pressures likewise are discharged unpredictably and erratically bythe lower-level disorders while they can be specifically expressed in an ego-syntonicepisode by higher level disorders. Sublimatory channels reflect assessments ofpotential versus actual performance. The lower-level disorders being inhibited withregard to their potential performance are unable to utilize their creativity. Thus thisaspect of ego functioning is limited both in terms of the patient's capacity for creativeenjoyment 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 thestimulation of creative expression. The false-self represents the adaptation allymotivated compromises to reality and a protective process for the true-selfs integrity.

What Kernberg presents in his classification of personality disorders is a meansfor comparing the different types of characters relative to each other on the dimensionof structural integration. In doing so he postulates both quantitative and qualitativedistinctions 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 thepsychodynamics account for the appearance of the disorder). Kernberg's use of theterm "borderline personality organization" further allows for an examination of

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a spectrum of conditions along the continuum of structural development from pre-psychotic to neurotic levels of functioning.

We will now explore some of the personalities of the DSM-IV as a referentialbase of character types and discuss them in term of descriptive, structural, defensive,and object-relational conditions. As you are probably aware, the DSM-IV isatheoretical and descriptive such that it divides the personality disorders into threeclusters (A, B, C) based upon manifest symptoms. Cluster A represents thosedisorders 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 isconstituted by the Dependent, Avoidant, and Obsessive-Compulsive. The DSM-III-Rincluded the Passive Aggressive Personality Disorder in Cluster C as well; thedisorder would be diagnosed as "NOS" using the DSM-IV.

Cluster A

The Paranoid Personality Disorder describes individuals characterized bysuspiciousness, mistrust, irritability, and emotional coldness. They appear hyper-vigilant to anticipated dangers and are likely to put others on the defensive by beingaccusatory and judgmental. Like all character types, these persons perceive and actupon the environment in this manner all the time. This is in contrast to a DelusionalDisorder where a patient is likely to have evolved a delusional explanation orjustification for their views or behavior. This latter condition is also not reflective of alifetime pattern or a pervasive orientation to the world, but rather, is a symptomaticcondition that arose from the breakdown of repression. In paranoia the impulse and itsderivative ideational content is projected onto the environment where it can bedefended against externally. Freud (1911) in the Schreber case elucidated the processwhereby paranoia evolved from the repressed homosexual urges of the patient. In aseries of defensive transformations the thought derivative "I love him" was denied andtransformed by reaction formation into "I don't love him, I hate him." This moreconsciously acceptable idea was projected in the further transform "It is not that I hatehim, he hates me!" With this version of the thought near consciousness, the patientcould modify the idea slightly with rationalization to become "I hate him because ofhis hatred for me." Thus Freud accounted for the range of persecutory, erotic, andjealous delusions as the transforms of unacceptable libidinal drive derivatives.

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For the Paranoid Personality we see a slightly different picture from that ofdelusional paranoia in that there is a constant flow of aggressively determinedprojections from the patient to the environment that establishes a world that isdangerous. This world becomes the reification of the patient's intolerable feelings andthoughts. The relationship to the world and its occupants is understandably dangerousgiven that it is constantly being populated by these aggressively determinedprojections. The internal world of the patient is prevented from maturing beyond theinfantile level given that the negative part-objects are being projected and are thusunavailable for integration with the positive part-objects that are retained. A viciouscycle ensues such that the projections are reintrojected as perceptions of hostility anddanger. An intensification of the splitting process keeps the patient's libidinallydetermined part-objects (positive part-objects) from being contaminated by theseperceptions of danger and affords a false sense of objectivity and perspective. Thepatient has effected an internal polarization of aggressive and libidinal part-objectswith the former being attributed to the perception of external events and the latter tothe patient's rational, objective mind. Emotional restrictiveness would be a by-productof a process that maintains the basic simplicity of good-bad, me-not me distinctionscaused 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 beremembered that these processes are not operating independent of reality. Cameron(1963) notes that the origin of the Paranoid Personality is likely an environment thatwas . hostile, unloving, possibly abusive, but certainly not conducive for thedevelopment of basic trust.

The Schizoid Personality can also be presumed to have originated from anenvironment that was lacking in basic trust (Cameron, 1963). They differ to the extentthat the expression of rage and aggression was so stifled as to leave the individualpassive, compliant, obedient, and detached. Fairbairn (1940) stressed the role ofdepersonalization, de-realization, and disturbances of the reality-sense such that thesepersons 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 thefamiliar and familiarity with the unfamiliar. One gets the impression that thesepatients exist in a perennial dream-like detachment. Winnicott's concept of the "falseself" 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 ifsufficiently 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, inauthenticand devoid of pride.

The interpersonal relations of the Schizoid are, as Guntrip (1952) described: "emptiedby a massive withdrawal of real libidinal self ... The attitude to the outer world is thesame: 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 ofcoldness and betrayal, are masked behind a shroud of apparent apathy. Whereas thesepatients appear bland and deadened, they may engage in active primary processreveries which are rarely revealed to any of the few relations they may have.Therapists sometimes underestimate these patient's true emotional commitment andunwittingly victimize them with premature terminations or other countertransferencerejections like falling asleep or changing their appointment times.

From an object relations perspective we could expect that the self-objectimages of these patients are not clearly differentiated. Rather than projecting theaggressively determined object representations into the environment and thendefending against them externally, as the Paranoid Personality does, these patientsregress to a pre-psychotic state of self-object undifferentiation. Their ability to remainstable at this level prevents them from degenerating into a more classic schizophrenicautism. The withdrawal of object libido is not reinvested in the self, as we would seein a Narcissistic Personality, but rather is dissipated into primary process imaginingsand "protective" distractions. This latter process gives the Schizoid their detached,dream-like appearance.

An interesting and somewhat unique description of the Schizoid patient ispresented by Bollas (1989) in what he calls the "ghostline personality." These patientsexperience a failure of the "potential space" between the self and the other such thatthe child cannot "live" in this intermediate or transitional area. The consequence ofthis failure is a psychic death of the part of the "true self' or the potential "true self' orthe transitional object. The essence of that which dies is transferred to an inner worldBollas refers to as the "alternative world." This "alternative world" functions as aninternal world populated by the foreclosed self states and object representations.Unlike the conventional use of the internal world to contain representations of objectsin external reality, this "alternative world" contains ghosts of object and selfrepresentations that could not be sustained. This realm of the mind becomes thepsychic afterlife. The patient conserves these ghosts in the "alternative world" wherethey can potentially be re-incarnated through the transference. It is through thealiveness of the analyst, who serves as

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the transitional object, that the "alternative world" can be transformed. Thesealternative objects can be transformed into "true self' states and objectified objects bythe use of the transitional object (therapist) who provides life and an arena wherein toshare the experience of the "alternative world." What Bollas so poetically capturesabout the Schizoid Personality is the macabre romanticizing of a death-like being statethat could easily remain unseen by a superficial symptomatic description of thepatient.

In contrast to the Schizoid Personality who withdraws passively from socialcontact, is the Schizotypal Personality who withdraws erratically and is active only onthe 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 "schizophrenicphenotype" (the full term from which "schizotypal" is a shortened form) by Rado(1950). What is striking about these patients is their peculiarities of speech, behavior,and beliefs which can give them the appearance of a psychosis. They remain,however, connected to reality if only in the form of bizarre, eccentric, or out-of-the-ordinary beliefs. Like the Schizoid Personality, their emotional life is deadened, butthe Schizotypal is clearly capable of explosive and aggressive outbursts (Millon,1981).

So, if we were to extend the above discussion about the psychodynamics and objectrelatedness of the Schizoid to that of the Schizotypal, we could propose that ratherthan a massive withdrawal of libidinal cathexis, here we find an occasional intenseinfusion of aggressive energy in some part-object representation. Given that thesepatients present with the "primary symptoms" of schizophrenia (disturbed associationsof thought; splits between affect and intellect; ambivalence toward objects; and anautistic detachment from reality (Bleuler, 1911)), their self and object representationswould be fragments of external reality. Should their detachment from society beintruded upon in some way their internal state becomes agitated and they perceive thisas a violent aggressive act. The primitive quality of their mind is limited in itscapacity to accommodate to the intrusion and they regress to a pre-psychotic fusedself-object experience with the intrusion. Their aggressive explosions are essentiallyan externalization of this internal chaos. Some stabilizing ego functions allow for asemblance of a synthesizing of these fragmented elements by adhering to fringebeliefs such as UFO's; clairvoyance; reincarnation; etc. The interface between theirprimary process thinking and society's "twilight zone" of belief systems, gives thesepatients a meeting ground that supports their ability to connect. Their odd speech andneologisms can likewise serve as a consolidation of autistic thinking with a sociallanguage system. They can thus retain their detachment by employing unusual oridiosyncratic 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 capabilitiessometimes confuses this character with the Borderline Personality (Millon, 1981).This similarity exists only at the level of some manifest symptoms. A more basicdifference 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 varyingalong a continuum of "borderline personality organization, " other psychoanalyticdescriptions 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 manifestsymptoms of: unstable interpersonal relationships; impulsive behavior; affectiveinstability; inappropriate intense anger or rage; recurrent suicidal threats, gestures orbehavior; marked and persistent identity disorder; chronic feelings of emptiness orboredom; and frantic efforts to avoid real or imagined abandonment.

Historically, the Borderline Personality Disorder has referred to a condition midwaybetween neurotic disorders and psychotic disorders (Stem, 1938) or as a complex oftraits and symptom features of both neurotic and psychotic type that constellates in arather stabilized instability (Schmideberg, 1947, 1959). Knight (1957) added to thepsychodynamic understanding by highlighting ego-weakness as a critical feature ofthe disorder. Kernberg's formulations (1967, 1975) about the borderline personalityorganization 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, projectiveidentification, and denial. The psychic stress experienced by the Borderline patient inan effort to organize internal and external experience leads to an intensification of thesplitting process leaving the patient ultimately unable to integrate good and bad self-object images. Aggressive instincts are not neutralized so the intensity of these drivesremains 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 ofaggressively determined object images, the Borderline patient is fixated at a level ofambi-tendency with the world (i.e., an approach-avoidance type oscillation).

The Borderline alternately projects the aggressive images to get distance fromthem, then reintrojects the object in response to feelings of estrangement andabandonment.

Masterson (1981) offers another variation of the Borderline Personalitypsychodynamics through the incorporation of developmental theory and the conceptof a "split object-relations unit." Briefly, this model focuses on the adaptivecharacteristics of the mother and child during the rapprochement sub-phase of theseparation-individuation process in Mahler's theory. Significant for this sub-phasetoward the development of Self, is the child's ability to retain the newly evolved,tenuously held experiences of separateness under the impact of individuationautonomy and the need for periodic re-attachment to the mother. Masterson contendsthat parental inconsistency during this period can result in an abandonment depressionthat is fundamental to borderline psychopathology. The child can experience thematernal part-object representation as withdrawing, angry and critical of the child'sefforts to separate. The affective link to this experience (a form of emotional memory)is a profound abandonment panic, depression, helplessness, emptiness, or rage. Thechild's part-self representation is internalized as inadequate, bad, ugly or insignificant.The resulting personality disturbance centers around the projections and defensesagainst abandonment as it emerges in interpersonal relationships. Clearly, bothMasterson and Kernberg describe personalities that meet the DSM symptoms; theydiffer in terms of how and why the symptoms appear.

In turning to an examination of the Narcissistic Personality Disorder we shouldbegin with Freud's rather straight forward model of libidinal maturity. Freud originallydescribed 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-eroticsensations to the appreciation for the other. In 1914 this concept was linked to libidotheory wherein a developmental progression for libido was presented. In theautoerotic phase, "primary narcissism" was the investment of libido into theexperience of the body. This investment is eventually made into an other who canthen be loved as the self once was. Object-love comes to replace self-love as anelaboration and extension of loving. Complications to this sequence can occur whenthe 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 objectsand re-invested in the self. This defensive re-cathexis of the ego (ego and self wereused interchangeably) leads to an exaggeration of self importance and power. Themegalomania, omnipotence and grandiosity of this form of narcissism was viewed aspathological and a "secondary narcissism" (as opposed to normal "primarynarcissism"). For Freud, then, a pathological narcissist was the result of a libidinallydetermined regression to a pre-object-love state. Wilhelm Reich (1926) coined theterm "phallic-narcissist" to refer to a fixation at the phallic stage of developmentwhere arrogance and self-assurance serve as defenses against castration anxiety.

As was noted earlier, Kernberg views narcissistic pathology as a variant of theborderline personality organization. He interprets the arrogance and grandiosity as adefense against the projection of oral rage. This rage stems from a incapacity todepend upon "internalized good objects" that keep the narcissist in a perpetual state ofinner emptiness and abandonment. Their anger is a revengeful resentment for theirincapacitating internal world. Kernberg notes that these patients often reveal historiesof parents who were cold, aggressive, and spiteful towards their children. He alsonotes that the children were often once viewed by the parents as having special talentsor genius making them exceptional targets for the parent's idealization and eventualdevaluation.

Masterson (1981) describes the Narcissistic Personality also as a variant ofborderline pathology, but with regard to an object-relations unit of the parent andchild that is rewarding for clinging, dependent, and regressive behavior. The child isessentially fixated by the parent-child dyad at a level of self-object fusion thatundermines the child's ability to differentiate and further guarantees the child'sinevitable disappointment with others who could never supplant the parent-childspecialness. In contrast to Kernberg who would tend to view the NarcissisticPersonality as a slightly more developed Borderline disorder, Masterson sees theNarcissistic Personality as pre-dating the development of the Borderline Personalitygiven the more symbiotic character to the part-object relations fused unit.

Heinz Kohut (1971, 1977) has offered an explanation of narcissism that isfundamentally different from any of the above. He posits that at birth two fonns oflibido exist and follow different lines of development. Object libido follows the pathelucidated by Freud and is responsible for the transformation of auto-eroticism intoobject-love. This process is essential to the maturation of the ego system indifferentiating self from object representations. Another form of libido, narcissisticlibido, 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 residueof infantile grandiosity while the latter represents the residue of dependency andprotective symbiosis. Collectively, these spheres represent the "bi-polar Self. "

The development of narcissism is facilitated by the maintenance and creation ofselfobjects which are representations of the person's Self organization. That is, theyare what the compound word itself represents, a merged self and object experience(pure subjectivity). Selfobjects serve to maintain the child's equilibrium by adjustingto shifts in internal emotional vulnerability. Parents function as the first selfobjectsthrough the provision of an empathic relationship to the child that mirrors the child'sself state. Serving as a selfobject they provide a transforming or transmuting functionfor the child's painful emotional experiences (not unlike the auxiliary ego functions orstimulus barrier functions discussed by object-relations theorists). Pathology resultsfrom empathic failures that impede the integration of the two spheres of the Selfleaving one or the other to serve in a compensatory fashion. For instance, a failure ofgrandiosity can be compensated by a symbiotic re-fusion with an idealized parentalimago selfobject, or, a disappointment by a fallen ideal can be compensated by agrandiose inflation, seeking validation from the world.

As pathological conditions persist, the dynamic tension arc between these twopoles of Self oscillates to extreme degrees of compensation that prevent essentialintegration and keep the Self fixed at an infantile level. This process may soundsimilar to the reinforced splitting mechanism described by Kernberg, but is used in anentirely different context. Kernberg was describing ego integration with self assubsumed within those processes. Kohut is referring to the development of Self asseparate from ego such that the development of Self and ego are independent.Interestingly, these differences prove to be quite profound when we compare howthese different theories interpret the severity of the narcissistic pathology. TheKernberg narcissists (narcissistic-borderlines) are illustrative of more severeborderline conditions than the Kohut narcissists. This latter group could theoreticallyhave higher developed ego functions than the narcissistic-borderlines would suggestand owe their narcissistic pathology solely to a failure of Self development. In anyevent, Kohut's model proposes forms of narcissistic transferences that correspond tothe selfobject representations of the grandiose and idealized parental imago spheresthat are immensely helpful in understanding the unique requirements of thetherapeutic alliance; namely the mirroring, merger, alter-ego and idealizing functions.

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The Anti-Social Personality is an individual with a life history of aggressive,destructive, oppositional, and defiant acts. They are often regarded as lacking aconscience and operating without guilt or empathy. They manifest a diffuse lack ofimpulse control that results in frequent irresponsible and thoughtless behaviors which,at the time of performance (and possibly afterward as well), are ego-syntonic. TheDSM behavioral criteria for this disorder attempts to account for the long history ofanti-social conduct by requiring evidence of symptomatology before age 15 as well asafterward. What the symptom description lacks, however, are the essential, but lessobvious, characterological features of the sociopath. DSM-III-R replaced the olderDSM-II categories of Sociopathic Personalities (Dissociative and Anti-Social Types)with the Anti-Social Personality Disorder. The psychodynamic literature howeverdescribes a character disorder of the sociopath whose charm, intelligence, callousnessand ability to manipulate others is lost by the contemporary description that appearsmore indicative of a common criminal type. The sociopath that Fenichel (1945),Cleckley (1959), Cameron (1963), and Kernberg (1967) describe is a person whosebasically borderline personality structure uses others and society as exploited part-objects to compensate for structural deficiencies. The absence of conscience, forexample, which is often cited as indicative of the sociopath is compensated for byexploiting the conscience of others. These persons project their anger, hatred, and rageon 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 convictedmurderer, who shot two teenagers after stealing their car, praised the protesters of theexecution and condemned the state for failing to be empathic about his abusivechildhood. After once winning a stay of execution some years earlier, the convictcommented "oh, well" when asked about his gratitude toward the protesters. This useof projective identification puts into the Other what the sociopath never has toconsciously feel. They are spared from developing a superego by essentiallymanipulating society into serving that function. The sociopath's behavior can berationalized 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. Thesupervising responsibility for the ego is externalized giving free reign to instinctualdrives and wishes, hence the high incidence of impulse disorders, addictions, andsexual perversions. Collectively, these individuals come to personify the dark side ofhumanity and, as such, are of an ironic necessity for civilized social values. Theyprovide the necessary dialectic for the good-evil dichotomy. Perhaps it is for thisreason that these patients create such powerful countertransference reactions. They tapinto the anti-social or sociopathic potential that each of us has attempted to mature outof. Winnicott

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(1956) notes that the "anti-social tendency" retains a sense of hope in a world that canbe nurturing. Once hope is lost, the anti-social tendency gives rise to delinquency andcriminality. I was once taught that a child would rather be a bad child in a good worldthan a good child in a bad world. The sociopath, having lost all hope, depicts a badchild 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 theHistrionic Personality Disorder. These individuals typically present as sociallymotivated, dramatic, exhibitionistic, and yet, dependent persons. Compared to theother disorders of this Cluster, the Histrionic is clearly higher functioning in terms ofego structure, types of defenses used, emotional development, insight into themselves,and apparent developmental level (Kernberg, 1975). While these patients can exhibitthe impulse conflicts, fears of abandonment, hyper-emotionality, and interpersonalmanipulations which would suggest a similarity with the above disorders, theHistrionic demonstrates these symptoms from a more reality based and matureperspective. For example, the Histrionic Personality may be impulsive in regard totheir behavior, but this impulsivity would be more in line with spontaneity rather thanthe destructive or dangerous acting-out by the Borderline or Anti-Social Personalities.The Histrionic fears abandonment and loss out of strong dependency needs but tendsto protect from these experiences by maintaining a backlog of friendships andacquaintances. Once faced with a loss or abandonment they can recover by utilizingmore mature ego functions like reality testing or sublimating their dependency needsinto 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 tosuggest patients with a distinct "feminine character" (Cameron, 1963). The emotionalquality 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 acorresponding wish to destroy and spoil, the Histrionic tends toward jealousy and awish to win over or possess. The Borderline intrudes into the psychologicalboundaries of others while the Histrionic seduces and entices the crossing ofboundaries. If the Borderline needs to be contained emotionally; the Narcissistentertained; the Anti-Social restrained; the Histrionic needs to do the entertaining.They require recognition and are active in the pursuit of being noticed. The Narcissistwould never be content with just being noticed, they must be admired!Developmentally, Histrionic patients are fixated at the phallic level

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of sexual development (Cameron, 1963). They have not resolved the oedipal conflictand seem to be in a continual re-creation of oedipal triangles. The ability to fosterrivalries 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 thatmight evolve should they settle into a long-term dyad. In this case, the dyad oftentakes on parent-child characteristics which represent repressed incestuous conflictsnecessitating an outside relationship or extra-marital affair to displace the sexualdrives. The ensuing triangle keeps all of the relationships manageably superficial.

Under stress, these patients are prone toward regressions which resemble thelower-level character disorders of the borderline spectrum. While they also present apredominantly "false" self as evidenced by their being easily influenced by fads andtrends (Millon, 1981) and their tendency to market themselves as if a commodity, theyare sufficiently developed structurally (Kernberg, 1967) as to be able to capitalize oncreative talents and skills indicative of a fair degree of "true" self development(Winnicott, 1960). Their subsequent inability to retain the narcissistic suppliesachieved by their accomplishments suggests the insufficiency of the "true" self, hencetheir dependency upon others for acceptance and approval.

Cluster C

The final cluster of personality disorders is distinguished by the manifestation ofanxiety and fearfulness in their symptom pictures. This cluster is comprised of theDependent, Avoidant, Passive-Aggressive, and Obsessive-Compulsive PersonalityDisorders. While these conditions all express varying examples of anxiety and fearthey do not appear to have other pronounced mood or thought disturbances. Thesecharacters are more typical of neurotic conditions and seem to best be accounted for interms of developmental fixations and ego defense configurations.

The Dependent Personality Disorder has been alternatively called the Passive-Dependent (Cameron, 1963), the Compliant-Type (Horney, 1945), and theSubmissive Character (Millon, 1981). Utilizing Freud's psychosexual stages as areferent for character fixations or regressions, Abraham (1924) presented the "Oral-Character." These individuals presumably bring with them an expectation forcontinued nurturing and gratification from the world. They remain helpless child-likepersons expecting to be rescued, protected, fed, and supported. Fenichel (1945) addedthat these characters become fixated to the world of oral wishes and disinclined tocare for themselves. They can identify with persons by whom they

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wish to be cared for and therefore act as generous indulgent parents. In doing so, theyact toward others as they wish others would act toward them. Their lack of self-protectiveness borders on masochism and self sacrifice in an obstinate, and yet naive,refusal to move from this passive-dependent position.

The Dependent Personality uses their weakness and inadequacy to circumventresponsibilities and can also employ self-depreciation as a manipulation of others togain their attention and receive their absolution. This process has to be carefullybalanced to avoid guilt which would only reinforce the vicious cycle of guilt andforgiveness. They tend to rationalize their dependency by attributing theirhelplessness to circumstances, luck or some other external source of control. TheDependent, like the idealizing Narcissist, will ally with powerful others to cover-uptheir own inadequacy. The Narcissist attempts to "psychically steal" those attributesthrough their supplication to the other, while the Dependent merely desires a life ofsecure passivity in the shadows of the ideal one. The Dependent willingly submergestheir independence in return for acceptance and support, they do not desire a vicariousself-aggrandizement through this association. Predictably, these persons alsosubmerge or repress all expressions of anger or aggressiveness as this could be lethalto their dependency needs. The hostile impulses, feelings or thoughts are turnedagainst the self in an effort to protect the relationship at all costs. Their anxiety andfear is largely of their own individuality emerging such that it would threaten anorientation dedicated to compliance and submission.

The Avoidant Personality Disorder is also dependent upon others foracceptance but is consumed by fears of criticism, embarrassment, humiliation, andshame. They represent what Fenichel (1945) called a "phobic character" as theyreactively avoid situations they originally wished for. Out of the anxiety generated bythe "what if. .. " predictions of doom, these persons built a character dedicated toallaying chronic insecurity and fear. Their defenses against the anticipated rejectionfoster 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 arenot noticeable subjectively. These are worrisome individuals who always findinsecurities and ambiguities to support their concerns. Avoidant Personalities areactively detached (Millon, 1981) and actively dependent. They withdraw in fear butwith desire, unlike the Schizoid who is apathetic. Rather than responding to theanxiety over dependency needs with passive compliance and a repression ofaggressive impulses, the Avoidant represses libidinal as well as aggressive impulses.The motivation for the repression of the aggressive impulses would be similar to theDependent while the repression or suppression of libidinal impulses protects themfrom the pain of desire. Diminished sexual needs and

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expression avoids the potential for rejection and humiliation. A retreat into fantasycan serve as an outlet for these impulses. Given a lack of real experience, the fantasiestend to be both aggressive and sexual which, when coupled with a punitive superego,can justify the need for self-exile. Avoidant Personalities help perpetuate theirloneliness and isolation largely from an identification with those who weredepreciating and rejecting. They maintain a relationship with their abusers by playingboth roles in their mind, that of the belittled and condemned child, as well as therejecting parent. They are not beaten down into apathy like the Schizoid nor angeredinto battle like the Paranoid; the Avoidant, instead, tries to hide from the persecutorwho resides within them and from whom they also hope to gain acceptance.

The Passive-Aggressive Personality Disorder has been described both as an "oralsadistic melancholiac" by Abraham (1924) and Menninger (1940) and as the"masochistic character" by Reich (1933) and Homey (1939). The term "passive-aggressive personality" was also credited to the U.S. Joint Armed Services nosologyof medical classifications (cited in Millon, 1981) to describe those persons with aunique propensity for undermining morale and proving to be corrosive to authoritativestructure.

Abraham (1924) differentiated the oral stage into a receptive, passive, suckingstage and an aggressive, destructive, biting stage. In the late oral stage, biting becomesas aggressively determined process of incorporation where the object is destroyed inthe process of internalization (i.e., it is cannibalized). The ego develops an attitude ofambivalence toward the object which is now experienced under the influence of theaggressive instinct. The formerly all-gratifying object is now at times frustrating,depleted, or injured. Menninger (1940) notes that sadism replaces passive dependencyand gives rise to a characterological type that is the direct opposite, namelypessimistic, blaming, contemptuous and petulant. The person becomes over-demanding and perpetually discontented. The Passive-Aggressive character representsa back and forth movement from oral dependency to oral sadism that keeps theemotional and interpersonal functioning at an infantile level.

Reich (1933) describes a passive form of aggression in persons who usesuffering and a tendency to complain to inflict pain upon and debase both themselvesand others who care for them. He proposed that a deep disappointment in love liesbehind their provocation of love objects. Their "infantile spite reaction" is an attemptto get back at those who they feel rejected them by courting love through provocationand defiance. Homey (1939) added that the masochistic type despises their owndependency. Their inordinate need for

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others leads to inevitable disappointment and regressive retaliation. Given stronginhibitions about the destructiveness of their aggressive fantasies and the guilt theyevoke, the individual regresses to a passive-dependent position where a pseudo-aggression such as forgetfulness, procrastination, or self-demeaning behaviors canemerge in a disguised form of unintentional hostility. The fear and anxiety overdependency leaves these patients to view almost everyone as a potential tyrant to bemistrusted and disobeyed.

The final character type to be discussed is the Obsessive-Compulsive PersonalityDisorder. These are persons who are caught in a powerful ambivalence overconformity and rebellion. They utilize thoughts and actions to bind the anxietygenerated by conflicting impulses under the scrutiny of a powerfully repressivesuperego. Freud (1908) specified three distinct traits of the "anal character" thatprovide 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, andobstinacy may amount to outright defiance. He clearly identified an array ofambivalent characteristics that were subsequently elaborated upon by Abraham (1921)to include exaggerated criticism of others, avoidance of initiative, and a preoccupationwith the control over money and time (there is never enough of either).

While the above addresses mostly the obsessive or thinking components of thecharacter, Reich (1933) discussed the compulsive or behavioral characteristics. Theseinclude a pedantic sense of order typified by cataloging, indexing and organizing andan unswerving adherence to pattern and routine. Rado (1959) described how thesepersons are most critically affected by the experience of toilet training during the analphase 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 andresponds with a defiant resistance and a fearful obedience to her punishments. Thedisobedient child is made to feel guilty, undergo deserved punishment and ask forforgiveness. The guilt comes to repress the defiant rage, and obedience overcomesdefiance. We see, here, the precursors to reaction-formation in the form of a pride inobedience that hides the desire for rebellion, and the beginning of undoing patternsthat expiate sins with ritualized acts to "undo" evils and wrongs.

These persons become extraordinarily consistent to the point of being rigid andunyielding. They have learned to repress all urges toward autonomy or individualitythat might challenge real or imagined authority. Secretly, they wish to subvertauthority, but instead, use these wishes to further strengthen a restrictive

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superego structure. They vigorously defend rules and convention lest they exposesome excuse for disobedience. Since emotions are expressions of subjective truth theymay betray the cognitive conforming pattern. Thus, emotions are mistrusted and to bedefended against. Defenses such as rationalization, intellectualization, and isolation allserve the organizing and controlling need to conform emotions to some pre-set socialstandard .. These are classic bureaucrats who adhere to "the book" for protocol andpropriety. When faced with unanticipated events these persons can become paralyzedor search frantically for the "correct" course of action. They are likely to spend anhour looking for a lost shopping list that would take 10 minutes to re-create. While theObsessive-Compulsive Personality is also a procrastinator like the Passive-Aggressive, the former is constricted by anxiety over deciding on an action while thelatter is withholding the action in order to control.

The Obsessive-Compulsive is also credited with higher functioning sublimatorychannels (Kernberg, 1967) allowing them socially acceptable channels foraggressivity such as police work or surgery, and outlets for conformity such as forjudges and administrators. To the extreme, these tendencies can be debilitating andrestricting leaving the patient frustrated and bitter. Such conditions can lead to personswho are fiercely moralistic or over controlling of themselves or others. It may beinteresting to contrast this character with the Histrionic who is almost the directopposite in many ways. The Histrionic is so emotional they can hardly think, whilethe Obsessive-Compulsive is so into thinking they avoid feeling. The Histrionic isspontaneous while the Obsessive-Compulsive rarely varies their routine. TheHistrionic is hyper-sexual while the Obsessive-Compulsive is sexually constrainedand conservative. The Histrionic sees a world of impressions and sensations while theObsessive-Compulsive sees a world that is precise and geometrically balanced. Inshort, they are a marriage made in heaven. Each can provide a vicarious expression ofthe 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 availableliterature, a great deal of material had to be omitted with respect to time andpracticality. Should you wish to pursue this subject more fully, I would direct you tothe 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 Paperson Psychoanalysis. London: Hogarth.

Abraham, K. (1924). The influence of oral eroticism on character formation. In SelectedPapers on Psychoanalysis. London: Hogarth.

Abraham, K. (1925). Character formation on the genital level of the libido. In SelectedPapers on Psychoanalysis. London: Hogarth.

American Psychiatric Association. (1952). Diagnostic and statistical manual of mentaldisorders (DSM-I) (1st ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (1968). Diagnostic and statistical manual of mentaldisorders (DSM-II) (2nd ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mentaldisorders (DSM-III) (3rd ed.). Washington, DC: American PsychiatricAssociation.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mentaldisorders (DSM-III-R) (3rd ed. revised). Washington, DC: American PsychiatricAssociation.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mentaldisorders (DSM-IV) (4th ed.). Washington, DC: American PsychiatricAssociation.

Bollas, C. (1989). Forces of Destiny. London: Free Association Books.

Cameron, N. (1963). Personality Development and Psychopathology: A DynamicApproach. 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. AmericanJournal 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 caseof 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 CollectedPapers. 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 AmericanPsychoanalytic 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 UniversitiesPress.

Masterson, J. (1981). The Narcissistic and Borderline Disorders: An IntegratedApproach. New York: Brunner/Mazel.

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Menninger, K. (1940). Character disorders. In J.F. Brown (Ed.), The Psychodynamics ofAbnormal 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 ofPsychiatry, 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. AmericanJournal of Psychotherapy, 1, 45-55.

Winnicott, D.W. (1956). The antisocial tendency. In Through Pediatrics to Psycho-Analysis. New York: Basic Books.

Winnicott, D.W. (1960). Ego distortion in terms of the true and false self. In TheMaturation 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

URETHRA

PHALLIC

GENITAL

KERNBER

STRUCTUAInfantile (Borderline)

WINNICOL C

POW

MAT

G : BORDE

L DIFFERE Narc

TT : TRUE/F

False Self

TrueSelf OMPETITION Anti-Social

Grandiose Narcissist

ER

Hysterical

URITY

RLINE PERSONALITY ORGANIZATION

NTIATION : SUPEREGO DEVELOPMENT

issistic Histrionic

ALSE SELF

26

Social Conformity

Creative Potential

FENICHEL : CHARACTER TYPES

SUBLIMATION REACTIVE

PHOBIC REACTION-FORMATION

AVOIDANT OBSESSIVE-COMPULISIVE

KOHUT : DEVELOPMENT OF SELF

POLES OF SELF

GRANDIOSE IDEALIZED PARENTAL IMAGE

MERGER TWINSHIP ALTER-EGO IDEALIZATION

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MASTERSON : DEVELOPMENTAL OBJECT RELATIONS

RORU WORU

Rewarding Object -Relations Unit Withdrawing Object -Relations Unit

Reinforced for Clinging (Narcissistic) Abandoned for Independence (Borderline)

Pre-Ambivalent Ambitendant/Ambivalent

BOLLAS : GHOSTLINE PERSONALITY

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ExternalObject

GHOSTLINE

TransitionalSpaceInternalWorldAlternativeWorld