Our model of personality is based on contemporary American object relations theory, as developed in the work of Otto Kernberg. Personality according to our model – a person’s habitual way of experiencing self and others and of behaving – is understood as being grounded in underlying psychological structures comprised of images of the self in relation to others. These psychological structures include internalized relationship patterns, affects cognition and moral values. These combine to form what we think of as “character”, and contribute to how an individual experiences the world.
More specifically, emotionally-charged interactions between the infant/child and significant caregivers, which are patterned and repeated over time, result in the development of specific representations of the self and of significant others, linked by the emotional quality in which they were initially experienced; these linked representations of self and other are referred to as “object relations dyads.” The emotion associated with a specific dyad, may range from intense love to extreme hatred. In early life, these dyads are not accurate or literal representations of historical reality; rather, they tend to represent polarized, extreme images and affects. Consequently, in response to triggers (life events), an individual experiences himself, and others, in terms of extreme and simplistic representations that are not coherently connected with the representations of self and other that might be triggered by a different event (e.g., the individual may feel very happy and valued when a friend smiles at him, and may feel sad and worthless if the friend is late for meeting; the corresponding images of the friend would be a loving person in the first instance and a rejecting person in the second.)
In the case of healthy psychological development, these early, extreme and disconnected representations gradually become integrated into more complex, subtle and realistic internal images of self and others. We come to realize that ourselves, and others, have both good qualities and bad, that we can experience disappointments in ourselves or others while still appreciating the good qualities. We learn that experiencing negative emotions does not destroy the capacity for positive emotions and that our emotional state can be complex, with a variety of emotions of multiple valence (rather than only all positive or all negative) in relation to others.
A sine qua non of psychological well-being is the development of a sense of identity. Healthy development leads to an integrated and coherent identity that is stable across time, and is based on a realistic self assessment in which positive affects predominate over negative affects and ego strength is sufficient to navigate life’s challenges and disappointments. In the course of normal psychological development, polarized dyadic representations of self and other become integrated into a unified whole leading to a more mature and flexible sense of self and others in the world.
In the psychological development that leads to personality disorders, however, there is a failure of integration of these more extreme representations. Internalized dyads associated with sharply different affects remain split off and continue to exist independently from one another so that the world is experienced in highly concrete/all-or-nothing terms, and with confusion and lack of continuity. This is perhaps most dramatically seen in individuals with borderline personality but is also seen in individuals with other personality disorders such as narcissistic, histrionic and paranoid. Absence of an integrated identity (a stable sense of self) leads to the generalized ego weakness which accounts for the emotional lability, impulsivity, intolerance of anxiety and disappointment, extreme sensitivity to rejection, and a host of other symptoms common to the personality disorders. In particular, the failure to achieve a durable sense of self and other leads to severe disturbances within interpersonal relationships. In certain less severe personality disorders, such as depressive-masochistic or obsessive-compulsive, the individual’s internal representations are better integrated – leading to some core sense of self – but the lack of integration of a key element of their internal world can lead to a rigid, inflexible character style.
The question arises as to why an integrated identity does not occur in some individuals. Our model proposes a combination of reasons for this. Elements of biologically-determined temperament combine with environmental factors to maintain this split psychological structure.
To summarize, internal representations of gratifying caregivers in relation to a satisfied self are totally split off from internal representations of frustrating caregivers in relation to a helpless deprived self. These opposite images are imbued with intense affects: loving affects in association with the first internal representation, and hateful ones in association with the second. While the patient has no conscious awareness of this split internal world, his or her reactions to events involve an oscillation between the extreme positive and the negative sides of his mind. This oscillation creates the subjective instability that determines the individual’s specific symptoms, that might include: chaos in interpersonal relations, emotional lability, black-and-white thinking, anger, and proneness to distortions in reality testing.