Journal of Personality Disorders, 24(3), 344364, 2010

2010 The Guilford Press

INVITED ESSAY: IDENTITY AND BORDERLINE

PERSONALITY DISORDER
Carsten Rene Jrgensen, PhD

The general consensus is that disturbed identity is one of the defining

characteristics of borderline personality disorder. So far it has not been
possible to reach a generally accepted definition of identity, and the
clinical phenomenon of identity disturbance involves inner subjective
states that are not directly accessible to observation and reliable assessment. In this article a preliminary definition of identity is suggested
and different levels, dimensions, and categories of identity are delineated. Essential elements of identity disturbance or identity diffusion in
BPD patients are described and related to other aspects of borderline
personality disorder: mentalization failures, disrupted relationships,
impulsive or nonvolitional behavior, deficits in memory, dissociation,
and dysfunctional self-narratives.

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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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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deficits in ego-identity can cause problems in personal identity (confusion

regarding ones basic characteristics, talents, etc.), social identity (What
groups do I want to join?, How do I want others to see me?, etc.), and
collective identity (Am I a Christian or a Muslim?, Am I proud to be an
American or do I want to deny my American identity?, etc.).
According to psychodynamic theory (Kernberg, 2004), a well-integrated
ego identity is a (structural) precondition for the development of mature
and adaptive personal, social, and collective identities. More specifically,
the establishment of a mature identity is based on the capacity to integrate
contradictory elements of the self and others and to form a coherent sense
of the self and significant others. Severe problems in the establishment
of an integrated ego-identity, manifested in clinical phenomena such as
splitting, will often impede the normal development of adaptive and socially-adjusted personal, social, and collective identities.
In the normal process of socialization, the individual is integrated into a
community with a common set of norms, ideals, and rules for how to behave and realize ones (personal and social) identity (Habermas, 1981, p.
148f). The values underlying the communitys normal or socially legitimate
way of life are incorporated in the individuals identity and how s/he is
located in a given culture (Bruner, 1990, p. 29). The individual internalizes
this common collective identity as a frame of reference for being in the
world, which is a precondition for the development of adaptive personal
and social identities. Severe failures in the socialization process, which are
often seen in the history of BPD patients, and the resulting failures to
internalize essential aspects of collective identitycommon norms, rules,
ideals, social roles, and conceptions of the worldthus constitute a serious diathesis for the development of disturbed ego, personal and social
identities. Identity disturbances in general can thus be related to a lack of
commitment to common values, failures in the socialization process, and
deficits in the internalization (and construction) of a collective identity.
The main problem with this theoretically useful differentiation of four
levels of identity is the shortage of valid operationalizations. At present we
have just two instruments that measure aspects of identity with acceptable validity and reliability: Marcias (1966) identity status model and Berzonskys (1990) identity style model. Both models were developed as tools
to understand normal identity development, rather than severe identity
diffusion. The analysis of identity status is based on a semi-structured
interview developed by Marcia (Marcia, Waterman, Matteson, Archer, &
Orlofsky, 1993), whereas Identity style is measured on the basis of a specially designed questionnairethe Identity Style Inventory (ISI; Berzonsky, 1992). The usefulness of the two models in this context lies primarily
in their descriptions of different categories of identity.
On the assumption that human identity is structured around two basic
dimensions: (1) exploration (deliberate self-examination, attempts to separate and individuate from childhood identifications in the quest for an individuated and integrated sense of identity, and experiments with different

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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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cept of identity style is more dynamic and process-oriented. Whereas

identity status assignments are based on actions one has taken [or has
not taken] in the past, identity style classifications focus on ones present
method of handling daily situations (Schwartz, 2001, p. 22).

IDENTITY FUNCTION IN BDP

Identity diffusion and other identity-related dysfunctions are prominent
in most BPD patients. The normal resolution of identity conflicts and the
integration of identity in adolescence have failed, in some cases to a significant degree, and a subjective sense of identity coherence has not been
established. On the basis of the object relations model, identity diffusion
can be defined as a psychological structure characterized by the fragmentation rather than integration of the representations of the self and others
that are internalized in the course of development (Yeomans, Clarkin, &
Kernberg, 2002, p. 8). Identity diffusion at the level of ego-identity thus
stems from the fragmented nature of a split or nonintegrated internal organization.
Descriptively, identity diffusion has been related to a broad spectrum of
symptoms and conditions (Akhtar, 1984, 1992, p. 28ff; Jrgensen, 2008),
including the inability to form, stick to and pursue realistic long-term
goals; impaired capacity to remain the same amid change and with the
passage of time (deficits in subjective integration of past, present, and future); a subjective sense of incoherence and discontinuity; deeply felt insecurity over questions such as who am I, really?; lack of authenticity,
manifested in caricature-like beliefs, feelings, and actions (cf. the as-if personality described by Deutsch (1965), and Winnicotts concept of the false
self); pronounced dependency on external objects to stabilize the self; feelings of emptiness, meaninglessness, and estrangement; self-destructive
behavior; deep-seated confusion with regard to ones own gender, future,
and values; and an inability to identify with, and commit to, a mature set
of norms and ideals and a nuanced understanding of the world. In addition, identity diffusion can be accompanied by a tendency to confuse
ones own attributes, feelings, and desires [mental states] with those of
another person (Wilkinson-Ryan & Westen, 2000, p. 529), especially in
intimate relationships, and by a related fear of losing important parts of
ones identity if the relationship is disrupted, giving rise to dependency
and, in some BPD patients, to a characteristic alternation between attack
and submission in intimate relationships.
Psychoanalysis has developed in-depth theoretical accounts of identity
disturbance. In the last decade cognitive theories have also contributed to
our understanding of identity dysfunctions in BPD patients. Unfortunately, however, relatively little attention has been paid by empirical researchers to identity disturbance in BPD. One reason for this may be that
we have not been able to arrive at a commonly accepted definition of iden-

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tity, which is a precondition for the successful assessment of identity and

identity disturbance.
One study (Jrgensen, 2009) that compares BPD patients (n = 66) with
normal controls (n = 65) found highly significant differences in identity
style between the group of BPD patients and normal controls. More than
half the BPD patients (59%) were classified as diffuse-avoidant in identity
style compared with only 12% in the control group. Level of commitment,
a factor that is theoretically related to identity function, was also significantly lower in the BPD patients than in the controls.
Analyses of identity style are based on self-report questionnaires. Given
their characteristic deficits in mentalization and realistic self-appraisal it
is likely that some BPD patients will have difficulty providing accurate information in a questionnaire format about important aspects of identity
and identity disturbance, for example showing over-absorption in particular social roles, inconsistent or rigid self-representations, and so on. Thus
one could argue that a valid in-depth description of identity disturbance
in BPD patients would require a specially designed interview.
Wilkinson-Ryan & Westen (2000) compared therapist-rated identity
function/disturbance in BPD patients (n = 34), patients with other (non
BPD) personality disorders (n = 20), and patients with no PD (n = 41).
Based on factor analyses of 35 therapist-rated items they found four identity disturbance factors: (1) role absorption, where patients tend to define
themselves in terms of a single role, cause, or social group; (2) painful
incoherence, reflecting the patients subjective experience of incoherence,
lack of continuity and emptiness; (3) inconsistency in thoughts, feelings,
and behavior; and (4) lack of commitment to jobs, values, long-term goals,
etc. Subjects with BPD stood out from both the other groups, scoring significantly higher on all four factors, which suggests that each of the four
elements of identity disturbance is more severe in patients with BPD than
seen in other nonpsychotic psychiatric disorders (Wilkinson-Ryan & Westen, 2000, p. 538). These four elements of identity disturbance thus distinguished BPD patients from patients with other PDs. The weakest of the
four elements in predicting BPD was lack of commitment, which could
indicate that this factor is less specifically related to BPD and should be
considered a more general indicator of psychopathology.

IDENTITY DISTURBANCE ROOTED IN MENTALIZATION

FAILURES AND DISRUPTED RELATIONSHIPS
We infer who we are from how others react to us and our identity is normally constituted and stabilized by consistent feedback from significant
others. As the symbolic interactionists (Mead, 1934; Cooley, 1902) have
argued, our view of ourselves and our sense of identity result from seeing
ourselves in the eyes of others. Close relationships thus play an important
role in developing and sustaining a coherent sense of identity. A stable

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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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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.

IDENTITY AND AGENCY/AUTONOMY

A well-established (ego) identity is a precondition for autonomous, adaptive, and stable behavior. An individual is autonomous and an active/competent agent in her life to the extent that she governs herself in accordance
with relatively coherent, stable, and volitional intentions and desires. The
American philosopher Harry Frankfurt has argued that having so-called
second order volitions is essential to being a person; it is essential, in other
words, that one wants certain (compatible and stable) desires to be ones
will (Frankfurt, 1988, p. 16). By contrast, what he calls a wanton is indifferent to her own will and allows her (shifting) desires to determine what
she does. It is in securing the conformity of ones will and behavior to ones
second order volitionsI want to stay in therapy despite my recurring
impulses to quit, I want to refrain from self-destructive behaviourthat
a person exercises autonomy (Frankfurt, 1988, p. 20). Having an integrated, stable, and coherent identity is an essential precondition for effective second order volitions that stay the same over time.
The situation for the BPD patient with severe identity disturbance is
akin to that of the person who, in Frankfurts description, is estranged
from herself, a more or less helpless or passive bystander to the inner and
outer forces that move her (Frankfurt, 1988, p. 22). In a sense she has no
autonomous or free will because she has no stable inner compassidentityto guide her behavior. If she has no stable inner core (identity) or is
dominated by unresolved conflicts between different desiresI want to
take drugs, I no longer want to take drugsshe is in danger of having
no second order volition at all. Until an inner core or identity is established
and/or the conflict between hitherto incompatible desires (or elements of

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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.

IDENTITY AND MEMORY

John Locke (1690) was one of the first to relate the human self to memory.
He saw identity as residing directly in memory, ones memory of oneself.
Consequently, a person who remembers nothing of his or her past literally
has no identity (Kihlstrom, Beer, & Klein, 2003, p. 71). Later, David Hume
added that one of the essential functions of memory is to enable us to
comprehend (or construct) causal relations between events and construct
a coherent representation and understanding of (past) experiences. It is
reasonable to assume, therefore, that memory dysfunctions create greater
vulnerability to identity diffusion.
Traditionally, distinctions have been drawn between different levels of
memory. The notions of episodic and semantic memory are both essential
to understanding how identity and dysfunctional identity are related to
memory. Episodic memory contains autobiographical memories of past
events and experiences, whereas semantic memory is related to more generic, context-free knowledge about the self and the world.
In recent years we have seen several studies of memory in BPD patients
that can contribute to our understanding of identity disturbance. Jones et
al. (1999) compared the ability to recall autobiographical memories in BPD
patients and a matched normal control group. They found that, compared
with the control group, the BPD patients had difficulty in recalling specific
autobiographical memories. In particular, the group of BPD patients gave

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a disproportionately high number of general responses to negative cues

and the authors speculate that this tendency to recall general memories
may help patients to avoid memories that might involve negative or painful
affects. Thus it may be related to the tendency to dissociate that is often
found among BDP patients, particularly in stressful situations and when
confronted with painful experiences. Startup et al. (2001) found that the
more BPD patients produced over-general memories, the less they engaged
in parasuicidal behavior, which may indicate that the tendency to overgeneral recall also helps to protect the BPD patient from parasuicidal acts.
Another study (Arntz, Meeren, & Wessel, 2002) based on a relatively small
group of BPD patients (n = 9) found no evidence that BDP patients were
more inclined to over-general autobiographical recall than other groups of
psychiatric patients, which may indicate that the phenomenon is not confined to BPD patients. More studies on a larger scale are needed to clarify
the extent to which over-general recall is specific to BPD. If BPD patients
have a tendency to over-general and hollow recall of autobiographical
memories (i.e., memories that lack emotionally important details), a tendency that presumably relates to the activation of defenses (dissociation)
in order to avoid painful memories, this might compromise the development of a coherent and multi-faceted identity rooted in the patients individual history.
Some studies have found more general memory dysfunctions in patients
with BPD. In a study comparing the capacity to recall emotionally laden
words in three different groupsrespectively, patients with major depression and comorbid BPD, patients with major depression without comorbid
BPD, and normal controlsKurtz and Morey (1999) found that patients
with BPD performed worse than the two other groups in both recall and
recognition memory. In a more recent study of memory function in prisoners with BPD and other (nonborderline) PDs, Kirkpatrick et al. (2007, p.
24) found significant impairments in BPD patients recall of thematic and
complex information from verbal and visuospatial memory and demonstrated that this form of memory impairment has some specificity in relation to BPD.
The ability to construct a coherent life narrative and use autobiographical reasoning (Habermas & Bluck, 2000, p. 749)a form of self-reflective
thinking about the past that involves forming links between elements of
ones life and the self, frames ones individuality in terms of a specific
history and can be seen as an exercise in personal integration (McAdams,
2008, p. 243)relies on memory and is important for the development
and stabilization of identity. BPD patients often have great difficulty in
making meaningful links between past and present in their personal life
and in integrating past and present in a coherent whole. Life is experienced merely as a series of fragments, causal links between present problems and elements of the past are lacking or highly idiosyncratic and life
appears to have been determined by chance (or by powers completely outside the patients control) and is in that sense meaningless.

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IDENTITY AND DISSOCIATION

The concept of self or subjectively experienced identity typically varies
across different contexts and states of mind and most people are able to
hold different views of the self and of their past, present and (imaginary)
future identity in different contexts and states of the self. From the perspective of cognitive psychology, the more a person is able to organize
multiple self schemas into a coherent whole, the more likely that individual is to experience a sense of identity cohesiveness and continuity (Horowitz, 1998, p. 87). The level of impairment in BPD patients fluctuates over
time and probably depends upon factors such as trends in interpersonal
relationships, where stress and activation of the attachment system may
cause severe deterioration in cognitive and identity function. A sense of
sameness and coherent identity is derived from supraordinate configurations that can associate multiple self schemas (p. 87). BPD patients with
few supraordinate schemas, and with antithetical self schemas are vulnerable to explosive shifts in states (Horowitz, 1998, p. 90), and particularly in stressful situations they are apt to dissociate their self schemas or
other elements of identity.
According to Erikson (1968, p. 159), identity normally arises from the
selective repudiation and mutual assimilation of childhood identifications
and their absorption in a new configuration. Similarly, Kleinians (Hinshelwood, 1997, p. 177ff) have argued that the development and stabilization
of human identity inevitably involves the splitting-off of some mental content and its location in others (through projection, projective identification,
etc.). Identity is organized and attains coherence and stability through the
internalizing acquisition of certain aspects of significant others and the
dissociation from or disowning of what is experienced as alien or not-me.
One might argue that these processes are radicalized in pathological dissociation and severe identity dysfunction. Various elements of identity, separate self-representations, part-object-relations or different states of mind
contradict one another or are in conflict, and the BPD patient alternates
between these conflicting states. The psyche is dominated by alternating
sub-identities/nonintegrated self-representations and the patient is not
able to understand, reflect upon, or integrate these elements of identity.
As a result, the patient is deeply confused about her own identity and
about essential questions such as who am I?, sexual orientation, goals
for the future, etc. Only the evacuation of some of these nonintegrated
elements of identity, or dissociation from them, can give temporary relief
from this unbearable confusion.
In Kernbergs view the insufficient integration of identity is in part the
result of a defensive process initiated by the egos efforts to protect good
parts of the self from the destructive potential of evil parts. On the other
hand one might argue that this nonintegration of different parts of identity
or states-of-mind is a manifestation of the BPD patients general inability
to contain and integrate conflicting elements of identity, conflicting statesof-mind, self-representations, and representations of the world. This con-

INVITED ESSAY

357

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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JRGENSEN

understand and regulate the processes governing shifts between different

states of mind or sub-identities: an idea intimately related to Bateman and
Fonagys mentalization theory. The BPD patient switches abruptly from
one role pattern and response mode to another, often with no evident provocation, generating confusion in both the patient herself (identity diffusion) and in others, and thereby aggravating her relational problems.
Similarly, Young et al. (2003, p. 306) have focused on how BPD patients
continually switch between one schema mode and another in response to
life events and immediate subjective experiences. As Young et al. argue,
BPD patients have a greater number of more extreme modes than healthier individuals and they tend to switch modes from moment to moment.
When the patient switches into a given schema mode the other modes
seem to vanish and the patient then has virtually no access to these other
modes. The modes are almost completely dissociated in BPD patients
(Young et al., 2003, p. 307) whereas healthier individuals can usually experience more than one schema mode simultaneously (p. 40). In BPD patients, different schema modes or elements of identity exist as more or
less separate compartments with limited or no integration, resulting in
sometimes rapid and dramatic shifts from one mode or part-identity to
another. Identity diffusion is conceptualized as a manifestation of this constant switching between nonintegrated schema modes, each with its own
view of the self and a constant need to please others which, combined with
the experience of not being allowed to be oneself, inhibits the development
of a secure identity (Young et al., 2003, p. 314). According to Young and
colleagues, the BPD patient feels confused about who she really is, especially while in the so-called detached protector mode: a mode where all
emotions are shut off and the patient disconnects from others and functions in a robot-like manner (Young et al., 2003, p. 314f). The patients
identity is extremely unstable and flips rapidly between identity fragments,
depending on contextual factors. Young et al. argue that the BPD patient
is unable to develop a distinct identity of her own because she is not following her natural inclination (Young et al., 2003, p. 315). This conceptualization of identity diffusion in BPD is clearly insufficient to understand
the core problem. Due to inadequate integration of the ego-identity, the
natural inclinations of most BPD patients are extremely confused, nonintegrated and therefore flawed as the basis for the development of a distinct
individual identity.

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-

INVITED ESSAY

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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JRGENSEN

The key question is how we are to understand deficits in narrative and

integrative function and the identity dysfunctions related to them. Are
these problems primarily manifestations of cognitive deficits and an insufficiently developed narrative function or are they related to deep-seated
deficits in the structural organization of the personality, the integration of
ego-identity, or mental representations of the self and others, as argued
by object relations theory? The more or less chronic inability to regulate
emotional states that is seen in many BPD patients may contribute substantially to their fragmented narratives and general inability to create a
coherent autobiography.

IDENTITY DISTURBANCE AND LATE MODERN CULTURE

Paris (2008, p. 83f) has differentiated between socially sensitive disorders,
i.e., mental disorders whose prevalence changes with time and changes in
culture, and socially insensitive disorders, whose prevalence is relatively
stable across different contexts. Identity disorders are highly sensitive to
social and cultural change (Jrgensen, 2006a,b).
In relatively stable, tradition-oriented (sub-)cultures and social settings,
the extremely stable (or rigid) normative identity orientation described by
Berzonsky (1989) (and the foreclosed identity style associated with it), may
be a viable, or even the most adaptive, identity style. In modern Western
culture, however, the breakdown of tradition and traditional social norms,
institutions and value-bases has forced the individual to explore alternative options and construct his or her own unique and flexible identity. Late
modern society calls for the flexible, self-constructed and reflexive identities (Berzonsky & Adams, 1999, p. 585) represented by the informationoriented identity style. Generally speaking, the information-oriented style
can be seen as the most adaptive and mature style in late modern societies, whereas the diffuse-avoidant style is the least adaptive and is associated with a higher risk of developing psychopathologies, especially BPD.
The mature information-oriented style and an integrated/coherent egoidentity will increase the individuals resilience, whereas a diffuse-avoidant style and a nonintegrated/incoherent ego-identity will increase the individuals vulnerability to various symptoms and behavioral disorders,
especially in societies and (sub-)cultures where outer structures, structures that could stabilize and guide the life of the individual, have been
weakened. Similarly, strong commitments enhance the individuals ability
to navigate in a culture characterized by a multitude of options, choices,
and alternatives and a high degree of social complexity. Commitment is
intimately related to the process of identifying with (to some extent common) goals, personal and social issues (including social and collective
identity), significant others, etc., and helps the individual to establish a
stable inner frame of reference. On the other hand, low levels of commitment can imply an unstable self-definition and confusion concerning what
one should do and believe (what is good/bad, right/wrong, of value, etc.).

INVITED ESSAY

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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