Personality Disorders: A Psychoanalytic Perspective
Organization Psychotic
Schizoid
Fixation at the separation-individuation phase. Division between object relations into good and bad. Impoverishment of interpersonal relationships. Replacement of relationships with a fantasy life. Social withdrawal. Apparent lack of affects, resulting in an empty affective experience and interpersonal life.
Borderline
Impulsive interpersonal interactions. Intrapsychic life is acted out in interpersonal patterns, often replaced by impulsive and repetitive behaviors. Intensity of affective arousal and lack of control over affects suggest a temperamental factor. The integration of libidinal and aggressive affects is nuanced and often leads to modulating affective responses and improving impulse control. This casts doubt on the prominence of the temperamental factor. Essential evidence of the split in the self-other boundary.
Paranoid
Increased aggression compared to schizoid. Projection and projective identification predominate. Defensive auto-idealization to control an external world full of persecutory figures.
Hypochondriac
Projection of persecutory objects into the body.
Schizotypal
More severe form of schizoid personality.
Cyclothymia
Affective-temperamental bias seems to be indicated.
Hypomania
Affective temperamental predisposition seems to be indicated.
Masochistic-Depressive
Sadomasochistic superego structure, incorporating potential for depression and guilt, leading to achieved self-identity. Sadomasochistic pathology, predominantly in the attack, and pathology of affection. Masochistic-depressive neurotic organization with a well-integrated, though punitive, superego. This predisposes to a defeatist attitude (suffering to expiate guilt or as a precondition for sexual pleasure, a manifestation of Oedipal dynamics). A depressive response occurs when one would expect an aggressive response.
Narcissism
Integrated but pathological grandiose self replaces the lack of integration of an underlying normal self (versus identity diffusion). Impoverishment of idealized superego structures, predominance of persecutory superego precursors that are projected (fault protection and excessive pathological). Weakening of the more integrated superego functions, so the narcissist always exhibits some degree of antisocial behavior.
Malignant Narcissism
Predominantly narcissistic structure with aggression. The grandiose self is infiltrated by ego-syntonic aggression, developing with cruelty, sadism, and hatred. Antisocial behavior, ego-syntonic aggression, and paranoid tendencies. Some degree of commitment to others remains, along with some capacity for genuine guilt.
Antisocial
Severe underlying paranoid tendencies. Absolute inability for non-exploitative investment in significant others. Total impairment or absence of superego functions. Total lack of guilt, concern for self or others, and identification with moral or ethical values. Inability to project into the future.
Obsessive-Compulsive Disorder
Excessive aggression neutralized within an integrated but overly sadistic superego. This produces perfectionism, self-doubt, and a constant need to control their environment and themselves. In some cases, the neutralization of aggression is incomplete, and the severity of aggression determines regressive elements.
Histrionic
Lability, extraversion, etc., not restricted to the sexual area. Sexual freedom. Non-specific gender orientation.
Adjoining Structures
Anxiety: Diffuse and floating.
Polysymptomatic Neurosis: Multiple phobias, obsessive-compulsive symptoms, multiple conversion symptoms, dissociative reactions, hypochondriasis, paranoid tendencies.
Polymorphous perverse sexual trends
Prepsychotic classic personality structures: Paranoid, schizoid, hypomanic, cyclothymic with strong hypomanic tendencies.
Impulse neurosis and addictions
Lower-level character disorders: Chaotic and impulsive, childlike, narcissistic, antisocial.
Structural Diagnostics I
Weak ego: clinically expressed as pan-anxiety and identity diffusion syndrome.
Splitting: Division of self and environment, hence other objects into good and bad aspects that are not integrated.
Early forms of projection, projective identification: The tendency to continue to feel the projected momentum, fear of another person characterized by the projected momentum, the need to control the other person to validate the projection. Projective identification is based on a structure of primitive division or dissociation.
Structural Diagnostics II
Denial: Exemplified in borderline patients by emotionally independent areas of consciousness.
Omnipotence and devaluation: Derived from the split of active ego states into an omnipotent and grandiose self related to devalued representations of others.
Primitive idealization: Exaggeration of others’ goodness to exclude common human failings.
Structural Diagnostics III
Primitive and/or lacunar superego: Primitive and sadistic, setting high standards, generating guilt, and devaluing self-image. Sometimes, an integrated superego manifests with persecutory and lax moments, allowing uncontrolled impulses (robbery, assault, promiscuity), maintaining a vicious cycle of blame and excesses.
Id: Constantly overflowing, manifesting as impulsive demands and wish-fulfillment in aggressiveness, hypersexuality, greed, etc.
Identity Diffusion Syndrome
Contradictory character traits
Temporal discontinuity in the self
Lack of authenticity
Subtle alterations of body image
Feelings of emptiness
Failure of sexual identity
Moral and ethical relativism
Identity
A strong identity implies (Dr. S. Akhtar):
A sharp sense of self-similarity across different contexts.
Temporal continuity of self-experience.
Genuineness and authenticity.
Realistic body image.
Inner strength and ability to be alone.
Clarity of subjective relation to sex.
Solidarity with ethnic ideals and a well-internalized conscience.