When the identity, when the self, whatever they may be, when this core, immutable core, the feeling that you are the same person from one minute to another, the continuity of being you from one day to another are disturbed.

There are three types of identity disturbance to my mind.

One is cyclical, where the borderline, and to a very large extent a narcissist, actually cycle between behaviors, which are mutually exclusive behaviors, don’t characterize the same type of personality.

I will take the example of promiscuity. Borderlines have stretches of unbridled self-trashing promiscuity, which is way over the top, extreme. And then suddenly they hibernate, they go into a state of celibacy and abstinence, which could last years.

Now the two behaviors are mutually exclusive. That’s why we cannot say that borderlines are sex addicts, because they can go through long stretches of time without sex. But they alternate, they cycle between these modes, between these identity states or self-states, between promiscuity and abstinence.

Abstinence and promiscuity are associated with mood disorders, such as depression and with anxiety disorders. So we can’t safely say that the reason for the fluctuation of the cycling is the mood, that they had acquired depression, and so consequently they became abstinent or celibate.

No, that’s not the reason.

Actually, borderlines are notorious for self-medicating and soothing with rampant, unbounded, unregulated or dysregulated sex. So it’s not about mood, it’s simply an internal process, possibly a neurological process, we don’t know, which kind of regulates these transitions between identity figments or identity elements, which are utterly incompatible.

Then we have allotropic identity disservice. It’s when there are two or three variants of the same person, and there is an alternation between them, subject to stressors, to stress, anxiety and environmental and social cues.

So the borderline may switch between borderline A, borderline B, borderline C, and very frequently, borderlines give names to these self-states as if they were separate people. And this is the allotropic identity disservice.

And finally, there’s object-related identity disservice. Preferences regarding friends, spouses, boyfriends, intimate partners, co-workers, role models, politicians, rock stars, etc. Preferences regarding other people. These preferences reflect underlying values, and yet there is no consistency, constancy and continuity with the borderline.

One day, she could be held bent against extramarital sex. The next day, she could see nothing wrong with it. One day, a certain politician is her role model. The next day, she detests him. One day, her spouse or intimate partner is the center of her life. The next day, he’s the center of a twister.

So this is object-related identity disservice.

The problem is that autobiographical memory, memory of one’s personal history, the narrative that is the glue that holds identity together is disrupted. It’s disrupted because of dissociation.

There’s a lot of dissociation in cluster B, especially in narcissistic and borderline personality disorder. Dissociation involves amnesia, forgetting things. It involves depersonalization, the feeling that you’re not really there, and derealization, the feeling that what’s happening to you is not real.

And so all these processes, dissociative processes, disrupt massively the ability to maintain continuous, smoothly flowing autobiographical memory, or even stream of consciousness.

And of course, given these conditions, it’s impossible to form a core identity. It’s impossible to feel that you are yourself at subsequent moments. It’s like you’re a different person every now and then.

This is intimately connected to splitting and other primitive defenses where you can’t see other people as a single unitary entity, where you divide people in dichotomous thinking into black and white, good and bad, as if they were fragments of people, split of people, not real people.

And there is self-splitting, the application of the splitting defense mechanism to yourself, splitting yourself, breaking yourself apart, unable to connect the parts.

This is very reminiscent, as I said, to other dissociative disorders. I’m going to read to you from the DSM Edition 5. I’m going to read to you what they say about other specified dissociative disorder.

They say, chronic and recurrent syndromes of mixed dissociative symptoms. This category, they say, includes identity disturbance associated with less than marked discontinuities in sense of self and agency or alterations of identity or episodes of possession in an individual who reports non-dissociative amnesia.

And the alternative is identity disturbance due to prolonged and intense coercive persuasion.

Individuals who have been subjected to intense coercive persuasion, brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects and cults, or by terror organizations.

These individuals may present with prolonged changes in or conscious questioning of their identity. I think they forgot one thing, abusive families. Children who are subjected to abuse in early childhood usually find themselves in a cult-like setting with a dead parent, a parent who is narcissistic, self-centered. These children are subjected to what they perceive to be torture.

And so they’re likely to show an identity disturbance due to prolonged and intense coercive persuasion, which is an integral hallmark and part of what today we call complex trauma, complex post-traumatic stress disorder.

In borderline personality disorder, the DSM has this to say, diagnostic criterion number three, identity disturbance, markedly and persistently unstable self-image or sense of self.

They elaborate in the DSM. There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self.

They are sudden and dramatic shifts in self-image. I call it switching, characterized by shifting goals, shifting values, and vocational aspirations.

There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to that of a righteous avenger for past mistreatment.

Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which an individual feels a lack of a meaningful relationship, nurturing, and support.

In other words, abandonment and rejection. These individuals may show worse performance in unstructured work or schooling situations.

The French philosopher Paul Ricoeur suggested a typology, or not typology, but let’s say a break, a deconstruction of personal identity. He said that personal identity is a triangle.

There is what you call idem identity, sameness, ipse identity, selfhood, and interpersonal relationships. Idem identity, or sameness, refers to persisting, yet malleable personal features such as personality traits, your character, temperamental dispositions, and values which can change and do change over the span of a lifespan, and also can and do change in the throes of social interactions.

These features are expressed in linguistic, propositional terms, and when you self-reflect, you can spot them.

Now, Ericsson, the mega-master of human personal development, the guy who brought it all together, in my view, Ericsson described identity as referring to a conscious self of individual identity, an unconscious striving for a continuity of personal character, a criterion for the silent doings of ego synthesis, and an inner solidarity with a group’s ideals and identity.

Koenberg is the one who introduced a self-concept. Koenberg said that it’s the integration of representations of the self, but it’s not clear. Did Koenberg mean to discuss a person’s beliefs about himself or herself, beliefs that she can verbalize, fematize, I don’t know, express, or was he referring actually to subpersonal, unconscious, dispositional structures that only occasionally became actualized as a belief about oneself, I don’t know, through, for example, talking to me in therapy or treatment.

So that part remained unclear.

Go back three decades from Koenberg to Deutsch. Deutsch had written a seminal article titled Some Forms of Emotional Disturbance and Their Relationship to Schizophrenia. She published it in Psychoanalytic Quarterly, or Psychoanalysis Quarterly, in 1942. Deutsch said that there are groups of patients, and she called them as if personalities.

It became a very widespread meme, as if personalities. It’s patients’ readiness to mold herself according to the surroundings. The patient anticipates the widely used characteristics of everyone around her, and kind of shapeshifts and morphs.

There’s a famous movie by Woody Allen, Zellig. Zellig is a chameleon, a kind of shapeshift. So the borderline patient, Deutsch described the borderline patient as having a chameleon-like adaptability to others.

Deutsch said that her patients were not aware of their as-if personality, which is very similar to the idea of persona or mask in Jungian psychoanalytic theory. It’s very similar to Goffman’s work in sociology or social psychology, etc.

But she preceded, Deutsch preceded Oliver. Deutsch said that the patients were not aware of this mask, of this as-if personality. They felt an inner emptiness, which they tried to overcome by an exaggerated identification with other people.

Deutsch considered these patients to belong to the schizophrenia spectrum, actually. There was no borderline conception at the time.

Ericsson described what he called identity diffusion. It’s a psychoanalytic concept, actually, which preceded Ericsson. But Ericsson was the first one to suggest that identity is a mutual relation in that it connotes both a persistent sameness within oneself, self-sameness, and a persistent sharing of some kind of essential character with other people.

So there is this Deutsch mask or as-if personality, and there is a feeling that you are the same person. And if you put these two together, you get your identity.

Identity diffusion is when there is a disintegration of the sense of inner continuity and sameness.

There are difficulties in committing to occupational choices and difficulties with intimacy. And, of course, all adolescents go through identity diffusion.

But if identity diffusion persists beyond adolescence, it becomes identity disturbance.

And that is one of the main reasons we can diagnose borderline personality disorder fairly safely in puberty.

Kernberg, though, provided the main contribution to formulating identity diffusion as a key pathology in borderline personality disorder.

Kernberg took all this aforementioned information, and he said that identity diffusion is the lack of an integrated self-concept and an integrated and stable concept of total objects in relationship with the self.

So when we have a self-image or a self-concept and an image of others, a theory of mind of other people, and other people’s concept, a concept which represents us and a concept which represents other people, these are essentially internal objects.

But when they contradict each other, when there is a conflict or a dissonance between our self-image and the image of others in our mind, there is a split. There is a split and inability to synthesize these two.

So it’s on the unconscious level, or what Kernberg called the subpersonal level.

Klein described the mechanism of splitting and the association between excessive splitting and the disturbance in the feeling of the ego, as she called it. She believed it to be the root of some forms of schizophrenia.

What about the experience of self? How do you experience a self and how does the borderline experience her disturbed self, disturbed identity?

On the experiential level, Kernberg thought that identity diffusion is reflected in the patient’s incapacity to give an integrated description of herself and who offers significant others.

These patients, these patients, said Kernberg, they are uncertain about their major interests. They don’t know, they can’t promulgate a consistent pattern of behaviors. They’re very chaotic. Their commitments to work and to other people are very unstable.

So Kernberg’s seminal, very important, crucial concept of borderline personality organization includes patients with schizoid, paranoid, narcissistic, hypomanic, anti-social personalities, impulse disorders, as if personalities, psychotic characters, inadequate personalities, patients with multiple sexual deviations, and so on and so forth. It’s a kind of a basket.

In Kernberg’s terms, borderline personality disorder is a basket term, actually comprising most of what we call what most of the diagnostic and statistical manual.

He put together numerous categories which at the time were considered strongly linked to schizophrenia.

What he was trying to do, he was trying to create a schizophrenia light diagnosis, which he termed borderline personality disorder, the capacity for reality testing and the relative intact ego boundaries in patients with borderline personality disorder.

He said these are the differences between borderline and schizophrenia.

Borderlines are still enmeshed and embedded in reality. They can still judge reality more or less accurately. By the way, they can judge reality better than narcissists do. And their ego boundaries are pretty much intact, which is not something I can say about narcissists.

I therefore, as opposed to Kernberg, I think that narcissists are the true borderlines.

Narcissists are the ones who are much closer to psychosis. They’re much closer to a disintegrative framework of self and identity. They are very, very close to hyper-reflexivity. In other words, a blurring of the lines between external and internal objects.

So I think borderlines are less severe personality organization than narcissism or narcissistic personality disorder.

Feeling of emptiness have also been described, but they’ve been described not only in borderline personality disorder. They’ve been described in psychosis, depression, schizoid conditions, narcissistic conditions, and borderline.

So emptiness is not unique to borderline. What is called the empty inner core or the empty schizoid core characterizes all these people.

There are descriptions of a sense of being dead, deadness, an absence of inner feeling, a kind of gaping hole, a black hole, a void, which many patients describe spatially, like in space, they do this with the hands. And many patients can even describe the size of the hole, small, big, fluctuating.

Borderlines very often say that when they’re in love or in a relationship, the hole, the emptiness becomes smaller. It’s a very common borderline utterance or description.

So they know there’s an absence of inner feelings, a feeling of being dead, unresponsiveness. There’s a lot of intolerable boredom, superficiality, unhedonia, inability to enjoy anything or to find pleasure in life and depersonalization, the feeling that you are not you, that you’re just an observer of what’s happening to you on autopilot, so to speak.

These experiences are not permanent. They’re not a fixture like, let’s say, in psychosis. They’re fluctuating. They’re episodic. They are, but they are chronic.

In other words, these conditions are likely to recur.

The condition of identity disturbance and the attendant emptiness and void, they’re lifelong. They’re likely to happen again and again and again, but they don’t happen all the time. They’re not like permanent fixture or feature.

The feelings of emptiness in borderline patients, they are the experiential consequence of an identity disturbance or a disturbance in some sense of self.

When you don’t have a core, when you don’t have a self, of course, you feel empty because there’s nothing there. As I keep saying, there’s nobody home. There’s nobody there. It’s a hole of mirrors. It’s empty space. There’s a continuum of experiences from a sense of incompleteness, vagueness, a search for one’s being to a psychotic conviction of actual personal extinction or non-existence, which is not common in borderline.

That’s why borderlines keep searching for something, searching for meaning, searching for the truth. They go from one cult insect to another cult insect. They follow role models and thought leaders and public intellectuals. They try to discover themselves via numerous therapies, conventional and alternative.

They’re constantly on a lookout and a search can but describe that patients with identity diffusion experience various forms of emptiness, depending on the pathological structure of the personality.

He said, for example, patients with schizoid personality experience the emptiness as an innate quality that makes them different to other people. There’s a bit of grandiosity here, actually. I’m special. I’m unique. I can never be understood by other people.

The experience of emptiness is related to phenomena such as apathy and anhedonia, as I mentioned, in these patients, in schizoid patients. In patients with a narcissistic personality, the feeling of emptiness is characterized by strong feelings of boredom and restlessness. And this is a result of the potential lack of gratification from other people.

In other words, deficient narcissistic supply.

This, by the way, is also common to psychopaths.