Levels Over Labels: The Borderline Personality Organization
The clinical consequences of borderline personality are consistent.
Posted May 4, 2026 | Reviewed by Gary Drevitch
Part 2 of a two-part series. Click here for part one, "How Borderline Personality Begins"
Whether the origins lie in rapprochement failure, overt trauma , or their interaction, the clinical consequences of borderline personality are consistent: not having a sense of a coherent self leads to pervasive difficulties as the child grows into adulthood. The inability to maintain an internalized view of others as both good and bad means that those in the person’s orbit are split into either an idealized or vilified other, and these splits can vacillate quickly, leaving the other feeling whiplash due to the rapidity of the changing view of them (Kernberg, 1975; Stern, Caligor, Hörz-Sagstetter, Clarkin, 2018). These adults experience a primary fear of abandonment , as a reflection of the internalized abandoning, rejecting, or neglectful mother, and yet they are furious at those close to them for all manner of disappointments, whether real or projections of childhood hurts. These patients are often full of rage that belongs to childhood and reflects the failure to integrate anger and love. The inevitable disappointments of imperfect others activate projections of the bad mother, and because of this tension between fear of abandonment and rage at loved ones, the experience becomes one of rapidly alternating clinging and hostility (Kernberg, 1975; Adler Buie, 1979).
This anger is sometimes felt to be too dangerous to express outwardly. Instead it can be expressed against the self – in behaviors such as restricted eating or binging and purging, self-harm or self-mutilation , suicide attempts, substance abuse , or sexual impulsivity – though some of these behaviors, particularly self-harm, may function less as self- punishment and more as self-soothing, resolving dissociated states through pain or releasing unbearable tension. Such behavior can create intense shame , which often rapidly converts to rage. For other individuals at the borderline level, rage is directed outwards towards others, and patients with a borderline organization and narcissistic or antisocial character traits can be perpetrators of sexual, family, or relational violence as they succumb to their transference projections of the all-bad mother, father, or important other. Their rageful fantasies tend to include elements of omnipotent fantasies of control, with sadistic elements (punishing the “bad” other) and masochistic elements (unconsciously provoking the very abandonment they fear) (Kernberg, 1975). Efforts to control can be felt by others as manipulation (though the manipulation is not conscious), and if admitted to a psychiatric unit, these patients often cause havoc when their efforts to split and control lead to some staff feeling deeply sympathetic for their suffering and other staff feeling strongly manipulated. In fact, both positions are true, and the splitting among the staff is an enactment of the same splitting defense within the patient (Kernberg, 1984).
The primary wish of people organized at the borderline level is to return to Eden — a symbiotic union with the perfect, pre-rapprochement mother who meets all needs without the child having to experience the anxiety of separateness (Mahler et al., 1975; Adler Buie, 1979). This longed-for union is an unconscious fantasy, but it drives an intense desire for closeness in romantic relationships , friendships, and therapeutic relationships. The closeness promises not just comfort but a borrowed sense of identity , filling the emptiness left by identity diffusion (Kernberg, 1975). Yet this wish contains its own contradiction: The very merger that is longed for also threatens to dissolve the fragile sense of self the individual does possess, raising the fear of engulfment. The result is an oscillation — desperate clinging followed by panicked withdrawal or rageful attack — as the individual alternates between the terror of abandonment and the terror of being swallowed (Kernberg, 1975; Adler Buie, 1979). Partners and loved ones, experiencing this as suffocating neediness punctuated by inexplicable hostility, often withdraw, which activates the person’s deepest fear of abandonment, and can make the most feared outcome the reality.
This example is a complement to the example used in the neurotic personality organization article. Someone organized at the borderline level with an obsessional character might be, like the person organized at the neurotic level, rigid, perfectionistic , and detail oriented. At the borderline level his need to maintain order in his environment will not remain confined to his own actions and choices; instead he will insist that his household runs “just so”, and no amount of deviation from his personal rules will be tolerated. Unlike the neurotically organized individual who realizes his issues are his own, here the problems are seen as completely external (Kernberg, 1975; 1984). His spouse and children will quickly learn to fear his wrath if they leave items out of place or make a mess. He will take these actions as personal affronts or attacks and fight back with vengeful diatribes or even violence. The attacks are not about the item left out, or the bit of dirt – but instead the carelessness is experienced as neglectful, unloving, or malevolent – in other words, projections of the “bad mother” (Kernberg, 1975). He might be easily disgusted by germs, dirt, and sexuality , but unlike at the neurotic level, where these feelings are often ego-dystonic, here they are frequently experienced as ego-syntonic, and his reactions as completely justifiable responses (Kernberg, 1984). There may be many rules within the household to deal with the threat of germs and dirt, with no awareness that he is being excessive in his demands. He might expect that his sexual partners shower both before and after sex, and even wash themselves in specific ways. More than about cleanliness, there is an unconscious need to control his partner to be the perfect, pre-rapprochement symbiotic mother. In this way he seeks symbiosis, although it is frequently experienced as domination. These controlling behaviors and rageful attacks often lead to dissolution of his relationships, the very thing he fears most.
At work his need to control others in his environment might initially seem like “decisive leadership ”, but quickly become problematic when his verbal attacks on subordinates escalate as their inability or unwillingness to adhere strictly to his rules accumulate. He may divide coworkers into split objects – friend or foe, and sow divisions among colleagues that create chaos and conflict. This often leads him to become increasingly isolated at work, or fired due to his controlling, hostile behavior.
In therapy , he is likely to feel strongly like other people are the problem. He may only come to therapy after being forced by his spouse or employer. When asked what he would like to work on, he will have trouble naming internal issues, and likely request help in forcing others to “behave properly”. He will use more primitive defense mechanisms like splitting, denial , and projection (Kernberg, 1975; 1984). He will sometimes feel like the therapist is the best in the world and the only person who could ever help him, and other times like his therapist is useless, or, worse, malevolent. This is the same splitting defense that results from the rapprochement failure: The therapist cannot be good but imperfect, only all good or all bad (Kernberg, 1975). The therapy will involve much containment and support to build a capacity to tolerate ambivalent feelings of self and other before more exploratory dynamic work can truly begin (Kernberg, 1984; Winnicott, 1969).
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Irene Hurford, MD, is a psychiatrist and psychoanalyst with over 20 years of experience treating psychosis with both medications and psychotherapy.
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