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Kernberg, O. (1968). The Treatment of Patients with Borderline Personality Organization. Int. J. Psycho-Anal., 49:600-619.
    

(1968). International Journal of Psycho-Analysis, 49:600-619

The Treatment of Patients with Borderline Personality Organization

Otto Kernberg

Introduction

This is the third in a series of papers about borderline personality organization. In the first (1966), I suggested that there exist two levels of ego organization resulting from the degree of synthesis of "identification systems." The term "identification systems" was used to include introjections, identifications, and ego identity as a progressive sequence in the process of internalization of object relationships. The organization of identification systems takes place first at a basic level of ego functioning at which primitive dissociation or "splitting" is the crucial mechanism for the defensive organization of the ego. Later, a second, more advanced level of defensive organization of the ego is reached, at which repression becomes the central mechanism replacing splitting. Splitting can be defined, in this restricted sense, as the active process of keeping apart identification systems of opposite quality.

I also suggested that patients with so-called "borderline" personality disorders present a pathological fixation at the lower level of ego organization, at which splitting and other related defensive mechanisms predominate. The persistence of the lower level of ego organization itself interferes with the normal development and integration of identification systems and, therefore, also with the normal development of the ego and superego.

In the second paper of this series (1967), the term "borderline personality organization" for these conditions rather than "borderline states, " or other nomenclature, was used because it appears that these patients present a rather specific, quite stable, pathological personality organization rather than transitory states on the road from neurosis to psychosis, or from psychosis to neurosis.

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