 Anyone with borderline will tell you that she switches between whole identities. She doesn't feel herself in various states. And before I proceed, borderline personality disorder is equally diagnosed nowadays in women as in men. I'm using the female pronouns because the vast majority of scholarly literature, either to, had focused on the manifestations of borderline personality disorder in women. And yes, I think this is a form of gender bias and sexism in psychiatry and psychology. Having dispensed with this disclaimer, this walk politically correct disclaimer, let us proceed. Borderlines switch between what looks to be completely different personalities and identities. It is eerily reminiscent of multiple personality disorder today called dissociative identity disorder, but there are of course very important differences. Anyone living with a borderline will attest that borderlines switch, especially when they feel rejected, humiliated, abandoned or, on the very contrary, engulfed, assimilated, merged and fused with a love object. They tend to switch. I described all this in terms of self-states. And no, I regret that I am not the one who came up with this idea. It was Philip Bromberg. Philip Bromberg was the first to conceptualize and propose the idea of self-states rather than a coherent, unitary self. Borderlines, like everyone else, have self-states, but there is something very important, different about borderline. In addition to self-states, they have identity disturbance and internal emptiness. And today, in this video lecture, I'm going to discuss both of these concepts. This lecture is a CIAPS, Center for International Advanced and Professional Studies lecture, part of the new syllabus on human sexuality and personality disorders that I have spent three years compiling. My name is Sam Baknin. I'm the author of Malignant Self-Love, Narcissism Revisited. I'm also a professor of psychology and very well acquainted firsthand with borderline personality disorder and narcissistic personality disorder, sometimes on the receiving end. Okay, Shoshaneem, time to delve in and plunge in and get immersed in the Sam Baknin horror show. Until 1980, with the Diagnostic and Statistical Manual 3, borderline personality disorder was considered a form of schizophrenia. It was called pseudo neurotic schizophrenia. The ICD-8, the International Classification of Diseases, which is the world's DSM, the DSM outside North America, mainly European, so the ICD-8, edition 8 and the ICD-9 stated that schizophrenia, and I'm quoting, entails a fundamental disturbance of personality that involves its most basic functions. Those that give the normal person his feeling of individuality, uniqueness, and self-direction. These experiential self-disorders were called pseudo neurotic schizophrenia. It was Otto Kanback, who had suggested in the 1970s that some patients are on the border between neurosis and psychosis. Psychosis is a fancy term for losing it, so they were on the border between neurosis and psychosis. That's why he called them borderlines, but people don't know that the original conception of borderline included what today we call psychopathy and narcissistic personality disorder. In short, delectable characters, people you want to spend the rest of your life with. Okay, Leink, who was a controversial iconoclastic psychiatrist, described the experiences of what he called schizoid, schizophrenic borderline cases. He described their experiences as a lack of autonomous identity, personal consistency, and temporal continuity. They usually experience their self, he said, as disembodied, not connected to their bodies. They feel empty, unreal, dead, and differentiated from the world. So well into the end of the 20th century, there was no real distinction between borderline personality disorder, schizophrenia, schizoid personality disorder, and schizotypal personality disorder. Leink said, these patients are unable to sustain a sense of self as persons, which is why they are equally unable to experience neither separateness from nor relatedness to other people in a usual way. They may fear losing their identity in a relationship as well as feel dependent on the other for their very being in existence. That's an excellent description of borderline, although Leink was actually talking about schizophrenia. In 1918, Diagnostic and Statistical Manual Edition 3, there was a very extensive description of identity disturbance, which was later mysteriously removed from consequent editions. It said, identity is manifested by uncertainty about several issues relating to identity, such as self-image, gender identity, long-term goals of career choice, friendship patterns, values, and loyalties. Example given, who am I? I feel like I am my sister when I am good. The Diagnostic 3 continued to elaborate. It said that identity is the sense of self, providing a unity of personality over time. Prominent disturbances in identity or the sense of self are seen in schizophrenia, borderline personality disorder, and identity disorder. And yet, not a single edition of the Diagnostic and Statistical Manual bothered to define what the heck is a self. When the Diagnostic 3 had been revised when a text revision was issued, they added this, marked and persistent identity disturbance manifested by uncertainty about at least two of the following, self-image, sexual orientation, long-term goals of career choice, type of friends' desire, and preferred values. Fast forward to the Diagnostic and Statistical Manual Edition 5, published nine years ago, 2013, and they ventured a little into the territory of reforming the diagnostic criteria. They didn't dare go all the way because of pressure from the pharmaceutical and insurance industries, but they kind of hinted at what they call the alternative model of personality disorders, page, I think, 766. And this is what they had written, what they have written in the Diagnostic and Statistical Manual Edition 5. Identity, markedly impoverished, poorly developed or unstable self-image, often associated with excessive self-criticism, chronic feelings of emptiness, dissociative states, and distress. Self-direction, instability in goals, aspirations, values, or career plans. And then they defined identity as the experience of oneself as unique, with clear boundaries between self and others, stability of self-esteem, and accuracy of self-appraisal, capacity for and ability to regulate a range of emotional experience. Again, there was no definition of what is a self. In the International Classification of Disorders, they say that there are disturbances in and uncertainty about self-image, aims, internal preferences, including very important sexual preferences. So this is identity disturbance. 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 self-soothing with rampant unboundary, 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, allotropic identity disorders. It's when there are two or three variants of the same person and there is an alternation between the subject to stress-source, 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 disturbance and finally there's object-related identity disturbance. 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 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 a spouse or intimate partner is the center of her life, the next day is the center of a twister. So this is object-related identity disturbance. 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 for getting 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 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. Of 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. Criterion, 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. There 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 of 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 Ricard suggested a typology, or not typology, but let's say a deconstruction of personal identity. He said that personal identity is a triangle. There is what he called idem identity, sameness, ipsa 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 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 megamaster of human personal development, the guy who brought it all together in my view, Ericsson described the 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 the group's ideals and identity. Kernberg is the one who introduced a self-concept. Kernberg said that it's the integration of representations of the self, but it's not clear. Did Kernberg mean to discuss a person's beliefs about himself or herself, beliefs that she can verbalize, thematize, I don't know, express, or was he referring actually to sub-personal unconscious dispositional structures that only occasionally became actualized as a belief about oneself, I don't know, for example, talking to me in therapy or treatment. So that part remained unclear. Go back three decades, from Kernberg to Deutsch. Deutsch had written a seminal article titled Some Forms of Emotional Disturbance and Their Relationship to Schizophrenia. It was published in Psychoanalytic Quarterly, or Psychoanalysis Quarterly 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 shape shifts and morphs. There's a famous movie by Woody Allen, Zeleg. Zeleg is a chameleon, he kind of shape shifts. 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 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 sub-personal 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 of significant others. These people, 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, bipolar, antisocial personalities, impulse-ridden, 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, 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. Anyway, 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 thinks, 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 hyperreflexivity. In other words, a blurring of the lines between external and internal objects. So I think borderlines are, 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, void, which many patients describe spatially, like in space. They do this with their 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 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 deep personalization. The feeling that you are not you, that you are 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 are 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 a 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 whole of mirrors. It's empty space. And so 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 and sect to another cult and sect. 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. So 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. And so the cutting edge knowledge we have, the latest thinking on the topic in contemporary phenomenology, philosophy, cognitive science, we think there's a distinction between a narrative self in a core or basic or minimal self. The core self is the first personal manifestation of all experience. It's how you experience yourself in the world in you. This experience is never anonymous. It manifests as my experience. It's identified with a core, with a self, with a conviction of continuity and constancy, across time with what Rikko called idem identity, the sameness. Experiencing articulates itself in a first person perspective. That's why we use the word, the pronouns I, me, myself. Experience is always first-hand. And this is a persistent, an experience gives us a persistent feeling, a persistent sense of self-presence and self-sameness to use Ericsson's term. This is the healthy, the healthy type of core self. So it's a core self is a sense of self-coincidence. The privacy of our inner world and a kind of boundary or demarcation between me and not me. A unity of body and mind, psychosomatic unity or what we call embodiment in clinical terms. An experience of existing in a special way, a combination of being and becoming, having begun in or around birth and liable to extinction with death, but transforming in the middle in ways which never negate the core. So the core is the foundational fundamental layer. And on this layer we have the narrative self. The narrative self is an outcome of socialization and acculturation. It's largely about language. It's wholly about interacting with other people. It's story about you in the world, you with others. The narrative self implies to use Recur's term the who. Who are you? Well, I'm introverted, I'm ambitious, I'm friendly. These are all outgoing descriptions. Descriptions that have no meaning. If you were left alone in the whole world, in a post-apocalyptic world, you're the only human being, these descriptions have no meaning. You can never have a narrative self. It's questionable whether you can have a core self. The object relations school in the 1960s also believed that you cannot have any kind of self without object relations, without interactions with other people. In normal experience, the structure and the content of experience are interwoven, intermingled, entangled. The structure of experience does not become an object of reflection or object of experience, it just happens. You're just in it. You are it in many ways. The distinction is artificial. But when you go to patients with borderline personalities or you observe patients with schizophrenia, there are structural disturbances of self-experience, distortions of first-person perspective. There's an incomplete sense of substance, substantiality, embodiment. There's a feeling of having divorced your own body sometimes. There's a femoral sense of self-presence. Very often these patients describe themselves as not here or I was just observing myself or an out-of-body experience kind of. So the disturbance of the structural level of selfhood and instability of basic subject-world relation also manifests as a disturbance of narrative features, including interpersonal functioning, emotional regulation, direction in life. What I'm trying to say to the uninitiated is that emotional dysregulation in borderline personality disorder is an outcome of identity disturbance. Contrary to what a few scholars say, I think the opposite. I think the directionality is from problems in identity formation to problems in regulating emotions and not vice versa. The disturbance of the narrative level of the selfhood is not in itself a structural problem. It's not a major problem. If you're confused about your career choice or you're impulsive or you're unfriendly or you're extroverted and introverted, it indicates some identity diffusion, but there's no problem in differentiating yourself from others. The demarcation, the boundary between self-presence and others is perfectly okay. But when the core identity is disturbed, when the core identity is ruptured and you have identity fragments, self-states, pseudo-identities, sub-personalities, ego-states, as they are called in some schools, when you're not constellated as Jung said, when you're not integrated, there is no host, there's no center, there's no pivot, there's nobody there to regulate your emotions and cognitions actually. So you have cognitive distortions and you have emotional dysregulation. The criterion of chronic feelings of emptiness is also an outcome of identity disturbance. Of course, if you have no identity and no core, there's no one there and you would feel empty. I would like to refer to a few recent articles that have attracted my attention. Let's start with an article titled Autobiographical Memories, Identity Disturbance and Brain Functioning in Patients with Borderline Personality Disorder. An fMRI, Functional Magnetic Resonance Imaging, studying on this issue. It was authored by Bosatello, Movesse and others and it was published in Helium Volume 5, March 2019. The authors say identity disturbance is a core feature of borderline personality disorder. Autobiographical memory is a process of reflective thinking through which we form links between elements of life and elements of self. It can be considered as an indirect index of identity integration. With reference to the Condition Resolve, Condition of Identity Disturbance, when it's resolved, when it's ameliorated, they found increased cerebral activity in certain areas of the brain, an area known as ACC, the anterior cingulate cortex. And they also find enhanced activity in the right medial prefrontal cortex and the right dorsal lateral prefrontal cortex and bilateral insular. All these were registered in BPD patients and not in controls. Clearly, in borderline, there is some abnormality of functioning in the brain as we had suspected for a long time. When the identity disturbance is not resolved, again, borderline brain differs to normal brains. There is increased brain activity in these patients in the bilateral ACC, bilateral DLPFC and right temporal parietal junction. Hyperactivity in ACC and DLPFC in borderline patients with both conditions, in other words, fluctuating between resolved disturbance and unresolved disturbance, is due, maybe due, to an inefficient attempt to reconstruct a coherent narrative of life events. So this is the neurological background. Let's proceed to another article published in Psychiatry Research Vol. 271, January 2019. And it's titled, Facets of Identity Disturbance Reported by Patients with Borderline Personality Disorder and Personality Disorder Comparison Subjects over 20 years of prospective follow-up. This longitudinal study, this kind of study is very valuable. It was authored by Muhammad A. Gadda, Hannah E. Packer, your mind is in the gutter, get it out, Catherine E. Hein and others. And the highlights are, patients with other personality disorders reported less identity disturbance over time than patients with borderline personality disorder. The recovery status in borderline personality disorder is significantly associated with a decline in negative identity. For three out of four inner states, recovered patients had higher rates of decline in this problem of negative image or negative identity. Feeling evil or bad showed a steeper decline in the case of non-recovered patients. So that's good news. It means negative self-image and the resulting disturbance to identity tend to decline with age in both types of patients who haven't recovered and patients who have recovered. The abstract is interesting. It says, participants were followed and reassessed every two years for a total of 20 years of follow-up. Borderline patients reported levels of these states that were more than three times higher than personality disorder comparison subjects, with both groups demonstrating significant declines in these states over time. The good news. For three out of these four inner states, I feel like I'm worthless, I feel a complete failure and I feel like I'm evil, recovered borderline patients had lower baseline scores and significantly different patterns of decline than non-recovered patients. When it comes to the fourth state, I feel like I'm a bad person, recovered patients had lower scores over time, but the groups declined at the same rate, even non-recovered borderlines, got rid of this perception of being a bad object, a worthless object. These results say the authors suggested borderline patients report experiencing inner states related to having a negative identity less often over time. Additionally, recovery status is significantly associated with decreased time experiencing these states. A very interesting article, at least intellectually and philosophically, if not clinically, was published by Maya Zanderson and Joseph Parnas. It's titled Identity Disturbance, Feelings of Emptiness and the Boundaries of the Schizophrenia Spectrum. It was published, where else, in the Schizophrenia Bulletin, Volume 45, issue 1 January 2019. And here's what they say. Historical and current research on borderline personality disorder reveal certain affinities with Schizophrenia Spectrum Psychopathology. This is also the case for the borderline criteria of identity disturbance and feelings of emptiness, which reflect symptomatology frequently found in Schizophrenia and Schizophrenia personality disorder. Unfortunately, the diagnostic manuals offer limited insight into the nature of this criteria, including possible deviations and similarities with Schizophrenia Spectrum Symptomatology. In this article say the authors, we attempt to clarify the concepts of identity disturbance and feelings of emptiness with an emphasis on the criteria's differential diagnostic significance. Drawing on contemporary philosophy, we distinguish between a narrative self and a core self, suggesting that this distinction may assist differential diagnostic efforts and contribute to mark the psychopathological boundaries of these disorders, Schizophrenia, as opposed to borderline personality disorder. Fascinating article, which would lead you to conclude, and I think correctly, that there are very, very fuzzy and permeable boundaries between borderline and non-sacistic disorders of the self, psychosis and Schizophrenia, including Schizophrenia light, like Schizotypal personality disorder and Schizoid personality disorder. Onward Jewish soldiers to the Journal of Personality Disorders, Volume 35, Supplement B. The article is titled The Junction of Clinical and Developmental Science, Associations of Borderline Identity Disturbance Symptoms with Identity Formation Processes in Adolescence. Very critical topic with borderline and the identity disturbance attendant upon borderline, associated with borderline, resulting in clinical features and symptoms of borderline. All of them start in early adolescence, between the ages of 10 and 13, most commonly 12 to 14. This article, Timely article, was authored by Shona Mastro-Kambo, Melanie Zimmery-Gembeck, and Amanda Duffy, published in June 2021. And this is what they have to say. Developmental scientists describe the raw confusion that can occur for adolescents as their forming personal identity. Clinical psychologists describe low sense of self-worth, lack of self-clarity, feelings of emptiness and dissociation as the key elements of identity disturbance. To give this to borderline personality disorder, emptiness stood out as the strongest correlate of borderline symptoms. Youth, young people, reporting greater emptiness, when nearly twice as likely to report a high borderline symptom profile. So it seems that emptiness and identity disturbance are between engines that lead later to full-fledged borderline pathology and to full-fledged narcissistic pathology. Narcissistic pathology is a more egregious stage, a more egregious form of the borderline pathology. That's why Grossstein suggested that borderlines are failed narcissists. Borderlines are children who didn't progress with their mental illness as far as narcissists. They stopped midway and they became borderlines. Narcissism is extremely close to psychosis and schizophrenia. It could easily be conceived as a post-traumatic state that leads inexorably and under prolonged stress and abuse, from complex trauma to a disintegration of the personality, a sense of emptiness that are indistinguishable, literally, from schizophrenia, schizotypal personality disorder, schizoid personality disorder and of course psychosis. This is all emerging in current literature and current debates and I encourage you to read, to download and read the articles that I've mentioned. They are available on scholar.google.com Scholar, S-C-H-O-L-A-A-R .google.com Just type in the titles of the articles which are available in the description of this video down and you will be rewarded with fascinating read. Living with a borderline with a person with borderline personality disorder and I have had my share of such experiences is harrowing. It's harrowing because you constantly have to mourn and grieve the person who is not there. This absence, this fluctuating, shimmering mirage and this process of grieving and mourning affects you and if you are also mentally ill and if you also suffer from identity disturbance there is a resonance and amplifying resonance between these two identity disturbances. There is a confluence and congruence of the emptiness of your borderline partner and your own emptiness. It becomes the equivalent of a massive black hole at the center of an illusory galaxy. Some kind of a swirling vortex that threatens to digest and assimilate and swallow you and never spit you out. This experience could be addictive because both the borderline and her typically narcissistic partner try to appropriate the other person's identity as a self and a medicine to their own identity disturbance and knowing emptiness, howling void. They try to annex each other, to digest each other to merge with each other so as to form a complete person but the outcome is never a complete person. The outcome is more of the same exponentially so. This is the sadness. This is the frustration. This is the maddening recurrence and repetition compulsion at the core of the narcissistic borderline couple. And here I refer you to Johan Lachkar. Johan Lachkar's pioneering work on the topic and she's about to publish a new book with the Rookledge about this but she had pioneered the film. It is by far the most agonizing experience imaginable because through the borderline you get annihilated you get disintegrated and you can't save her you can't help her you can't be her you can't provide her with surrogate or vicarious or or by proxy existence she doesn't have her own and so she can't get it from the outside of course and so if you have a fixer and savior type if you're the healer type there is no experience more horrible even in therapy this inability to reach and touch something because there's nothing there is between terrifying and and maddening in the sense it can drive you mad, drive you crazy. It's not for the faint hearted you need to be very centered and very grounded to live with the borderline or with the narcissists emptiness identity disturbance personal discontinuity and so the show goes on you find yourself living with a kaleidoscope of people a circus a panoply a smuggler's board and every morning you get up and you're not sure who is in bed with you who is sharing your life it's the closest one gets to a horror movie