The Cognitive Perspective

The cognitive style of borderlines may be viewed as the direct result of the split architecture of their object-representations. Regression is evident in their tendency to function well under structured conditions in the presence of a constant object, but to deteriorate to more primitive levels of functioning without structure and without the ensured presence of others. That is, when the presence of significant others is ensured, borderlines often seem to have a more firm hold on reality.

When relationships are threatened, however, their level of ego functioning begins to slip. Secondary process thinking, based on the reality principle, begins to give way to primary process thinking, based on wishes, fantasies, and direct drive discharge. The ability to weigh facts, to consider situations from the viewpoints of everyone involved, to develop a plan adaptive in both the short term and long term, and to keep id impulses from overriding conscious controls begins to give way as the ego functions weaken or are suspended entirely over the course of temporary psychotic episodes. At this level, splitting and its associated mechanisms, such as projective identification, dominate the clinical picture. Such individuals exhibit their needs transparently, appearing clinging, demanding, or rageful, for example, or all three in succession. The tendency to regress to lower levels of ego function has inspired some to term such subjects the psychotic character (Frosch, 1960, 1964, 1970).

The level of borderline cognition is also dependent on the degree of structure in the external environment. Clinicians have long known that borderlines look healthier on structured tests, such as pencil-and-paper personality tests, but less healthy on projective instruments, such as the Rorschach Inkblot Test or Thematic Apperception Test, where the subject invents stories based on pictures. In any projective situation, subjects appeal to their own internal structure to bring order to the interpretation of an ambiguous stimulus. Most human behavior involves the interaction between individual characteristics and situational constraints. Almost everyone stops at a red light; in such highly scripted situations—the social equivalent of a structured test—borderlines are often able to behave in accordance with social expectations. As a result, they often look more competent or healthy than they really are. Because borderlines have little internal structure to bring to unscripted situations, however, they can only project fluidity onto ambiguity. In effect, borderlines borrow the structure of the environment to organize themselves. Without such structure, they can quickly regress to more primitive ego states.

All personality disorders have a certain cognitive style. In the compulsive personality, excessive rigidity is enforced by a preponderance of "should statements." Compulsives must perform to perfection, and anything less is horribly flawed and condemned. Narcissists deserve the endless loyalty and service of others because they are all good and all knowing by definition. The histrionic is excessively impressionistic; nothing is processed in depth. The borderline, however, is distinguished by a fluidity of thought and emotion, and the degree of fluidity is dependent on the quality of relationships and on the amount of structure inherent in task demands. Even the integrated judgments of the more neurotic borderlines are fragile and cannot be sustained under the weight of the intense affect characteristic of regressed periods. Jenny, for example, does not jump from her boyfriend's Jeep when they're getting along; likewise, Elsa's spending spree takes place in the context of marital difficulties. Solid attachments, therefore, foster better judgment.

Other cognitive characteristics of the borderline personality can be deduced from the idea of split object-representations. Many statements or actions that would create intense cognitive dissonance in individuals with an integrated sense of identity do not cause dissonance for the borderline person. Split object-representations are effectively two opposite ways of viewing self, other, and world, any of which may be in effect at any time, depending on the circumstances. Assume, for example, that the actions of a friend summon up images of a controlling and verbally abusive caretaker; the borderline would undeniably lash out in anger. A few moments later, this same friend may somehow be redeemed as the world's greatest friend, depending on the subject's stream of consciousness. By definition, such separate images are deliberately kept apart so that they cannot conflict; accordingly, they cannot cause the subject cognitive dissonance.

When attention is called to such reversals of opinion and action, borderlines usually dismiss these discrepancies with shallow rationalizations and nonchalance. Borderlines cannot be bothered with their own paradoxical behavior.

Another observation of the borderline personality that intersects the cognitive perspective comes from Kroll (1993), who noted that borderlines often appear to be at the mercy of their own stream of consciousness. The identity diffusion of borderlines suggests that they are particularly vulnerable to intrusive thoughts and images, including flashbacks and nightmares. Borderlines do seem to associate from one unpleasant thought to the next, evoking a succession of intense affective states connected only by the private experiences of the person. For example, a new acquaintance might be looked at admiringly until it is discovered that he or she has a particular mannerism that resembles someone in the past with whom the borderline has unresolved issues. Awareness of this similarity may bring to mind morbid memories so intense that the acquaintance becomes a lightning rod for the negative emotions that he or she has unwittingly evoked. To the outside observer, the sequence of emotions seems discontinuous and irrational. In fact, the stream of consciousness simply flows with its own logic, derived from the unique life history of the individual.

For this reason, Kroll (1993) argues that the borderline personality is essentially similar to posttraumatic stress disorder (PTSD), in that most borderlines have a history of early traumatic experiences. Thus, Kroll speaks of the PTSD/borderline, a hybrid entity consisting of individuals whose abuse history has led to cognitive disturbances characteristic of those of posttraumatic stress. He writes that such persons suffer "first and foremost from a disorder of the stream of consciousness" that "has become its own enemy" and cannot be turned off (p. xv). As with PTSD, the cognitive apparatus of the PTSD/borderline has been changed so that the individual is condemned to reexperience the original trauma. Actual images and memories may come flooding back to consciousness at unpredictable moments in whole, fragmented, or distorted forms. In addition, the stream of consciousness consists of "unwelcome somatic sensations, negative self-commentaries running like a tickertape through the mind, fantasied and feared elaborations from childhood of the abuse experiences, and concomitant strongly dysphoric moods of anxiety and anger" (p. xv). Other characteristics, such as unstable identity, intolerance of aloneness, and self-destructiveness, may also be linked to past abusive experiences. From this perspective, the psychodynamic approach is seriously deficient because it emphasizes objects, that is, fantasied projections, rather than the importance of real experiences of abuse.

Writing in Beck et al. (1990), Pretzer regards dichotomous thinking, the chronic use of mutually exclusive categories, as the central cognitive distortion of the borderline personality. By construing the world in either/or terms, borderlines are forced into extreme interpretations that disqualify adaptive responses proportional to situational needs; there are few intermediate responses, few shades of gray, and few qualitatively complex appraisals following a period of detached deliberation. Opinions of self, world, and future tend to be either completely positive or completely negative. As noted by Pretzer (quoted in Beck et al., 1990, p. 186), beliefs formed in this context include, "The world is dangerous and malevolent," "I am powerless and vulnerable," and "I am inherently unacceptable."

By thinking in dichotomous terms, borderlines have little opportunity to make subtle revisions or to elaborate aspects of past opinions in one way or another without completely discarding the original appraisal. This creates a considerable conundrum in living, namely: How do you change your mind? For the borderline, the solution is to switch rapidly from one extreme to its diametrical opposite. Moreover, because affect and cognition are closely connected, borderlines cannot easily vary the intensity of their emotions. Instead, they tend to be intense all the time, but in opposite ways, what observers witness as a succession of intense, random, and irrational emotional states. All of the cases presented in this chapter exemplify such "rigid fluidity."

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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