How problems with identity underlie BPD and other personality disorders
“I used to spend hours when I was a kid just looking in the mirror, trying to figure out if I was handsome or not. It just depended on the day. If someone told me I was handsome, then I was handsome, and if someone told me I was ugly, then I believed that. I hardly ever look in the mirror anymore though, not if I can help it. It’s just too stressful.”
When Dane de Haan (as Jesse) appears for his last session in the HBO series "In Treatment", it’s a shock both for the audience and for his therapist. He arrives with Angelo, his adoptive father – a man with whom we feel he has little in common – at least from what we know of Jesse through his therapy. His therapist struggles to remain neutral in the face of this backflip – and Jesse’s choice to quit therapy. As viewers who have followed Jesse through his exploration of independence, we are also flummoxed - and disappointed, that this young man chooses to abandon therapy and what we might see as a search for his ‘true self.’
Part of his struggle is in trying to come to terms with his attachments, both biological and adoptive. Having “tested out” his biological parents by turning up at their home under the influence of drugs and asking them for money, he rejects them on the basis that they appear to have rejected him. Jesse’s step-father Angelo is waiting in the wings to provide reconciliation and the acceptance that the young man craves. Jesse is seduced by this acceptance, even though we feel it comes at too high a price. His unstable sense of self is at risk, especially given Angelo’s scepticism about therapy and that he has disparaged his wife as part of his growing closeness with Jesse. These indicators provide evidence of an unhealthy tug-of-war for Jesse’s allegiance and affections that has little to do with allowing the real Jesse to emerge.
But just what is our true self?
The idea of identity is a fascinating one - who we are, what we believe in, what we value and how we manage our relationships in the context of holding onto a stable self-image. Identity is the way we picture ourselves and keep a sense of our needs, desires, ideas and thoughts consistent through time. It gives us a solid base from which to explore the world and relate to others. Without it we are at risk of being influenced too much by those around us, and by the external world.
For adolescents and young people, identity is a common arena of struggle and achievement. It is something that can preoccupy young people to a greater or lesser degree, without necessarily being a sign of illness.
Dramatic turns such as Jesse’s are uncommon, but there are times when young people will try on different ways to be themselves, join different peer groups, adopt different personas, and explore different interests. For example, they may go from being a sporty early teen who enjoys the outdoors and an easy physicality, to a moody and sullen emo, wearing black and hiding in their bedroom. It can be a pretty confusing time for parents.
“Consolidation of identity is one of the most central tasks in normal adolescent development…Despite experimentations with different roles, the experience of the self remains consistent across situations and across time, forming an integrated identity that is both flexible and adaptable. It is this core sense of identity that permits the maturing adolescent or young adult to develop rewarding and satisfying friendships, form clear life goals, interact appropriately with parents and teachers, establish intimate relations, and maintain positive self-esteem.”
From Adolescent Identity Treatment
In exploring the idea of identity it can be useful to look at what happens when things go wrong.
Personality disorders like BPD and NPD are seen by theorists as primary disorders of the self where the formation of identity has somehow been derailed.
“Some adolescents struggle with this process [of identity formation] and have a loss of capacity for self-definition, experience a painful sense of incoherence and chronic emptiness, exhibit contradictory behaviours, have poor anxiety tolerance and impulse control, and lack commitment to values, goals, or relationships.”
But what does that look like in the real world?
Problems with identity can manifest in both subtle and more concrete ways.
We might meet someone or have a friend who seems very different every time we see them - they might seem to hold one view of themselves at one time, but a contrasting one in a different context. If we disagree with them, they might feel rejected or negated, becoming hostile or adversarial in the face of a challenging difference.
It can often be very hard to maintain a relationship with people who have an unstable sense of identity. They have difficulty with the “long view” of relationships and will react strongly to perceived slights or rejections. You are either “in” (the most wonderful friend in the world) or “out” (the worst of the worst). It doesn't take much to tip them over.
BPD can make people hard to live with.
People with this problem often appear to be unpredictable, because they don't have that core of stability to guide them through the ups and downs of life and the social world. They can also be volatile, highly influenced by the external environment - if those around them don't reflect back what they want, expect or need, they may become angry, or demanding. And, depending on how important we are to them, they may lash out, take revenge, or dissolve in tears that can leave us feeling guilty, confused or frustrated, which may in turn, escalate their distress. This is why carers and people close to those with BPD often feel like they are treading on eggshells, fearful of triggering an outburst.
Looking at the theory behind personality disorders and identity formation can help us understand adolescence as the second major crisis of the self (the first being the age of “practicing” when an infant starts to crawl). From toddlerhood onwards, every "no" or temper tantrum, every slammed door or disobedient challenge to the authority of parents is really an attempt to assert the self and “individuate,” continuously testing out the possibility of self in the face of relationship - is it safe to be me and still be close to someone - will they still love the real me?
Those are the questions to which we absorb the answers in our early childhood. That doesn't mean that we should indulge our child's every whim, which would be just as damaging as a constant and arbitrary rejection. It is more a question of remaining consistent and validating our children's emotional states even if we need to say "no" to them.
In his theory of psychosocial development, Erik Erikson describes eight stages which he sees as psychosocial conflicts. All individuals must resolve them successfully in order to adjust well to the environment and mature into well-balanced adults. The period of adolescence (13-21 years) is seen as a conflict between “Identity and Role Confusion” (or diffusion). Crisis at this stage may be brought about by expectations from young people themselves and from people around them (parents, peers, romantic partners or valued friends). It can also be the result of earlier failures in the developmental pathway. According to Erikson’s theory, not having navigated any period securely leaves us with unfinished tasks, and we bring these unfinished tasks forward into the succeeding stages as emotional "liabilities" or vulnerabilites that can get us into trouble, perhaps leading to more serious illness as we mature.
An adolescent who is struggling with self will oscillate between attempts to please those around them, rebellion and rejection of previously held values and ideas, and adoption of identities or personas that appear contradictory, inconsistent – and fragile. Their relationships will often be fraught, and their moods unstable (beyond normal teenage moodiness). They will often be highly anxious and their ability to withstand negative feedback or rejection is usually quite poor. They just don't have the core of self-esteem or self-worth to carry them through the upheavals of adolescent development. It can be a tough road for young people who find themselves without that core stability and it’s not an easy fix.
Catching it early is the best way to help, but it can take a lot of hard work in therapy to restructure the personality (if there is a disorder present) – and not something that everyone is up for. Of course, it’s not something that can be diagnosed very easily either – it’s a long term problem that needs to be assessed over time. No young person is likely to come to therapy saying that they want to work on with their identity!
But problems with identity may lie underneath many of the more serious behavioural issues that parents and young people struggle with, and treating the symptoms alone may not have a lasting impact. In the end, psychotherapy is never a quick fix and serious problems such as BPD and other personality disorders require long-term solutions.
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References: Adolescent Identity Treatment: An Integrative Approach for Personality Pathology by Foelsch, P.A., Schlüter-Müller, S., Odom, A.E., Arena, H.T., Borzutzky H., A., Schmeck, K.)
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