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The theory of borderline psychopathology is complex and can be difficult to incorporate initially. A young woman with a case history and clinical presentation consistent with borderline psychodynamics and a clnical diagnosis of borderline personality disorder (APA, 1980) was seen in consultation recently. She reported a nightmare that illustrates in an exemplary and pedagogically useful fashion several key components of the psychodynamic theory of borderline psychopathology. The theory and the patient's case history, clinical presentation, and nightmare are discussed below.
Adler (1985) says the developing infant must internalize “holding-soothing” caretakers to maintain a feeling of security when separated from them. He goes on to say “the absence of goodenough mothering … whether because of unavoidable traumatic separation, inconsistency of supportive presence, aversive anger, or purposeful abandonment” (p. 27) prevented such “holding-soothing” introjects from becoming a stable part of the borderline person's psychic structure. This absence sets the stage for the central “need-fear” conflict of the borderline person: Lacking stable “holding-soothing” introjects, the person experiences an intense need for caring others and their absence is a threat of complete annihilation. Unfortunately, this threatening need is coupled with unconscious oral rage regarding the traumatic early relationships and accompanying unmet security/dependency needs. In turn, this rage engenders a panicking fear of destroying the essential desired and hated object in a fury of oral incorporation. In defense, the person psychically withdraws from the object and is left with a pervasive sense of “inner emptiness.”
This “need-fear” conflict and its attendant difficulty in modulating distance and closeness to significant others mark the borderline's failure to adequately resolve the separation-individuation developmental subphase and achieve complete object constancy. By definition, the person with