Structural Derivatives of Object Relationships1

This paper began with the observation of some peculiar defensive operations in patients suffering from severe character disorders and so called 'borderline' conditions (Knight, 1954). There is a kind of 'selective' impulsivity shown by many borderline patients, especially those suffering from 'acting out' character disorders with some borderline features. I am referring here to the observation that the apparent lack of impulse control of these patients is often of a particular, selective kind. Some patients may present very good impulse control in all but one area. In this one area, there may exist rather than lack of impulse control, alternative activation of contradictory manifestations of the patient of such an impressive nature that one comes to feel that there is a compartmentalization of the entire psychic life of the patient. For example, a patient showed constant switching between severe fears in regard to sexual activity at times and an impulse ridden sexual behaviour at other times, both alternating conditions being temporarily ego syntonic during their respective appearance. Another patient appeared to be lying 'impulsively' at times; at other times he gave the impression of feeling guilty or ashamed of lying, and insisted that lying was no longer a problem for him and angrily accused other people (the therapist) of lying. What was striking was the complete separation of the times the 'impulsive' lying occurred, from the times the patient remembered the lying but would feel no longer emotionally connected with it and, on the contrary, was strongly convinced that lying was not or no longer part of his psychic reality. This patient presented good impulse control in other areas of his life, and it finally appeared that both the lying and the 'anti-lying' episodes were psychic manifestations of one global, rigid characterological pattern.

In more general terms, in these patients there was an alternating expression of complementary sides of