Journal of Personality Disorders, 20(6), 577–596, 2006

 2006 The Guilford Press

EGO IDENTITY AND PERSONALITY DISORDERS

James E. Marcia, PhD

Although “identity disturbance” is part of the DSM-IVR defining criteria

for one of the personality disorders, borderline, the relationship between
identity and the personality disorders is not immediately obvious. The per-
sonality disorder (PD) categories are based upon clinicians’ observations of
clusters of behaviors, usually without regard to etiology or developmental
course (Heim & Westen, 2005). The general approach is atheoretical. Iden-
tity, as it is most frequently understood in the developmental psychology
literature, is an empirically validated theoretical construct. It is assumed
to have its earliest origins in infancy, reaching its crucial period at late
adolescence, and continuing to develop throughout the life cycle (Erikson,
1963, 1968; Marcia, 1998). The purpose of the DSM PD categories is to
diagnose patients for dispositional, medico-legal, and therapeutic pur-
poses. The central scientific concern is the reliability of categorization.
Less attention is paid to the construct validity of the labels. In contrast,
identity is a construct within a psychodynamic, developmental model of
personality. The main purpose of such a construct, and the theory in
which it is embedded, is to furnish a coherent picture of human personal-
ity development. Issues of developmental history, current status, and de-
velopmental course are paramount. The central scientific concern is with
the construct validity of concepts (such as identity) within the theory. Reli-
ability is important with respect to measures of the theoretical concepts,
but it is a means to the end of establishing the constructs’ validity.
Combining approaches such as psychodynamic developmental theory
and ego identity research and applying them to current categorizations
of personality disorders is a difficult and somewhat scientifically dubious
endeavor, given their differing origins and purposes. However, there is suf-
ficient potentially common ground to make the effort an interesting, if not
wholly satisfying, one. For example, in earlier diagnostic schemes, person-
ality disorders were referred to as “character disorders,” having typical
patterns of ego defenses with hypothetical developmental antecedents.
(Heim & Westen, 2005). For example, obsessive-compulsive persons were
assumed to experience difficulties stemming from the anal/urethral period

From Department of Psychology, Simon Fraser University.

The author thanks Dr. Janet Strayer for her helpful comments on earlier drafts of this paper
and Dr. Simon Hearn for his lecture notes on personality disorders.
Address correspondence to James E. Marcia, #1003-1100 Harwood St., Vancouver, B.C.
Canada VGE 1R7.

577
578 MARCIA

(around two years old) when issues of autonomy, shame, and doubt are
predominant (Erikson, 1963). And, indeed, adults diagnosed as obsessive-
compulsive (OCD) PD’s do exhibit difficulties in decision-making, acting
directly and decisively in willed directions. They are plagued with self-
doubt and haunted by the prospect of being shamed—in the eyes of others
and of themselves. These phenotypic similarities provide a starting-point
for causal research, but, of course, they do not by themselves, constitute
validity for the presumed developmental antecedents. In order to do that,
one must construct reliable and valid measures of OCD in adults, reliable
and valid measures of disturbance at the anal period, and then trace the
course of difficulties through the developmental stages between 2 years
old and early adulthood. That is, through the oedipal—Initiative, latent—
Industry, adolescent—Identity and early adulthood–Intimacy psychosex-
ual and psychosocial periods. To my knowledge, no such research has
been undertaken. Nor, given what seems to be both the current disfavor
into which “grand theories” seem to have fallen, as well as the financial
and career pressure on young researchers, is such research likely to be
undertaken by individual investigators. This is more a task for research
institutes such as (Pulkkinen & Kokko, 2000; Fadjukoff, Pulkkinen, &
Kokko, in press) capable of gathering and analyzing large-scale life cycle
data. What one would hope is that if such efforts were grounded in some
theoretical foundation, then broader and more efficient treatment proce-
dures would ensue.
In the absence of such systematic research, what we do, largely, is to
weave developmental “stories” about how a particular personality disorder
might have developed and then construct treatment programs based upon
these stories. In this process, we are not as unknowledgable as it would
seem. We do have the research that has been done, however unsystematic,
as well as our own and our colleagues’ accumulated experience. We know
that judicious “expressive” techniques are likely to be more useful for emo-
tionally constricted OCD’s than for histrionic or borderline persons who
are all too much in touch with their feelings (Shapiro, 1965; Linehan,
1993).
What I shall discuss in this article is Erikson’s view of identity develop-
ment, the identity statuses (differing forms of identity resolution), the de-
scription and differentiation of the concepts of ego, self, and identity, and
the hypothesized relationship of identity to the personality disorders—
focusing especially on the borderline category.

EGO IDENTITY DEVELOPMENT

The most important aspect of Erikson’s approach to identity is its defini-
tion as an ongoing developmental process. Identity is the fourth of eight
psychosocial stages extending from infancy through old age (Erikson,
1963; Marcia, 1998). Each stage reaches its ascendancy during a broadly
EGO IDENTITY 579

defined chronological period (e.g., the stage of Basic Trust—from birth to

toddlerhood; Generativity during middle adulthood, etc.) and is assumed
to have somatic, psychological, and social aspects, as well as a historical-
cultural context. Also, because the theory is an epigenetic one, each stage
has both predecessors and legacies, so that what might appear to be an
8-stage theory is actually a 64-stage one. For example, there is an Identity
issue beginning in infancy when Basic Trust is predominant, as well as
old age, when Integrity is paramount. Identity is most important at late
adolescence because this is the first time that all of the necessary compo-
nents for Identity are present. Identities formed before that time are partial
and constitute the stuff out of which the late adolescent identity structure
is formed. Identities following the late adolescent one are assumed to be
variations (sometimes very extensive, sometimes very circumscribed) on
the original late adolescent theme.
Identity formation at adolescence is the result of a synthesis of earlier
identifications that, in the most optimal cases, transcends the content of
any one specific identification. A constructed, as contrasted with a con-
ferred, identity is the result of an exploratory, self-reflective, and integra-
tive process wherein the individual attempts to make the best fit between
self-perceived abilities and needs and available societal niches. The areas
within which this exploratory process occurs include at least occupational
choice and ideological stance. Another (under-researched) aspect of iden-
tity is an individual’s “style”—the particular way in which one goes about
“doing” one’s life projects and “being” in the world. A musical analogy
would have “style” refer to aspects of performance that go beyond notes
and rhythm, that encompass individual expressions of dynamics, phras-
ing, etc. “Style” will become important later in this article in the discussion
of the personality disorders as possible, albeit severely limited, identities.
Adolescence is an especially crucial developmental period because it con-
stitutes the transition between childhood and adulthood. As the individual
stands on the threshold of shifting from one-who-has-been-cared-for to
one-who-is-to-care-for-self-and-others, the need to decide upon occupa-
tional directions and to shift world outlooks becomes pressing. In fact,
combining the social/psychological aspects noted above with the cognitive
and physiological changes also occurring during adolescence, one can see
why adolescence is so widely considered a period of vulnerability and dis-
equilibration.
The use of the term “disequilibration” above is intended in the Piagetian
sense as motivating the formation of cognitive structures (Piaget, 1963),
and identity is conceived of as a personality structure (Marcia, 1980).
From a broadly psychodynamic perspective, it is seen as the fourth in a
developmental series of personality structures including ego, self, and su-
perego. That this identity structure coalesces around late adolescence has
important implications for a developmental view of personality disorders.
Erikson, in a number of writings, remarks upon the importance of refrain-
580 MARCIA

ing from labeling adolescents in pejorative legal and psychiatric terms. “If,
for simplicity’s sake or in order to accommodate ingrown habits of law or
psychiatry, [societal representatives] diagnose and treat as a criminal, as
a constitutional misfit, as a derelict doomed by his upbringing, or indeed
as a deranged patient, a young person who, for reasons of personal or
social marginality, is close to choosing a negative identity, that young per-
son may well put his energy into becoming exactly what the careless and
fearful community expects him to be—and make a total job of it” (Erikson,
1968, p. 196). Hence, calling an adolescent “a borderline,” or “an obses-
sive-compulsive,” or “a schizoid” may have the effect of fixing prematurely
a pathological identity in an adolescent already vulnerable to external defi-
nition and lacking sufficient ego strength to resist adopting others’ labels.

THE IDENTITY STATUSES

Identity, then, from the ego developmental perspective, is viewed as a per-
sonality structure reaching its initial configuration at late adolescence and
undergoing successive modifications via the processes of disequilibration,
assimilation, and accommodation (or re-synthesis) throughout the life cy-
cle. Four modes of identity resolution, the identity statuses, make their
initial appearance at late adolescence. The identity statuses are ways in
which a late adolescent might be found to be dealing with the issue of
identity formation. The criteria for these four descriptive categories are
based upon the two processes of exploration and commitment in impor-
tant life areas, including occupation and ideology. They are: Identity
Achievement (exploration undergone and commitments made); Foreclo-
sure (no exploration, but adoption of commitments conferred from child-
hood); Moratorium (exploration current and commitments generally broad
and tenuous); and Identity Diffusion (desultory or no exploration, and no
firm commitments). Extensive research has been undertaken on these
constructs which has established their validity empirically, and by exten-
sion, validity for identity within Erikson’s theory (Marcia, Waterman,
Matteson, Archer, & Orlofsky, 1993). Some of the implications of these
identity statuses for personality disorders are discussed briefly below.

FORECLOSURE

Except for Identity Achievement, there is a fairly wide range of “mental

health” within each of the identity statuses. Well-functioning Foreclosures
may present as stable, although rigid, and reasonably intact, although
somewhat cognitively constricted. At the more pathological extreme, they
may be highly authoritarian (left or right, religious or anti-religious) and
may verge on the paranoid—projecting onto others those unacceptable as-
pects of themselves that cannot be incorporated within their circum-
scribed and unexplored identities. The likely source of their rigidity and
reluctance to explore is their underlying self-doubt and their vulnerability
EGO IDENTITY 581

to shame. This largely unconscious sense of shame and doubt is reacted to

with unrealistic self-assuredness and a reluctance to acknowledge failure.

MORATORIUM

Typically, Moratoriums, currently in some form of identity crisis, appear

as vital, struggling, engaging, and intense. More pathologically, they may
manifest thought disorders, depression, self-destructive acting-out, and
histrionic behaviors. Moratorium is usually a transitory state, but, be-
cause of its characteristics of uncertainty and vulnerability, it can be
pushed into pathological directions by the premature labeling referred to
above. It is at this developmental point that clinicians, while they cannot
responsibly overlook self-destructive behavior, need to be cautious in over-
pathologizing this normative, although painful, developmental period. An
identity crisis (whether at late adolescence or subsequently in the life cy-
cle) is an understandable, expectable and, to some extent, desirable event,
what can cause such an identity-disequilibrating period to go awry is the
lack of a supportive and confirming context. Support and confirmation
here do not refer to the contents of the identity struggle, but to the neces-
sity and validity of the struggle itself.

IDENTITY DIFFUSION

It is within the category of Identity Diffusion that the widest range of

adaptability, and most serious forms of psychopathology, exist. At the
most positive level, Diffusions, because they have no firm commitments,
are flexible and capable of responding readily to rapid societal changes.
However, this very “flexibility” gives them an undependable quality. Be-
cause they do not know where they stand, no one else knows either. With
sufficient ego strength, this kind of “playboy/girl” Diffusion can appear to
adapt well to a fast-moving technological society—especially if they pair
up with an Identity Achievement or Foreclosure partner who can give their
lives at least some external structure. The more pathological forms of dif-
fusion are the avoidant “loner,” the schizoid, and borderline personality
disorder. The “loner” shuns social contact, preferring solitary activities
that preclude social contact and potentially hurtful rejection and shame.
All the while, of course, craving desperately just that acceptance and rec-
ognition that could come only through such contact and connection. Hav-
ing been interpersonally burnt early on, this Diffuse person abstains ac-
tively from just those situations that would provide for identity-confirming
and supportive experiences. Schizoid Diffusions would appear to be either
long-term avoidant persons become “peculiar” as a result of their pro-
longed isolation, or individuals with some genetic predisposition to such a
position. The issue of Identity Diffusion and borderline personality disor-
der (BPD) will be the topic of the next section of this paper.
582 MARCIA

IDENTITY DIFFUSION AND BORDERLINE

PERSONALITY DISORDER
One of the DSM IV R defining criteria for BPD is “Identity disturbance:
markedly and persistently unstable self-image or sense of self” (American
Psychiatric Association, 2000). Note that identity and self are treated here
almost as if they were synonymous. This conflation of terms appears in
many writings. Treating the two concepts as equivalent can lead to confu-
sion in understanding the relative roles of each in BPD. Similar to the
DSM, Kernberg (1975; 1984) also cites Erikson’s concept of “identity diffu-
sion” in discussing BPD. He relates this diffusion to what he sees as the
fundamental problem in BPD: splitting between positive and negative rep-
resentations of the self and others (Kernberg, Selzer, Koenigsberg, Carr, &
Appelbaum,1989; Westen and Cohen, 1993). It is this failure to integrate
good and bad self and good and bad other into unified senses of self and
other that leads to constantly shifting representations of self and others
and produces, in psychotherapy, the therapist’s disturbing experiences of
projective identification. Rather than treating self and identity as syn-
onyms, I shall argue later that there is much to be gained both conceptu-
ally—and, hence, empirically—and especially therapeutically, from keep-
ing these two concepts within their separate theoretical domains.
Juxtaposing statements from Erikson (1968, pp. 165–188) concerning
severe identity confusion with Westen and Heim’s (2003) summary de-
scriptions of BPD based upon Kernberg (1975) and Akhtar (1984), one
could legitimately question whether or not BPD is more than severe iden-
tity confusion.

Westen and Heim (all p. 65) Erikson

“a lack of consistently invested
goals, values, ideals and relation-
ships”
“a lack of continuity of relationships
that results in the loss of shared
memories that contribute to a co-
herent sense of self over time.”
“a tendency to make temporary hy-
perinvestments in roles, value sys-
tems, worldviews, and relationships
that ultimately break down and
lead to a sense of emptiness and
meaninglessness”
“Without some such ideological
commitments . . . youth suffers a
confusion of values which can be
specifically dangerous to some [per-
sons] . . . ” (p. 188)
“Where youth does not resolve such
strain [of intimacy], he may isolate
himself and enter, at best, only
stereo-typed and formalized inter-
personal relations, or he may. . . .
Seek intimacy with the most im-
probable partners.” (p. 167)
“When the human being . . . loses
an essential wholeness, he restruc-
tures himself and the world by tak-
ing recourse to . . . totalism.” (p. 81)
EGO IDENTITY 583

“gross inconsistencies in behavior “Symptomatically, this state con-

over time and across situations that
lead to a relatively accurate percep-
tion of the self as lacking coher-
ence”
“a lack of coherent life narrative or
sense of continuity over time”
“difficulty integrating multiple rep-
resentations of the self at any given
time”
sists of a painfully heightened sense
of isolation; a disintegration of the
sense of inner continuity and same-
ness; a sense of overall ashamed-
ness; an inability to derive a sense
of accomplishment from any kind of
activity.” (p. 168)
“Identity formation, finally, begins
where the usefulness of identifica-
tion ends. It arises from the selec-
tive repudiation and assimilation of
childhood identitifications and their
absorption into a new configura-
tion. . . .” (p. 159)

Noting these correspondences, the question arises as to the distinction

between a severe identity crisis that can be part of a Moratorium process
or a pathological and continuing state of Identity Diffusion, and borderline
personality disorder. The phenotypic similarity among these has been to
some extent reinforced in research by Wilkinson-Ryan and Westen (2000).
They constructed a questionnaire based upon Marcia’s (1987, 1993) and
Erikson’s (1963, 1968) ideas about identity and found that four identity
factors, especially “feeling of painful incoherence,” discriminated patients
with BPD from those with other personality disorders and those with no
personality disorders. The question remains, however, as to the differences
between BPD and identity disturbance. Is BPD nothing more than a “se-
vere identity disturbance?” In order to begin to answer this question, it is
necessary to make theoretical distinctions among those personality struc-
tures I assume to be important in BPD: ego, self, and identity. Further-
more, having done this, it is possible to suggest a developmental course
that could illustrate why BPD and identity might be linked, but not synon-
ymous.

EGO
Freud (1961) described the ego as a personality structure emerging from
the conflict between individual desires and impulses and external, and
internalized, societal constraints and prohibitions. Hartmann (1958),
among others, attributed more, and earlier, capabilities to the ego than
did Freud. Within Hartmann’s ego analytic psychology, the roots of ego
are postulated to be present at birth and not derivative from, nor wholly
dependent upon, conflict for development. Rapaport (1959) succinctly de-
fined the essential nature of ego in functional terms as “mechanisms of
delay and products of delay.” Erikson (1963), following Anna Freud’s
(1946) pioneering concept of developmental lines of ego development, went
584 MARCIA

on to specify stages of ego growth throughout the life cycle. So what we

currently have is a concept of ego processes beginning at birth, serving the
most basic function of delay, fulfilling, among others, the tasks of defense,
motor coordination, perception, memory, speech, reflection, and personal-
ity organization (synthesis). The structure ego is assumed to develop and
differentiate throughout the life cycle. The formation of all subsequent
structures (self, superego, and identity) is dependent upon ego processes.

THE OBJECT RELATIONAL SELF

The second developmental concept is the self as described by object rela-
tions theorists, including Mahler (1971; Mahler, Pine, & Bergman, 1975),
Bowlby (1969, 1973), Kohut (1971, 1977, 1984) and others (see Greenberg
& Mitchell, 1983). Although many conceptualizations of the self abound in
psychology, few are developmental, and it is the developmental focus that
concerns us here. Classical and ego psychoanalytic theory hold that per-
sonality is structured by habitual ways in which persons restrain and ex-
press instinctual drives. However, object relations theory views personality
structure as a function of internalized patterns of interpersonal relation-
ships. For classical psychoanalytic theorists, sexual and aggressive drives
are fundamental and relationships are a means to their fulfillment and
expression. In contrast, object relations theorists consider relationships
to be fundamental and the drives as important only because they bring
individuals into relationship with others. Blending the views of the theo-
rists noted above, it is proposed that the self develops from the internalized
and metabolized interactions between self and other, beginning at birth.
That is, from birth, the individual is the participant in innumerable self-
other transactions out of which the eventual precipitate of a self takes
shape (Kohut, 1977). This self takes more definitive shape as a result of
the processes of symbiosis, differentiation, practicing, rapprochement,
and individuation described by Mahler, et al. (1975). The self is then main-
tained and enhanced throughout the life span by the self-object functions
of mirroring, idealizing, and twinship described by Kohut (1977). The re-
sults of these processes are both a structure, the self, as well as internal
working models or representations of self-other interactional expectations
as discussed by Bowlby (1969) and Main, Kaplan, & Cassidy (1985).
One might ask at this point: “What is responsible for the relating, inter-
nalizing, metabolizing, and transmuting that is essential for the formation
of the self?” I think that this is the ego process discussed previously. It is
at this point that psychoanalytic theory (both classical and ego) and object
relational theory usefully coincide. Both of these theoretical perspectives
seem necessary to account for the formation of a self. If ego processes are
impaired, then an impaired self will result. If the self is impaired or frag-
mented, further ego development will be hampered because the individu-
al’s very sense of being will be tenuous and easily threatened. The implica-
tion of the foregoing is that ego functions are fundamental to the formation
EGO IDENTITY 585

of a self. They furnish the adaptive social interactional skills that are the
scaffolding for the organization and consolidation of the self-structure. At
the same time, it is necessary to recognize that the development of both
these ego processes and of a self are dependent from the very beginning
upon a certain quality of attuned relationships. That is, the ego processes
necessary to form the self are dependent for their optimal functioning
upon the attuned attentiveness of caretakers.

EGO IDENTITY
The third personality structure under consideration is identity. As stated
previously, Erikson (1963) sees identity as being formed during late ado-
lescence when the individual is faced with the psychosocial task of making
the transition from childhood to adulthood. Identity, optimally, is an indi-
vidually-constructed sense of who one is, based upon who one has been,
and who one can realistically imagine oneself to be in the future. Our re-
search (Marcia, et al., 1993) on identity formation suggests that identity is
constructed by means of exploration of alternatives and subsequent com-
mitments in important life areas, as well as the synthesis of previous iden-
tifications as described by Erikson (1963). Of the three personality struc-
tures under consideration here, identity is the most externally-oriented,
the most subject to the social and political conditions of one’s time. The
ego roots of identity are clearly spelled out by Erikson in the stages of ego
growth preceding identity formation: viz., Basic Trust, Autonomy, Initia-
tive, and Industry. What has not been so clearly delineated by the ego
psychologists are the self roots of identity. It is apparent from Erikson that
identity is the sense of who one is. The self, by contrast, because it is basic
to one’s very sense of being, furnishes the ongoing awareness that one is,
that one exists. Hence, just as ego processes are necessary but not suffi-
cient for the formation of a self, so the self may be said to be a necessary,
but not a sufficient, condition for the formation of an identity. Once an
identity has been formed, it constitutes a powerful organizer of experience
and a lens through which reality is made meaningful. Identity is not only
a theory about oneself, but operates as a set of feelings, beliefs, and guides
for individual direction through life.

THE DEVELOPMENTAL COURSE OF SELF AND IDENTITY

The development of a self and of an identity occur at different points in the
life cycle. The formation of a self is an event, initially, of infancy and early
childhood. The individual at this time is differentiating from the original
“dual unity,” recognizing one’s existence separate from the mothering
(caregiving) person. This differentiation becomes more advanced with loco-
motion when, as Erikson says, the child can “walk and walk away.” The
task of the young child is to be able to endure this separation by develop-
ing a sense of what Mahler refers to as emotional object constancy. That
586 MARCIA

is, the attachment figure is sensed as existing when no longer in sight

(evocative memory), and later on, as a comforting and soothing internal
presence (an introject). Finally, this introject is replaced as a separate dis-
tinguishable figure by a secure sense of self. As Mahler puts it, physical
birth precedes by several years the “psychological birth” of the infant,
which takes place only after emotional object constancy has been
achieved, permitting further differentiation and development of self.
From an Eriksonian perspective, the formation of an identity is an event
of late adolescence when childhood identifications with parental figures
become less serviceable as the person stands on the threshold of adult-
hood. Ideologies and occupational dreams formed in childhood must un-
dergo modification for the assumption of adult tasks. Blos (1962) refers to
the adolescent period as a second separation/individuation period. Even
though there are pre-figurations of identity existing at earlier psychosocial
periods, it is at adolescence when all of the physical, sexual, cognitive, and
social expectational ingredients are sufficiently developed in order to make
identity formation possible.
Neither the initial self nor the initial identity is the final self or the final
identity. Both structures undergo subsequent development during the life
cycle. The self grows because of absences, losses, or threatened losses ex-
perienced in the context of supportive self-objects. It is based upon rela-
tionships whose representations must be internalized because of the anxi-
ety occasioned by the absence of attachment figures in tangible proximity.
One does not have to internalize what one is confident will always be pres-
ent, but only what is, or may be, absent and not contactable. It may be
said, then, that the self is strengthened in adult life to the extent that one
has loved and lost significant others and has internalized representations
of one’s relationships with them. Identity expands and deepens as one un-
dergoes identity crises subsequent to adolescence due to the disequilibra-
tion of one identity structure after another by life events (Marcia, 1999).
Still, within what appears to be a context of constant change, a thread of
continuity persists. One is both the same and different from whom one
has always been.

SUMMARY
Three interrelated personality structures were discussed: ego, self, and
identity. Ego processes are fundamental and necessary conditions for all
further structural development. Moreover, given an intact organism and
“average expectable conditions,” ego processes will develop and differen-
tiate according to an epigenetic ground plan that interacts with so-
cial-historical reality. The development of the self in early childhood is de-
pendent upon ego processes and consists of internalized and metabolized
representations of self-other interactions. The coherence of the self de-
pends upon attunement of early caretakers, and it undergoes ongoing de-
velopment throughout the lifespan in the context of mirroring, idealizing,
EGO IDENTITY 587

and twinship self-object relationships. Identity is a psychosocial task of

adolescence and proceeds according to an individual’s awareness and in-
tegration of previous childhood identifications. Specifically, an identity is
formed out of a synthesis of commitments to life directions, those commit-
ments having been preceded by exploratory periods. Both exploration and
commitment are linked to a society’s openness to individuals searching
among alternatives and its provision of a confirming context furnishing a
variety of possibilities for viable commitments. Like the development of the
ego and the self, identity development is a life-long process, initiated by
incidents of disequilibration of an existing identity structure, and resolved
by subsequent explorations and new commitments. Both self and identity
are structures proceeding from maturing ego processes. Their develop-
ment, especially after adolescence, is parallel and reciprocally enhancing.
Because the self is fundamental (i.e., it establishes the person’s very exis-
tence as an individual), and is developmentally prior (early childhood) to
identity, it constitutes a necessary, but not sufficient, condition for the
formation of an identity at adolescence.

IDENTITY DEVELOPMENT AND PERSONALITY DISORDERS

Westen and Heim (2003) describe personality disorders as “enduring ways
of thinking, understanding [one]self and others, regulating . . . impulses,
and interacting with other people” (p. 650). Personality disorder is defined
in the DSM (DSM-IV; American Psychiatric Association, 1994) as “an en-
during pattern of inner experience and behavior that deviates markedly
from the expectations of the individual’s culture, is pervasive and inflexi-
ble, has an onset in adolescence or early adulthood, is stable over time,
and leads to distress or impairment” (p. 629). Erikson, in describing iden-
tity, refers to it as “. . . a configuration gradually integrating constitutional
givens, . . . idiosyncratic libidinal needs, . . . effective defenses . . .) (p.
163), also occurring around late adolescence. The emphasis in these three
descriptions is on the enduring nature of both personality disorders and
identity as personality structures. The difference, of course, concerns the
breadth of facets synthesized, the degree of integration, and the openness
of the structure to change.
If one recalls what was written previously in this article concerning the
importance of style, a particular way of being in the world, as an identity
element, it is possible to consider personality disorders as kinds of identi-
ties. One may make a virtue, an identity, of one’s necessity, one’s more or
less integrated defensive structure. The histrionic person may insist that
their emotional storms are simply “being honest.” The obsessive-compul-
sive individual can prize “being cautious, thoughtful, and consistent.” The
schizoid personality can take refuge in valuing “solitude, creativity, and
introspectiveness.” One could construct similar portraits of “virtues” char-
acterizing each of the personality disorders. That is, one becomes what
one must because of one’s particular array and organization of defenses
588 MARCIA

and then identifies with this pattern and asserts it—and defends it—as
being “who they are.” What can disquilibrate this PD-as-identity-struc-
ture, besides psychotherapy, is its impact on others with whom the person
is, or would like to be, in some kind of relationship: friend, lover, employer,
parent, etc. However, because a PD is not a “chosen” identity but one
adopted by default, by necessity, it is particularly resistant to change. In
this sense, it is very much like a Foreclosure identity that is most often
externally conferred and adopted as one’s own. Foreclosed identities are
usually formed and maintained for defensive reasons; viz., the shame,
guilt, and/or anxiety associated with exploration and the questioning of
external and internalized childhood authorities. They are especially diffi-
cult to modify as the individual ages and is more subject to their own and
others’ expectations of consistency. Personality-disorders-as-identities
may also be resistant to change because of their defensive function and
the anxiety that would be occasioned by their dissolution. Because adoles-
cence is a naturally-occurring period of instability and de-structuring, it
can be a fortuitous occasion for the modification of a potential PD-based
identity.
When Erikson uses the word “versus” to describe the psychosocial is-
sues (e.g., Basic Trust vs. Mistrust, Identity vs. Identity Diffusion) he
means to connote a dialectic: a time of particular vulnerability as well as
particular opportunity. For the person with a childhood pattern of de-
fenses predisposing him/her to a personality disorder (Cicchetti, 1991),
adolescence provides either the chance to change direction or the danger
of solidifying old maladaptive patterns. Hence, context in which the indi-
vidual “adolesces” becomes crucial. This context can support positive
growth and furnish new directions, or it can label the adolescent pejora-
tively and fix the person in a constricting or negative identity. To quote
Erikson: “. . . there remains always the decisive question whether, . . . an
identity confusion of the paranoic type [for example] is to be taken as a
case of paranoia that happens to occur in youth or as a disposition for
paranoia aggravated by acute identity confusion, which is relatively re-
versible if the confusion can be made to subside” (1968, p. 179). Because
so much of normal adolescence mimics some of the borderline diagnostic
criteria, it is particularly important to maintain this diagnosis tentatively
for youth. The goal is not to create borderlines by facile or expedient label-
ing, but to provide a therapeutic context that may intervene in a process
that looks as if it might be headed in a pathological direction. Adolescents,
because their identities are in flux, are particularly vulnerable to labels
that might be affixed, especially by legal authorities or mental health agen-
cies. All too often, the young person would prefer to become something
negative (“a delinquent,” “a borderline,” etc.) than to be nothing. And then
to become that with a vengeance.
The impact on identity formation of the attitudes, behaviors, and feelings
underlying almost all of the personality disorders is similar: they deprive
individuals of experiences of themselves and the world that are crucial
EGO IDENTITY 589

in order to undergo genuine exploration and make informed and viable

commitments. The persons with disorders in the odd or eccentric cluster
(schizotypal, schizoid, and paranoid) keep themselves at such a distance
from others that they cannot realistically test out their skewed assump-
tions about others and use these data to locate themselves accurately in
their interpersonal world. They are fearful of exploration and their choices
for commitments are then, necessarily, highly circumscribed. Once made,
if made, they are very resistant to subsequent change.
Individuals in two of the dramatic, emotional, or erratic cluster—histri-
onic and borderline—are so dominated by their emotions that no strong
identity commitment can long be maintained. Because they are unable to
give thoughtful consideration to alternatives and are thus at the mercy of
strong but transitory feelings, they find no stable place from which to pro-
ceed towards a planful future. For some of these persons, external neces-
sity (e.g., wartime, forced cultural shift) can provide an organizing and di-
recting context. However, once these conditions no longer exist, they find
themselves again in thrall to their emotions.
Narcissistic individuals can undergo exploration and make commit-
ments, but their subsequent choices are always more contingent upon ap-
plause than upon an introspective assay of abilities and needs and a genu-
ine search for viable niches. Some antisocial persons are too impulse-
dominated to bother with the encumbrance of an identity which might
require them to forego immediate gratification of some desire. Others may
adopt an antisocial identity and be supported in this by the criminal jus-
tice system. Part of the difficulty in determining the relationship between
identity and antisocial personality lies in the confusion between this cate-
gory and psychopathy (see Hare & Hart, 1995). Probably all psychopaths
are likely to engage in persistent, and ego-syntonic, illegal behavior and,
hence, be labeled as antisocial; however, not all persons meeting at least
3 of the DSM-IV criteria for antisocial personality would necessarily be
called psychopaths. By definition, the confirming context for the identity
that an antisocial person might form will be circumscribed and incongru-
ent with the general society.
Persons in the anxious or fearful cluster (obsessive-compulsive, avoid-
ant, and dependent) have often eschewed exploration long before adoles-
cence. Characterizing all of these individuals is a painful self-conscious-
ness. “Self-consciousness . . . is a new edition of that original doubt which
concerned the trustworthiness of the parents and of the child himself—
only in adolescence, such self-conscious doubt concerns the reliability of
the whole span of childhood which is now to be left behind and the trust-
worthiness of the whole social universe now envisaged. The obligation now
to commit oneself with a sense of free will to one’s autonomous identity
can arouse a painful over-all ashamedness, somehow comparable to the
original shame and rage over being visible all around to all-knowing
adults—only such shame now adheres to one’s having a public personality
exposed to age mates and to be judged by leaders (Erikson, 1968, p. 183).
590 MARCIA

And further, “The display of a total commitment to a role fixation . . . as

against a free experimentation with available roles has an obvious connec-
tion with earlier conflicts between free initiative and Oedipal guilt in infan-
tile reality, fantasy, and play” (Erikson, 1968, p. 184).
In terms of the identity statuses discussed previously, one would most
likely find schizotypal, schizoid, histrionic, borderline, avoidant, and de-
pendent persons at the less adaptive levels of Identity Diffusion. Narcissis-
tic persons might also fall here unless they have hit upon commitments
that are successful crowd-pleasers. However, because so much of the nar-
cissist’s emphasis is upon appearance, aging is a particular problem, and
may lead in old age to self-disgust and despair, no matter how viable an
identity had been formed previously. Obsessive-compulsive and paranoid
persons are most likely to be at less adapative levels of Foreclosure, rigidly
“rationally” defending their entrenched positions, relatively impermeable
to disequilibration and change. In this respect, they are just the opposite
of diffused, histrionic, and borderline individuals who are all too suscepti-
ble to change and, hence, lack of commitment (see also Shapiro, 1965).

IMPLICATIONS OF THEORETICAL CLARITY

FOR PSYCHOTHERAPY WITH BORDERLINES
Although all of the personality disorders and their childhood antecedents
have implications for identity formation, it is the borderline category that
is most often associated with identity disturbance. However, closer exami-
nation of this linkage reveals identity disturbance of a different order than
that displayed by most identity diffuse late adolescents. A case history may
be useful here.
Mary Ann was 23, sweet-faced, quite overweight, often dressed in dull-
colored coveralls. Her most dramatic symptoms were self-injury (cutting
and burning herself with a curling iron), dissociation (which took the form
of “going little”—e.g., speaking in the voice of a three-year-old), and mood
swings (from a hypomanic extremely “capable” self-presentation) to a dis-
traught, depressed, and helpless “vulnerable” presentation). She had been
sexually abused by her father when she was a child and her mother re-
fused to believe this. As a child, she had been made to feel responsible for
both parents: to be her father’s wife and to be her mother’s confidante and
companion. When I began seeing her, she had nearly completed college
and was on full-time disability, living in a therapeutic group home for
women.
Our first year of sessions was punctuated by frequent instances of silent
regression during which she would curl up in her chair and stroke a
stuffed animal that she carried with her in her knapsack. There were nu-
merous emergencies in her everyday life: burning, cutting, threats of over-
doses, dissociative episodes so severe that she once had to be “talked”
home by me via cell phone. Projective identification in our sessions took
the form of her casting me as either all-nurturing and omnipotent or with-
EGO IDENTITY 591

holding and useless. Her relationships with others were likewise charac-
terized by extreme black/white, good/bad perceptions. As with most bor-
derlines, the difficulty in therapy was maintaining a steadily caring stance
in the face of the onslaught of emotional projections.
Although she did have identity problems, ranging from diverging and
contradictory belief systems (e.g., fundamentalist Christianity vs. femi-
nism and gay rights), occupational confusion (becoming a counseling psy-
chologist vs. caring for animals), her difficulties were at a more fundamen-
tal level of ego processes and self-integration. She had periods when she
could not think clearly; her head, she said, “felt like mush,” and she even
had difficulty walking, having to think about just putting one foot in front
of the other. These regressive episodes were almost always initiated by
relationship crises, which were frequent and severe. She had instances of
self-fragmentation when she doubted both her own and my existence. She
had difficulty remembering my face from session to session, and was not
wholly certain of my being alive unless she could see or hear me—hence,
frequent umbilical telephone calls. Concurrent with these dramatic swings,
she could appear extraordinarily insightful and empathic. One of her most
apt descriptions of herself was that she was carrying around “a parent-
sized hole.” Once, when looking back on an especially difficult regressive
period, she said, “I don’t want you to think this is all of who I am”—clearly
an identity statement.
Even though Mary Ann had obvious identity problems, it would have
been a mistake to treat her as a young adult who merely had difficulty in
identity formation. Her problems were at a much earlier developmental
level; identity diffusion was just the inevitable outcome of these prior prob-
lems. One cannot establish a coherent identity without a secure sense of
self. If one reserves the concept of identity formation for adolescence, as I
am advocating here, then, with borderline personalities, one has a ratio-
nale for targeting interventions at the more appropriate levels of ego pro-
cesses and self-integration. Most of my efforts with Mary Ann were di-
rected towards being a realistically holding-soothing self object (Adler,
1985), interpreting the negative transference and leaving most of the posi-
tive alone (Kernberg, 1975). My goal was that, over time, she would inter-
nalize, metabolize, and integrate our interactions into a more solid sense
of self. At the same time that I was treating her largely from an object
relational/self psychological perspective, she was also involved in a dialec-
tical behavioral therapy (DBT) program. This approach, developed by Mar-
cia Linehan (1993) involves learning techniques of emotional control in a
group setting. Construed in psychodynamic terms, DBT helps patients to
acquire skills (e.g., delay mechanisms) that will lead to the strengthening
of ego processes.
Psychotherapy with Mary Ann proceeded along two separate but related
tracks: 1) strengthening of ego processes via skills learning in order to
moderate emotionally-driven behavior and thereby forestall regressive epi-
sodes (a kind of “outside” approach); and, 2) providing conditions for the
592 MARCIA

integration of a fragile self via a holding-soothing mildly interpretive thera-

peutic relationship (a kind of “inside” approach). After two years of treat-
ment, Mary Ann had moved out of the initial group home, as well as a
second one, and was living in her own apartment. She had re-entered uni-
versity. Her cutting and burning behavior had decreased substantially (to
about twice a year) and her almost daily periods of dissociation had de-
creased to about once a month, occurring around her menstrual period.
Her relationships were somewhat improved, and she was learning how to
stay with a potential friend even if the person was not available exactly
when and how she wanted them to be. However, these close relationships
were still subject to good/bad splitting. She will be in therapy for some
time. As the work progresses, I think that it can become less of a structur-
ally reparative nature, both of ego and self, and can begin eventually to
focus more on identity and relationship issues.
I have discussed the case of Mary Ann in order to illustrate the different
developmental structural levels that I described previously: ego, self, and
identity. Until ego processes are sufficiently intact, there is little chance of
remaining in a self-integrative relationship long enough to build a self sta-
ble enough to avoid fragmentation and regression. Once a secure self be-
gins to be established, then issues of identity can be addressed. Even
though “identity diffusion” may be a diagnostic criterion for BPD, it is not
a useful developmental level at which to treat. Any more than one would
treat a smallpox patient dermatologically, even though bubos are a promi-
nent sign of the disease. This raises the question of the therapeutic useful-
ness of including “identity diffusion” as one of the hallmarks of BPD. If
identity diffusion is inevitable given the more basic structural difficulties,
and if one cannot realistically treat at the identity level, its inclusion has
limited value for directing the early, and most important, stages of psycho-
therapy with borderlines.
Some support for the therapeutic dubiousness of including identity dif-
fusion, as it is defined developmentally by Erikson and Marcia, in a de-
scription of BPD, is found in one of the few research projects undertaken
to investigate the relationship between BPD and identity disturbance. Wil-
kinson-Ryan and Westen (2000) isolated four identity factors: role absorp-
tion; painful incoherence (subjective) ; inconsistency in thoughts, feelings,
and behavior (objective); and lack of occupational and ideological commit-
ment. Although all four identity factors distinguished BPD patients from
patients with other personality disorders and from patients with no per-
sonality disorder, the “painful incoherence” factor was the most discrimi-
natory. The lack of commitment factor was the least discriminatory. If one
were to choose one of their factors most reflective of difficulties at the level
of self structure, “a subjective sense of painful incoherence” would be the
most likely candidate. Similarly, the factor closest to our definition of iden-
tity diffusion would be “lack of commitment.” Hence, although borderline
persons do lack a sense of a stable identity, this is not the most fundamen-
EGO IDENTITY 593

tal level of difficulty, and “unstable identity” could be more accurately and
usefully designated as a fragmented self.
In attempting to disentangle concepts of “identity” and “self,” it does not
help that these terms are often used synonymously by even the most so-
phisticated researchers, theorists, and practitioners. The problem exists
in the DSM-IV-TR (American Psychiatric Association, 2000) defining crite-
ria for BPD: 301.83 (3) “identity disturbance: markedly and persistently
unstable self-image or sense of self.” Similarly, in discussing Kernberg’s
conceptualization of Borderline Personality Organization, Westen and
Heim (2003) state: “. . . . Patients with BPO suffer from a lack of integra-
tion of self-representations, for which Kernberg (1984) uses Erikson’s
term, ‘identity diffusion’ . . .” (p. 651). Probably the most sophisticated dis-
cussion of the roles of self and identity in borderline pathology is found in
the work of Drew Westen (Westen, 1991; Westen & Cohen, 1993; Westen
& Heim, 2003; Heim & Westen, 2005). Even here, though, “self” is treated
as “self-representation” and there seems to be a reluctance to speak of self
and identity as separate personality structures.
My reason for wanting to differentiate these concepts, beyond issues of
theoretical and empirical clarity, is that such a discrimination has thera-
peutic implications. Although issues of self and identity do get touched
upon when working primarily on an ego psychological level (e.g., DBT),
they are more directly approached through more accurately targeted inter-
vention techniques. While the ego strengthening methods employed in a
group setting by DBT practitioners may impact the remediation of a faulty
self-structure, this is more effectively done in a one-to-one context that
permits the internalization of a positive self-object as a cornerstone for a
secure self. Likewise, identity development, especially in late adolescents
or emerging adults, is probably best approached via counseling techniques
aimed at resolving a psychosocial stage-specific issue (Marcia, 1994). From
an Eriksonian perspective, the distinction I would make between counsel-
ing and psychotherapy is that counseling focuses on the resolution of a
psychosocial issue at its age-appropriate time (e.g., Identity at adoles-
cence, Intimacy at young adulthood). Techniques could involve client-
centred, solution-focused, or cognitive behavioral methods. Psychotherapy
aims at remediating previously unresolved psychosocial issues (e.g., Au-
tonomy [a developmental issue of toddlerhood] at adolescence, or Trust [a
developmental issue of infancy] at young adulthood). Treatment would
likely consist of psychodynamic methods. Counseling deals more with
contemporary, age-appropriate stage resolution; psychotherapy concerns
itself more with previously unresolved psychosocial issues which are a
pre-condition or co-condition for current stage resolution. What I am sug-
gesting is a kind of three-pronged approach to treatment of BPD. Ego
strengthening via methods like DBT; repair of self via self psychological/
object relational individual psychotherapy; and, when these two have been
accomplished, identity development via psychological counseling methods.
594 MARCIA

By considering separately the three structures of ego, self, and identity,

one can target interventions accurately and appropriately.

CONCLUSION
What I have emphasized here is the importance of theory and related re-
search in understanding personality disorders as categorized taxonomi-
cally in the DSM. While this paper is not intended as a critique of the DSM,
it is intended as a warning and an encouragement. What I would caution
against is taking a purely taxonomic approach that runs the danger of
treatments being targeted to specific symptoms, when the issues underly-
ing those symptoms may have a complex developmental history, knowl-
edge of which would be useful in formulating more effective treatment
plans. I would encourage using language carefully, not treating terms such
as self and identity synonymously, when, in fact, they derive from different
theoretical perspectives and have different treatment implications. To this
end, I have proposed that the concept of identity be located and discussed
within the framework of Erikson’s psychosocial developmental theory,
rather than conflated with the concept of self. I have suggested that differ-
ent identity statuses may be related to particular personality disorders
and that personality disorders, in general, impede identity formation by
limiting the experience necessary to undergo meaningful exploration and
maintain viable commitments. Finally, I have argued that identity distur-
bance in borderline patients is secondary to the problems of a debilitated
ego and a fragmented self.

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