Journal of Personality Disorders, Volume 30(2), 145-156, 2016

2016 The Guilford Press

KERNBERG
WHAT IS PERSONALITY?

invited essay
WHAT IS PERSONALITY?
Otto F. Kernberg, MD

The concept of personality, in my view (Kernberg & Caligor, 2005; Posner

et al, 2003), refers to the dynamic integration of the totality of a persons
subjective experience and behavior patterns, including both (1) conscious,
concrete, and habitual behaviors, experiences of self and of the surrounding
world, conscious, explicit psychic thinking, and habitual desires and fears
and (2) unconscious behavior patterns, experiences and views, and intentional states. It is a dynamic integration insofar as it implies an organized,
integrated association of multiple traits and experiences that influence each
other, the final outcome of the coordination of multiple dispositions. In this
regard, personality represents a much more complex and sophisticated entity
than simply the sum of all its component features.
Personality derives from the human organisms capacity to experience
subjective states that reflect the internal condition of the body as well as
the perception of the external environment within which this body functions. It includes discrete psychic functions, such as affects, perception, cognition, and instrumental as well as declarative memory, and various levels
of self-reflective functions, from relatively simple mirroring of perceived and
intended motor movements and perceived sensory experiences to complex
self-reflective evaluation of cognitive and affective states.
The combination of the scientific advances in the area of genetic determination of neurotransmitters that activate and regulate various affective states, the observation of interacting relationships between baby and
caregiver from birth on, and the observation of psychological functioning
throughout early development and into adulthood is gradually facilitating an
integrated view of the determinants of personality. The study of brain structures related to affect activation and control, instrumental and declarative
development of memory, and cognitive capacities and the psychodynamic
study of the intrapsychic relationships among behaviors, motivational states,

From Personality Disorders Institute, New York Presbyterian Hospital, Westchester Division; Weill Medical College of Cornell University; and Columbia University Center for Psychoanalytic Training and Research, New York.
Address correspondence to Otto F. Kernberg, 21 Bloomingdale Rd., White Plains, NY 10605. E-mail:
[email protected]

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fantasy, and registration of psychosocial reality are slowly finding contact

boundaries. The study of the sociology of small groups and the psychological
influence of educational and cultural mores and the study of specific types
of organic and personality pathology jointly permit, I believe, establishing a
general frame of reference regarding the dominant features of the personality and their harmonious or disharmonious functioning in health and illness.
Probably all personality researchers and experts would agree that personality is codetermined by genetic and constitutional dispositions, on the
one hand, and interaction of the individual with environmental, particularly
psychosocial, features in the course of psychological development, on the
other. However, enormous differences remain in the views of researchers in
the relevant fields regarding the key determinants of the personality, their
mutual influences, and assessment (Korner, 2010; Widiger & Mullins-Sweat,
2005). I believe that the main obstacle to progress in this general area of
human knowledge is the temptation for a radical reductionism in the development of theoretical frames that, in turn, then influences the development
of corresponding approaches and instruments to the study of personality,
which may lead to apparently incompatible frames of reference.
For example, the psychoanalytic studies of personality constellations in
the clinical practice of psychoanalytic investigation have permitted the description of major personality disorders, such as the narcissistic personality
disorders (Akhtar, 1992), and, in fact, have provided major advances in the
description of the constellation of features characterizing the entire field of
personality disorders. At the same time, however, the neglect of neurobiological determinants of motivational systems and intentional states, and of
the environmental determinants of personality features, has made any efforts
to construct a satisfactory, purely psychoanalytically informed theory of personality and personality disorders clearly inadequate. By the same token, a
radical reduction of personality studies to the descriptive mapping of personality traits and factor analytic evaluation of clusters of epidemiologically
predominant characterological traits, an approach that treats across various
normal populations, considers all traits as equivalent, and neglects deeper structures of organization of behavior, appears to be equally inadequate
(Kernberg, 2012a). This is reflected in the problematic efforts to relate such
a trait psychology to specific neurobiological structures and functions, without considering the complexity of the internal psychological organization
of behavior that gives the same traits a completely different meaning in the
context of different underlying structural dynamics. A simplistic model of
traits determined by neurobiological features reflecting specific genetic determinants seems as inadequate as a simplistic psychodynamic model based on
unconscious conflict constellations. The same criticism, I believe, could be
directed at other theoretical approaches to personality that neglect the complexity of the neurobiological and intrapsychic structures involved, such as a
simplistic model of normal or pathological psychosocial adaptation.
What follows is an effort to approach the organizational structure of
the personality from a multiplicity of viewpoints that corresponds to the
collaborative work of the Personality Disorders Institute at Weill Cornell
Medical College over the past 30 years. The main findings of this group on

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identity and identity disturbances now have a fundamental organizing place

in the classification of personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric
Association, 2013). It needs to be stressed that what follows certainly is not
assumed to be the only or definitive way to integrate our presently evolving
knowledge regarding personality structure, development, and pathology, but
an approach that attempts to do justice to the various fundamental scientific
developments now available for our evolving understanding of this field.
THE COMPONENTS OF THE PERSONALITY

Our fundamental proposal considers personality as an umbrella organization that includes a small number of major component systems: temperament, object relations, character, identity, ethical value systems, and cognitive capability (intelligence).
TEMPERAMENT

I consider temperament as the fundamental constitutive structure of the

personality, represented by the general psychological reactivity of the organism, particularly psychomotor, cognitive, and affective reactivity (Kernberg, 1992; Panksepp, 1998). Affective reactivity is the fundamental aspect
of the organisms psychic operation, in terms of constituting the primary
motivational system, relating the individual to the environment in terms of
positive, rewarding, or negative, aversive affective states reflected, particularly, in peak affect state activation. Neurobiological affective systems are
activated in response to organismic requirements that trigger alternative or
combined activation of some of these systems. I am referring, particularly,
to the attachment-separation panic system, the fight-flight system, the playbonding system, the erotic system, the feeding system, and the agentic panic
system (Panksepp, 1998; Wright & Panksepp, 2012). Each of these systems
response to organismic needs of the individual is constituted by a combined
activation of specific brain structures and neurotransmitters, particularly
specific neuropeptide and neuro-amine affective neurotransmitters, the serotonergic, dopaminergic, and noradrenergic systems.
Of central relevance in early development is the attachment-separation
panic system. It motivates the babys search for mothers breast and mothers
bodily contact and represents the prototype of the establishment of relations
with significant others (object relations). This system determines the establishment of internalized representations of these interactions with mother in
the form of dyadic, affective memory units constituted by representations of
self and representations of the object, within the context of a determined,
dominant positive or negative primary affect.
CHARACTER AND EGO IDENTITY

These internalized affective memory traces constitute the building blocks of

internal representation of relationships with significant others (Kernberg,

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1976). The repetitive activation of both extremely pleasurable and extremely

unpleasurable and potentially traumatic affective experiences determines the
primary motivation toward and away from an object. Within contemporary
attachment theory, these motivational structures constitute internal models
of behavior. Within psychoanalytic theory, these primary ideal and all
bad internalized object relations will become organized into two major,
mutually dissociated segments of idealized and feared or persecutory
segments of earliest experience. Out of these internalized representations of
relations with significant othersinternal models of behaviorwill derive
habitual behavior patterns that, in their dynamic integration, eventually will
constitute character, that is, the dynamically integrated structure of habitual
behavior pattern. At the same time, in the gradual consolidation of all the integrated representations of self, surrounded, so to speak, by an integrated set
of representations of significant others, ego identity or, rather, self-identity
crystalizes, as the overall, integrated view of oneself and the nature of ones
habitual relations with significant others.
In summary, so far, all these processes might be subsumed under the statement that temperament reflects the motivation for activation of interpersonal
behavior, and the resulting internalized object relations will determine the
development of character and identity: character as the objective, individualized integration of habitual behavior patterns, and identity as the subjective
correspondent of character in terms of the integration of self-perception and
experience and the experience of significant others. Identity and character
are mutually complementary expressions of the organization of psychic life.
Character traits, the behavioral expression of the internal models of behavior derived from internalized self and object representation units, express
the reflection of past experience on present, mostly automatized, functioning
modes of reaction. These traits, however, may depend in varying degrees on
temperamental predispositions that influence past affective gratification or
frustration of the persons own needs and desires in the context of adaptive
relations with significant others. In addition, character traits may represent
protective reactions against the expression of deeper needs felt to be risky or
unacceptable in the interpersonal field. In other words, character traits may
serve a defensive purpose, sometimes directed against impulses opposite to
the behavior expressed in the character trait.
For example, habitual timidity may be an expression of a defensive reaction against projected aggressive trends, the projection onto others of intense
negative affective experiences that are considered risky to express in the environment. But timidity, to stay with this example, may also express a defensive reaction against exhibitionistic impulses expressing erotic wishes that,
equally, cannot be tolerated consciously. In general terms, character traits
may serve defensive purposes against intolerable primitive aggressive and
erotic impulses linked to early infantile and childhood experiences that can
no longer be freely expressed in later developmental stages of the personality
(Kernberg & Caligor, 2005).
Defensive characterological traits are characterized by their rigidity, that
is, by their habitual activation, whether they are adaptively indicated at a
certain point or not, leading to rigidification of the personality that is charac-

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teristic of personality disorders. They may signal inhibition within certain areas of affective expression, typically of a sexual or aggressive origin, or else,
in a paradoxical mode, reactions against feared instinctual impulses may
lead to exaggerated counter-phobic behaviors. In short, defensive character
traits may be inhibitory, exaggerated, or reaction formations, and, particularly in the case of severe personality disorder, a contradictory combination
of inhibitory and reactive formations that conveys a chaotic nature to the
character structure so typical for these disorders. As mentioned before, some
traits may reflect non-conflictual, dominant temperamentally based dispositions, particularly introversion or extraversion. Characterological traits may
reflect vicissitudes of the major neurotransmitters that influence the activation of primary affective systems, such as, for example, the accentuation of
intensity of negative affects derived from decrease in the functioning of the
serotonergic system and genetically determined hyper-reactivity of the amygdala to aversive perceptions.
To this point, I have related character traits to the behavioral activation
of internalized models of behavior represented by dyadic units of self and object representations under the dominance of certain affects, particularly peak
affect states. However, significant learning, of course, gradually occurs more
and more under conditions of activation of low affective states, when direct
perception and cognitive elaboration of the perceived environment permit
cognitive learning relatively uninfluenced by the expression of organismic
needs reflected in affect activation. Character formation, in other words,
does not depend exclusively on peak affect states. Basic affective states, however, correspond to basic motivational tendencies that, in turn, are ultimately
activated by the basic neurobiological systems geared to express the instinctual needs related to attachment, feeding, self-protection, peer bonding, and
sexuality.
So far I have referred to dyadic relations between self and object representations. It needs to be added, at this point, that, from the beginning of
life and gradually in a more articulated way, triadic internalized object relations complicate the original dyadic structures and determine more complex
mechanisms of identity formation. As a child learns to accept and understand the relationship between the caretaking person and other significant
adults and siblings in his or her psychosocial environment, he or she begins
to evaluate interactions between significant others and to relate them, by
projection, to the childs own experiences in dyadic relations. Internalized
dyadic relations now become influenced by the awareness of dyadic relations
in the individuals immediate environment in the process of identification of
the self with such experienced relations between significant others: basically,
the relationship of the parents.
In other words, triangulations emerge that lead to the significant conflicts around infantile aggression, sexuality, and dependency described in
psychoanalytic developmental theory and that interest us here because such
triadic relations contribute to more realistic assessment of the self and of
significant others in the interpersonal and internalized world of object relations. These developments foster the emergence of idealized, as opposed to
realistic, representations of self, modeled by parental demands and prohibi-

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tions, praise, and criticism. A moralistic assessment of ones self, with dismantling of primitive illusions of ones own absolute goodness, power, and
righteousness, and a gradual internalization of expectations, demands, and
prohibitions evolves, which creates tension between ones desired sense of
self and the realistically perceived one. The psychological structuralization of
this tension represents the origin of the superego in psychoanalytic theory
(Jacobson, 1964).
NORMAL IDENTITY AND IDENTITY DIFFUSION

As mentioned before, the subjective aspect of the dynamic organization of

character is the development of identity. A major developmental process extends from the first 2 or 3 years of life to crucial developments during late
childhood and then again in adolescence. I am referring to the gradual integration of the representations of the self into an integrated self-concept and
the gradual integration of multiple representations of significant others. This
developmental process facilitates the capacity for awareness, concern, and
empathy for others. As mentioned, an early stage of development in which
rewarding, pleasurable peak affective states and their corresponding internalized object relationships are completely separated, dissociated, or split off
from negative, aversive peak affect states with early caretakers leads to the
consolidation of two separate segments of psychic experience, one an ideal
or idealized view of intrapsychic and external reality and one a frightening,
threatening, potentially destructive, and catastrophic world of experience.
This latter, by means of projective mechanisms, is mostly projected outside
and expressed as a diffuse panic, eventually originating the construction of a
fantastic, primitive, persecutory external world.
These two segments of experience originally represent the parallel buildup of idealized and persecutory dyadic units, linked to the separate channeling and corresponding cognitive-affective memory built up of the respective
self-representation-object-representation units. Later on, primitive psychological mechanisms of protection against overwhelming fears may lead to the
defensive maintenance of this split organization, resulting in reliance upon
the primitive defenses of splitting, projective identification, denial, primitive
idealization, devaluation, and omnipotent control as described by Melanie
Klein and her school (Klein, 1946/1952, 1957). These primitive defensive
operations can be observed clinically in the interpersonal behaviors of patients with severe personality disorders; under certain experimental situations, such as completely unstructured small and large study groups; and
under extremely traumatic social circumstances that lead to the emergence
of primitive dissociative mechanisms.
Under normal circumstances, however, or rather, when the strong predominance of positive experiences permits the development of basic trust
in a loving and reliable world of object relations, this experience and the
gradual predominance of a low affect activation learning environment facilitate the linking between positive and negative, idealized and persecutory
representations of self and others. The predominance of positive experiences
permits the absorption, integration, and mentalization of the negative seg-

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ment of experience. Usually between the third and the fifth or sixth year of
life an integrated view of self is consolidated, in the context of a more realistic, integrated view of significant others: this constitutes normal identity
(Kernberg, 2012b).
The failure of this process, with persistence of a lack of integration of the
concept of self and of significant others, constitutes the syndrome of identity
diffusion. Here a permanent splitting of the idealized and persecutory realm
of experience is established, interfering with the integration of the concept
of the self and of significant others. The syndrome of identity diffusion is
reflected clinically in the incapacity to convey to an observer an integrated
description of self and the equal lack of capacity to convey an integrated
view of significant others (Kernberg, 2012b). This incapacity is reflected,
psychopathologically, in chaotic behavior patterns, severe feelings of insecurity, rapidly fluctuating self-assessments and degrees of self-regard, and uncertainty about ones major interests and commitments. By the same token,
these patients present great difficulties in commitment to work or profession
and in commitment to intimate relations that integrates eroticism and tender
love. They evince general instability and chaos in relations with significant
others, related to the severe lack of capacity to assess others in depth and to
maintain stable and intimate relations with them.
It is this structurally fixated lack of integration of the self and of the representations of significant others that represents the main etiological feature
of the corresponding chaotic lack of integration and pathological organization of characterological traits of the various prototypes of severe personality disorders. We have designated these patients as presenting borderline
personality organization. In contrast, neurotic personality organization
refers to those personality disorders that, while still presenting significant
rigid, defensive, and pathological character traits, do not present the syndrome of identity diffusion. These patients, therefore, represent a less severe
level of personality disorder.
Obviously, normal personality is constituted both by normal identity
and by relative absence of a constellation of rigid, defensive character traits
that would justify, if such defensive constellations were dominant, classifying
them as the neurotic prototypes of personality disorders. From this general
perspective, the proposal in the DSM-5 classification of personality disorders
of identity pathology as the central criterion of severity of personality disorders, defined by the combination of lack of integration of the self and of the
selfs willful self-determination and by abnormal relations with others characterized by a lack of capacity for empathy and intimacy, clearly corresponds
to the syndrome of identity diffusion (Kernberg, 2012b).
AN INTEGRATED SYSTEM OF ETHICAL VALUES (SUPEREGO)

Having explored the constituent components of the personality represented

by temperament, character formation, and identity, I now return to the establishment of an internalized moral structure as reflected by an internalized commitment to ethical values and to universally valid ethical principles
of relationships with significant others and in social life in general. Such

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value systems and ethical commitments are in contrast to and transcend

the instrumental, practical requirements of direct interactions with the surrounding human society. This component of the personality corresponds
roughly to the Freudian Superego. By the same token, the Freudian Id
or Dynamic Unconscious corresponds to the totality of primitive aggressive, sexual, and dependent longings and their corresponding desired and
feared primitive object relations that cannot be accepted in consciousness
as ego identity consolidates. Active rejection of such intolerable desires and
fears tends to eliminate them from consciousness by means of repression and
other advanced defensive operations that depend on the very establishment
of ego identity. The Freudian ego, from the viewpoint of the organization
of the personality, is centered around the functions of identity, that is, it is
constituted by an integrated self and its surrounding world of internalized,
integrated object representations. In other words, the self and its internal
world of object relations governs, in the end, the organization of character
traits that permit the harmonious activation of effective, intimate, empathic,
and stable relations with significant others.
The superego is a complex structure, the pathology of which is an important indicator of the severityand the psychotherapeutic prognosisof
personality disorders. From the point of view of the corresponding internalization of ethical value systems, the work of Edith Jacobson (1964), it seems
to me, has clarified the developmental stages of the establishment of this
segment of the personality. What follows is a brief summary of her overall
conclusions.
The earliest precursor of the superego, in Jacobsons proposal, is the
internalization of the earliest prohibitions, in the parent/child interactions,
signaled by mothers clear and parental No!, usually a response to the babys behavior that may constitute an active danger for him or her (at least, in
mothers view). The fantastic distortions of such early prohibitions under the
activation of negative peak affect states, belonging to the persecutory segment of early experience, derive from the combination of projective mechanisms and external frustrations. The prohibitions are amplified in terms of
the babys misunderstanding and misinterpretations of them under the effects
of such projective mechanisms. The internalization of this first, negative layer of internalized prohibitions stimulates primitive, implicitly life-threatening
fantasized dangers and punishments, mostly centering around threatened
abandonment under the effect of the activation of the attachment-separation
panic system. The internalization of these prohibitions implies an acceptance
of them as a protective mechanism against greater threats of abandonment
and even annihilation. Obviously, under conditions of severe traumatic circumstances, physical abuse, sexual abuse, chronic witnessing of physical or
sexual abuse, such an early negative internalized sense of basic threats to
survival may become much more dominant than would be the case under
ordinary circumstances.
This first, most primitive level of internalized prohibitions, which already begins to influence both positive and negative segments of early experience, is gradually followed by a second level of experiences, under the
activation of positive peak affect states and also, in part, under conditions

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of low affective activation, reflecting the environmental demands for good

behavior. The expression of appreciation of the childs behavior, its stimulation, rewards, and gratitude on the part of the parental objects, fosters behaviors that the baby comes to see as ideal in terms of the rewards associated
with them. This layer constitutes the early ego ideal. It is constituted both
by the internalization of the demanding and rewarding aspects of the ideally
perceived images of the significant others and also by the development of
more realistic ideal self-representations under conditions of the gradual
toning down and integration of the idealized and persecutory segments of
the self.
The buildup of the ego ideal as an idealized internalized structure reinforces a sense of security, inner goodness, and intimate relations with significant others. This structure gradually tends to neutralize the most primitive,
persecutory segment of experiences within the superego referred to before.
Throughout the second and third year of life a process of integration between the most primitive persecutory and the secondary idealized level of
realistic and fantasized, desired and feared demands and prohibitions takes
place. This neutralization of negative experiences tends to reduce projective
processes under conditions of negative affect activation and facilitates the
internalization of still a third level of internalized demands and prohibitions.
This is what Freud described as the advanced Oedipal state of development,
consolidated between approximately the fourth and sixth year of life (Freud,
1923/1961).
This third, more realistic level of internalized demands and prohibitions
already contains many expectations derived from the family, reflecting the
cultural expectations of the immediate social environment and their specific
ethnic, social, national, religious, or racial traditions and biases. By the beginning of the school years (the latency years in traditional psychoanalytic
theory), sufficient integration of these levels of internalized value systems,
under the dominance of the third, more realistic and complex level, has taken
place to permit the child to enter a socially shared value system. This system
regulates behavior in terms of justice and concern for, and responsibility toward, others, as well as for ones own behavior.
Throughout the years leading to adolescence, a gradual process of depersonification, abstraction, and individualization of the superego takes place,
in other words, an abstraction and general integration of value systems no
longer linked concretely to demands or prohibitions from any particular parental image (Jacobson, 1964). Now, both deep, unconscious dispositions
from the early childhood years and later preconscious and conscious identifications with value systems acquired at home, school, and ones social group
characterize the pubescent child. Finally, in early adolescence, with the activation of intense sexual strivings that reactivate, deepen, and expand sexual
impulses, fantasies, fears, and desires from early childhood, and the impact
of the development of secondary sexual characteristics, a profound transformation takes place. Now infantile prohibitions against sexuality and aggression have to be somewhat modified to conform with the more adult demands
of intimate relationships under the combined impact of instinctual desires,
efforts to harmonize them with the adolescents identity and character for-

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mation, and the conscious and unconscious value systems reflected by the
developed, integrated superego. In short, the development of an internalized
set of ethical principles derives from particular aspects of internalized object
relations, namely, those in which different levels of a broad spectrum of demands and prohibitions initiates the childs identification with the moral and
ethical values of his or her home and social environment.
Under pathological circumstances, different levels of severity of personality disorders may affect the integration of this internalized system of ethical values and, in turn, influence the development of different levels of psychopathology. Under the dominance of severe aggressive impulses, whether
derived from genetically determined, temperamentally established predominance of negative affects and lack of cognitive control and contextualization
of affects, or severely pathological attachment experiences, or a traumatic
early infancy and childhood, identity diffusion may become fixed. The lack
of identity integration negatively influences the integration of the different
layers of the superego system. The first, persecutory superego level becomes
excessively dominant by aggressive internalized object relations, and the relative weakness of the ego ideal level interferes with the integration of these
two levels and brings about a persistent dominance of the first, persecutory
superego level. The establishment of the third, higher level of ethical values
suffers as well, a consequence of excessive projection of the negative earlier
superego features. Clinically, this predisposes the individual to the activation
of ego syntonic aggressive antisocial behavior.
In fact, the development of antisocial behavior is the most important
complication of the most severe level of borderline personality organization
and signifies a poor prognosis for psychotherapeutic treatments. It causes
damage to the capacity of relationships with others and to the normal modulation of affective expression of ones own emotional needs. In contrast,
under conditions when normal identity development proceeds adequately,
this positively influences superego integration. Under circumstances when
normal superego integration takes place, but with a strong induction of excessive guilt feelings over instinctual impulses, the early superego level may
contaminate the ego ideal with the development of sadistic demands for
perfection. Under these circumstances, the prohibitions against infantile sexuality during the development of the third level of superego development
may appear as excessively prohibitive, even violent, so that an integrated but
sadistic superego may inhibit sexual, aggressive, and dependent impulses,
leading to a defensive character structure that characterizes the higher level
of personality disorders (neurotic personality organization).
One may summarize, in a simplified way, the dominant etiological features of personality disorders at different levels of severity by stating that,
at the level of borderline personality organization, conflicts, whatever their
origin, around aggressive impulses predominate. At a higher level of development, with the establishment of normal identity, conflicts around infantile
sexuality and dependency are predominant in the pathology of neurotic personality organizations (Kernberg, 2012b). Obviously, this is a very general
statement that includes a broad spectrum of variations in terms of individual
history and development.

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INTELLIGENCE

The final major component of the personality is the cognitive potential of

the individual, intelligence, particularly expressed in the achieved level of
abstraction. The level of intelligence, it now seems to be generally agreed
upon, is dependent both on genetic disposition and on early experiences.
The stimulation of cognitive processes and linguistic development and the
explicit attention to a childs motivations, thought processes, and fantasy
development exert a fundamental influence on the development of cognitive
ability. In general, a high cognitive potential facilitates an ever more realistic
and subtle perception of the environment and the capacity to respond adequately to cognitive cues. The genetically determined development of the
prefrontal and preorbital cortex, the anterior cortical midline structures, and
the linguistic brain centers powerfully influences effortful control and participates in modulating affective response (Silbersweig et al., 2007).
In that regard, cognitive control may mitigate the effects of a severely
traumatic environment, although, by the same token, under severely pathological circumstances, intelligence even may amplify trauma by the development of complex distorted cognitive interpretations of a threatening
environment. At the same time, on the negative side, cognitive systems of rationalization of pathological character traits may powerfully reinforce faulty
adaptive strategies that may be encountered in severe personality disorders.
In clinical practice, we find patients with very high intelligence and with very
low intelligence at all levels of severity of personality disorders. Intelligence
has a positive prognostic implication for the indication of psychotherapeutic
treatments and, of course, also for the general level of social adaptation in
terms of educational development and level of work or profession.
From the viewpoint of both the development of the normal personality
and the etiology of personality disorders, we may distinguish, I believe, two
general organizational levels of psychic life: first, a neurobiological level of
development that determines the organization of basic neurobiological structures that find expression in psychological life, particularly the development
of perception and memory, the activation of consciousness, and, fundamentally, the development of affect systems that protect homeostasis and become
the primary motivator of object relations. To this basic level of psychic development has to be added a second level of organization at a purely symbolic,
intrapsychic level, best formulated in terms of the gradual building up of an
internal world centered around personal identity and the realistic perception
and investment in a world of significant others. This internal world organizes
the satisfactory expression of basic instinctual needs, autonomy, and self-affirmation and, by the same token, the relationship of gratifying and effective
relations with the surrounding social world. This includes sexual and romantic intimacy, friendship and commitments, effectiveness and gratification in
work, and personal creativity. The limitations in this development represented by personality disorders are now within the realm of our understanding regarding etiology, mechanisms of interactions and organization, and the

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potential for treatment, as well as the present limitations of our therapeutic

endeavors. I believe that further progress in all these areas requires the attention to these two systems, the neurobiological and the intrapsychic, and their
mutual influences in normality, pathology, and treatment.
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