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Borderline Conditions and Pathological Narcissism
The basic text for the understanding of patients with pathological narcissism.
376 pages, Hardcover
First published January 1, 1975
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950 people want to read
About the author
Otto F. Kernberg
108 books107 followersOtto Friedmann Kernberg (born 10 September 1928) is an Austrian-born American psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology.
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Displaying 1 - 10 of 10 reviews
December 17, 2016
This book made a great impression on me. It was loaned to me by a clinical psychologist friend who said it was the best in its field. My next door neighbor is a clinical psychiatrist who also held it in high regard. My psychologist friend warned that it's quite technical, e.g. lots of Freudian references, therefore not a lay book for the general public, but its in depth descriptions of pathological narcissism so described our current president-elect that I could hardly put it down. Anyone who truly wants to understand this unique syndrome and is willing to plow through what normally I would consider dry, didactic material, should give it a try.
October 9, 2017
Some detailed description of both borderline and narcissistic clients. Although making the reader empathetic to these clients in the description, there isn't much in the chapters of how to treat them.
July 24, 2024
While burdened with now outdated Freudian constructs, this classic discussion of the inter-relations among assorted borderline disorders between the self snd others and pathological narcissism is well worth studying. I first read it when I was contemplating becoming a psychoanalyst in 1985, triggered in part by working with a colleague who had been traumatized in Nazi Germany as a youth and then regressed into a narcissistic personality that proved tragically destructive to him. I leaned to understand him rather than condemn him.
March 4, 2023
a fun beach read!
October 27, 2025
Psychological functioning – the self, as it navigates through the world – must incorporate an understanding of 1) events and relationships occurring at the symbolic layer 2) a negotiation between impulses, social standards, and events in reality. Kernberg’s framework draws from both Freudian and Object relations schools but stands in opposition to Self Psychology in some of its more nuanced considerations and therapeutic approach. Psychoanalytic thought is a map into the inner world, an explanation of distortions, a language to describe torrents of emotion, a predictor of future behaviour.
When we have a wish, or opinion, or perspective towards someone (or yourself), consider what that is defending against – what it is easier, in some sense, to feel, to be. It may be easier to feel one way than to acknowledge a deeper feeling, which is more uncomfortable and intolerable. The current perspective can be considered an equilibrium position – underneath its static appearance lies deeper dynamic considerations. When things are intolerable – then we distort reality to compensate (defenses). Consider that one word alone can trigger a storm of emotion. Reality shifts. What was deliberately ignored, or forgotten, or distorted, cracks through. Or, it touches upon a conflict that was only hanging by a thread, the last thread snapped. On the surface layer, you have the conscious emotion, the decision, the thought. But what lies beneath is the feeling of the decision not-made, the thoughts and perspectives that are easier to feel, that are more tolerable.
Our relationships with others can be considered on the social layer, but also the deeper psychological interaction (consider what needs are being met, what the person symbolises) – and note that the relationship continues internally, and persists, through time (through experience and memory and conceptualisation). Wishes unfulfilled, needs unmet, cause us to seek a more stable arrangement, in both our self-conceptions, and in our dealings with others.
When we have a wish, or opinion, or perspective towards someone (or yourself), consider what that is defending against – what it is easier, in some sense, to feel, to be. It may be easier to feel one way than to acknowledge a deeper feeling, which is more uncomfortable and intolerable. The current perspective can be considered an equilibrium position – underneath its static appearance lies deeper dynamic considerations. When things are intolerable – then we distort reality to compensate (defenses). Consider that one word alone can trigger a storm of emotion. Reality shifts. What was deliberately ignored, or forgotten, or distorted, cracks through. Or, it touches upon a conflict that was only hanging by a thread, the last thread snapped. On the surface layer, you have the conscious emotion, the decision, the thought. But what lies beneath is the feeling of the decision not-made, the thoughts and perspectives that are easier to feel, that are more tolerable.
Our relationships with others can be considered on the social layer, but also the deeper psychological interaction (consider what needs are being met, what the person symbolises) – and note that the relationship continues internally, and persists, through time (through experience and memory and conceptualisation). Wishes unfulfilled, needs unmet, cause us to seek a more stable arrangement, in both our self-conceptions, and in our dealings with others.
June 9, 2023
There is a lot of dated, outmoded, thick psychoanalytic jargon (with pervasive cis-heteronormative presumptions, of course) through which to wade. But, this remains a valuably preeminent and comprehensive treatise on Cluster B pathology, particularly through an Object Relations lens.
April 15, 2025
I found this book a bit difficult to get into, but I warmed up to it. I have never been very impressed with the structural model of the mind (superego, ego, id) probably because I approached it from an intellectual point of view and did not find it particularly interesting or compelling. However, reading this book I was impressed with the value that Kernberg (and no doubt many others) manage to get from it. The structural model provides a clear framework with simple elements that can be broken down and developed in use with actual patients. Having a shared vocabulary with a group of fellow practionners also means that different ways of applying the framework or different adjustments to it can be explored in a collective dialogue aimed at making the framework as helpful as possible.
Take Kernberg's account of narcissism. He does not see it as a failure to outgrow a normal developmental phase. Instead he argues that an intolerable external reality leads to a fusion of ideal self, ideal object and actual self images with concomitant devaluation & destruction of object images as well as external objects. He helpfully glosses: "I do not need to fear rejection for not living up to my ideal of myself and securing the love of my ideal person, since the ideal person, my ideal self and my actual self are all one and the same." The technical formulation supports more detailed exploration. e.g. failure to develop normal super-ego, emptiness due lack of live other images, projection of negative self aspects etc. What started as a defence against dependency becomes a prison that allows no contact with the other (which makes me think of Proust, but that's another story!).
Kernberg's account of how pathological narcissism develops illustrates his use of the framework. He suggests that in normal development idealised object images (presumably of the parents and other early care-givers) are integrated into the ego ideal and later feed into the superego. In narcissists, however, these images are condensed into the self image. This blurs the boundaries between the ego and the superego and means the latter cannot develop normally. Also unacceptable aspects of the real self are dissassociated and/or repressed. And external objects (and their representations) are devalued in comparison with the idealised self image (which has had integrated into it idealised images of the parents). Since the narcissist has sabotaged the possibility of having realistic images of others, he is unable to have any real contact with them. But at least there is no risk of depending on them.
The narcissist's inner world is populated by: his grandiose self image; shadowy images of his (actual) self and others; and potential persecutors representing the non-integrated sadistic forerunners of the superego and distorted object images of others into which the narcissist's own sadism has been projected. He ends up with a highly defended ego (that may be very successful at manipulating its way to social success), no real superego (so no conscience, no belief that self-improvement is possible or necessary) and an id that has a relatively free rein to fulfil its libidinal and aggressive drives.
Obviously, this has massive downsides for everyone who has anything to do with the pathological narcissist, but it also has downsides for the narcissist who feels empty inside and is restless and easily bored since despite the many satisfactions he enjoys, none of them are truly fulfilling. And then somewhere deep inside there is the trauma the narcissist experienced and the fear linked to that trauma with perhaps some deeply buried sense that he does need other people and therefore that the nightmare could all start again - unless he sticks firmly to his chosen path.
I think this is an insightful story and, although I am sure you could get to something very like it without using the structural model, it does illustrate the good use that can be made of this framework.
Take Kernberg's account of narcissism. He does not see it as a failure to outgrow a normal developmental phase. Instead he argues that an intolerable external reality leads to a fusion of ideal self, ideal object and actual self images with concomitant devaluation & destruction of object images as well as external objects. He helpfully glosses: "I do not need to fear rejection for not living up to my ideal of myself and securing the love of my ideal person, since the ideal person, my ideal self and my actual self are all one and the same." The technical formulation supports more detailed exploration. e.g. failure to develop normal super-ego, emptiness due lack of live other images, projection of negative self aspects etc. What started as a defence against dependency becomes a prison that allows no contact with the other (which makes me think of Proust, but that's another story!).
Kernberg's account of how pathological narcissism develops illustrates his use of the framework. He suggests that in normal development idealised object images (presumably of the parents and other early care-givers) are integrated into the ego ideal and later feed into the superego. In narcissists, however, these images are condensed into the self image. This blurs the boundaries between the ego and the superego and means the latter cannot develop normally. Also unacceptable aspects of the real self are dissassociated and/or repressed. And external objects (and their representations) are devalued in comparison with the idealised self image (which has had integrated into it idealised images of the parents). Since the narcissist has sabotaged the possibility of having realistic images of others, he is unable to have any real contact with them. But at least there is no risk of depending on them.
The narcissist's inner world is populated by: his grandiose self image; shadowy images of his (actual) self and others; and potential persecutors representing the non-integrated sadistic forerunners of the superego and distorted object images of others into which the narcissist's own sadism has been projected. He ends up with a highly defended ego (that may be very successful at manipulating its way to social success), no real superego (so no conscience, no belief that self-improvement is possible or necessary) and an id that has a relatively free rein to fulfil its libidinal and aggressive drives.
Obviously, this has massive downsides for everyone who has anything to do with the pathological narcissist, but it also has downsides for the narcissist who feels empty inside and is restless and easily bored since despite the many satisfactions he enjoys, none of them are truly fulfilling. And then somewhere deep inside there is the trauma the narcissist experienced and the fear linked to that trauma with perhaps some deeply buried sense that he does need other people and therefore that the nightmare could all start again - unless he sticks firmly to his chosen path.
I think this is an insightful story and, although I am sure you could get to something very like it without using the structural model, it does illustrate the good use that can be made of this framework.
September 11, 2018
I finally gave up on this about halfway through. It's super clinical and written more for professionals in the psychology field than regular people just trying to deal with a BPD or narcissist in their life. I knew that this title was more psychology (rather than self-help) based when I purchased it, but it came so highly recommended that I thought I would give it a try. Unfortunately this reads like a science term paper and I couldn't force myself to finish it.
February 28, 2021
Es a mi parecer el mejor libro que se ha escrito para tratar el Trastorno Limítrofe de la Personalidad, muy recomendable.
November 14, 2022
wait...is this a fucking play about me??
Displaying 1 - 10 of 10 reviews