Borderline Bodies: Affect Regulation Therapy for Personality Disorders, a new book by Clara Mucci connects interpersonal neurobiology, attachment theory, and psychoanalytic theory with cognitive and neuroscientific work on implicit memory, trauma theory, and dissociation to propose an integrated method for treating severe borderline and narcissistic disorders, with the prime aim of resolving the affect dysregulation that affects the various realms of bodily discomfort and existential pain. the book proposes a revision of the origin of personality disorders. Read an excerpt from Borderline Bodies: Affect Regulation Therapy for Personality Disorders below.

“For suff’rance is the badge of all our tribe”

Merchant of Venice , I.3.106)

 The initial deprivation is not “the deprivation of a ‘property’ or ‘object’ constituting a material transferable heritage, but the loss of an unnamable domain, which one might, strangely enough, evoke or invoke, for a foreign land, for a constitutional exile” (Kristeva, Powers of Horror)

For subjects affected by personality disorders, the body becomes the place where the painful stories of various identity trajectories and family constellations and traumata, with subsequent introjections and projections, are painfully inscribed. We might get a sense of this complexity of inscriptions when for example the practice of tattooing is carried to an extreme; or when we encounter practices of piercing fraught with pain and physical sufferance, similar to scarifying practices, undergone in order to belong to a group, or when repeated plastic surgery result almost in destruction of (what was) the (given or received) body. Given that it is certainly true that a body is not born nor grows in a vacuum, as Alessandra Lemma has suggestively written (2010), I would say that the pathologies of the Self in the borderline body leave scars even more painful or disturbing than their appearing signals of developments that suggest a desire for annihilation. At the “primitive edge of experience “, as Thomas Ogden writes, (Ogden, 1990), or “a testament to relatedness” (Lemma, 2010), the body in personality disorders bears the traces of a fundamental dichotomy between wanting to be and the impossibility of coexisting in a stable way, of a radical fight between desiring life and desiring death, a wish that insists on the skin and on the flesh and the body, between an instance that wants to express itself and at once to silence itself, the place of a (paradoxical) erasure of the life wish. Signing the limit of a desire to be (see Correale, 2006) and not to be (in a sense, echoing classical and tragic ambivalences), it is within these boundaries that the battle for the personality disorder takes place, between the two extremes of a desperate desire to be alive and to leave a trace in one’s trajectory, and the impulse to damage and hurt oneself, a fight traced out on one’s skin. As Thomas Ogden writes:

Physiologically, it is essential that one’s skin be continually penetrating a layer of deep tissue that serves as a life-preserving outermost layer of the body. In this way ( as in Freud’s concept of the stimulus barrier), human life is physiologically encapsulated by death. (1996, p. 181, emphasis mine)

It is interesting that Thomas Ogden in this quotation cites Freud’s definition of trauma as given in Beyond the Pleasure Principle (1920), in which he identified the threshold of a potentially traumatic impact of an overwhelming event as residing in the body, or between body and mind, a threshold between life and death, and an (unstable) place of survival.

The body of a subject with severe personality disorder bears the signs of this battle and the price continuously being paid to survival. Freud used to speak of an intermediary region of illness (as displayed in the scenery of the transference in therapy), and he posited the marks and border of trauma in a barrier between body and mind. I would define this limit in the body as a zone of in-betweenness (Mucci, 2013), a transit, in which the relationship between self and other is inscribed, through the attacks on the body-self and the symptoms (both in presentia, when there are indeed psychosomatic symptoms, and in in absentia, in hypochondria). The body for the borderline becomes a place of continuous struggle and even of exile form himself/herself, the tormented abode where a possibility of consistency resides but is also continuously displaced and erased (Correale, 2006).

The borderline inhabits a uniquely unstable body, often too lean or too fat, marked with scars and punctured by tattooing and piercing, where the limits sanctioned by the skin are inscribed with peculiar values and meaning, always in search of a sexual identity and an authentically felt definition or border, as a form of rebirth (as Lemma considers the fantasies of giving birth to oneself in tattooing, Lemma, 2010), always depositing in the other the trace of his/her own exile or painful transitions from an unattainable place of consistency.

Jacques Lacan argued that the subject encounters in the other the traces of one’s own exile: in the other we meet the limits of our own existence. This is existentially true for the borderline subject, marked by his or her impossibly in consisting in one place, one identity, one sex, one’s bodily. Paraphrasing The Merchant of Veniceand the words of the outsider Shylock, suffering as expressed in the body and in their existential turmoil is the “badge” of their felt condition with the inconsistency or fluctuations and instabilities. Borderline bodies with their painful corporeal traces bear testimony to their uniquely conflictual existence.

Epigenetics, prenatal stress and methylation in conditions of abuse

Going back to genetics and epigenetics, anxieties linked to pregnancy seem to be correlated with the methylation of the gene receptor of the glucocorticoids. We now know that the mother’s stress may result in changes in the silencing or in the genic expression of elements in the genetic endowment of the child. The most common mechanism is that of methylation (see van Ijzerndoorn, et al. 2011; see Schore, 2017a).

Child maltreatment (together with other forms of adversity such as loss of a parent or severe deprivation) is associated with methylation of the glucocorticoids receptors which lead to inadequate levels of cortisol in reaction to stress. Methylations in adolescents and adults are associated with health problems, attempts at committing suicide, impulsivity and aggressiveness. Different modes of adversities lead to different processes of methylation. Moreover, poverty, combat, alcohol abuse and addiction, PTSD and even work-related stress are associated with methylation, to an increase in vulnerability to stress provoking factors in the future and even the possibility of transmitting these vulnerabilities to one’s children.

Still harping on mothers and fathers for transgenerational transmission

“How say you by that? Still harping on my daughter”, Hamlet, II.ii. 187-188

So far, we have referred mostly to mothers as caregivers, which in most cultures is the rule; but several studies conducted on non-humans, for instance on rats, lead to the importance of the role of the father or of a third element in the dyad first-caregiver-child, as already mentioned, as fundamental for a healthy psychological development. In the second year of life, the attachment that the child forms or might form with the second caregiver, usually a father, is crucial for further development of the brain (Schore, 1994; Schore, 2013, in Narvaetz et al., 2013) especially for the formation of those social, relational, linguistic and cognitive abilities that become established in the third year of life and require the development of higher order functions, extending to orbitofrontal, ventromedial and frontal areas.

It has been noted that if the father in rat families has been exposed to chronic stress this might lead to a modification of sperm and to depressive symptoms and anxiety even in the offspring. Other studies show that an improvement in the conditions of the fathers leads to improvement in the conditions of the offspring and even in the rearing capacity of the mother.

Attachment is notoriously the first element of intergenerational transmission of trauma, because of the strong correlation between the attachment of the child and that of the children (Fonagy, Steele, Steeele, 1991). In addition, the fact that a child might have secure attachment with one parent and insecure with another is a proof for the irrelevance of genetics in attachment.

Children of maltreating parents have disorganized attachment in 80 per cent of the cases against the 20% as found in the control group (Carlson, et al., 1989; Lyons-Ruth, et al., 1987). These children are predisposed to the development of dissociative disorders (Liotti, 1992; 2014). Some of these children had mothers who in the first two years of life of the child had had a serious unresolved loss (Liotti, Intreccialagli, Cerere, 1991) and presented a more than normal level of cortisol.

Studies of neuroimaging with fMRI demonstrate that patients with disorganized attachment presented levels of limbic-cortical activation different from the control group, especially when the task given involved viewing traumatic images (Buchheim, et al., 2006). This could be understood as one of the possible neurobiological bases for the development of disorganized attachment in children.

For these children the environment is a potential source of trauma, endangering the connectivity of the right hemisphere and that between right and left; moreover, traumatic, unresolved, experiences in the caregiver (Liotti, 2005, p. 138) might be reflected in the disorganization and dissociative tendencies of the children even in the absence of explicit maltreatment.

Disorganized attachment is viewed as a basis for vulnerability which might mediate the development of a personality disorder (Liotti, 2014).

If we examine traumatized generations, who have survived massive social trauma, genocide, extermination as in the Shoah, the transmission of trauma will be influenced by both security and insecurity of attachment in the parents and between parents and child (Ban-On et al., 1998; Sagi-Schwartz et al., 2003; Sagi-Swartz et al., 2008)

Advances in molecular biology, genomics and epigenomics allow now to study and understand the long term effects of stress even in the cases of massive social trauma as in the survivors of the Shoah, where in the following generations we find changes that in themselves do not mean pathology, but help us understand the risk factors of future traumatogenic responses to trauma (Yehuda et al., 2008; Yehuda et al., 1998). These factors are mediated by attachment dynamics (Fonagy et al., 1992, in Ammaniti & Stern, 1992; Lyons-Ruth, Bronfman & Atwood, in George & Solomon, 1999).”

Excerpted from Borderline Bodies: Affect Regulation Therapy for Personality Disorders © 2018 by Clara Mucci. Used with the permission of the publisher, W. W. Norton & Company. To purchase Borderline Bodies: Affect Regulation Therapy for Personality Disorders visit the W.W. Norton website here , or Amazon here .

Clara Mucci is a psychoanalytically-oriented psychotherapist practicing in Milan and Pescara, Italy. She is Full Professor of Clinical Psychology at the University of Chieti, where she taught English Literature and Shakespearean Drama. She received a PhD from Emory University, Atlanta, and was a fellow in 2005-2006 at the Personality Disorders Institute, New York, directed by Otto Kernberg. She is the author of several monographies on Shakespeare, psychoanalysis and literary theory, she has taught in London (Westminster College), Atlanta, and New York (Hunter College).