Understanding Neurotic, Borderline, and Psychotic Personalities

Back in the day, psychologists and psychiatrists categorized individuals as sane or insane, which later changed to neurotic or psychotic, respectively¹. However, not everyone fit neatly into these categories (duhhh), and so the concept of borderline was proposed¹. The borderline space is the space in between neurosis and psychosis, where individuals weren’t insane but also weren’t not insane either

Psychodynamic Personality Organizational Levels

Organizational levels of personality in psychoanalysis include those historical levels of neurotic, psychotic, and borderline. It does not refer to the type or category of personality, but the functioning and stability of one’s psyche. In other words, we are not talking about borderline personality disorder right now. All personality types can technically be found at any organization level, though some personalities tend to live at certain levels. It is also important to note that organization of personality can impact severity, but it does not imply severity¹.

Neurotic ¹

At the neurotic level, reality testing is intact, and there is an integrated, continuous, stable sense of self that can lead to increased insight and ego strength. Problems are pushed outside of the self (ego-dystonic) in order to analyze and fix them. There is an internal, unconscious conflict of acting out unacceptable impulses, resulting in overactive defenses to protect against guilt. This means they are too cold, like a freezerburnt snowman. They are inflexible, rigid, and critical of the self (and sometimes others), avoiding confrontation and conflict. Their defenses are verbal (secondary defenses) stemming from the oedipal stage of childhood (about age 3 to 6) where their struggle with initiative vs. guilt resulted in inhibition due to difficulties accepting their “bad” human instincts (i.e., aggression, libido). Specific defenses include reaction formation, repression, and sublimation. Personalities that tend to be found at the neurotic level include histrionic, obsessive-compulsive, and depressive-manic.

Psychotic ¹

At the psychotic level, reality testing is defective - like a melted snowman. They might not be sure they are actually alive and exist separate from others, let alone have a cohesive, integrated sense of self. There is an unconscious fear of nonexistence, resulting in underactive defenses to protect against fear of annihilation and dread. Thus, they are super sensitive to authenticity and genuineness in others, especially because they can access things that most other people reject in themselves, such as limitations and flaws. Their defenses are preverbal and prerational (primitive defenses) stemming from the oral stage of childhood (birth to about age 2) where their struggle with trust vs. mistrust resulted in withdrawal due to difficulties trusting what is inside and what is outside of themselves. Specific defenses include acting out, denial, extreme dissociation, omnipotent control, primitive idealization and devaluation, primitive forms of projection/introjection, somatization, splitting, and withdrawal. Personalities that tend to be found at the psychotic level include paranoid, schizoid, antisocial, and schizotypal.

Borderline ¹

At the borderline level, reality testing is inconsistent with brief episodes of being out of touch with reality - like a melting snowman. Unlike those at the psychotic level, they know that they exist, but they experience identity confusion due to having a discontinuous, inconsistent, and unstable sense of self. There is fear of separation and abandonment, resulting in instability. They are impulsive, having difficulty regulating emotions and can be more hostile with outbursts of intense emotion, including anger. The instability makes it difficult to function and can result in push-pull dynamics. Their defenses are pre- and post-verbal (primary and secondary defenses) stemming from the anal stage of childhood (about age 1.5 to 3) where the struggle with autonomy vs. shame/doubt resulted in fear of separation due to difficulties with separation-individuation and attachment. Specific defenses include denial, projective identification, and splitting. Personalities that tend to be found at the borderline level include dependent, avoidant, masochistic, borderline, and narcissistic.

Personality dysfunction and disorders can be tricky! If you want to better understand the differences between personalities at the neurotic, borderline, and psychotic levels, therapy and/or psychological testing can help! If you’re in Virginia (or a PsyPact state), check out Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!

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