Otto Kernberg. M.D., is credited for doing pioneering work on borderline
Credit: Otto Kernberg, M.D.
At age 79, Otto Kernberg, M.D., has a glistening pate and a mischievous
smile. His english is perfect, but occasionally his intonation is
intriguing—is it German or Spanish? and he exudes a lot of gravitas in
the worlds of psychoanalysis and psychiatry.
"He is, without a doubt, the most productive psychiatrist and
psychoanalyst I've ever met," Glen Gabbard, M.D., chair of
psychoanalysis and professor of psychiatry at Baylor College of Medicine, told
Psychiatric News. "He has an intellectual and clinical
curiosity that has led him to be one of the leading thinkers in psychiatry and
psychoanalysis. He is also the most-cited psychoanalyst in the world
"He is one of the most active and energetic people I've ever
known," Frank yeomans, M.D., a clinical associate professor of
psychiatry at Cornell university Weill Medical College, said in an interview."
It is astonishing how much he can do, how much he teach... in addition
to all his writing and seeing patients. It is remarkable because a lot of
people of his stature don't do direct patient work anymore."
Added John Oldham, M.D., senior vice president of the Menninger Clinic:"
He is extremely committed, dedicated, hardworking—a very
concerned professional educator with a giant of an intellect. He has been
extremely influential in the field of psychoanalysis and increasingly in the
broad field of clinical work with patients."
Kernberg's professional odyssey started, most appropriately, in the city of
Freud—Vienna—where he was born in 1928. After Hitler's annexation
of Austria in 1938, Kernberg and his family fled first to Italy, then to
Chile, where he attended high school, university, and medical school and where
he became a psychiatrist. A fellowship at Rockefeller University brought him
to the United States. After that, he worked at Johns Hopkins University and
the Menninger Foundation. He then became a professor of psychiatry at Cornell
University, where he is still working and researching.
One of his major contributions, his colleagues believe, is that he
integrated the object-relations theory of psychoanalyst Melanie Klein into
American ego psychology, which was the reigning psychoanalytic model in the
1950s and for decades after that. "He largely made Kleinian thinking
legitimate before most Americans knew about it," said Gabbard.
"He was instrumental in identifying the borderline personality
disorder as a major entity in psychiatry long before it appeared in the
DSM," Gabbard pointed out. "He was the first person to
come up with a comprehensive psychodynamic understanding of what borderline
psychopathology is. All of the subsequent contributions to the literature are
indebted to him for that. We now think that borderline personality disorder
may be present in as many as 20 percent of inpatients; before Kernberg, many
of these patients were misdiagnosed."
"His most important contribution, or at least the one that has meant
the most to me, is that he excited an interest in, and an enthusiasm for,
treating borderline patients by a whole generation of clinicians who
previously had been both disinterested and unenthusiastic," John
Gunderson, M.D., said. In addition to being a professor of psychiatry at
Harvard Medical School, Gunderson is director of the Borderline Treatment and
Research Center at McLean Hospital.
Kernberg has also made tremendous contributions to the diagnosis and
treatment of narcissistic personality disorder, his colleagues said."
Many of his ideas about the diagnosis have shaped the DSM-IV
category of narcissistic personality disorder," Gabbard said.
Indeed, yeomans said, "Otto Kernberg helped psychoanalytic thinking
move toward the whole population of personality-disordered patients.. .to make
it extremely useful working with that population."
However, he has not limited his interests to object relations and
personality disorders. He has applied psychoanalytic understanding to
large-group behavior and institutions, has written about couples and love
relations, and is especially fascinated by aggression. Which brought up an
amusing anecdote from yeomans: "A lot of analysts and psychiatrists say,
'Sure, Kernberg is very smart, but he's always talking about aggression!' So
one day I asked him, 'Otto, are you really obsessed with aggression?' To which
he replied (I loved his answer): 'Only to the extent that it inhibits
libidinal love expression!'"
Kernberg is a doer as well as a thinker. He and his coworkers have
established a psychoanalytic treatment for borderline personality
disorder—transference-focused psychotherapy, have manualized it, and
have subjected it to randomized, controlled trials. Results from one of their
most recent trials—comparing transference-focused psychotherapy to
dialectical-behavior therapy and to supportive treatment—were published
in the june 2007 American Journal of Psychiatry.
The results showed that while subjects in all three treatment groups showed
significant positive changes in depression, anxiety, global functioning, and
social adjustment across one year of treatment, there were some differences.
For example, whereas subjects getting the transference-focused psychotherapy
or the dialectical behavior therapy showed significant improvement in
suicidality, subjects getting the former or supportive treatment showed
significant improvement in facets of impulsivity. Only transference-focused
psychotherapy significantly predicted a change in irritability and in verbal
and direct assault.
"That has been a major contribution and took a long time to do, a lot
of effort," Oldham said.
"Kernberg has been at the forefront of the need for psychoanalysts to
validate the efficacy of their treatment with empirical research," said
Gabbard. "He has always warned analysts that they can't simply rely on
their personal convictions that the treatment works [and] that they need to
demonstrate it with well-done research."
"He is one of the main figures to bring serious research to the
psychoanalytic world and to the world of psychodynamic psychotherapy,"
And in decades to come Kernberg's ideas and contributions will undoubtedly
continue to impact the psychoanalytic and psychiatric worlds, his colleagues
Those ideas are influencing the development of DSM-V, observed
Oldham, who is a member of the DSM-V work group.
"His contributions are so fundamental that anyone who wants to write
about borderline or narcissistic personality disorder needs to position
themselves in terms of Kernberg's views," Gabbard asserted. "Also,
his research will be very influential in persuading the public and third-party
payers that borderline personality disorder is treatable and that the
treatment should be reimbursed."
"I think his most-enduring contribution will be his research,"
Gunderson predicted. "By identifying a specific type of psychoanalytic
therapy that can be tested as to whether clinicians are adherent or not, and
by demonstrating that it is specifically needed for a certain patient group,
this builds bridges from psychoanalytic treatments to psychiatry.... It is
very far reaching."
And as far as his present plans go, Kernberg told Psychiatric
News, "they include continuing research on the treatment of severe
personality disorders here at Cornell, treating patients, writing, and
enjoying life with [my wife] Kay." ▪