The Substance (2024): A Psychodynamic Exploration of Fragmented Identity and Borderline Personality Organisation

In this video, Dr Sanil Rege, consultant psychiatrist, offers a psychodynamic analysis of The Substance (2024), a psychological horror film. Through the character of Elisabeth Sparkle, Dr Rege unpacks key borderline personality organisation insights, including identity fragmentation, emotional instability, and the inner conflict between the vulnerable and desiring self.

Using frameworks from Kernberg and Wachtel, the video explores how unmet emotional needs, fear of abandonment, and self-sabotage manifest in disturbed personality structure. Elisabeth’s journey serves as a metaphor for the psychological struggles seen in borderline personality organisation, illustrating concepts such as role absorption, painful incoherence, and cyclical psychodynamics.

These borderline personality organisation insights provide clinicians with a deeper understanding of the psychodynamic underpinnings of emotional dysregulation—both in fiction and clinical practice.

Watch now to explore the intersection of psychiatry and film, and gain new perspectives on complex personality dynamics.