I Hate You--Don't Leave Me: Third Edition: Understanding the Borderline Personality

by Jerold J. Kreisman

attempts to acknowledge the sufferer’s anguish and chaotic feelings with a “You” statement: “How awful you must be feeling.” “This must be a difficult time for you.” “You must have felt really desperate to do this.” “It’s impossible to imagine what you must be going through.” It is important not to confuse empathy with sympathy (“I feel so sorry for you”; “you poor thing”), which may elicit rage over perceived condescension. Also,

The emphasis here is on the borderline person’s painful experience, not the speaker’s.

The T statement, representing Truth, recognizes the reality of the situation and emphasizes that the person with BPD is ultimately accountable for his life and that others’ attempts to help cannot preempt this primary responsibility.

Other characteristic Truth expressions refer to actions that the speaker feels compelled to take in response to borderline behaviors. These Truth statements should be expressed in a neutral matter-of-fact fashion (“Here’s what happened . . . These are the consequences . . . This is what I can do . . . What are you going to do?”). But they should be stated in a way that avoids blaming and sadistic punishing (“This is a fine mess you’ve gotten us into!”

Truth is also intended to begin consideration of possible solutions and to counter expressions of hopelessness and helplessness. The Truth part of the SET system is the most important and the most difficult for the borderline person to accept, since so much of his world view excludes or rejects realistic consequences.

The borderline accusation that “You don’t care!” usually suggests that the Support statement is not being integrated or communicated. It is then helpful to reflect more Support

The inability to successfully communicate the Empathy part of the message (see Figure 5-3) leads to feelings that the other person does not understand what the borderline individual is going through. (“You don’t know how I feel!”) Here, he will justify his rejection of the communication by saying he is being misunderstood.

When either the Support or the Empathy overtures are not accepted, further communications are not heard. Therefore, it is often necessary to reinforce Support and/or Empathy statements when...

borderline individual will interpret others’ acquiescence in ways he finds most comfortable for his needs, usually as confirmation that others really can be responsible for him when he cannot, or that his own perceptions are universally shared and supported. The borderline individual’s fragile merger with these other people eventually disintegrates when the relationship is unable to sustain the weight of his unrealistic expectations. Without clearly stated Truth and confrontation, he continues to be overly entangled with others.

His needs gratified, he will perceive that all is well, or at least that things will get better without further effort on his part. Indeed, the evidence for this enmeshment is often a striking temporary absence of conflict.

The UP extension to the SET framework is intended as a continuous reminder that relationships require Understanding and Perseverance. Understanding borderline pathology and symptoms allows for patience in pursuing improvement. Acknowledging the anguish of an illness, however, is recognition of adjustments to be made, not absolution from responsibility. Persevering in treatment and in a relationship, despite disappointments, is necessary for improvement. Often one of the most important contributors to improved health is the fact that the community surrounding the person with BPD—his doctors, therapists, family, friends, and lovers, as well as the

BPD individual himself—consistently hung in there despite the frustrations along the way. It is helpful for all involved in the relationships, through spoken and unspoken communications, to continue to sustain these sentiments (see Figure 5-5).

Borderline confusion often results in contradictory messages to others.

Further, Gloria splits off the negative portions of her available choices and projects them onto Alex, preserving for herself the positive side of the ambivalence. No matter how Alex responds, he will be criticized. If he does not actively intercede, he is uncaring and heartless and she is “tragically misunderstood.” If he tries to stop her suicide attempts, he is controlling and insensitive, while she is bereft of her self-respect.

Borderline individuals typically respond to depression, anxiety, frustration, or anger by superimposing more layers of these same feelings.

One of the goals for his therapists and other close relations is to crack through these successive layers to locate the original feeling and help him accept it as part of himself. The borderline individual must learn to allow himself the luxury of “bad” feelings without rebuke, guilt, or denial.

Much of Neil’s professional success has resulted from trying harder. Studying harder usually results in better grades. Practicing harder usually results in a better performance. But some situations in life require the opposite. The more you grit your teeth and clench your fists and try to go to sleep, the more likely you will be awake all night. The harder you try to make yourself relax, the more tense you may become. The more you try to not be anxious, the more anxious you become.

A person with BPD frequently gets involved in predicaments in which he becomes a victim.

Much of dramatic borderline behavior is related to his interminable search for something to fill the emptiness that continually haunts him. Destructive relationships, binge eating, self-injuring, and drugs are some of the mechanisms the borderline person uses to combat the loneliness and to capture a sense of existing in a world that feels real.

Borderline people are often reared in situations in which their threats and dramatic actions are the only ways to achieve what is sought.

Mr. and Mrs. Hopkins begged, demanded, and threatened, all to no avail. When they tried to take the TV out of the room, Kevin became physically aggressive and threatened suicide, since he had nothing else to do. His room was a mess, and he refused to help with household chores. Every so often, a friend would call and invite Kevin out. Kevin would then demand money for the evening, which his parents readily gave him, encouraged that he was willing to leave his room.

Mr. and Mrs. Hopkins began to argue more. Mr. Hopkins demanded that they throw Kevin out of the house, but Mrs. Hopkins feared Kevin couldn’t survive on his own. Then the family endured a series of misfortunes. Mrs. Hopkins was diagnosed with breast cancer. Mr. Hopkins’s business went through a financial setback. Both parents were more stressed and grew distant from each other. Mr. Hopkins continued to fume, but both silently agreed that it was easier to just give in to Kevin’s lifestyle for the time being. Still, they worried: What will happen to our son when we’re gone?

help him feel better, and complimented him on staying with his current job (Support). They recognized how unhappy he was and understood that he must be dissatisfied with his current situation (Empathy). They then shared their concern about the health of all three of them and made it clear that they could not tolerate continuing the current situation. They also related their concern that by not confronting these issues they were inadvertently contributing to Kevin’s discontent. Finally, they acknowledged that they had had similar conversations with Kevin in the past but had never followed through on proposals. They fully understood that Kevin might not be able to comply with the requests, and they were prepared to assist him in leaving

“I just needed a bit of a tune-up,” Marnie explained. “Some adjustment of my meds, some sleep, and some food got me back together. I must have kind of freaked you out when I went cuckoo there. I’m sorry. You’re a good friend, Robin.” Marnie went on to explain she was seeing her doctor more regularly and had already arranged a less stressful schedule at work. “I’m learning to recognize when stress is getting to be too much and when to get help.”

Perseverance is necessary to effect change over the long haul. For many with BPD, having a consistent unflappable figure in their lives, whether it be a neighbor, a friend, or a therapist, may be one of the most important requirements for healing. Such a figure may contribute little except for consistency and acceptance (in the face of frequent provocations), yet furnish the borderline loved one with a model of constancy in her otherwise chaotic world.

Indeed, some of the hallmarks of borderline behavior are the sudden, unpredictable,

and “out of nowhere” eruptions of anger, extreme suspiciousness, or suicidal depression from someone who has appeared so normal.

The unpredictable outbursts are usually very frightening and mystifying—both to the person with BPD himself and to those closest to him. Because of the sudden and extreme nature of more prominent symptoms, the concerned party can be easily misled and not recognize that it is a common manifestation of BPD rather than a separate primary illness. For example, a person who attempts to kill himself by overdosing or cutting his wrists may be diagnosed with depression and prescribed antidepressant medications and brief supportive psychotherapy. If

If, however, the destructive behaviors are a manifestation of BPD, his self-harming will continue, unabated by the treatment. Even if he suffers from both depression and BPD (a common combination), this approach will only partially treat the illness and further problems will ensue. If the borderline features are not recognized, the continuation of suicidal or other destructive behaviors, despite treatment, becomes puzzling and frustrating for the patient, the doctor, and everyone concerned.

It is important to keep in mind that BPD is an illness, not a willful attempt to get attention. The borderline individual lacks boots, much less the bootstraps with which to pull himself up. It is useless to get angry or to cajole and plead with him to change; without help and motivation, he cannot easily modify his behavior. However, this does not imply that he is helpless and should not be held responsible for his conduct. Actually, the opposite is true. He must accept, without being excused or protected, the real consequences of his actions, even though initially he may feel powerless to alter them. In this way, BPD is no different from any other handicap. The individual confined to a wheelchair will elicit sympathy, but he is still responsible for finding wheelchair accessibility to the places he wishes to go, and for making sure his vehicle is in good enough condition to take him there.

Those who interact with a person with BPD must attempt to walk a very thin line between, on the one hand, providing reassurance of her worthiness and, on the other, confirming the necessary expectations. They must try to respond supportively, but without overreacting. Affection and physical touching, such as hugging and holding a hand, can communicate that she is a valued person, but if it is exploitative, it will hinder trust. If caring results in overprotectiveness, she stops feeling responsible for her behavior. A delicate balance of Support and Empathy with Truth is the ideal approach (see chapter 5).

Attempting to maintain consistent child-rearing after separation or divorce is especially challenging. Consistency among all supervisory figures—parents and stepparents—is the most important feature in establishing child-rearing rules with definitive boundaries.

However, this may be difficult for the borderline parent, who may consciously or unconsciously use the children to continue the battle with her

estranged spouse. The other parent should try to minimize conflicts by being highly selective in choosing his or her battles. Trying to defend oneself or debate accusations will not alter the resentment and will only confuse the child(ren). Contradicting or undermining directives of the other parent simply adds to the chaos. Often the best approach is to redirect the conversation away from the personal relationship by acknowledging mutual dedication to the ch...

A large UK/U.S. collaborative study demonstrated that significant borderline symptoms exhibited by age twelve were predictive of pervasive impaired functioning in transitioning to adulthood at age eighteen.2 Although some pediatricians have declared that they can recognize, by their early behavior, which young children will become borderline adults, BPD is generally first recognized in adolescence and early adulthood.

By definition, the struggles of adolescence and BPD are very similar: Both the typical adolescent and the adolescent with BPD struggle for individual identity and separation from parents, seek bonds with friends and identification with groups, try to avoid being left alone, tend to go through dramatic mood changes, have anger outbursts, and are generally prone to impulsivity. The teenager’s easy distractibility and oblivious daydreaming are analogous to borderline dissociative experiences and difficulties with committing to a goal and following through.

However, the normal adolescent does not cut his wrists, binge and purge several times a day, become addicted to drugs, or attack his mother; it is these behavioral extremes that foreshadow the development of BPD. Some parents will deny the seriousness of an adolescent’s problems (a drug overdose, for example) by dismissing them as accidental or seeing them as a typical teenager’s bid for attention.

Borderline adolescents exhibit higher lifetime rates of sexually transmitted infections and medical problems. They are more likely to abuse cigarettes, alcohol, and other drugs.3

Most people diagnosed with BPD, with or without treatment, improve over time. Many recover fully. Higher functioning borderline adults who do not fully recuperate may still have successful careers, assume traditional family roles, and have a cadre of friends and support systems. They may live generally satisfactory lives within their own separate corner of existence, despite recurrent frustrations with themselves and others who inhabit that niche.

Those with BPD who are lower functioning, however, have more difficulty maintaining a job and friends, and may lack family and support systems; they may inhabit lonelier and more desperate “black holes” within their own personal universe.

Thus, those sharing life with a loved one with BPD can expect his behaviors to become more tolerable over time. At this point the unpredictable reactions become more predictable and therefore easier

When BPD symptoms such as moodiness, anger, fears of abandonment, and poor outside relationships persist into later life, maintaining tolerable contacts is difficult, especially with a borderline parent.

In the workplace environment, borderline coworkers are often perceived as strange or eccentric. They tend to isolate themselves, avoid personal contacts, and keep others away with an aura of surliness, suspicion, or eccentricity. Some habitually complain of physical ailments or personal problems or occasionally have fits of paranoia and rage.

At play, the individual with BPD is typically unpredictable and sometimes very disconcerting. He may have great difficulty with recreation and play, exhibiting a seriousness all out of proportion to the relaxed nature of the activity. He may be your newly assigned tennis doubles partner who at first seems nice enough, but as the game goes on becomes increasingly frustrated and angry. Though you continually remind him that it’s just a game, he may stomp around, curse himself, throw the racket, and swear to give up the sport. He may be your son’s Little League coach who works well with your kids, but suddenly becomes wildly abusive to the teenage umpire or angrily cruel to his own son—seen as an extension of himself—who strikes out with the bases loaded.

This intensity interferes with his ability to relax and have fun. Others’ attempts at humor may frustrate him and make him angry. It is virtually impossible to kid him out of it. If you elect to continue playing tennis with your borderline partner, judicious use of SET-UP principles may make the experience more tolerable (see chapter 5).

Neither a hero nor a scapegoat be. When you are being perceived as an “angel,” accept without debate positive idealizing. Offering a humble “Aw shucks, I’m not that wonderful” protestation only invites frustration for the BPD victim; on the other hand, don’t promote a savior mission nor accept a villain role.

Take responsibility but challenge unreasonable vilification. Try to understand your borderline partner’s abrupt shifts in attitude. Acknowledge that he is upset with you and why. But don’t automatically concede demonization if it’s not true. After enduring repeated attacks, you might say, “I understand you’re frustrated and angry at me for not picking you up at the airport, but you know I have picked you up many times before and this time I just couldn’t get away from work.” After pointing out your previous airport runs, don’t continue to be defensive. Further explanations risk elevating anger. Sometimes the best approach is simply saying, “I’m sorry I disappointed you,” and letting it go.

Explain the “no-win” dilemma. In some situations, when who she is and what she wants is constantly wavering, her only consistent affects may be frustration and antagonism. At such times it doesn’t matter what you say or do—you’re damned if you do, damned if you

don’t. You can’t really win such no-win predicaments.

Deflect. When you anticipate you may be entering a no-win domain, ferret out your partner’s stance first. “I’m not sure about that. What do you think?”