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

by Jerold J. Kreisman

Everything looked and sounded unreal. Nothing was what it is. That’s what I wanted—to be alone with myself in another world where truth is untrue and life can hide from itself. —From Long Day’s Journey into Night, by Eugene O’Neill

inconsistency is the hallmark of BPD. Unable to tolerate paradox, those with borderline personality are walking paradoxes, human catch-22s. Their inconstancy is a major reason why the mental health profession has had such difficulty defining a uniform set of criteria for the illness.

Frantic efforts to avoid real or imagined abandonment. Unstable and intense interpersonal relationships. Lack of clear sense of identity. Impulsiveness in potentially self-damaging behaviors, such as substance abuse, sex, shoplifting, reckless driving, binge eating. Recurrent suicidal threats or gestures, or self-mutilating behaviors. Severe mood shifts and extreme reactivity to situational stresses. Chronic feelings of emptiness. Frequent and inappropriate displays of anger. Transient, stress-related feelings of unreality or paranoia.

When the idealized person finally disappoints (as we all do, sooner or later), the borderline person must drastically restructure her strict, inflexible conceptualization. Either the idol is banished to the dungeon or she banishes herself in order to preserve the “all-good” image of the other person.

Most individuals can experience ambivalence and perceive two contradictory feeling states at one time; those with BPD characteristically shift back and forth, entirely unaware of one emotional state while immersed in another.

Despite feeling continually victimized by others, a borderline individual desperately seeks out new relationships; for solitude, even temporary aloneness, is more intolerable than mistreatment.

Not a symptom for me. I am usually isolating.

relationships often disintegrate quickly. Maintaining closeness with her requires an understanding of the syndrome and a willingness to walk a long, perilous tightrope. Too much closeness threatens her with suffocation. Keeping one’s distance or leaving her alone—even for brief periods—recalls the sense of abandonment she felt as a child. In either case, the borderline individual reacts intensely.

He fears abandonment, so he clings; he fears engulfment, so he pushes away. He craves intimacy and is terrified of it at the same time. He winds up repelling those with whom he most wants to connect.

The helping professions—medicine, nursing, clergy, counseling—also attract many with BPD, who strive to achieve the power or control that elude them in social relationships. Perhaps more important, in these roles they can provide the care for others—and receive the recognition from others—that they yearn for in their own lives.

To one degree or another, we all struggle with the same issues as the borderline patient—the threat of separation, the fear of rejection, confusion about identity, feelings of emptiness and boredom. How many of us have not had a few intense unstable relationships? Or flown into a rage now and then? Or felt the allure of ecstatic states? Or dreaded being alone, or gone through mood swings, or acted in a self-destructive manner in some way?

All is caprice. They love without measure those whom they will soon hate without reason. —Thomas Sydenham, seventeenth-century English physician, on “hystericks,” the equivalent of today’s borderline personality

What an obsession is identity! We search for it, because the private sensation when we are in our own identity is that we feel sincere as we speak, we feel real, and this little phenomenon of good feeling conceals an existential mystery as important to psychology as the cogito ergo sum—it is nothing less than that the emotional condition of feeling real is, for whatever reason, so far superior to the feeling of a void in oneself that it can become for protagonists like Marilyn a motivation more powerful than the instinct of sex, or the hunger for position or money. Some will give up love or security before they dare to lose the comfort of identity.46

As Kurt Vonnegut wrote in Mother Night, “We are what we pretend to be, so we must be careful about what we pretend to be.” Or as some phrase it, “Fake it till you make it.”

Characteristically, after such alcohol or sexual binges, she would berate herself with guilt and feel deserving of her husband’s abandonment. Then the cycle would start again, as she required more punishment for her worthlessness. Thus, impulsive self-destructive behaviors became both a means of avoiding pain and a mechanism for inflicting it as expiation for her sins.

directed at those close to the BPD person—spouse, children, parents. Borderline anger may represent a cry for help, a testing of devotion, or a fear of intimacy—whatever the underlying factors, it pushes away those whom he needs most.

A further complicating factor during this time is that the developing infant tends to perceive each individual in the environment as two separate personae. For example, when mother is comforting and sensitive, she is seen as “all-good.” When she is unavailable or unable to comfort and soothe, she is perceived as a separate “all-bad” mother. When she leaves his sight, the infant perceives her as annihilated, gone forever, and cries for her return to relieve the despair and panic. As the child develops, this normal “splitting” is replaced by a healthier integration of mother’s good and bad traits, and separation anxiety is replaced by the knowledge that mother exists even when she is not physically present and will in time return—a phenomenon commonly known as object constancy (see below). Prevailing over these developmental milestones is the child’s developing brain, which can sabotage normal adaptation.

the mother of a pre-borderline child, however, tends to respond to her child in a different way—either by pushing her child away prematurely and discouraging reunion (perhaps due to her own fear of closeness) or by insisting on a clinging symbiosis (perhaps due to her own fear of abandonment and need for intimacy). In either case, the child becomes burdened by intense fears of abandonment and/or engulfment that are mirrored back to him by the mother’s own fears.

Later in life, the borderline adult’s inability to achieve intimacy in personal relationships reflects this infant stage. When an adult with BPD confronts closeness, she may resurrect from childhood either the devastating feelings of abandonment that always followed her futile attempts at intimacy or the feeling of suffocation from mother’s constant smothering. Defying such controls risks losing mother’s love; satisfying her attempts at intimacy risks losing oneself.

the familiar comforts (teddy bears, dolls, blankets) that represent the mother and are carried everywhere by the child to help ease separations. The object’s form, smell, and texture are physical representations of the comforting mother. Transitional objects are one of the first compromises made by the developing child in negotiating the conflict between the need to establish autonomy and the need for dependency. This conflict of opposites is the first “dialectic” that a child learns to negotiate.

Though now trusting in mother’s permanent presence, the growing child must still contend with the fear of losing her love. The four-year-old who is scolded for being “bad” may still feel threatened with the withdrawal of his mother’s love; he may not yet conceive of the possibility that his mother may be expressing her own frustrations quite apart from his own behavior, nor has he learned that his mother can be angry and yet love him just as much at the same time.

Great actors usually discover they have a talent by first searching in desperation for an identity. It is no ordinary identity that will suit them, and no ordinary desperation can drive them. The force that propels a great actor in his youth is insane ambition. Illegitimacy and insanity are the godparents of the great actor. A child who is missing either parent is a study in the search for identity and quickly becomes a candidate for actor (since the most creative way to discover a new and possible identity is through the close fit of a role).23

(1) Gloria’s overt message, which essentially states, “If you care about me, you will respect my wishes and not challenge my autonomy to control my own destiny and even die, if I choose”; and (2) the opposite message, conveyed in the very act of announcing her intentions, which says, “For God’s sake, if you care about me, help me, and don’t let me die.”

Borderline individuals typically respond to depression, anxiety, frustration, or anger by superimposing more layers of these same feelings. Because of his perfectionism and tendency to perceive things in black-and-white extremes, he attempts to obliterate unpleasant feelings rather than understand or cope with them. When he finds that he cannot simply erase these bad feelings, he becomes even more frustrated or guilty. Since feeling bad is unacceptable, he feels bad about feeling bad. When this makes him feel even worse, he becomes caught in a seemingly bottomless downward spiral.

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.

Someone trapped in this dilemma will often break free when he least expects it—when he relaxes, becomes less obsessive and self-demanding, and learns to accept himself. It is no coincidence that the borderline character who seeks a healthy love relationship more often finds it when he is least desperate for one and more engaged in self-fulfilling activities. For it is at this point that he is more attractive to others and less pressured to grasp at immediate and unrealistic solutions to loneliness.

Pat lacked object constancy (see chapter 2 and Appendix B). Friendships and love relationships had to be constantly tested because she never felt secure with any human contact. Her need for reassurance was insatiable. She had been through countless other relationships in which she first appeared ingenuous and in need of caretaking and then tested them with outrageous demands.

There is a Monster in me. . . . It scares me. It makes me go up and down and back and forth, and I hate it. I will die if it doesn’t let me alone. —From the diary of a borderline patient

Doctors are men who prescribe medicines of which they know little, to cure disease of which they know less, in human beings of whom they know nothing. —Voltaire

In order to initiate change, he must break out of an impossible catch-22 position: To accept himself and others, he must learn to trust, but to trust others really means starting to trust himself—that is, his own perceptions of others.

“I’m finding,” Elizabeth noted, “that the roots of my indecisiveness are the beginning of success. I mean, the agony of choosing is that I suddenly see choices.”

to integrate the positive and negative aspects of other individuals. When the borderline person wants to get close to another, he must learn to be independent enough to be dependent in comfortable, not desperate, ways. He learns to function symbiotically, not parasitically.