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

by Jerold J. Kreisman

She needed someone to love and protect her from the world. She desperately sought closeness, but when someone came too close, she ran.

Additionally, studies corroborate that about 90 percent of patients with the BPD diagnosis also share at least one other major psychiatric diagnosis.7,8 BPD is also often connected to significant medical diseases, especially in women. These include chronic headaches and other pain, arthritis, and diseases of the cardiovascular, gastrointestinal, urinary, pulmonary, hepatic, immune, and oncological systems.

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.

Numerous studies have linked BPD with anorexia, bulimia, ADHD, drug addiction, and teenage suicide—all of which have increased alarmingly over the last decade.

In most cases, borderline and other personality disorders are a secondary diagnosis, describing the underlying characterological functioning of a patient who exhibits more acute and prominent symptoms of a state disorder.

Thus, under stress, one borderline patient turns to drugs, another develops an eating disorder, and still another becomes severely depressed. Third, BPD may so completely mimic another disorder that the patient may be erroneously diagnosed with schizophrenia, anxiety, bipolar disease, attention deficit hyperactivity disorder (ADHD), or other illnesses.

Borderline patients, in contrast, typically have difficulties in functioning (at least internally) even when not displaying prominent mood swings.

Not surprisingly, several studies have noted correlations between these diagnoses. Some prospective studies have noted that children diagnosed with ADHD frequently develop a personality disorder, especially BPD, as they get older. A Swedish study indicated that individuals with a diagnosis of ADHD were almost twenty times more likely to also have a BPD diagnosis than those not diagnosed with ADHD.

The borderline individual does not accept her own intelligence, attractiveness, or sensitivity as constant traits, but rather as comparative qualities to be continually re-earned and judged against others’.

Self-esteem is attained only through impressing others, so pleasing others becomes critical to loving herself.

Limited patience and need for immediate gratification may be connected to behaviors that define other BPD criteria:

or may provoke frequent fights in which he feels less directly responsible; circumstances or others provide the violence for him.

His base mood is not usually calm and controlled, but more often either hyperactive and irrepressible or pessimistic, cynical, and depressed.

These mood shifts are usually responses to the immediate situation and may be way out of proportion to the circumstances.

Yet literally minutes later he was spied laughing and joking with his new roommate.

Lacking a core sense of identity, individuals with BPD commonly experience a painful loneliness that motivates them to search for ways to fill up the “holes.” At other times they may simply withdraw and resist seeking help.

A significant percentage of borderline patients have a history of brain trauma, encephalitis, epilepsy, learning disabilities, ADHD, and maternal pregnancy complications.

many borderline children have an absent or psychologically disturbed father. Primary mother figures (who may sometimes be the father) tend to be erratic and depressed and have significant psychopathology themselves, often BPD. The borderline family background is frequently marked by incest, violence, and/or alcoholism. Many cases show an ongoing hostile or combative relationship between mother and pre-borderline child.

In some cases an individual therapy for the borderline patient is best directed toward distancing or separating from an unremittingly pathological family system.

Borderline personality disorder is a complex tapestry, richly embroidered with innumerable intersecting threads.

Like the world of those with borderline personality, ours in many ways is a world of massive contradictions. We presume we believe in peace, yet our streets, schools, movies, television, video games, and sports are filled with aggression and violence. We are a nation virtually founded on the principle of “Help thy neighbor,” yet we have become one of the most politically conservative, self-absorbed, and materialistic societies in the history of humankind. Assertiveness and action are encouraged; reflection and introspection are equated with weakness and incompetency.

Sixty percent of marriages for couples between the ages of twenty and twenty-five end in divorce; the number is 50 percent for those over twenty-five.

Such children may grow up bored and lonely, looking for constant stimulation. Continually forced to adapt to new situations and people, they may lose the stable sense of self encouraged by secure community anchors. Though socially graceful, like Lisa they typically feel they are gracefully faking it.

Several of the social changes described below strain borderline thoughts, feelings, and behaviors, which is to say the nine BPD criteria, perhaps more than any other mental disorder.

For those vulnerable with BPD symptoms, emotions like anxiety and fear are significantly magnified.

The U.S. Department of Health Resources and Services Administration was even more blunt: “Loneliness can be as damaging as fifteen cigarettes a day.”51

During stressful times, communication with a person with BPD is hindered by his impenetrable, chaotic internal force field, characterized by three major feeling states: terrifying aloneness, feeling misunderstood, and overwhelming helplessness.

SET-UP Communication

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 assurances.

Therefore, it is often necessary to reinforce Support and/or Empathy statements when you are accused of not caring or not understanding.

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.

The borderline individual must learn to allow himself the luxury of “bad” feelings without rebuke, guilt, or denial.

Adjusting to a world that is continually inconsistent and untrustworthy is a major problem for someone with BPD. His universe lacks pattern and predictability. Friends, jobs, and skills can never be relied upon. He must keep testing and retesting all of these aspects of his life; he is in constant fear that a trusted person or situation will change into the total opposite—absolute betrayal.

Every day he must begin anew, trying desperately to prove to himself that the world can be trusted. Just because the sun has risen in the east for thousands of years does not mean it will happen today. He must see it for himself each and every day.

She is in constant fear that Support could be withdrawn if at any point she displeases. Thus, attempts at reassurance are never-ending and never enough.

Because people with BPD have such difficulty with equivocation, intentions must be backed up with clear, predictable actions.

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

Like Play-Doh, the BPD individual can model herself into many configurations. While Play-Doh is composed of flour, water, salt, borax, and mineral oil, the BPD identity is fabricated from insecurity, fear, and dread. This chameleon aspect of BPD reveals her remarkable sensitivity toward others, deriving an impression of what she feels the other person wants her to be. She can sincerely slip into the protest crowd on either side of the barricade, argue both sides of the debate, yet without the context of others, she cannot divine her own, independent stance.

Thus, the future borderline adult is deprived of the opportunity to develop a consistent core identity.

“I don’t really know who I am” is a common BPD mantra. Developing a reliable, consistent sense of identity is a challenge for someone with BPD.

Individuals with BPD are very sensitive to people and things around them. Affective changes are usually reactive to environmental circumstances and can whipsaw from one emotion to another. Negative responses, in particular, can be intense.

Be gentle with Truth, but don’t lie. Inconsistencies and lies are frequent aspects of borderline experiences. An uncovered falsehood undermines the necessity of establishing credibility and trust.

Because hypnosis can produce an unfamiliar trance state resulting in panic or even psychosis, it is also usually avoided as a therapeutic technique.

Specific borderline traits—anxiety, emotional lability, suicidal tendencies, impulsivity, anger, sensation-seeking, aggression, cognitive distortions, identity confusion, and relationship problems—can also be highly genetic. Heritability also extends to family members. Relatives of borderline patients exhibit significantly greater rates of mood and impulse disorders, substance abuse, and personality disorders, especially BPD and antisocial personality.2

However, it is now generally accepted that personality traits can change over time, and that these changes can emerge at any point in the lifespan.19 Longer-term evaluations of individuals with BPD have demonstrated significant improvement over time.20,21,22

This suggests that the more acute and prominent symptoms of BPD (which primarily define the disorder), such as suicidal or self-mutilating behaviors, destructive impulsivity, and quasi-psychotic thinking, are more quickly responsive to treatment or time than the more enduring temperamental symptoms (fears of abandonment, feelings of emptiness, dependency, etc.).

Those who conquer the illness display a greater capacity to trust and establish satisfactory relationships. They have a clearer sense of purpose and a more stable understanding of themselves. In a sense, then, even if some borderline issues remain, they maintain productive lives speckled with fragmented relics of borderline personality.