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

by Jerold J. Kreisman

The disorder also coexists with, and borders on, other mental illnesses: depression, anxiety, bipolar (manic-depressive) disorder, schizophrenia, somatization disorder (hypochondriasis), dissociative identity disorder (multiple personality), attention deficit/ hyperactivity disorder (ADHD), post-traumatic stress disorder, alcoholism, drug abuse (including nicotine dependence), eating disorders, phobias, obsessive-compulsive disorder, hysteria, sociopathy, and other personality disorders.

The risk multiplies even more among borderline patients who also suffer from depressive or manic-depressive (bipolar) disorders, or from alcoholism or drug abuse.10,11

Because of the borderline’s inability to see the big picture, to learn from previous mistakes, and to observe patterns in his own behavior, he often repeats destructive relationships.

The borderline’s endless quest is to find a perfect caregiver who will be all-giving and omnipresent. The search often leads to partners with complementary pathology: both lack insight into their mutual destructiveness.

Afflicted with self-loathing, the borderline distrusts others’ expressions of caring.

Borderlines lack a constant, core sense of identity, just as they lack a constant, core conceptualization of others.

For the borderline, identity is graded on a curve. Who she is (and what she does) today determines her worth, with little regard to what has come before.

The borderline frequently experiences a kind of existential angst, which can be a major obstacle in treatment for it saps the motivational energy to get well.

The rage, so intense and so near the surface, is often directed at the borderline’s closest relationships—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 the borderline needs most. The spouse, friend, lover, or family member who sticks around despite these assaults may be very patient and understanding, or, sometimes, very disturbed himself.

In the face of these eruptions, empathy is difficult and the relation must draw on every resource at hand in order to cope (see chapter 5).

The lack of structure in American society, for example, is especially difficult for borderlines to handle, since they typically have immense problems creating structure for themselves.

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.

With little interest in the past, the borderline is almost a cultural amnesiac; his cupboard of warm memories (which sustain most of us in troubled times) is bare. As a result, he is doomed to suffer torment with no breathers, no cache of memories of happier times to get him through the tough periods. Unable to learn from his mistakes, he is doomed to repeat them.

During such times, communication with the borderline is hindered by his impenetrable, chaotic internal force field, characterized by three major feeling states: terrifying aloneness, feeling misunderstood, and overwhelming helplessness.

“SET”—Support, Empathy, Truth—is

UP stands for Understanding and Perseverance—the

The S stage of this system, Support, invokes a personal, “I” statement of concern.

With the Empathy segment, one attempts to acknowledge the borderline’s chaotic feelings with a “You” statement:

Empathy should be expressed in a neutral way with minimal personal reference to the speaker’s own feelings.

The T statement, representing Truth or reality, emphasizes that the borderline is ultimately accountable for his life and that others’ attempts to help cannot preempt this primary responsibility.

Truth statements acknowledge that a problem exists and address the practical, objective issue of what can be done to solve it.

The borderline may frequently need to be reminded that others’ reactions to him are based primarily on what he does, and that he must take responsibility for the consequences, rather than blaming others for realistic responses to his behavior.

The borderline’s split view of himself includes a special, entitled part and an angry, unworthy part that masochistically deserves punishment,

The borderline “victim” must, however, hear all three parts of the message, otherwise the impact of the message will be lost. If “The Truth will set you free,” then Support and Empathy must accompany it to ensure it will be heard.

For many borderlines, having a consistent, unflappable figure in their lives (neighbor, friend, therapist) may be one of the most important requirements for healing.

this does not imply that the borderline 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 be powerless to alter them.

Those who interact with a borderline must attempt to walk a very thin line between, on the one hand, providing reassurance of the borderline’s worthiness and, on the other, confirming the necessary expectations. They must try to respond supportively, but without overreacting.

It takes only one actor in the drama to initiate change.

Although no medication is targeted specifically for BPD, research has demonstrated that three primary classes of medicines—antidepressants, mood stabilizers, and neuroleptics (antipsychotics)—ameliorate many of the maladaptive behaviors associated with the disorder.