I Hate You--Don't Leave Me - Jerold J. Kreisman [10]
In a sense, the borderline is like an emotional explorer who carries only a sketchy map of interpersonal relations; he finds it extremely difficult to gauge the optimal psychic distance from others, particularly significant others. To compensate, he caroms back and forth from clinging dependency to angry manipulation, from gushes of gratitude to fits of irrational anger. 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.
Job and Workplace Problems
Though borderlines have extreme difficulties managing their personal lives, many are able to function productively in a work situation—particularly if the job is well structured, clearly defined, and supportive. Some perform well for long periods, but then suddenly—because of a change in the job structure, or a drastic shift in personal life, or just plain boredom and a craving for change—they abruptly leave or sabotage their position and go on to the next opportunity. Many borderlines complain of frequent or chronic minor medical illnesses, leading to recurrent doctor visits and sick days.18
The work world can provide sanctuary from the anarchy of their social relationships. For this reason, borderlines frequently function best in highly structured work environments. The helping professions—medicine, nursing, clergy, counseling—also attract many borderlines who strive to achieve the power or control that elude them in social relationships. Perhaps more important, in these roles borderlines can provide the care for others—and receive the recognition from others—that they yearn for in their own lives. Borderlines are often very intelligent and display striking artistic abilities; fueled by easy access to powerful emotions, they can be creative and successful professionally.
But a highly competitive or unstructured job, or a highly critical supervisor, can trigger the intense, uncontrolled anger and the hypersensitivity to rejection to which the borderline is susceptible. The rage can permeate the workplace and literally destroy a career.
A “Woman’s Illness”?
Until recently, studies suggested that women borderlines outnumbered men by as much as three or four to one. However, more recent epidemiological research confirms that prevalence is similar in both genders, although women enter treatment more frequently. Moreover, severity of symptoms and disability are greater among women. These factors may help explain why females have been overrepresented in clinical trials. But there may be other factors that contribute to the impression that BPD is a “woman’s disease.”
Some critics feel that a kind of clinician bias operates with borderline diagnoses: Psychotherapists may perceive problems with identity and impulsivity as more “normal” in men; as a result, they may underdiagnose BPD among males. Where destructive behavior in women may be seen as a result of mood dysfunction, similar behavior in men may be perceived as antisocial. Where women in such predicaments may be directed toward treatment, men may instead be channeled through the criminal justice system where they may elude correct diagnosis forever.
BPD in Different Age Groups
Many of the features of the borderline syndrome—impulsivity, tumultuous relationships, identity confusion, mood instability—are major developmental hurdles for any adolescent. Indeed, establishing a core identity is the primary quest for both the teenager and the borderline. It follows, then, that BPD is diagnosed more commonly among adolescents and young adults than other age groups.19
BPD appears to be rare in the elderly. Recent studies demonstrate that the greatest decline in diagnosis of BPD occurs after the mid-forties. From this data, some researchers hypothesize that many older borderline adults “mature out” and are able to achieve stabilization over time. However, elderly adults must contend with a progressive decline in physical and mental functioning,