I Hate You--Don't Leave Me - Jerold J. Kreisman [17]
Both borderlines and narcissists display hypersensitivity to criticism; failures or rejections can precipitate severe depression. Both exploit others; both demand almost constant attention. The narcissistic personality, however, usually functions at a higher level. He exhibits an inflated sense of self-importance (sometimes camouflaging desperate insecurity), displays disdain for others, and lacks even a semblance of empathy. In contrast, the borderline has a lower self-esteem and is highly dependent on others’ reassurance. The borderline desperately clings to others and is usually more sensitive to their reaction.
Like the borderline, the antisocial personality exhibits impulsivity, poor tolerance of frustration, and manipulative relationships. The antisocial personality, however, lacks a sense of guilt or conscience; he is more detached and is not purposefully self-destructive.
The histrionic personality shares with the borderline tendencies of attention-seeking, manipulativeness, and shifting emotions. The histrionic, however, usually develops more stable roles and relationships. He is usually more flamboyant in speech and manner, and emotional reactions are exaggerated. Physical attractiveness is the histrionic’s primary concern. One study compared psychological and social functioning in patients with BPD, schizotypal, obsessive-compulsive, or avoidant personality disorders and patients with major depression. Patients with borderline and schizotypal personality disorders were significantly more functionally impaired than those with the other personality disorders and those with major depression.14
BPD and Substance Abuse
BPD and chemical abuse are frequently associated. Nearly one-third of those with a lifetime diagnosis of substance abuse also fulfill criteria for BPD. And over 50 percent of BPD inpatients also abuse drugs or alcohol.15,16 Alcohol or drugs might reflect self-punishing, angry, or impulsive behaviors, a craving for excitement, or a mechanism of coping with loneliness. Drug dependency may be a substitute for nurturing social relationships, a familiar, comforting way to stabilize or self-medicate fluctuating moods, or a way to establish some sense of belonging or self-identification. These possible explanations for the appeal of chemical abuse are also some of the defining criteria for BPD.
The Anorexic/Bulimic Borderline or the Borderline Anorexic/Bulimic?
Anorexia nervosa and bulimia have become major health problems in this country, especially among young women. Eating disorders are fueled by a fundamental distaste for one’s own body and a general disapproval of one’s identity. The anorexic sees herself in absolute black or white extremes—as either obese (which she always feels) or thin (which she feels she never completely achieves). Since she constantly feels out of control, she impulsively utilizes starvation or binging and purging to maintain an illusion of self-control. The similarity of this pattern to the borderline pattern has led many mental health professionals to infer a strong connection between the two. Indeed, many studies confirm the high prevalence of personality disorders in those with eating disorders and, conversely, the frequent co-occurrence of personality disorders in those with any eating disorder. 17
BPD and Compulsive Behaviors
Certain compulsive or destructive behaviors may reflect borderline patterns. For example, a compulsive gambler will continue to gamble despite a shortage of funds. He may be seeking a thrill from a world that habitually leaves him bored, restless, and numb. Or the gambling may be an expression of impulsive self-punishment. Shoplifters often steal items they do not need. Fifty percent of bulimics exhibit kleptomania, drug use, or promiscuity.18 When these behaviors are governed by compulsion,