I Hate You--Don't Leave Me - Jerold J. Kreisman [18]
Promiscuity often reflects a need for constant love and attention from others, in order to hold on to positive feelings about oneself. The borderline typically lacks consistent, positive self-regard and requires continuous reassurance. A borderline woman, lacking in self-esteem, may perceive her physical attractiveness as her only asset and may require confirmation of her worth by engaging in frequent sexual encounters. Such involvements avoid the pain of being alone and create artificial relationships she can totally control. Feeling desired can instill a sense of identity. When self-punishment becomes a prominent part of the psychodynamics, humiliation and masochistic perversions may enter the relationships. From this perspective, it is logical to speculate that many prostitutes and pornographic actors and models may be borderline.
Difficulties with relationships may result in private, ritualistic thinking and behaviors, often expressed as obsessions or compulsion. A borderline may develop specific phobias as he employs magical thinking to deal with fears; sexual perversions may evolve as a mechanism to approach intimacy.
Appeal of Cults
Because borderlines yearn for direction and acceptance, they may be attracted to strong leaders of disciplined groups. The cult can be very enticing since it provides instant and unconditional acceptance, automatic intimacy, and a paternalistic leader who will be readily idealized. The borderline can be very vulnerable to such a black-and-white worldview in which “evil” is personified by the outside world and “good” is encompassed within the cult group.
BPD and Suicide
As many as 70 percent of BPD patients attempt suicide, and the rate of completed suicide approaches 10 percent, almost a thousand times the rate seen in the general population. In the high-risk group of adolescents and young adults (ages fifteen to twenty-nine), BPD was diagnosed in a third of suicide cases. Hopelessness, impulsive aggressiveness, major depression, concurrent drug use, and a history of childhood abuse increase the risk. Although anxiety symptoms are often associated with suicide in other illnesses, borderlines who exhibit significant anxiousness are actually less likely to commit suicide.19, 20, 21
Clinical Definition of Borderline Personality Disorder
The current official definition of borderline pathology is contained in the DSM-IV-TR diagnostic criteria of Borderline Personality Disorder.22 This designation emphasizes descriptive, observable behavior.
The diagnosis of BPD is confirmed when at least five of the following nine criteria are present.
“Others Act Upon Me, Therefore I Am”
Criterion 1. Frantic efforts to avoid real or imagined abandonment.
Just as an infant cannot distinguish between the temporary absence of her mother and her “extinction,” the borderline often experiences temporary aloneness as perpetual isolation. As a result, the borderline becomes severely depressed over the real or perceived abandonment by significant others and then enraged at the world (or whoever is handy) for depriving her of this basic fulfillment.
Fears of abandonment in the borderline can even be measured in the brain. One study utilized PET scanning to demonstrate that women with BPD experienced alterations of blood flow in certain areas of the brain when exposed to memories of abandonment.23 Particularly when they are alone, borderlines may lose the sensation of existing, of feeling real. Rather than embracing Descartes’ “I think, therefore I am” principle of existence, they live by a philosophy closer to “Others act upon me, therefore I am.”
The theologian Paul Tillich wrote that “loneliness can be conquered only by those who can bear solitude.” Because the borderline finds solitude so difficult to tolerate, she is trapped in a relentless metaphysical loneliness from which the only relief comes in the form of the physical presence of others. So she will often rush to singles bars or other crowded haunts, often with disappointing