I Hate You--Don't Leave Me - Jerold J. Kreisman [5]
Jennifer felt like a child clad in the armor of an adult. She was perplexed at the respect she received from other adults; she expected them to see through her disguise at any moment, revealing her as an empress with no clothes. She needed someone to love and protect her from the world. She desperately sought closeness, but when someone came too close, she ran.
Jennifer is afflicted with Borderline Personality Disorder (BPD). She is not alone. Recent studies estimate that 18 million or more Americans (almost 6 percent of the population) exhibit primary symptoms of BPD, and many studies suggest this figure is an underestimation. 1 Approximately 10 percent of psychiatric outpatients and 20 percent of inpatients, and between 15 and 25 percent of all patients seeking psychiatric care, are diagnosed with the disorder. It is one of the most common of all of the personality disorders.2,3,4
Yet, despite its prevalence, BPD remains relatively unknown to the general public. Ask the man on the street about anxiety, depression, or alcoholism, and he would probably be able to provide a sketchy, if not technically accurate, description of the illness. Ask him to define Borderline Personality Disorder, and he would probably give you a blank stare. Ask an experienced mental health clinician about the disorder, on the other hand, and you will get a much different response. She will sigh deeply and exclaim that of all the psychiatric patients, borderlines are the most difficult, the most dreaded, and the most to be avoided—more than schizophrenics, more than alcoholics, more than any other patient. For more than a decade, BPD has been lurking as a kind of “Third World” of mental illness—indistinct, massive, and vaguely threatening.
BPD has been underrecognized partly because the diagnosis is still relatively new. For years, “borderline” was used as a catchall category for patients who did not fit more established diagnoses. People described as “borderline” seemed more ill than neurotics (who experience severe anxiety secondary to emotional conflict), yet less ill than psychotics (whose detachment from reality makes normal functioning impossible).
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.
Though the term borderline was first coined in the 1930s, the condition was not clearly defined until the 1970s. For years, psychiatrists could not seem to agree on the separate existence of the syndrome, much less on the specific symptoms necessary for diagnosis. But as more and more people began to seek therapy for a unique set of life problems, the parameters of the disorder crystallized. In 1980, the diagnosis of Borderline Personality Disorder was first defined in the American Psychiatric Association’s third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the diagnostic “bible” of the psychiatric profession. Since then, several revisions of the DSM have been produced, the most recent being DSM-IV-TR, published in 2000. Though various schools within psychiatry still quarrel over the exact nature, causes, and treatment of BPD, the disorder is officially recognized as a major mental health problem in America today. Indeed, BPD patients consume a greater percentage of mental