I Hate You--Don't Leave Me - Jerold J. Kreisman [6]
In many ways, the borderline syndrome has been to psychiatry what the virus is to general medicine: an inexact term for a vague but pernicious illness that is frustrating to treat, difficult to define, and impossible for the doctor to explain adequately to his patient.
Demographic Borders
Who are the borderline people one meets in everyday life?
She is Carol, a friend since grade school. Over a minor slight, she accuses you of stabbing her in the back and tells you that you were really never her friend at all. Weeks or months later, Carol calls back, congenial and blasé, as if nothing had happened between you.
He is Bob, a boss in your office. One day, Bob bestows glowing praise on your efforts in a routine assignment; another day, he berates you for an insignificant error. At times he is reserved and distant; other times he is suddenly and uproariously “one of the boys.”
She is Arlene, your son’s girlfriend. One week, she is the picture of preppy; the next, she is the epitome of punk. She breaks up with your son one night, only to return hours later, pledging endless devotion.
He is Brett, your next-door neighbor. Unable to come to grips with his collapsing marriage, he denies his wife’s obvious unfaithfulness in one breath, and then takes complete blame for it in the next. He clings desperately to his family, caroming from guilt and self-loathing to raging attacks on his wife and children who have so “unfairly” accused him.
If the people in these short profiles seem inconsistent, it should not be surprising—inconsistency is the hallmark of BPD. Unable to tolerate paradox, borderlines are walking paradoxes, human catch-22s. Their inconstancy is a major reason why the mental health profession has had such difficulty defining a uniform set of criteria for the illness.
If these people seem all too familiar, this also should not be surprising. The chances are good that you have a spouse, relative, close friend, or coworker who is borderline. Perhaps you know a little bit about BPD or recognize borderline characteristics within yourself.
Though it is difficult to get a firm grasp on the figures, mental health professionals generally agree that the number of borderlines in the general population is growing—and at a rapid pace—though some observers claim that it is the therapists’ awareness of the disorder that is growing rather than the number of borderlines.
Is borderline personality really a modern-day “plague,” or is merely the diagnostic label borderline new? In any event, the disorder has provided new insight into the psychological framework of several related conditions. Numerous studies have linked BPD with anorexia, bulimia, ADHD, drug addiction, and teenage suicide—all of which have increased alarmingly over the last decade. Some studies have uncovered BPD in almost 50 percent of all patients admitted to a facility for an eating disorder.9 Other studies have found that over 50 percent of substance abusers also fulfill criteria for BPD.
Self-destructive tendencies or suicidal gestures are very common among borderlines—indeed, they are one of the syndrome’s defining criteria. As many as 70 percent of BPD patients attempt suicide. The incidence of documented death by suicide is about 8 to 10 percent and even higher for borderline adolescents. A history of previous suicide attempts, a chaotic family life, and a lack of support systems increase the likelihood. 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
How Doctors Diagnose Psychiatric Disease
Before 1980, the previous two editions of the DSM described psychiatric illnesses in descriptive terms. However, DSM-III defined psychiatric disorders along structured, categorical paradigms; that is, several symptoms have been