I Hate You--Don't Leave Me - Jerold J. Kreisman [63]
A normal adolescent may listen to gloomy music, write pessimistic poetry, glorify suicidal celebrities, dramatically scream, cry, and threaten. However, the normal adolescent does not cut his wrists, binge and purge several times a day, become addicted to drugs, or attack his mother; and it is these extremes that anticipate the development of BPD.
Some parents will deny the seriousness of an adolescent’s problems (a drug overdose, for example) by dismissing them as a typical teenager’s bid for attention. Though it is true that children often seek attention in dramatic ways, neither suicide attempts nor any destructive behaviors are “normal.” They instead suggest the possibility of incipient borderline personality or another disorder and should be evaluated by a professional. Compared to teenagers with other psychiatric disorders, borderline adolescents experience some of the most severe pathology and dysfunction. Borderline adolescents exhibit higher lifetime rates of sexually transmitted infections and medical problems. They are more likely to abuse alcohol, cigarettes, and other drugs.1
Usually others—parents, teachers, employers, friends—will recognize when the normal teenager crosses the border into borderline behavior, even before the adolescent himself. Continuous drug abuse, serial tumultuous relationships, or anorexic fasting are reliable indicators that deeper problems may be involved. The teen’s whole style of functioning should be the focus of examination, rather than individual symptoms. This is especially crucial when considering the potential for suicide.
Suicide is a leading cause of death among teenagers, and is particularly prevalent in children who are depressed, abuse drugs, act impulsively or violently, and maintain few support systems—all prominent features of BPD.2,3 Threats of self-harm should always be taken seriously. Attempts to self-mutilate or harm oneself “only for attention” can go tragically awry. Parents who try to distinguish “real suicide” from “attention-seeking” miss the point—both are seriously pathological behaviors and require treatment, often hospitalization.
Working with the Borderline
In the work environment, borderlines are often perceived as “strange” or “eccentric”: they may tend to isolate themselves, avoid personal contacts, and keep others away with an aura of surliness, suspicion, or eccentricity. Some habitually complain of physical ailments or personal problems, and occasionally have fits of paranoia and rage. Still others may act perfectly normal in the work situation, but appear awkward or uncomfortable around coworkers outside the workplace.
Many employers have implemented Employee Assistance Programs (EAPs), in-house counselors, and referral departments initially designed to help employees deal with alcohol and drug abuse problems. Today, many EAPs are also available to help workers confront other emotional problems as well as legal and financial difficulties.
Many EAP counselors are well equipped to identify features of alcohol or drug abuse, or of prominent psychiatric illnesses such as depression or psychosis, but they may be less familiar with the more intricate symptoms of BPD. Though the employee’s supervisor, coworkers, counselor, even the employee himself may be aware of some dysfunctional or disruptive behaviors, the borderline might not be referred for treatment because his behaviors cannot be clearly associated with a more commonly recognized disorder.
The prospective employer may suspect borderline characteristics in an applicant who has a history of frequent job changes. These terminations will often be explained by “personality conflicts” (which, indeed, is often accurate). Other job separations may be sparked by a significant change—a new supervisor, new computer system, or an adjustment in job description—that disrupted a very structured (perhaps even monotonous) routine.
Because the borderline may be very creative and dedicated, he can be a most valuable employee. When functioning on a higher level, he can be colorful, stimulating,