The revised and expanded third edition of the bestselling guide to understanding borderline personality disorder with advice for communicating with and helping the borderline individuals in your life.

After more than three decades as the essential guide to borderline personality disorder (BPD), the third edition of I Hate You Don t Leave Me now reflects the most up-to-date research that has opened doors to the neurobiological, genetic, and developmental roots of the disorder, as well as connections between BPD and substance abuse, sexual abuse, post-traumatic stress syndrome, ADHD, and eating disorders.

Both pharmacological and psychotherapeutic advancements point to real hope for success in the treatment and understanding of BPD.

This expanded and revised edition is an invaluable resource for those diagnosed with BPD and their family, friends, and colleagues, as well as professionals and students in the field, and the practical tools and advice are easy to understand and use in your day-to-day interactions with the borderline individuals in your life.

Autorentext

Jerold J. Kreisman, MD, and Hal Straus

Leseprobe

Chapter One

The World of Borderline Personality Disorder

Everything looked and sounded unreal. Nothing was what it is. That's what I wanted-to be alone with myself in another world where truth is untrue and life can hide from itself.

-From Long Day's Journey into Night, by Eugene O'Neill

Dr. White thought it would all be relatively straightforward. Over the five years he had been treating Jennifer, she'd had few medical problems. Her stomach complaints were probably due to gastritis, he thought, so he treated her with antacids. But when her stomach pains became more intense despite treatment and routine testing proved normal, Dr. White admitted Jennifer to the hospital.

After a thorough medical workup, Dr. White inquired about stresses Jennifer might be experiencing at work and home. She readily acknowledged that her job as a personnel manager for a major corporation was very pressured, but as she put it, "Many people have pressure jobs." She also revealed that her home life was more hectic recently. She was trying to cope with her husband's busy legal practice while tending to the responsibilities of being a mother. But she doubted the connection of these factors to her stomach pains.

When Dr. White recommended that Jennifer seek psychiatric consultation, she initially resisted. It was only after her discomfort turned into stabs of pain that she reluctantly agreed to see the psychiatrist Dr. Gray.

They met a few days later. Appearing childlike and younger than her twenty-eight years, Jennifer lay in bed in a hospital room that had been transformed from an anonymous cubicle into a personalized lair. A stuffed animal sat next to her in bed, and another lay on the nightstand beside several pictures of her husband and son. Get-well cards were meticulously displayed in a line along the windowsill, flanked by flower arrangements.

At first Jennifer was very formal, answering all of Dr. Gray's questions with great seriousness. Then she joked about how her job was "driving me to see a shrink." The longer she talked, the sadder she looked. Her voice became less domineering and more childlike.

She told him how a job promotion was exacting more demands-new responsibilities that were making her feel insecure. Her five-year-old son was starting school, which was proving to be a difficult separation for both of them. Conflicts with Allan, her husband, were increasing. She described rapid mood swings and trouble sleeping. Her appetite had steadily decreased and she was losing weight. Her concentration, energy, and sex drive had all diminished.

Dr. Gray recommended a trial of antidepressant medications, which improved her gastric symptoms and seemed to normalize her sleeping patterns. In a few days she was ready for discharge and agreed to continue outpatient therapy.

Over the following weeks, Jennifer talked more about her upbringing. Reared in a small town, she was the daughter of a prominent businessman and his socialite wife. Her father, an elder in the local church, demanded perfection from his daughter and her two older brothers, constantly reminding the children that the community was scrutinizing their behavior. Jennifer's grades, her behavior, even her thoughts were never quite good enough. She feared her father, yet constantly-and unsuccessfully-sought his approval. Her mother remained passive and detached. Her parents evaluated her friends, often deeming them unacceptable. As a result, she had few friends and even fewer dates.

Jennifer described her roller-coaster emotions, which seemed to have worsened when she started college. She began drinking for

the first time, sometimes to excess. Without warning, she would feel lonely and depressed and then high with happiness and love. On occasion, she would burst out in rage against her friends-fits of anger that she had somehow managed to suppress as a child.

It was at about this time that she also began to appreciate the attention of men, something she had previously always avoided. Though she enjoyed being desired, she always felt she was "fooling" or tricking them somehow. After she began dating a man, she would sabotage the relationship by stirring up conflict.

She met Allan as he was completing his law studies. He pursued her relentlessly and refused to be driven away when she tried to back off. He liked to choose her clothes and advise her on how to walk, how to talk, and how to eat nutritiously. He insisted she accompany him to the gym where he frequently worked out.

"Allan gave me an identity," she explained. He advised her on how to interact with his society partners and clients, when to be aggressive, when to be demure. She developed a cast of "repertoire players"-characters or roles whom she could call to the stage on cue.

They married, at Allan's insistence, before the end of her junior year. She quit school and began working as a receptionist, but her employer recognized her intelligence and promoted her to more responsible jobs.

At home, however, things began to sour. Allan's career and his interest in bodybuilding caused him to spend more time away from home, which Jennifer hated. Sometimes she would start fights just to keep him home a little longer. Frequently, she would provoke him into hitting her. Afterward she would invite him to make love to her.

Jennifer had few friends. She devalued women as gossipy and uninteresting. She hoped that her son Scott's birth, coming two years after her marriage, would provide the comfort she lacked. She felt her son would always love her and always be there for her. But the demands of an infant were overwhelming, and after a while, Jennifer decided to return to work.

Despite frequent praise and successes at work, Jennifer continued to feel insecure, that she was "faking it." She became sexually involved with a coworker who was almost forty years her senior.

"Usually I'm okay," she told Dr. Gray. "But there's another side that takes over and controls me. I'm a good mother. But my other side makes me a whore; it makes me act crazy!"

Jennifer continued to deride herself, particularly when alone; during times of solitude, she would feel abandoned, which she attributed to her own unworthiness. Anxiety would threaten to overwhelm her unless she found some kind of release. Sometimes she'd indulge in eating binges, once consuming an entire bowl of cookie batter. She would spend long hours gazing at pictures of her son and husband, trying to "keep them alive in my brain."

Jennifer's physical appearance at her therapy sessions fluctuated dramatically. When coming directly from work, she would dress in a business sui…