I Hate You—Don't Leave Me by Jerold J. Kreisman Read Free Book Online Page A

natural disaster or combat. It is characterized by intense fear, emotional re-experiencing of the event, nightmares, irritability, exaggerated startle response, avoidance of associated places or activities, and a sense of helplessness. Since both BPD and PTSD have frequently been associated with a history of extreme abuse in childhood and reflect similar symptoms—such as extreme emotional reactions and impulsivity—some have posited that they are the same illness. Although some studies indicate that they may occur together as much as 50 percent or more of the time, they are distinctly different disorders with different defining criteria. 13
BPD and Associated Personality Disorders
    Many characteristics of BPD overlap with those of other personality disorders. For example, the dependent personality shares with the borderline the features of dependency, avoidance of being alone, and strained relationships. But the dependent personality lacks the self-destructiveness, anger, and mood swings of a borderline. Similarly, the schizotypal personality exhibits poor relations with others and difficulty in trusting, but is more eccentric and less self-destructive. Often a patient exhibits enough characteristics of two or more personality disorders to warrant diagnoses for each. For example, a patient may demonstrate characteristics that lead to diagnoses of both borderline personality disorder and obsessive-compulsive personality disorder.
    In DSM-IV-TR, BPD is grouped in a cluster of personality disorders that generally reflect dramatic, emotional, or erratic features (see Appendix A). The others in this group are narcissistic, antisocial, and histrionic personality disorders, to which BPD is often compared.
    Both borderlines and narcissists display hypersensitivity to criticism; failures or rejections can precipitate severe depression. Both exploit others; both demand almost constant attention. The narcissistic personality, however, usually functions at a higher level. He exhibits an inflated sense of self-importance (sometimes camouflaging desperate insecurity), displays disdain for others, and lacks even a semblance of empathy. In contrast, the borderline has a lower self-esteem and is highly dependent on others’ reassurance. The borderline desperately clings to others and is usually more sensitive to their reaction.
    Like the borderline, the antisocial personality exhibits impulsivity, poor tolerance of frustration, and manipulative relationships. The antisocial personality, however, lacks a sense of guilt or conscience; he is more detached and is not purposefully self-destructive.
    The histrionic personality shares with the borderline tendencies of attention-seeking, manipulativeness, and shifting emotions. The histrionic, however, usually develops more stable roles and relationships. He is usually more flamboyant in speech and manner, and emotional reactions are exaggerated. Physical attractiveness is the histrionic’s primary concern. One study compared psychological and social functioning in patients with BPD, schizotypal, obsessive-compulsive, or avoidant personality disorders and patients with major depression. Patients with borderline and schizotypal personality disorders were significantly more functionally impaired than those with the other personality disorders and those with major depression. 14
BPD and Substance Abuse
    BPD and chemical abuse are frequently associated. Nearly one-third of those with a lifetime diagnosis of substance abuse also fulfill criteria for BPD. And over 50 percent of BPD inpatients also abuse drugs or alcohol. 15 , 16 Alcohol or drugs might reflect self-punishing, angry, or impulsive behaviors, a craving for excitement, or a mechanism of coping with loneliness. Drug dependency may be a substitute for nurturing social relationships, a familiar, comforting way to stabilize or self-medicate fluctuating moods, or a way to establish some sense of belonging or self-identification.