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

These possible explanations for the appeal of chemical abuse are also some of the defining criteria for BPD.
The Anorexic/Bulimic Borderline or the Borderline Anorexic/Bulimic?
    Anorexia nervosa and bulimia have become major health problems in this country, especially among young women. Eating disorders are fueled by a fundamental distaste for one’s own body and a general disapproval of one’s identity. The anorexic sees herself in absolute black or white extremes—as either obese (which she always feels) or thin (which she feels she never completely achieves). Since she constantly feels out of control, she impulsively utilizes starvation or binging and purging to maintain an illusion of self-control. The similarity of this pattern to the borderline pattern has led many mental health professionals to infer a strong connection between the two. Indeed, many studies confirm the high prevalence of personality disorders in those with eating disorders and, conversely, the frequent co-occurrence of personality disorders in those with any eating disorder. 17
BPD and Compulsive Behaviors
    Certain compulsive or destructive behaviors may reflect borderline patterns. For example, a compulsive gambler will continue to gamble despite a shortage of funds. He may be seeking a thrill from a world that habitually leaves him bored, restless, and numb. Or the gambling may be an expression of impulsive self-punishment. Shoplifters often steal items they do not need. Fifty percent of bulimics exhibit kleptomania, drug use, or promiscuity. 18 When these behaviors are governed by compulsion, they may represent a need to feel or a need to self-inflict pain.
    Promiscuity often reflects a need for constant love and attention from others, in order to hold on to positive feelings about oneself. The borderline typically lacks consistent, positive self-regard and requires continuous reassurance. A borderline woman, lacking in self-esteem, may perceive her physical attractiveness as her only asset and may require confirmation of her worth by engaging in frequent sexual encounters. Such involvements avoid the pain of being alone and create artificial relationships she can totally control. Feeling desired can instill a sense of identity. When self-punishment becomes a prominent part of the psychodynamics, humiliation and masochistic perversions may enter the relationships. From this perspective, it is logical to speculate that many prostitutes and pornographic actors and models may be borderline.
    Difficulties with relationships may result in private, ritualistic thinking and behaviors, often expressed as obsessions or compulsion. A borderline may develop specific phobias as he employs magical thinking to deal with fears; sexual perversions may evolve as a mechanism to approach intimacy.
Appeal of Cults
    Because borderlines yearn for direction and acceptance, they may be attracted to strong leaders of disciplined groups. The cult can be very enticing since it provides instant and unconditional acceptance, automatic intimacy, and a paternalistic leader who will be readily idealized. The borderline can be very vulnerable to such a black-and-white worldview in which “evil” is personified by the outside world and “good” is encompassed within the cult group.
BPD and Suicide
    As many as 70 percent of BPD patients attempt suicide, and the rate of completed suicide approaches 10 percent, almost a thousand times the rate seen in the general population. In the high-risk group of adolescents and young adults (ages fifteen to twenty-nine), BPD was diagnosed in a third of suicide cases. Hopelessness, impulsive aggressiveness, major depression, concurrent drug use, and a history of childhood abuse increase the risk. Although anxiety symptoms are often associated with suicide in other illnesses, borderlines who exhibit significant anxiousness are actually less likely to commit suicide. 19 , 20 , 21

Clinical Definition of Borderline