I Hate You—Don't Leave Me: Understanding the Borderline Personality
Jerold J. Kreisman and Hal Straus, 1989
“I hate you,” and a minute later: “Please don't leave.” Psychiatrist Jerold Kreisman explains what borderline personality disorder is: where it comes from, what an ordinary week looks like from inside for a person who has it, what to say at the height of a storm, and what is known today about treatment. The book does not diagnose anyone; it explains the mechanism.
Who it is for
For people who want to understand borderline personality disorder from the inside: for those who have this diagnosis, for their loved ones, and for anyone who needs to know what lies behind stormy reactions.
A borderline person suffers from a kind of “emotional haemophilia”: there is no mechanism that allows the bleeding to be stopped.
About this book
Jennifer, twenty-eight years old, is admitted to hospital with stomach pains. Tests find nothing. The doctor, who has treated her for five years, advises her to see a psychiatrist, and Jennifer resists: if the tests are clean, then she has made it all up, and if she has not made it up, then she is mad. There is no third option in her head.
This story opens the book by psychiatrist Jerold Kreisman and journalist Hal Straus: the first book on borderline personality disorder written not for doctors. The third edition came out in 2021 and added what was not there in 1989: what is known today about the biology of the disorder, its causes and how it is treated.
Ahead are the origin of the word “borderline,” what is inherited and what takes shape in childhood, how an ordinary week looks from inside, what to say at the height of a storm, and what long observation has shown. The last turned out to be unexpected even for doctors.
One caveat. The book explains a mechanism but does not diagnose: recognising a familiar trait in a description is not yet a finding of the disorder.
Idea 1. The word “borderline” describes a medical dispute, not a person
Why does the disorder have such a strange name? It is not about the person, but about an old dispute among doctors. Psychiatrists of the last century divided patients into two camps: neurosis, when contact with reality is kept, and psychosis, when it is broken. Some people did not fit either, and they began to be called borderline, living on the border.
Today borderline personality disorder is a separate diagnosis. In the authors' description its essence lies in the difficulty of coping with strong feelings and of holding a steady picture of oneself and of relationships. The American DSM manual lists nine signs, and for a diagnosis at least five must match. Among them are fear of abandonment, intense relationships and an unstable self-image. Others are impulsivity, self-harm and mood swings. Then come a chronic feeling of emptiness, outbursts of anger, and brief loss of contact with reality under stress. The authors group them into four clusters: mood, impulsivity, relationships and distortions of thinking.
Now the arithmetic that explains all the confusion around the diagnosis. Five signs out of nine can be combined in 126 different ways. So one name covers at least 126 different sets, and two people with the same diagnosis may have almost nothing in common.
Hence the main mistake of the reader: turning the list into a questionnaire and trying it on oneself or a relative. Research estimates that BPD affects roughly one or two people in a hundred, while a single trait from the list is found in far more people and means nothing on its own.
What this means for you: recognising a description of someone you know means recognising a cluster of signs, not the person himself.
Two people with one diagnosis. One changed jobs three times in a year and cuts his arms. The other, from the outside, has done nothing noticeable, but every evening she feels an emptiness she has nothing to fill. Each has five points out of nine, and they are different five.
The diagnosis describes not one portrait but an area within which the portraits are very different, so the argument “alike or not alike” is almost always pointless.
About the author
Jerold Kreisman is an American psychiatrist who has worked for many years with people with borderline personality disorder. Hal Straus is a journalist who co-wrote with him the first book on this disorder for the general reader.
All books by this author: Jerold J. Kreisman and Hal Straus
Terms from the book
- Mindfulness
- Heritability
- neurosis
- splitting
- DSM
- Psychosis
- Borderline personality disorder
- Impulsivity: A tendency to act under the influence of the moment, without a pause to consider the consequences. One of the nine signs in the DSM list.
- Emotional haemophilia: An image from the book, not a medical term: as in haemophilia blood does not clot, so here a rising feeling does not stop.
- Linehan: Marsha Linehan, American psychologist, creator of dialectical behaviour therapy and of the biosocial theory of BPD. She later said publicly that she had been treated for a severe condition herself as a young woman.
- Emotional vulnerability: In Linehan's model, a property of the nervous system with three parts: a low threshold of reaction, high intensity of it, and slow return to calm.
- Biosocial theory: Marsha Linehan's model, which explains BPD by a combination of innate emotional vulnerability and an environment that dismisses a child's feelings. It is a model, not a proven cause.
- Invalidating environment: An environment in which a person's feelings are regularly answered by saying they are absent or wrong. A term from biosocial theory; invalidation can be meant kindly.
- Chronic feeling of emptiness: One sign of BPD: a persistent sense of inner emptiness, different from both sadness and boredom.
- SET method: Kreisman's method for a difficult conversation: support, empathy and truth, in exactly that order. An author's technique, not a clinical protocol.
- Dialectical behaviour therapy: A method created by Marsha Linehan specifically for BPD. It combines individual work with a group in which four sets of skills are practised.
- Schema therapy: A psychotherapy method that works with long-standing childhood schemas of how we see ourselves and others. One of the approaches used for BPD.
- Mentalization: The ability to understand what intentions and feelings lie behind actions, one's own and others'. A separate treatment method is built on training it.
- Zanarini: Mary Zanarini, American researcher who observed the same group of people with BPD for many years. Her work gave data on how the disorder changes over the years.
All terms
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