I Hate You Don’t Leave Me is a deep, highly informational and well researched book on borderline personality disorder.
It’s one of the best books to understand BPD.
- Bullet Summary
- Full Summary
- Real Life Applications
- Also Read
- BPDs are impulsive and have wild mood swings
- BPDs have troubled interpersonal relationships
- Over time BPD tend to improve, and improve even quicker with good therapy
Borderline individuals are the psychological equivalent of third-degree burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense sufferingMarsha Linehan
Incidence of BPD
Some studies say that around 6% of the US population suffers from BPD, but Jerold Kreisman says that figure might be an underestimation.
Among patients seeking psychiatric care, between 15% and 25% are diagnosed with BPD, making it one of the most common of all of the personality disorders.
Comorbidity & Similarities
BPD present similarities, and sometimes coexists with: depression, anxiety, bipolar (manic-depressive) disorder, schizophrenia, somatization disorder (hypochondriasis), dissociative identity disorder (multiple personality), attention deficit/ hyperactivity disorder (ADHD), post-traumatic stress disorder, alcoholism, drug abuse (including nicotine dependence), eating disorders, phobias, obsessive-compulsive disorder, hysteria, sociopathy.
90% of BPD present at least one more other major psychiatric disorder.
One individual is diagnosed with BPD if he presents 5 of the following 9 criteria:
- Frantic efforts to avoid real or imagined abandonment
- Unstable and intense interpersonal relationships going from extremes idealization and devaluation (also known as “splitting”)
- Lack of clear sense of identity: unstable self-image or sense of self
- Impulsiveness in potentially self-damaging behavior (spending, sex, drugs, reckless driving, binge eating)
- Recurrent suicidal threats, or gestures, or self-harming behavior
- Severe mood shifts and instability in reaction to day-to-day events (intense episodic sadness, irritability, or anxiety)
- Chronic feelings of emptiness
- Frequent and inappropriate displays of anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms (unreality or paranoia)
The author says that these 9 symptoms can be grouped into 4 categories:
- Mood instability (criteria 1, 6, 7, and 8).
- Impulsivity and dangerous uncontrolled behavior (criteria 4 and 5).
- Interpersonal psychopathology (criteria 2 and 3).
- Distortions of thought and perception (criterion 9).
However, Jerold Kreisman warns, people shouldn’t make the mistake of considering each symptom as its own constellation: they are all related and they all move together like pistons in an engine.
In a nutshell, life for the borderline is a relentless emotional roller coaster with no apparent destination.
Degrees of Borderline
Jerold Kreisman says that some researchers suggests to change the definition of borderline to move from a “yes” or “no” to a more modular definition.
This would make sense because there are different “levels” of being a BPD. Some function better in society while some others struggle more and present more marked signs.
It’s A Mix of Nature & Nurture
Causing BPD is a mix of genes (nature) and (nurture) life experiences.
Says Jerold Kreisman:
The available evidence points to no one definitive cause—or even type of cause—of BPD. Rather, a combination of genetic, developmental, neurobiological, and social factors contribute to the development of the illness.
Many studies have also found a history of severe psychological, physical, or sexual abuse in BPD.
Borderlines cannot stand loneliness and desperately seeks relationships. Even when they feel mistreated by others, an abusive relationship is better than loneliness.
Relationships for borderlines tend to be, like their life, a difficult emotional roller coaster.
Writes Jerold Kreisman:
Too much closeness threatens the borderline with suffocation. Keeping one’s distance or leaving a borderline alone—even for brief periods—recalls the sense of abandonment he felt as a child. In either case, the borderline reacts intensely.
Borderline’s behavior is also incompatible with loving and stable relationships.
With their erratic behavior and their need and fear for intimacy at the same time, they often end up repelling the people with whom they most want to connect.
In this sense, borderline’s relationships resemble a lot the anxious avoidant relationship trap (check the article it’s very well done), with the borderline alternating between an anxious (craving intimacy) and an avoidant (running away from intimacy) attachment style (read here an overview of attachment styles).
The “I Love Him” Fallacy
The need for physical closeness to avoid chronic loneliness can push the BPD into serial sexual relationship with disappointing -or even violent- results.
BPD, with their fragile ego and low self-esteem, often repeat the same mistakes and go back to their abusive exes.
Their dependency is often disguised as passion, and you will hear the BPD justify their destructive behavior by repeating “because I love him”.
The BPD unrealistic goal is to find a perfect partner-caregiver who gives it all and is always ready to tend for them.
The quest often leads to partners with complementary pathology leading to toxic relationships and destructive relationship dances.
If she is a BPD for example, she can end up with an insecure man who displays fake confidence and needs a helpless partner to feel strong and in control (also read: codependent no more).
When a partner needs you “down”, he will resist all your attempts to improve and get better.
In a codependent relationship your partner needs you needy and desperate.
If you want to really improve, consider breaking the relationship.
Testing For Commitment
The author says that the threats and the rage are sometimes a way to test for commitment (not to be confused with shit tests during the courtship phase).
The Workplace for The BPD
Albeit BPD have major difficulties in their personal lives and personal relationships, they can function well at work.
Indeed, as long as their job is well structured, it can work as a sanctuary from their turbulent personal lives.
They don’t function as well in highly competitive or random and unstructured jobs.
A highly critical supervisor, can also make the hypersensitive BPD overreact and fly in uncontrolled anger (remember that the BPD is hypersensitive to rejection).
The constant BPD’s quest for happiness and contentedness often leads to changing the environment around, which often includes people and jobs.
Genders & BPD
BPD is prevalent in both genders are roughly the same number, but the severity of the symptoms is greater among women.
Cults and sects appeal more strongly to the borderline because they yearn for direction and acceptance.
They also have a tendency to idealization, which the cult leader is all too happy to fulfill.
The borderline is also very vulnerable to black and white thinking and depictions of reality a either “good” or “evil”, which is also often present in cults.
The borderline goes from a high opinion to a destructive self-assessment in a matter of hours, sometimes based solely on a single feedback or a silly mistake.
Borderlines tend to have a fixed mindset, such as, they believe that their traits are carved in stone and they are either great or idiotic. And they switch between the two at the drop of a hat.
Read here how to develop a growth mindset.
Most of BPD’s self esteem is achieved by impressing others, so pleasing others becomes critical to the BPD’s own self-love.
A Bit Like a Child
The borderline experiences life a bit like a child, with the same intense emotions and perspectives.
And the same fears of abandonment.
Also read transaction analysis for child-adult exchanges and I’m OK-You’re OK.
Unable to see his world through adult eyes, the borderline continues to experience life as a child—with a child’s intense emotions and perspective. When a young child is punished or reprimanded, he sees himself as unquestionably bad; he cannot conceive of the possibility that mother might be having a bad day. As the healthy child matures, he sees his expanding world as more complex and less dogmatic. But the borderline remains stuck—a child in an adult’s body.
Sexual Freedom is Bad for BPD
Strict cultural norms provide a safer, more structured environment for BPD.
Periods of great freedom, less structured relationships and open sexual mores are more difficult for the BPD to handle.
The shifting role patters for women might be one of the reasons why women have a higher incidence of BPD’s symptoms, says the author.
Dealing With BPD
Jerold Kreisman introduces here his ” SET” paradigm to communicate with BPD.
SET sands for:
- Support (I statements, ie.: “I am sincerely worried about how you are feeling”)
- Empathy (ie.: “you must be feeling really awful”)
- Truth (emphasize the BPD is ultimately responsible for his behavior)
Support statements must help the BPD feel like she is cared for, which something she struggles with: BPD feel like they need to earn acceptance again and again.
This is Jerold Kreisman example of a response to a suicide threat:
I recognize how bad you are feeling and your wish to die. I know you said that if I cared at all for you, I should just leave you alone. But if I cared, how could I possibly sit back and watch you destroy yourself? Your communication of your suicidal plans tells me that, as much as you may wish to die, there is at least some part of you that doesn’t want to die. And it is to that part that I feel I must respond. I want you to come with me to see a doctor to help us with these problems
After the immediate danger Truth statements can focus on the destructive patterns the BPD falls into and the need -and opportunity- for them to address them.
You must remind the BPD that hte must take responsibility and not blame others.
Prognosis Of BPD
BPD tend to improve over time, with or without therapy.
Therapy helps accelerate the improvement rate though.
Classical psychoanalysis is best avoided because it’s an unstructured environment in which BPD do very poorly.
Most other approaches work, albeit it’s difficult to pinpoint which one works best.
Jerold Kreisman describes them all and I invite you to get the book for more details.
The most important element, anyway, is a good and trusting relationship with the therapist.
Medication tend not to be helpful long term, but can be used for short term relief.
Real Life Applications
Handling Suicidal Threats: Take Them Seriously
Often, the suicide threats or suicide attempts are not a wish to die but rather a way to communicate pain and a plea for attention and intervention.
Addressing it can result in continuous confrontations, ignoring it can result in death.
Accept Feeling Bad
BPD add to their woes by “feeling bad about feeling bad”. The author recommends BPDs accept feeling bad as a more constructive approach to improving themselves.
Psychoanalyzing Historical Figures
The author provides a prompt diagnosis to several movie characters and historical figures.
That’s not really a scientific or prudent approach in my opinion. He should ahve at least prefaced that diagnosys from afar are far from accurate.
Tattoos An Indicator of BPD?
The author says that the societal increasing fascination with tattoos and piercings may be a reflection of borderline tendencies in society.
To me this is an example of seeing connections where there are likely none (read “Fooled by Randomness“).
Some Poor & Irrelevant Social & Historical Analysis
There is some bad social analysis in my opinion.
For examples, writes the author:
the looming possibility of a catastrophic event—the threat of nuclear annihilation, another massive terrorist attack like 9/11, environmental destruction due to global warming, and so on—contributes to our lack of faith in the past and our dread of the future.
I think you can pick any era and list a hundred reasons why people should “lose faith in the past and dread the future”.
Instead of listing all the pros, this is simply the bet overview of BPD I have ever read.
“I Hate You Don’t Leave Me” is a wonderful text to underStand borderline personality disorder from all facets.
Highly recommended to any BPD, to anyone living with BPD and also to anyone who wants to better understand people and human’s psychology.
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