I Hate You— Don’t Leave Me UNDERSTANDING THE BORDERLINE PERSONALITY COMPLETELY REVISED AND UPDATED Jerold J. Kreisman, MD, and Hal Straus A Perigee Book 9780399536212_IHateYou_FM_pi-xvi.indd iii 16/09/10 7:41 AM 9780399536212_IHateYou_FM_pi-xvi.indd ii 16/09/10 7:41 AM “I Hate You—Don’t Leave Me was the first book to introduce BPD to the public. We are all indebted to Dr. Kreisman for his pioneering efforts to raise awareness of this painful mental disorder. As research and treatment have advanced so much since then, we welcome this needed update to what is now a classic text.” —Valerie Porr, MA, president and founder of Treatment and Research Advancements National Association for Personality Disorder, and author of Overcoming BPD “Dr. Kreisman and Hal Straus have thoroughly revised their twenty­ year classic to include the latest advances in therapies and medications while retaining the rich, easy- to-read style of the first edition. Real- life case studies and the extensive list of references illuminate our under­ standing of borderline personality not only for the general public but for professionals as well. This book belongs on the bookshelf of patients, their friends and family, and for all those who help in their healing.” —Randi Kreger, author of Stop Walking on Eggshells and The Essential Family Guide to Borderline Personality Disorder 9780399536212_IHateYou_FM_pi-xvi.indd i 16/09/10 7:41 AM 9780399536212_IHateYou_FM_pi-xvi.indd ii 16/09/10 7:41 AM I Hate You— Don’t Leave Me UNDERSTANDING THE BORDERLINE PERSONALITY COMPLETELY REVISED AND UPDATED Jerold J. Kreisman, MD, and Hal Straus A Perigee Book 9780399536212_IHateYou_FM_pi-xvi.indd iii 16/09/10 7:41 AM A PERIGEE BOOK Published by the Penguin Group Penguin Group (USA) Inc. 375 Hudson Street, New York, New York 10014, USA Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario M4P 2Y3, Canada (a division of Pearson Penguin Canada Inc.) Penguin Books Ltd., 80 Strand, London WC2R 0RL, England Penguin Group Ireland, 25 St. Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books Ltd.) Penguin Group (Australia), 250 Camberwell Road, Camberwell, Victoria 3124, Australia (a division of Pearson Australia Group Pty. Ltd.) Penguin Books India Pvt. Ltd., 11 Community Centre, Panchsheel Park, New Delhi—110 017, India Penguin Group (NZ), 67 Apollo Drive, Rosedale, North Shore 0632, New Zealand (a division of Pearson New Zealand Ltd.) Penguin Books (South Africa) (Pty.) Ltd., 24 Sturdee Avenue, Rosebank, Johannesburg 2196, South Africa Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England While the author has made every effort to provide accurate telephone numbers and Internet addresses at the time of publication, neither the publisher nor the author assumes any responsibility for errors or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content. Copyright © 2010 by Jerold J. Kreisman, MD, and Hal Straus Text design by Tiffany Estreicher All rights reserved. No part of this book may be reproduced, scanned, or distributed in any printed or electronic form with­ out permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions. PERIGEE is a registered trademark of Penguin Group (USA) Inc. The “P” design is a trademark belonging to Penguin Group (USA) Inc. Library of Congress Cataloging-in-Publication Data Kreisman, Jerold J. (Jerold Jay) I hate you—don’t leave me : understanding the borderline personality / Jerold J. Kreisman and Hal Straus.— Rev. and updated. p.cm. “A Perigee book.” Includes bibliographical references and index. ISBN 1-101-44168-2 1. Borderline personality disorder. I. Straus, Hal. II. Title. RC569.5.B67K74 2010 616.85'852—dc22 2010029714 Disclaimer: The information in this book is true and correct to the best of our knowledge. The book is intended only as a general guide to a specific type of personality disorder and is not intended as a replace­ ment for sound medical advice or services from the individual reader’s personal physician. The stories that begin many chapters, and other case history material throughout the book, have been developed from composites of several people and do not represent any actual person, living or dead. Any resemblance to any actual person is unintentional and purely coincidental. All recommendations herein are made without guarantees by the authors or publisher. The authors and the publisher disclaim all liability, direct or con­ sequential, in connection with the use of any information or suggestion in this book. Most Perigee books are available at special quantity discounts for bulk purchases for sales promotions, premiums, fund-raising, or educational use. Special books, or book excerpts, can also be created to fi t specific needs. For details, write: Special Markets, Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014. 9780399536212_IHateYou_FM_pi-xvi.indd iv 16/09/10 7:41 AM As all things, still, for Doody 9780399536212_IHateYou_FM_pi-xvi.indd v 16/09/10 7:41 AM 9780399536212_IHateYou_FM_pi-xvi.indd vi 16/09/10 7:41 AM CONTENTS Acknowledgments ix Preface xi Note to Reader xv 1. The World of the Borderline 1 2. Chaos and Emptiness 22 3. Roots of the Borderline Syndrome 54 4. The Borderline Society 74 5. Communicating with the Borderline 101 6. Coping with the Borderline 123 7. Seeking Therapy 142 8. Specific Psychotherapeutic Approaches 176 9. Medications: The Science and the Promise 192 10. Understanding and Healing 204 Appendix A. DSM-IV-TR Classifications 223 Appendix B. Evolution of the Borderline Syndrome 229 Resources 241 Notes 247 Index 261 9780399536212_IHateYou_FM_pi-xvi.indd vii 16/09/10 7:41 AM 9780399536212_IHateYou_FM_pi-xvi.indd viii 16/09/10 7:41 AM ACKNOWLEDGMENTS The efforts necessary to complete this new edition required both great assistance and forbearance. Assistance initiated with Bruce Seymour of Goodeye Photoshare (goodeye-photoshare.com), who donated much time and effort with technical issues producing the manuscript. Another dear friend, Eugene Horwitz, massaged frustrating computer conundrums. My secretaries, Jennifer Jacob and Cindy Fridley, helped gather articles and books incorporated into the work. Lynne Klippel, energetic librarian at DePaul Health Center, St. Louis, tracked down helpful references. Great forbearance was demonstrated by my partners and staff of Allied Behavioral Consultants of St. Louis, who allowed me the freedom to pursue this task. My wife, Judy, and children, Jenny, Adam, Brett, and Alicia, and the little ones, Owen and Audrey and a Player to Be Named Later, courageously consented to miss a few ball games, several plays, and a lot of movies while I indulged sunny afternoons researching and writing. 9780399536212_IHateYou_FM_pi-xvi.indd ix 16/09/10 7:41 AM x ACKNOWLEDGMENTS We wish to thank our agent, Danielle Egan-Miller, at Browne & Miller Literary Associates, and John Duff and Jeanette Shaw, our publisher and editor, respectively, at Perigee/Penguin. All played important roles in shaping the contents of this book. 9780399536212_IHateYou_FM_pi-xvi.indd x 16/09/10 7:41 AM PREFACE When the first edition of I Hate You—Don’t Leave Me was pub­ lished in 1989, very little information was available to the general public on the subject of Borderline Personality Disorder. Research into the causes of, and treatments for, BPD was in its infancy. The few articles that had appeared in consumer magazines vaguely outlined the disorder as it began to infiltrate the “American con­ sciousness.” There were virtually no books on BPD for the patient or the patient’s close family and friends. The response to our book, both in this country and abroad with foreign translations, has been most gratifying. My intention to produce a work accessible to the general public, yet functional for professionals with useful refer­ ences, seems to have been fulfi lled. To say that a lot has happened in this area over twenty years is obviously a vast understatement. Several other books on BPD have been published, including our own Sometimes I Act Crazy (2004), describing the experience of this illness from the perspectives of 9780399536212_IHateYou_FM_pi-xvi.indd xi 16/09/10 7:41 AM xii PREFACE afflicted individuals, family members, and treating professionals. Greater understanding of the etiology, biological, genetic, psy­ chological, and social implications and treatment approaches has added exponentially to our knowledge. So the challenge of writing this second edition was to highlight and explain the most impor­ tant advances, present useful, referenced information for the pro­ fessional, and yet manage the length of the book so it can continue to serve as an engaging introduction to BPD for the lay reader. To achieve this balance, a few chapters needed only updating, but oth­ ers, especially those on the possible biological and genetic roots of the syndrome, were extensively rewritten in order to incorporate the latest scientific research. Additionally, specifi c psychothera­ peutic approaches and drug treatments have evolved to such an extent that it was necessary to include entirely new chapters on these topics. The book’s reliance on real-life case stories, to give the reader insight into what life is like for—and with—a border­ line, continues in this edition, though the backdrop of these stories was altered to reflect the changes in American society from one century to the next. Perhaps the biggest change from the fi rst edi­ tion is one of overall tone: whereas the prognosis for patients was understandably bleak two decades ago, it is now (based on numer­ ous longitudinal studies) much more positive. And yet, despite these advancements, it is disappointing to review the preface to the first edition and recognize that misun­ derstanding and especially stigma still run rampant.