The Interpersonal Perspective

Although borderlines have a reputation for being angry, difficult, impulsive, and erratic, they can function with stability for long time periods under certain conditions. They perform well if given structure and much more poorly without it. Finding a significant other who provides a stable and accepting environment has proven most beneficial to the harmony of a borderline's interpersonal relations. In such cases, structure within the relationship is sustained through well-defined and easily met expectations. Often, however, potential for interpersonal stability is derailed as borderlines lapse into stereotypical misinterpretations of their current mate's intentions or behaviors. Again, the onus of abatement usually rests on the caring and tolerant individuals in their lives who have a knack for anticipating misinterpretations, choosing their words carefully, and diffusing trouble as it occurs by centering the subject on the authentic and healthy realities of current relationships. In effect, they insulate the subject when necessary but usually provide reassurance and supplement the reality testing of the borderline person during periods of incipient chaos. Georgia and Harold provide an example, though Georgia's negativistic traits make Harold's job almost impossible at times.

Moreover, similar to most personality disorders, the borderline diagnosis is but a matter of degree. The needs and pathologies of some individuals are more profound than others. Those with a less cohesive sense of self, with greater emotional dysregula-tion and more identity disturbance, will find few individuals outside the therapy office willing to create the "holding environment" necessary to assuage their pathologies. Conversely, those with a more cohesive sense of self, with less emotional dysregulation and less identity disturbance, are more easily tolerated during the bad periods because the relationship is reinforcing for both parties at least some of the time. Such subjects often have redeeming qualities that make the trying times "worth it" in the eyes of their spouse or lover. In the context of a stabilizing relationship, the borderline person might seem outgoing, highly intelligent, and blessed with a good sense of humor, for example. Alternatively, the significant other may simply have complementary traits that the subject, for whatever reason, finds calming to a certain degree.

TABLE 14.1 Summary Statements from the Revised Diagnostic Interview for Borderlines

. . . Has had a chronic low-grade depression or experienced one or more major depressive episodes. . . . Has had sustained feelings of helplessness, hopelessness, worthlessness, or guilt. . . . Has chronically felt very angry or frequently acted in an angry manner

(i.e., has often been sarcastic, argumentative, or quick-tempered). . . . Has chronically felt very anxious or suffered from frequent physical symptoms of anxiety. . . . Has experienced chronic feelings of loneliness, boredom, or emptiness. Cognition Section (The person . . .)

. . . Has been prone to odd thinking or unusual perceptual experiences (e.g., magical thinking, recurrent illusions, depersonalization). . . . Has frequently had transcient, nondelusional paranoid experiences

(i.e., undue suspiciousness, ideas of reference, other paranoid ideation). . . . Has repeatedly had "quasi" delusions or hallucinations.

Impulse Action Patterns Section (The person . . .) . . . Has had a pattern of serious substance abuse.

. . . Has had a pattern of sexual deviance (i.e., promiscuity or paraphilia). . . . Has had a pattern of physical self-mutilation.

. . . Has had a pattern of manipulative suicide threats, gestures, or attempts

(i.e., the suicidal efforts were mainly designed to elicit a "saving" response). . . . Has had another pattern of impulsive behavior. Interpersonal Relationships Section (The person . . .)

. . . Has typically tried to avoid being alone or felt extremely dysphoric when alone. . . . Has repeatedly experienced fears of abandonment, engulfment, or annihilation. . . . Has been strongly counterdependent or seriously conflicted about giving and receiving care. . . . Has tended to have intense, unstable close relationships.

. . . Has had recurrent problems with dependency or masochism in close relationships. . . . Has had recurrent problems with devaluation, manipulation, or sadism in close relationships. . . . Has had recurrent problems with demandingness or entitlement in close relationships. . . . Has undergone a clear-cut behavioral regression during the course of psychotherapy or psychiatric hospitalization. . . . Has been the focus of a notable countertransference reaction on an inpatient unit or in psychotherapy, or formed a "special" relationship with a mental health professional.

Adapted from Gunderson and Zanarini (1992).

Nevertheless, the stormy interpersonal life of the borderline personality, where action flows freely from mood, is legendary. Although everyone wants a special someone, many borderlines hunger for that one relationship to validate their very existence, a powerful or nurturing figure who can make them feel secure. At the beginning, they feel magically involved, idealizing their partner, putting him or her on a pedestal as the greatest thing the world has ever seen. Because their partner is so special, borderlines are special, too, for it is they who are the recipient of the love and affection of this perfect person. Distance is intolerable and separation unthinkable. At one time, Jenny probably felt exactly this way about her boyfriend.

As a consequence of their concentrated need to be intensely emotionally connected with someone, borderlines have tremendous abandonment fears. These have already been discussed in a psychodynamic context, but the interpersonal perspective adds a sense of immediacy and context somewhat neglected in psychodynamic formulations,

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