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Book Review: “I Hate You, Don’t Leave Me”
Roberto Becerra

BOOK REVIEW: I HATE YOU
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Book Review: “I Hate You, Don’t Leave Me”
Introduction
For this assignment, I choose to review the book:
I Hate You­Don't Leave Me:
Understanding the borderline personality
(Kreisman & Straus, 2010). This book helps shed light on Borderline Personality Disorder.
Borderline Personality Disorder (BPD) is exemplified by intense emotional dysregulation. This is a serious mental illness in which affected individuals experience severe mood swings for no apparent reason. They are moved to rage over the slightest insult. Mood swings begin quickly and explosively. The person with BPD can go from experiencing intense pleasure, to explosive rage, in a matter of hours or sometimes even minutes. These negative emotional states tend to be prompted by feelings of hollowness and despair. People with BPD are inclined towards experiencing intense self­hate and depression. Periods of prolonged happiness are alien to the person with BPD. Chronic emptiness and self­loathing prompts the individual with BPD to engage in destructive, impulsive acts, such as substance abuse, risky behavior, self­mutilation, binge eating episodes, gambling, basically anything to escape the pain inside. Not surprisingly, the rates of suicide in patients with Borderline Personality Disorder are quite high (Kreisman & Straus, 2010).
Individuals with Borderline Personality Disorder lack a core sense of who they are.
People with BPD typically have a conflicting sense of self. They are constantly searching for a sense of self, and often move from one role to the next. Their interests, talents, and hobbies are

BOOK REVIEW: I HATE YOU
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ever­changing. They adapt quite well to a changing environment in terms of fitting in, They will change core things about themselves to belong (Kreisman & Straus, 2010).
The family background of individuals with BPD is often characterized by alcoholism, depression, and abuse. Many studies have found a significant history of emotional, sexual, and physical abuse in patients with BPD. These unstable relationships patterns persist throughout an individual’s life for those with BPD. Their relationships are highly conflictual and often short lived. People with BPD can literally feel love for a partner one minute and hatred the next. Their relationships are characterized by love, hate, wonder, and excitement (Kreisman & Straus, 2010).
Individuals with Borderline Personality Disorder have thinking that is characterized by
“black and white” cognitions. A person with BPD cannot cope with vagueness. They are not able to merge a person’s good and bad qualities into one person. They cannot accept that everyone has good and bad sides to them. For the person with BPD, at any specific moment a person is either bad or good. Partners, children, sisters, brothers, and parents may be loved by the person with BPD and hated the next. This is because of black and white thinking or splitting, as it is sometimes called. Initially a person with BPD venerates a lover, friend, or even their therapist. In the next moment, the person will disappoint, as everyone does at some point. But, the person with BPD responds with rage. This type of behavior is known as splitting. It is a defense mechanism in which the person with BPD cannot fuse competing feelings about a person, according to Kreisman & Straus (2010). BPD patients cannot experience two different inconsistent emotions at once. They shift back and forth constantly. One minute, they love their

BOOK REVIEW: I HATE YOU
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spouse, and the next minute, they hate their spouse. During the hated phase the borderline unleashes rage towards the spouse without guilt. In the BPD patient’s mind, the spouse is evil and deserves the rage. This “splitting” is what leads to severe problems in relationships for the person with BPD (Kreisman & Straus, 2010). Theories on the Cause of Borderline Personality Disorder
Many people wonder how Borderline Personality Disorder develops. In the book,
I Hate
You­Don't Leave Me: Understanding the borderline personality
, Kreisman & Straus (2010) points out, not surprisingly, that there are many theories on the cause of Borderline Personality
Disorder. Some of the theories include a biosocial model, developmental theory, as well as various biological theories.
Biosocial Model of Borderline Personality Disorder
The biosocial model, an early theory, suggested that Borderline Personality Disorder results when a person with a biological disposition towards emotional regulation is raised in an emotionally invalidating environment. This is known as the Biosocial Theory. This theory draws upon research finding that a significant number of persons with BPD had been abused as children. The theory focuses heavily on the interaction between childhood vulnerability to BPD traits and invalidating parenting (Linehan, 1993).

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Recent research though, has failed to find a link between invalidating parenting and the development of Borderline Personality Disorder. Gill & Warburton (2014) conducted a study in which they tested the biosocial theory of Borderline Personality Disorder to determine whether or not borderline traits are due to emotional dysregulation that is caused by the interaction between childhood vulnerability and invaliding parenting. They studied 250 adults (mostly female) with an average age of 32 years, who completed self­report assessments. Borderline traits and emotional dysregulation were assessed. Participants were given surveys that measured emotional susceptibility during childhood and invalidation in the childhood environment. The results of the study did not support the biosocial theory of borderline Personality Disorder. They found no direct link between susceptibility to emotional dysregulation and invalidation in the childhood environment (Gill & Warburton, 2014).
Developmental Theory of Borderline Personality Disorder
According to reisman & Straus (2010), the developmental theory of Borderline
K
Personality Disorder focuses highly on the interactions between parents and the person with BPD during the early years. This theory postulates that the ages between eighteen and thirty months is especially significant in the development of this disorder. This theory argues that between these ages, if a parent is overly controlling, hostile, or erratic, the child may not develop a stable sense of self. This, in turn, leads to long­lasting intense needs for attachment, as well as abandonment fears. BOOK REVIEW: I HATE YOU
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Biological Theories
Recently, there has been a lot of evidence to support theories that suggest that Borderline
Personality Disorder is genetic. Borderline Personality Disorder is more common in relatives of people with the disorder, according to Kreisman & Straus (2010).
Bøen et al., 2014 conducted research into the biological foundation of Borderline
Personality Disorder. They investigated the thickness of layers of the cerebral cortex, and its relationship to the problems with identifying and describing emotions seen in BPD patients.
Eighteen female patients diagnosed with BPD and 21 healthy female controls underwent magnetic resonance imaging (MRI). The Toronto Alexithymia Scale (TAS) was also completed by study participants. This is an assessment that is designed to identify whether or not participants are able to identify and describe emotions within the self. The thickness of the cerebral cortical was contrasted between patients with Borderline and healthy control subjects.
The researchers found that compared with controls, BPD patients had significantly reduced cortical thickness in the prefrontal cortex. Previous studies have found that certain cortical structures are involved in social cognition. The pattern of thinning in the prefrontal cortex in patients with BPD was similar to the results found in the social cognition studies. This suggests that cortical thinning may be related to relational dysfunction in patients with BPD. The thinning seen in the cerebral cortex may indicate a possible biological indicator for Borderline Personality
Disorder (Bøen et al., 2014).

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Conclusion
Borderline Personality Disorder (BPD) is a personality disorder characterized by an inability to regulate emotions. This is serious disorder that affects many areas of a person’s functioning, not only relationships, but in work, school, and other domains. Individuals affected with BPD have high rates of suicide, and often engage in risky behaviors. Persons with BPD have unstable relationships which are likely impacted by
“splitting” which is the inability of the person with BPD to integrate opposing characteristics of a person. The person with BPD either idolizes a person or devalues them, there is no in­between.
There is likely there is no one definitive cause to Borderline Personality Disorder. It is most likely that a combination of genetic, developmental, neurobiological, and social factors contribute to the development of this disorder.

BOOK REVIEW: I HATE YOU
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References
Bøen, E., Westlye, L. T., Elvsåshagen, T., Hummelen, B., Hol, P. K., Boye, B., & ... Malt, U.
F. (2014). Regional cortical thinning may be a biological marker for borderline personality disorder. Acta Psychiatrica Scandinavica, 130(3), 193­204. doi:10.1111/acps.12234. Gill, D., & Warburton, W. (2014). An investigation of the biosocial model of borderline personality disorder.
Journal Of Clinical Psychology
, 70(9), 866­873. doi:10.1002/jclp.22074. Kreisman, J., & Straus, H. (2010).
I Hate You­­ Don't Leave Me: Understanding the borderline personality (Perigee rev. trade pbk. ed.). New York: Penguin Group.
Linehan, M. (1993).
Cognitive­behavioral treatment of borderline personality disorder
. New
York: Guilford Press.

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