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There are numerous references in the BPD literature to a skill or talent to perceive, involve, and influence people, although there has been minimal formal investigation of this characteristic. It is considered to be a manifestation of pathology and/or a skill that is peculiar in some way, and/or simply a learned response to childhood stress. Adier (1985) and Gunderson (1989) discuss the tendency of borderline patients to evoke disturbing emotional conflicts between hospital staff members, as well as intense feelings of rage and helplessness in therapists. Gutheil (1989) and Averill et al. (1989) emphasize their ability to be remarkably appealing and/or compelling, and to frequently "seduce, provoke or invite" even experienced therapists Into serious boundary violations, including patient—therapist sex. Numerous authors have described an "uncanny capacity" (Krohn, 1974) of many borderline patients to recognize, and often to overreact to or act manipulatively or even helpfully upon, unexpressed or private attitudes and judgments, hidden feelings, and unconscious impulses of other people (Carter & Rinsley, 1977; Gabbard, 1990; Kernberg, 1984; Kernberg, Salzer, Koenigsberg, Carr, & Applebaum, 1989; Kreisman & Straus, 1989; Master-son, 1976; Shapiro, 1978; Stone, 1985). Krohn refers to this intuitive talent as "borderline empathy." It is intriguing that there has been no consideration of a DSM-III-R criterion for this striking characteristic since it might, if proven valid, help distinguish BPD from other personality disorders such as histrionic, antisocial, and narcissistic.

There are few studies exploring psychological abuse in the histories of borderline patients. In a controlled study. Zanarini, Gunderson, Marino, Schwartz, and Frankenburg (1989) found that chronic verbal psychological abuse, defined as chronically devaluative and/or blaming statements, occurred in the childhood histories of 72% of their borderline patients. This was far more common than physical (46%) or sexual (26%) abuse and was the only form of abuse that distinguished the borderline group from each of 2 control groups. Stone (1990b) found that 73% of 15 BPD patients reported a history of intense verbal abuse, with physical and sexual abuse having occurred in 47%. Psychological abuse generally has been explored as a relatively unidimensional phenomenon. However, the psychological development of human offspring is uniquely impacted by complex and subtle verbal and nonverbal cues that deserve closer examination. In our patient review, which follows, we examined a number of categories of psychological abuse, including one that may be particularly damaging to the psychological development of a gifted child: pervasive negative feedback to a child's Intuitive perceptions.

In this study we evaluated information about 23 borderline patients and 38 patients with other personality disorders, all in long-term outpatient therapy, with special reference to evidence for giftedness, for severe psychological abuse in the childhood history, and particularly for a concurrence of giftedness and psychological abuse. We also reviewed patient reports about family constellations for evidence of caretaker personality characteristics and marital patterns that were associated with psychological abuse.

METHODS

Our clinical experience with BPD comes primarily from private practice with patients of above average socioeconomic background. We reviewed the clinical records of 107 private outpatients and identified 23 (18 women) who met the DSM-III-R definition of BPD, that is, 5-8 criteria (American Psychiatric Assn., 1987; Frances, Clarkin, Gilmore, Hurt, & Brown, 1984). Treatment duration of at least 6 months was specified because brief contact may not reveal hidden intuitive talents or history of abuse, particularly psychological abuse. Twenty of these patients also had a history of Axis I, primarily affective, disorders (Fyer, Frances, Sullivan, Hurt, & Clarkin, 1988; Schwartz, Blazer, George, & Winfield, 1990; Widiger & Frances, 1989). Because only 6 patients had been hospitalized and only 7 met more than 5 diagnostic criteria, our results could differ from those of more severe cases. Furthermore, although several tended to manifest a few of the DSM criteria for antisocial personality disorder, only 1 of them satisfied enough criteria for the diagnosis, with 2 others meeting 4 adult criteria. Therefore, we may be working with a particular subset of BPD patients (Frances, Pincus, Widinger, Davis, & First, 1990; Stone, 1990a). As a control group we identified 38 (23 women) of the 107 patients as having other personality disorders and 2 or fewer DSM-III-R diagnostic criteria for BPD, with 22 controls also having a history of Axis I disorders. All but 2 of the 61 study patients were in individual therapy, the great majority seen 50 minutes once every 1 or 2 weeks. Six borderline patients and 1 control received concomitant group therapy, and 2 controls received only group therapy. Clinical judgments were made on a consensus basis but were not blind.

         
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©2004 Lee Crandall Park, M.D.