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Examination of caretaker abuse histories for the borderline patients revealed 26% (6/23) chronic physical and 13% (3/23) sexual. Thirty percent (7/23) had sexual abuse histories if noncaretakers were included. Fewer control patients were physically or sexually abused but this was not statistically significant.
Chronic, pervasive verbal/psychological abuse had occurred in 100% of the BPD sample. Psychological abuse subcategory findings were : 30% (7/23) chronic neglect; 70% (16/23) constant devaluation; 83% (19/23) intrusion/invasion; 74% (17/23) chronic attack on autonomy; and 74% (17/ 23) chronic attack on, depreciation of, or total nonrecognition of the child's special access to feelings and intuitive insights. At least 2 forms of verbal/ psychological abuse had occurred chronically in the lives of all 23 BPD patients, with 3 or more occurring in 17 cases. In comparison, 32% (12/38) of the control patients met the criteria for psychological abuse, a significant difference (x2 = 24.70, df = 1, p < .001).
Table 1 compares BPD and control patients. There are substantial numbers of gifted and abused patients in both groups. However, 74% (17/23) of the BPD patients were rated as both gifted and psychologically abused in contrast to only 13% (5/38) of the controls (x2 = 20.38, df = 1, p < .001).
Review of the borderline patients' perceptions about parental dominance and capacity for warmth revealed that in 91 % (21/23) of the cases there was a dominant parent (see Table 1), who was also the primary psychological abuser, and a parent who played only a secondary role in the abusive pattern. The parent perceived as dominant was not always the one who might look and sound in charge but was the one whose psychological power over the patient was greatest (Byers, 1987). This sometimes became clear only later in treatment. In 18 of the 23 BPD cases (78%), the mothers were experienced by the patients (14 females, 4 males) as very dominating and controlling, and either quite limited or lacking in expression of warmth. In 3 cases (13%) the fathers were seen as very dominant and controlling, usurping the parenting role and overattached to their children (in all 3 cases, daughters) in ways that had sexual overtones. In 1 case the parents as a rigid unit were very dominating to the patient; and in 1 case a judgment about dominance could not be made.
Patients frequently described the 21 dominant parents in ways that fit DSM-III-R criteria for narcissistic personality disorder (NPD). For instance, they invariably were described, particularly later in treatment, as very limited in empathy and as having a controlling sense of entitlement, the latter often expressed as parental wisdom. At least seven (33%) were frequently or chronically profoundly hostile to the child, and in all but one of the other cases (62%:13/21), the patients felt they avoided rage and abandonment only through skillful submission, sometimes with subtle or disguised manipulation of vulnerabilities of the parent.
The nondominant parents (21/23), usually fathers (18/23), were generally experienced as not intrusive and as somewhat warmer as a group, but in all cases not able, unavailable, too dependent, and/or too symptomatic to influence their abusing partners. In a number of cases (6/23) psychologically dominant mothers facilitated the perception that the fathers were dominant because of the male role and/or intimidating temper and/or physically abusive behaviors, a perception that tended to conceal or blur the mother's primary psychic power until after childhood. One of the dominant fathers functioned analogously, blaming the mother's dramatic emotionality. The finding of 30% neglect took into account only the dominant caretakers, but if the partner's behavior is also considered, there was a pervasive atmosphere of emotional neglect playing a background accompaniment to the active abuse. The most frequent family pattern, occurring in 61 % (14/23) of the cases, consisted of a dominant, unempathic mother, an emotionally neglectful father, and a borderline daughter.
In summary, for our group of borderline patients, there was major biparental psychological failure, by combined commission and omission, throughout childhood and adolescence. In addition to the categories of psychological abuse already described, there was in every case a chronic family atmosphere of morbid, disturbing dramas between parents, and/or between one or both parents and the child, usually involving strong negative affects. One of the few softening notes was that the dominant parents generally had grandiose ideas of competence, with malevolence demonstrated in tactics of control rather than in long-term designs of deliberate harm. The children frequently had strong feelings of love and concern (also rage, hate, fear, and so forth) for one or the other, sometimes both, parents, and at times were burdened by a painful wish to take care of and protect these parents. In addition, in a number of cases the dominant parents were appreciated for their intense attention to education and social development, although this was experienced later as for the parent rather than for the child.
Review of family constellations in the control group revealed that significantly fewer patients (37%: 14/38) had dominant, controlling, unempathic parents, all mothers, who were also reported to be quite lacking or limited in expression of warmth (x2 = 15.22, df= l,p < .001). Only 1 of these parents was profoundly hostile to the child, with just 8 other control patients reporting that they avoided rage and abandonment through skillful submission. There was not a general background atmosphere of neglect, disturbing family dramas, and negative affects, with only 6 spouses of dominant parents experienced as markedly unavailable.