Case Study M - Part 4

The Vicious Cycle

University and the Strategies

At some point, the time came when M. had to separate from her parental home. She chose to study at university. In doing so, she lost “Father” as she saw him, and Mother. M. had, in her view, only two problems:

a) She saw herself as not worthy of love (by now fulfilling all criteria for borderline disorder according to ICD-10 with sub-criteria)
b) The anorexia had already taken on a life of its own

To survive in this new cold world and to get what she had always sought (love), she unconsciously developed a strategy. Within a short time, she was known on campus as the woman with whom one could… You know. What lay behind this for her, naturally, no one noticed.

Due to the borderline disorder, she recognized very quickly that sex was a means that compensated for many things. In M.’s case, several aspects must be considered:

Feeling herself
Feeling loved
Tension relief
Filling the inner emptiness
Manipulative attachment behavior, control, power
Attention (self-esteem)

The Development of Hypochondria

M. very quickly realized that these things only helped in the short term. During this period, she also briefly resorted to marriage, the duration of which unfortunately did not exceed 8 weeks. Naturally, she was not to blame for its end.

And her brain fell back on an old strategy: “When was I cared for, loved, and the center of attention?”

When I was sick.

This is where the hypochondria now formed. It too had already been latently present over the years with the increasing manifestation of the anorexia.

The Role of Alcohol

The borderline disorder and the image of the father led her, at least from university onward, to very quickly discover the drug alcohol. Due to the borderline disorder, she soon lost all sense of moderation and developed addictive behavior.

Alcohol helped her in many ways:

It filled the inner emptiness
She could be relaxed
Reduced inner tensions
Shifted reality
Dampened feelings of guilt

Feelings of guilt partly from her childhood, partly from having to give up her body again and again in the search for love, for redemption by the Frog Prince. The frog she found was always somehow strange.

The alcohol naturally amplified the behavioral patterns of the borderline disorder to extreme degrees. Furthermore, it fulfilled an important function in terms of the anorexia: bridging the feeling of hunger.

The Breakdown

And so what had to happen, happened: a breakdown at age 34/35. Driven by external social circumstances, an abortion, ended relationships, she threw herself into work, alcohol in extreme amounts, followed by not eating (anorexia) and reaching for painkillers due to the hypochondria.

From psychological to psychosomatic complaints and physical pain, M. now displayed everything that could possibly have been present. Body and soul no longer cooperated, and admission to a psychiatric clinic followed.

M. had over time become very adept at concealing her symptoms, and so she was treated but once again not for the underlying causes. They recognized the addiction problem and the anorexia, but nothing more.

A Typical Day

Let us take a day in M.’s life.

Like most people with borderline, she is very achievement-oriented and could identify herself through her profession. Not much else remained for her. She often sat there and cried, wept from a deep inner pain, asking herself, “Why am I not loved?”

She gets up at 6:00 AM, having treated herself to 1.5 bottles of Prosecco the evening before. Let us say she slept 5 hours, having gone to bed around midnight. She was therefore somewhere around 1.6-1.8 per mille blood alcohol and needed approximately 19 hours to reach 0.0 per mille. So in the morning, she was still at approximately 1.1 per mille. For M., that was not a problem — she had been through worse.

The Daily Complaints

There was not a single day when M. woke up without an illness or complaint. Some examples:

Back pain
Kidney infection
Headaches
Tendinitis
Abdominal pain
Vaginal infection
Diarrhea
Skin burning
Floating kidney
Weakness
Chills, sweating at normal temperatures
Cervical cancer that came and went (it came during withdrawal phases and disappeared during idealization phases)
Tendon strains
Stomach pain
Psoriasis (that was never there)
Eye burning
Neck pain

There was no illness that M. did not have on some day or another. If one addressed her about it, she would completely lose control and have one of her typical rage outbursts.

The Painkillers

The current state of illness justifies the taking of painkillers. Many painkillers contain morphine or morphine/opium derivatives. They are synthetic and comparable to the body’s own morphines (endorphins). The synthetic morphines dock onto the same receptors as the endogenous ones.

Since M. had pain or was ill, taking painkillers became completely legitimate for her. And here we come to the aforementioned water bottle, which served two functions:

It satisfied the swallowing need
It moistened the dry mouth (morphines have the property of causing dry mouth)

And when M. was “really feeling terrible,” in the form of being shattered and exhausted but still having to deliver her performance, there were also the amphetamines, which at least provided a short-term boost and naturally functioned as appetite suppressants.

The Survival Strategies - A Summary

M., a person who has been exposed to enormous inner tensions since childhood, whether conscious or unconscious, who must and does deliver outsized achievements, has thus developed survival strategies:

Strategy	Function
Hypochondria	Receiving pity, love, being the center of attention
Anorexia	Self-perpetuating, forms the “image of the slim woman”
Sex	Tension relief, filling inner emptiness, feeling oneself, being loved, attachment manipulation
Alcohol	Relaxation, shifting reality, bridging hunger
Medication	Pain relief, bridging, performance enhancement

All three disorders thus secured M.’s soul’s survival.

M.’s self-harming behavior had thus reached enormous proportions.

Is a Relationship Possible?

Now you may ask yourself whether a relationship with M. is even possible.

It is — the question is only: for how long?

You can answer that question for yourself.

Back to the Introduction Case Study M - Introduction

Part 3: The Childhood The development of the disorder in early childhood

More on Relationships Borderline and Relationships