Borderline Personality Disorder. When I first read it a couple of years ago, I could not help but think, “How can personality be on a borderline?” This of course bred more questions: What borderline? Are they on the borderline of insanity? Is it on the border between bi-polar and another mental illness? Or is it one of those illnesses that has symptoms from all of them, but doesn’t fit just one?
It turns out, Borderline Personality Disorder (BPD) is much more complex than that. In fact, it is one of those illnesses where psychiatrists give their patients an overview of the illness and the patient either decides it fits them or it does not. That is what happened to me in August 2015 and in January 2016. In August, a friend sent me a link to it and I said that describes me. When I was hospitalised in January, the psychiatrist gave me a similar document. Afterwards, my diagnosis was settled for the most part.
Why talk about this?
- Provide a source of knowledge on the disorder from someone who can balance the academic and personal experience of the illness.
- To share a little bit about myself
- Why the hell not?
So without further ado, let’s talk about BPD :).
What is it?
BPD is one of many personality disorders under the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V for short). They are mental disorders characterised by a maladaptive personality characteristics. BPD affects about 6% of primary care patients and make up about 15-20% of psychiatric hospital patients. Most people with BPD, however, do not end up as inpatients unless they have a suicidal attempts. The clue for it for most psychiatrists is “Recurrent suicidal threats or acts, when combined with fears of abandonment” (Gunderson, 2037).
There is no one single cause of BPD. Biologically, the instability and impulsivity are shown to have genetic factors. This was demonstrated in studies where identical twins both had the similar impulsive behaviours and instable moods. Psychologically, it is often caused by a childhood that had a high frequency of traumatic events and family dysfunction (Paris, CMAJ, 1579).
Living with BPD and treating BPD are one of psychiatry’s toughest challenges. The reason for this is BPD is disorder of extremes: There is no gray middle between calm and chaos. The patient is usually one or the other. Furthermore, people with BPD have chronic suicidality, which includes suicide ideation and attempts, and 5% commit suicide during their 30s. Good thing I am preparing myself for those dark times now instead of later.
People with BPD think in black and white. A person is either all good or all bad, situations are either perfect or completely awful. These extremes can lead to a lot of misunderstandings. For example, in my life before I got diagnosed I could be an argument with someone and instead of the argument being about whatever we argued about, I would jump to the conclusion it means I am a horrible person who deserves to die.
Thankfully, those thoughts did not live to see victory (yes, that was a horrible pun). However, they will come back. It’s all a matter of management. Often BPD is a disorder that needs to be orderly managed (okay I’ll stop) through some medication, and a lot of psychotherapy. The main go-to for practitioners is group dialectical behaviour therapy. A month after I got diagnosed, I did the therapy for 8 weeks.
How does one get diagnosed?
For the DSM IV, one had to meet 5 of the 9 diagnostic criteria in order to be diagnosed with BPD. These are the symptoms according to the DSM-IV:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociation symptoms
I am not sure how that changed with the DSM-V, as it is not a very accessible resource since it is so new. When it does, I will be sure to update this blog post.
Well for me the so what was “Does this sound like you or not?”
For many people the answer is yes. For me it meant there was a reason, a summary of why I felt #s 1, 2, 3, 4, 5, sometimes 6, 7, and 8. I’m amazed the BPD Association in Canada didn’t call me a few days after I got the diagnosis to ask if I would be their poster woman.
Getting diagnosed for me was both a relief and mournful time. One of the few times where things are just a mixture, instead of black and white. I was relieved because I had an explanation for things. I had a summary for what mental map looks like, and with such a summary I can play a way to navigate this crazy world called life.
The mournful part comes with the realization that parts of me will probably never get better. I will be living with things like mood swings, depression, impulsivity, and even suicide ideation forever. That means I will do some of the stupidest things without even thinking, or thinking they won’t back to bite me, like overeating or draining my bank account.
It also means socializing will be more challenging for me than I thought possible. With autism I have a hard time reading people and understanding things like social cues. With BPD I will either over idealize someone or overtly despise them. I will also fear they are out to abandon me and will want to do anything to keep it from happening, or I will want to abandon them first. Those things have happened before I got diagnosed. I fear it will happen again.
It’s like I’m mourning aspects of my future that have not even happened yet. Thanks to the therapy, I have the tools to handle things better. But I’m human and BPD will lead me down roads I don’t want to go in my right mind, but just might because that is how my mind is shaped. One could say in the black and white thinking that is BPD my mind is divided against me.
That does not mean I’m giving up. I do strive to learn how to manage my mental disorder, and not let it manage me. It is a hard challenge, and one I fear not enough people appreciate. Unfortunately, I doubt they can unless they have the disorder or have their own disorder. I wrote about the lack of understanding and stigma around mental illness in the last paper for my Master’s degree, and a blog post for Bell’s Let’s Talk Day.