Borderline Personality Disorder: what the most ridculously named condition means to me

Absorbed in the illusion of an imagined abandonment

BPD stands for borderline personality disorder. I was diagnosed with BPD just over two months ago and out of all the diagnoses I've received, it was the one that I found most difficult to accept.  I think this is because there is a great deal of stigma attached to  BPD, even within the mental health services. Having been under the services for a significant period of time, I had received an impression that BPD patients have a reputation for being remarkably difficult to treat and have a tendency to become revolving door patients within inpatient services.  There seems to be this stereotypical idea that BPD sufferers are mood swinging, emotionally needy and manipulative people who attract intense and unstable relationships and result in excessive self harm and repeated, pitiless suicide attempts in order to receive the attention they so desperately seek and yet reject.  In reality, this could not be further from the truth but stereotypes will exist nonetheless.

I also found the name of the illness far from appealing.  The illness was originally named 'borderline personality disorder' because it was thought that the sufferer was on the border between neurosis and psychosis.  However, I have to say, being told your personality (your whole way of being and sense of self) is 'borderline' is pretty insulting.  When I told close friends and family about my diagnosis, so many of them have said "But there's nothing wrong with your personality?"  I believe they were hitting on a very valid point.

I don't think that the title BPD reflects the true nature of the illness and how it impacts upon sufferer.  Essentially, it is and emotional regulation disorder that is usually rooted in attachment issues.  More recently, the name 'Emotional Instability Disorder' has been used as an alternative to BPD, which in my opinion is an improvement.  Interestingly, on the report of my diagnosis, it includes both names.

One reason why I found my BPD diagnosis so difficult to accept was that I generally kept my symptoms, thoughts and feelings surrounding it to myself.  I suppose you could say they represented a part of myself that I was ashamed of.  While I was well aware that I fulfilled the diagnostic criteria for BPD and that it would only be a matter of time before I received a diagnosis, I dreaded being given the label for many of the reasons I've discussed above.  I suppose it made it seem more real and I couldn't hide from the problem anymore.

Diagnoses in general can be difficult to accept.  They can be incredibly useful as a guide to categorising our symptoms and offer reassurance that the things that trouble us are neither a figment of our imagination nor illegitimate of our worry.  They are also useful and sometimes indeed essential in identifying treatment paths for us.  However, when you receive a number of diagnoses, as I have, it can feel as though you've become a list of labels and it can be easy to lose sight of the person you are.  I used to make jokes that I've received so many diagnoses that they might as well just label me as a walking, talking mental health problem in my own right.  There can also be a tendency to 'play up' to a diagnosis - attempting to justify or becoming complacent about your unhealthy behaviours and thoughts by almost hiding behind the idea that such behaviours are the reason why you have the diagnosis.  I do it myself sometimes, 'I think I need to restrict more because that's what anorexics do'.  It can become particularly easy to slip into that net when you are diagnosed with a condition like BPD which can only be managed rather than overcome fully.

I often have to remind myself that there is far more to me than a list of labels and this type of thinking went a long way in helping me to accept the diagnosis.  I now see that I have no reason to be ashamed of my diagnosis – I developed the issues entailed in the disorder by a normal response to a number of traumatic experiences and difficult family circumstances which I had no control over.  Due to my background, I feel as though, throughout my life, I have had to break a lot of people's stereotypical ideas and prejudices through my decisions, actions and choices.  I now see the BPD stereotype as just another one I'm determined to break.  BPD has a significant impact on my life but it does not define who I am as a person and it never will.

In order to be diagnosed with BPD, you have to exhibit 5 or more out of a possible 9 symptoms on the diagnostic criteria.  In this post, I am going to attempt to give an insight into what BPD is and how it can affect a sufferer by explaining how each of the symptoms affect me.  I hope in the process to also dispel some of the myths surrounding the illness.

What Borderline Personality Disorder Means To Me

1. Frantic efforts to avoid real or imagined abandonment.

This is a very central one for me.  I have a real fear that anyone I allow to get close to me will eventually end up abandoning me.  I believe it stemmed from some of my experiences as a young child.  As I was growing up, I had an awareness that my mum was suffering from depression, even though I was too young to know what it was by that term.  At one point my mum became suicidal and at the age of six, I was the one who stopped her from taking her life.  My mum isn't a bad mum, if anything she has been the most stable figure I've had in my life, she was just very ill at the time and needed help.  However, it left me with a fear that if I upset people who were close to me or put too much stress on them, they would end up abandoning me.

This fear can cause me to avoid getting close to others in order to avoid all possibility that they could abandon me.  I can give the impression of being fiercely independent, that I enjoy my own company and don't need other people.  On the other side, the people I do allow in, I can become overly attached to.  I found that it is usually mother type figures that I will get attached to.  Interestingly, as with a lot of my BPD symptoms, my attachment issues are very much internalised.  What I mean by this is that, it wouldn't necessarily be very clear to the person that I was very attached to them.  If anything, I would probably come across as being quite distant as I am very conscious not to appear overly attached to others.  However, if I don't receive as much attention as I feel I need from the people I'm attached to, I can feel overwhelmed by a sense that they've abandoned me.  For example, something as simple as someone not responding to a text as quickly as I thought they might can cause me a great deal of distress.  I never send scary texts like 'why aren't you texting me back bitch?' as I recognise that it is my own insecurities that are causing me to feel abandoned.  I know that in reality, the person is probably just busy, distracted or may have just forgotten and that doesn't mean they are never going to speak to me again yet the overriding feeling is that they have abandoned me.

I also find that I tend to seek reassurance from family members a lot.  I will frequently ask them whether they love me and say things like 'you're not going to ever leave me are you?'  I know it must get annoying at times and be really difficult for them but it does help me to have their reassurance.

2.   A pattern of unstable and intense interpersonal relationships characterised by extremes of ideation and devaluation.

I am extremely avoidant of having intimate relationships due to my past issues with sexual abuse so the relationships I will speak about will be mainly ones of friendship and with family members.  I have a tendency to become quite submissive in relationships.  I seem to think that if I do everything I can to help a person, they will be less stressed and therefore there will be less chance that they will abandon me.  This means that I can almost end up engaging in a sort of compulsive helping in which I put other people's needs before my own and end up suffering as a consequence.  I can see that my fear of abandonment has in the past caused me to keep people in my life who were harmful to my wellbeing for longer than I should have done.  I can slip into a mindset that it is my duty to save other people even if they don't want to save themselves and end up neglecting my own needs in attempting to help them.  I feel as though, if they feel I've given up on them, they will end up abandoning me too.

I know that I am also very guilty of switching between extremes of ideation and devaluation.  Sometimes if a person I feel close to or attached to hasn't paid me enough attention as perhaps I expected, within minutes I can switch from seeing them as being the most perfect person in the world to being someone I despise and can't stand to even think about.  Sometimes the person actually hasn't done anything at all and my view of them can switch just as dramatically.  I know this sounds pretty scary and to be honest I scare myself a lot of the time.  I have never acted upon my thoughts and feelings towards a person when they have switched to the negative extreme as I can recognise that they actually haven't done anything wrong and that the problem is with my perception of the relationship.  If anything, I tend to turn the disgust I feel towards the person back on myself and beat myself up for feeling so negatively towards a person who has done nothing wrong and is so good to me.  I therefore tend to distance myself from the person until my negative feelings towards them pass.

3. Identity disturbance - markedly and persistent unstable self-image or sense of self.

I would say that this symptom highly underpins the cause of my eating disorder and body image issues.  Apparently, it is very common for BPD patients to also suffer from an eating disorder.  As I've explained in a previous post, I have a very distorted perception of my body image and it tends to fuel restrictive eating.  I would also say that I have a tendency to define my sense of self heavily on my use to others.  It has got to the point before when I felt as though I was living purely for the purpose of serving others rather than living for myself.  Consequently, I have quite low self esteem although I would say it is growing.

4. Impulsivity in at least two areas that are potentially self damaging eg. spending, sex, substance abuse, reckless driving or binge-eating.

It's funny because I wouldn't say I come across as a particularly impulsive person, if anything people would probably say I'm very restrained.  I have never taken drugs, I don't drink alcohol, in fact I don't even drink tea or coffee!  Having grown up with an alcoholic parent and being a part of a family with a long history of drug abuse, I have always been very conscious, if obsessive, to avoid all possibility that I could go down that root.  In fact I am largely phobic of any substance I could potentially become addicted or dependent upon.  As strange as it may sound though, I have always felt as though if I was to drink, it would be hard for me to do so in moderation, as I recognise I have a bit of an all or nothing personality.

While I don't come across as particularly impulsive, I can see that there are areas in which I am.  I have a bit of an issue with excessive spending, particularly on clothing.  I believe that I am genuinely a fashion loving girl and it can be difficult to distinguish between healthy and unhealthy obsessions.  I have been guilty of using shopping as a bit of an escape when I get stressed or overwhelmed as it can act as a bit of a distraction and give me a temporary high.  Retail therapy can be a great thing from time to time but not in excess.  At the end of last year I realised that my wardrobe situation bad become pretty dire, it was literally air-tight packed with clothes and I still didn't have enough room!  I made various attempts to have a spring clean but ended up throwing out very little.  I came to the conclusion that everything in my wardrobe fits me, I like every item, I wear every item, I just have way too much clothes!  So I made it my New Year's Resolution not to buy clothes for the whole of 2014 and so far I've stuck to my ban.  I think it's made me realise that while I can be impulsive when it comes to spending, I do have restraint and willpower.

I've also realised that I have been impulsive in the past when it has come to driving.  I feel quite ashamed to admit this as I really don't consider myself to be a reckless driver and I would hate to put anyone else's life in danger.  Under normal circumstances, I would say that I am a responsible, law abiding driver who sticks to the speed limit and tends to drive on the slower side.  However, I have had a tendency to impulsively jump in the car and drive regardless of the state I was in.  I would drive after having panic attacks, when heavily sleep deprived and worse, I have driven when dissociated.  I have had many a car journey that I have absolutely no recollection of.  I never had a car accident and I don't think I drove particularly recklessly when in that state.  People had seen me drive while dissociated and said that they didn't notice anything out of the ordinary.  However, I know that driving when I had little recollection of where I was, who I was and the time of day was extremely irresponsible.  It does not justify it but all I can say is that I was in a very desperate place at the time.  I always felt a sense of control when driving and so often when highly panicked and feeling very out of control, it was my instinct to jump in the car and drive away from the thing that was scaring me.  I'm pleased to say that this is something I no longer do.  I even have a system in place where I have to collect my car keys from someone else when I drive so they can decide if I'm in a fit state to drive.

5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.

I am reluctant to reveal too much on this one as I don't think it would be particularly helpful to anyone and could be triggering.  I have suffered from suicidal thoughts, ideation and have made attempts.  I know it can be incredibly difficult for outsiders to understand how anyone would get in such a position to want to end their own life and to be honest the act, by its nature, goes against comprehension and logic.  What I would like to say on the matter is that I never wanted to die and I believe that no one truly wants to kill themselves, it's just at times things can become so overwhelming that it seems like the only option.  I know there is a widely held conviction that suicide is selfish and I don't deny that a part of that is true.  I was completely consumed by the guilt surrounding how my plans would affect other people, I didn't expect anyone to forgive me, I knew that what I was planning to do was morally wrong but I felt as though there was no other option as I found living unbearable.  The truth is though that with suicide, there is not option at all - it ends all possible options.  I think it is important to recognise that for a person to consider taking their own life, they are desperate, their thinking has become extremely distorted and they are not in position to think rationally about the situation.

I am proud to say that I haven't experienced suicidal thoughts for over a couple of months now which is quite a dramatic turnaround considering at one point every hour of my day was consumed by suicidal thoughts.  Recently, I'll often think to myself, that I am so grateful to be alive and it scares me that I came so close to throwing everything away so many times.  I never thought that I would feel like this but I suppose it stands as evidence that there's no place in life so low that you can't bring yourself back from.  If you have suffered or are suffering from some of the issues I had mentioned, please know that however bad and hopeless things can seem, they can get better all the while you're around to see that it happens.  I used to laugh when people said things like this to me but now I can see that it is true.  I had given up completely on life, I felt completely hopeless, desperate and like there was no way out but I stuck with it.  My life isn't perfect, nothing ever is, I have my struggles but I feel as though I have something worth fighting for and that's a simple thing called life which is a gift that's not to be wasted.

Self harm, as in cutting and other forms of self-mutilation, is often associated with BPD.  I have never used cutting as a form of self harm, most probably because I have a very extreme phobia of blood but I can understand what can lead a person to engage in those behaviours.  My psychiatrist and therapist feel that I use restrictive eating and starving as a form of self harm.

6. Affective instability due to a marked reactivity of mood, eg. intense episodic dysmorphia, irritability or anxiety which usually lasts for between a few hours and several days.

This is a symptom that strongly characterises my experience of BPD.  I experience very quick and dramatic changes in mood.  At one particularly bad period in my life, in the morning I could be feeling active and productive, making a million unrealistic plans and then by the evening I could be completely lethargic and feeling as though I had lost the will to live.  I experience very intense bouts of emotion which usually last a few hours.  I find it very difficult to describe what this is like because it quite incomprehensible at times but I usually would tell people - imagine 'normal' emotions times by ten.  This usually happens when a memory of a traumatic event is triggered.  At times it can feel like a blessing as I can experience very intense ecstatic happiness but on the flip side, I can come crashing down from that great high and have intense emotions of chronic loneliness, hopelessness and despair.  These bouts of emotion are very all-consuming, I have felt like I am almost drowning in them at times and as though it will never end.  It can become surprisingly debilitating and has lead to me becoming suicidal on a number of occasions, as the experience can feel so trapping and unbearable.  I can become very impulsive in my suicidal thoughts and ideation so it requires a lot of well thought out safety planning.  I know I also tend to use restriction of my food intake in attempt to numb my emotions when they become very intense so this is another way in which BPD can fuel my anorexia.  Since I have started taking antidepressants my mood has not shifted to such great highs and lows and it is hence easier to manage.

While I experience emotion very intensely, I don't show my emotions very clearly to others.  I can feel extremely distressed and upset yet the people around me would have very little idea as I may be happy, laughing and smiling.  It would only become clear to others that there was a problem when I completely break down and can hide it no longer, which I imagine is equally as distressing for them.  It had even been flagged up that I might have Asperger's Syndrome due to my difficulties in showing emotion.  I saw a specialist and they concluded that in fact I don't have Asperger's and that the traits I display are a product of the mental health problems I suffer from.  Interestingly, a lot of people with Asperger's Syndrome are often misdiagnosed with BPD first and vice versa.  I have read in a number of articles that BPD sufferers have a low emotional intelligence - they struggle to read emotions in themselves as well as others and struggle to regulate emotions.  I would agree that BPD does make it difficult to regulate emotion but to say that we are of a lower emotional intelligence is far from the truth.  We experience the great depths of emotion, emotion at its most extreme perhaps and I would say such experience renders us emotionally intelligent.  If anything I would say that my own struggles with regulating emotion cause me to be more conscious of recognising the subtleties of emotion in others.

7. Chronic feelings of emptiness.

I wouldn't say that this symptom affects me as regularly as the others.  However, sometimes between bouts of emotion, I can be left feeling very numb and empty.  It is as though I can derive no sense of enjoyment or experience any emotion at all no matter what I do or how hard I try.  I have often found it very difficult to feel a sense of achievement.  For example, every time I have opened exam results of any kind and see that I have achieved good grades (some might say exceptional) that I've worked hard for, more often than not I have felt completely empty.  This can be extremely frustrating and often fuels my obsessive perfectionism.  I am constantly trying to achieve better in the hope that I might feel the sense of achievement I so long for.  This feeling of emptiness can also lead me to indulge in excessive spending, just to try and feel some form of high.  I can understand how the emptiness of BPD can lead people to take risks, just so that they may feel something.  In my case, I can come back from a shopping spree feeling more empty, my purse included!

8. Inappropriate intense anger, or difficulty controlling anger, eg. frequent displays of temper, constant anger or recurrent physical fights.

My anger is very much internalised.  A lot of people who know me have commented that I am one of the least angry people they've come across and that I rarely get cross about anything.  In truth though, I would say I have a lot of pent up anger and experience it as intensely as I do other emotions.  When I experience anger, it is often as a result of feeling misunderstood and frustrated.  It is as though a switch flicks in my mind and I become completely consumed by an internal rage.  I never display my anger through temper, shouting, screaming or violence.  Rather, my anger usually becomes expressed as anxiety.  Anger scares me and makes me feel out of control.  Any anger I feel towards others, I tend to direct back on myself and can feel my blood boiling inside.  As with all the intense emotional bouts I experience, it eventually passes but in the moment, anger can feel quite terrifying and bewildering.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

This is a symptom that has affected me a great deal as I have struggled a lot with very severe dissociative episodes.  I will probably write a post on dissociation at some point as there is an awful lot I could say about it.  Dissociation is quite difficult to explain to someone who has not experienced it themselves but in brief, it is a protective mechanism in which the sufferer loses touch with reality to relieve themselves of distress.  In my case, I experience depersonalisation dissociation which I would describe as my mind leaving my body almost as a form of escapism from high stress.  I have been sat in a pub or restaurant and several times, when feeling very anxious, it is as though my mind left my body and I was watching myself from outside the window, completely detached from everything going on around me.  It is a protective mechanism which a number of people who have experienced abuse or other traumas develop in order to relieve themselves of the pain and make it feel as though the abuse isn't happening to them.  I have had very little control over my dissociated episodes at times and that made me even more anxious, especially as I can dissociate to the point of collapse.

The auditory hallucinations I experience are also related to this symptom and they have made me become quite paranoid and hyper alert on occasion.  I have written quite an extensive post on hearing voices which you might find interesting to read.

Reflections on BPD

I have already said this but while it is clear that BPD is a severe psychological condition that has a significant impact on my life, it does not define me and it never will.  The diagnosis is relatively new to me and something I am still trying to process but the symptoms of the illness I have endured for many years.  BPD may be a condition that can only be managed rather than 'cured' but I am comforted by the stories of sufferers who claim that over time, with the right treatment, they have found that BPD no longer affects their life in a negative way.  I derive hope from the fact that I am very aware and conscious of my BPD symptoms.  I can recognise when BPD is affecting my reaction to a situation and have an awareness of what a 'normal', or rather a more regular reaction to the situation would be.  While this can be very frustrating, I am hopeful that this awareness will enable me to go further in managing my symptoms.

I read in an article once that a BPD sufferer is like a swan growing up on a family of ducks and I think that this is a really good analogy.  We were a sensitive swan growing up amongst a family of ducks quacking in a language that we didn't always understand.  It can be quite upsetting to acknowledge that BPD is often developed by growing up in an environment in which your emotional needs were not always met and you hence struggled to develop effective emotional regulation skills.  Such acknowledgement can be upsetting in the sense that it can be easy to place blame on our primary care givers.  While I did have a troubled upbringing, I have always had people around me who love me, care for me and are supportive.  I don't blame them for the difficulties I developed and I think the swan analogy illustrates this well.  My family were trying to treat me like another duck and for various reasons beyond both our control, I was not a duck, I was a swan and so they could not communicate with me in the way that I needed.  It wasn't their fault, it was just the way it turned out.

As a person who suffers from low self-esteem, it can be quite pleasant and refreshing to think of myself as a beautiful but delicate swan and so this is the image that I leave you with...