“I have Borderline Personality Disorder.”
These are the five words that inevitably lead to a shift in how others perceive me, and results in a change in their attitudes towards me. In recent years, we have managed to reduce the stigma that surrounds may mental illnesses, including mood disorders such as Bipolar, and we have seen an outpour in both sympathy and empathy for symptoms such as depression, anxiety or suicidality.
And yet, the stigma around personality disorders is still very much at large. I see it in the change of people’s body language, I see it in the shift of sympathy to fear when I correct my diagnosis, which has in the past widely been assumed as Bipolar.
The DSM-IV-TR (2000), states that a diagnosis of Borderline Personality Disorder can be made when a persistent pattern of unstable relationships, mood swings and self image present along with marked impulsivity beginning in early adulthood and across a range of contexts indicated by a minimum of five of the following:
1. Frantic efforts to avoid real or imagined abandonment.
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). This does not include suicidal or self-harming behavior.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood; intense feelings that can last from a few hours to a few days.
7. Chronic feelings of emptiness.
8. Inappropriate intense anger or difficulty controlling anger.
9. Transient, stress-related paranoid ideas or severe dissociative symptoms.
Unfortunately, suicidality is a defining feature of Borderline Personality Disorder, and a staggering 70% of sufferers will attempt suicide, with a further 10% being successful. Ashamedly I am one of the numbers that makes up that 70%. Sufferers of BPD experience intense emotions, with researcher Marsha Linehan claiming:
“People with Borderline Personality Disorder are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
When I am sad, I am severely depressed. Social situations can make me anxious, which more often than not unfortunately presents itself as anger. Stress inducing situations can result in temporary psychosis causing auditory and sometimes even visual hallucinations. “Splitting,” which refers to the “black and white, all or nothing” thinking, produces an inability to assess people, situations, or even myself as anything other than “good” or “bad,” and revolves around idealization and devaluation. Confusingly, it can swing back and forth rapidly.
I lack impulse control. Anxiety becomes intense paranoia. When these symptoms happen to present at the same time suicidality occurs. The splitting can somehow reshuffle the cards of my life so that it is impossible to recall a happy memory and low impulse control leaves no room for considering or debating. Hallucinatory voices chime in to remove any doubt that it is the only option.
Borderline patients can swing between these intense emotions in just one day, sometimes within an hour, which is perhaps the saddest thing of suicidality rates in BPD; what seems as though it is an endless feeling of despair could in reality be replaced within a matter of days with a happiness that others could only ever dream of. When I am happy, I am euphoric. Splitting in this sense is beautiful; the love I have for my friends and family is overwhelming, they are absolute angels. I have the absolute belief that I can do or be anything; every traumatic experience in my life receives endless gratitude. In these moments, I am in love with life, so much that I can’t possibly imagine any reason I would ever want to kill myself.
Fortunately, most days are a mix between the two, somehow providing some sort of “normality” and I’m fortunate enough to have a strong support network. Still, more often than not, I feel more alone in a room full of people than I do being by myself. It’s the acknowledgement that no matter how accepting I am of myself and my own diagnosis, it is awkward for other people. It’s difficult to build friendships or relationships when you can’t be yourself. When people ask why they haven’t seen you in while, they don’t want to hear that you’ve had a “break” or been suicidal because they don’t know how to respond, but lying about who I am only makes me unhappy. I’m very comfortable in my imperfections, but I’m constantly aware that other people are not.
Having a personality disorder is my life work. It is a learning process, paying attention to dates, situations, and even people that could trigger a severe episode. Paying attention to changes in sight, beliefs, and behaviors and having to constantly assess whether or not they are authentic or the result of psychosis. It means allowing myself time and space to breathe when necessary and learning to say “no” to situations and people that can be unhealthy. I’m having to learn how to harness my impulsivity and seek advice before making decisions. I’m learning to rely on other people, which for me personally is probably the most difficult. I’ve had to learn to never apologize for being myself, but how to apologize for the times I am not.
Despite how we are often portrayed in the media, people with Borderline Personality are not monsters. We are imperfect, yes, but we are human. We are all fighting our own battles, and I refuse to be ashamed of mine. What we need is to see more honesty regarding personality disorders in general, just as we have seen a shift in perception around other mental illnesses, understanding and compassion can only be brought about when we are more open about suffering.