The disorder of which I will talk about today is currently my primary diagnosis, yet I can count on one hand the number of people I have disclosed the diagnosis to. This is because despite affecting as many as 2.5% of the population, it is one of the least understood and most stigmatised mental health conditions, both among the general public and even health care professionals. I can almost guarantee that of those of you reading this, unless you have a diagnosis of your own, you will either have not heard of the condition or have an entirely warped view of it based on the way in which it is presented in the media. It is this stigma which caused me to be in denial for at least the first year following my diagnosis at the age of 17 and the reason so many people continue to live in denial and thus refuse to receive any help.
This diagnosis is borderline personality disorder (BPD), otherwise and more appropriately known in the UK as emotionally unstable personality disorder (EUPD).
As suggested by it’s name, BPD is a personality disorder, affecting the individual’s attitudes, beliefs and behaviours. The best way I have ever heard the disorder described is in comparison to a victim of third degree burns. Imagine your body with 90% of it’s surface covered in such burns. Every touch is agonizing as you feel it significantly more intensely than people without the burns do. For people with BPD, it is the psychological equivalent – we effectively have no emotional skin so any touch or movement causes immense suffering.
To achieve a diagnosis, there are a number of criteria which must be met. Rather than spiel these at you in a textbook manner, I will instead describe in detail the specific symptoms of which I present in order to meet my own diagnosis because I feel that this will give a more personable account and hopefully enable you all to see the diagnosis in a way other than the easily stigmatised, textbook definition.
Of the 7 possible criteria of which 5 must be met, one of the perhaps most marked of these in terms of signifying borderline personality disorder is emotional instability. To some degree, this emotional instability can be associated with those known to the better publicised illness, bipolar disorder, however this instability does vary in quite significant ways. Whilst the classic bipolar mood swings tend to vary from mania to depression, those experienced by a victim of BPD are on a much wider spectrum and cycling at a much quicker pace – you name an emotion and I guarantee I have felt it today. I have suffered with unstable mood swings for longer than I can remember; in fact it wouldn’t even be possible to pinpoint when they ‘began’ as such as there was no defining moment. Rather than a period of my moods lasting for weeks on end, they are changeable in hours or even minutes with no identifiable trigger, only ever remaining stable for a maximum of a day or two and that in itself is a very rare occurrence.
As if rapidly changing emotions aren’t draining enough, each individual emotion is also experienced signifcantly more intensely than your average person, this being the basis for the ‘burns victim’ metaphor. People with BPD do not feel embarrassment; they feel intense shame as something as small to anybody else as getting somebody’s name wrong makes us want to crawl into a hole and disappear. You may just apologise, laugh it off and forget it ever happened but for us we feel as if we have committed a horrifying crime we will ruminate on for the entire day. People with BPD do not feel happy, we feel elation so high I honestly wouldn’t be surprised if strangers (or even friends) thought I’d just taken ecstasy sometimes. My form of ‘happy’ is jumping up and down – quite literally – and singing at the top of my voice regardless of how appropriate the situation. It is making plans I will never keep because in the moment my life is rainbows and sunshine, I am confident and nothing can go wrong. I laugh, hysterically but honestly, at everything even if nobody else finds it funny. I cannot for the life of me, stop talking. Literally verbal diarrhoea. Whilst these happy moments may sound great (and believe me, I embrace them), they are not pure happiness but simply ‘happy hours’ and they always come crashing down. People with BPD do not feel shy or nervous, we feel crippling anxiety and this is why it is not unusual for those with a BPD diagnosis like me, to also be diagnosed with a co-morbid anxiety disorder. People with BPD do not feel sad or low, we feel clinically depressed. My depressed states are probably the most dominant of all of my BPD mood cycles, occurring most frequently and being more prolonged. When I feel depressed, I cannot and will not get out of bed. I won’t brush my hair nor my teeth nor will I shower. For no reason at all, there are more tears in me than words and the thought of communicating with a single person quite realistically makes me want to jump off the edge of a cliff (or at least I would if I had the energy to actually do so).
Another intense emotion characterising my borderline personality disorder to an extent where it is classified as a criterion to the diagnosis of it’s own, is profound and often irrational, anger. I’m not talking “ugh I’m so angry I can’t believe he/she did that, let’s talk this out and calm down”. I am talking, “I AM SO FUCKING ANGRY I’M GOING TO FUCKING KILL THAT FUCKING IDIOT I NEED TO PUNCH A WALL I AM NOT LISTENING OR TALKING TO ANYBODY UNTIL I HAVE CAUSED IMMENSE FUCKING DESTRUCTION” type anger. Nobody can calm me down when I feel this kind of anger at all; the only way to manage it is by either causing destruction (punching something/taking it out on myself) or crying. The result of this is excessive shame given the consequences brought with it. In bouts of anger (usually at health professionals), I can swear, shout or send impulsive emails expressing this anger. Although I will always understand I have done wrong and apologise to those affected profusely, I will still feel extreme guilt to the degree where I genuinely hate myself and wouldn’t blame others if they hated me too. It may be a major part of my condition but it does not prevent me from feeling regretful in the aftermath and can be an unfortunate but understanding reason for my relationships to break down.
Relationships themselves are a key aspect of BPD, as they are well known for being problematic as they swing from one end of the spectrum to the other. For myself, this often begins with idealising new relationships I form. The relationship becomes intense really, really quickly as I believe this person is the best thing to ever have happened to me; they can do no wrong and I want to be with them constantly. I apply a massive halo above their head, but not for long. With no warning and through no fault of their own, my opinion of the person will change. Idealisation becomes devaluation and suddenly they cannot do right. Your head views their every action negatively as love quickly becomes hate, springing as expeditiously as an elastic band and you do not wish to be near them. You push them away, causing them to hurt. But at the end of it all, you are the one who is inevitably hurt when devaluation becomes idealisation again but understandably, the person does not want you back in their life. Your relationships are toxic and lack consistency. Again, you feel like the worst person in the world and self hatred is horrific, yet no matter how hard you try you are incapable of controlling this on/off switch in your head. This instability means that relationships come and go, friendships constantly changing and once more, I do not blame others for not wanting to be part of it. I wouldn’t even want a relationship with me, let alone expect others to. The only benefit of this is that it means for those who do stay around and take the time to understand the reasons behind your behaviours, your relationships with them which eventually form are solid as a rock. My poor family have no choice but to put up with my ever evolving opinions of those around me and I cannot thank them enough for their support. Similarly, my best friend (I have been instructed to refer to her as princess Katie, my saviour) and I have the strongest relationship I have ever formed with another human being. Whilst others may run, Katie has stayed by my side for the three years, through the good and the bad. She understands if I am distant, but never lets me push her away. This is proof that although relationships are stormier than the typhoon season across the Pacific for those with borderline personality disorder, with love and understanding, they are not impossible.
BPD relationships don’t only occur on a black and white scale, but also lead to intense and damaging attachments and abandonment issues. Before I discuss this, I want to express that what I am about to disclose does bring rather strong feelings of embarrassment and shame for me so please, do not judge. Across the last few years in particular, there are a number of individuals with whom the idealisation has been so constant to a point where I have formed very strong attachments with them. I tend to find that the people such attachments occur with are always authoritative figures which brings a whole host of it’s own issues. At it’s worse, an attachment I formed with a healthcare professional lead to this person in fact losing their job. I am not proud of this and although being three years ago, the thoughts surrounding this situation are still raw. Whilst an inpatient in an adolescent psychiatric unit in 2013, I strongly associated myself with a particular nurse who I became so attached to and relied upon so heavily that she felt highly responsible for me; when going on home leave, this nurse gave me her personal telephone number in order for me to contact her as she was at this time quite concerned about my well being and knew that I would under no circumstances, contact the ward directly. This in itself is highly unacceptable behaviour from a professional but at the time, she was only trying to protect my well being. Furthermore, I had disclosed information to her which according to the hospital’s guidelines should have been passed on to the rest of my care team, however she made the decision not to do so based on my begging and pleading. A result of the combination of her giving me her telephone number and withholding information was that she lost her position at that hospital. In a bid to avoid abandonment from this nurse as the thought of never seeing her again was too much to bear, I found her on Facebook and bombarded her with messages of apologies, gratefulness and ultimately admiration which can only have made her situation worse, although at the time I could not see beyond my own desperation. Looking back, I am so beyond embarrassed and am only grateful that my attachments no longer occur to this extent and have not had any further devastating consequences for another professional.
Nevertheless, I do continue to have some attachment issues which can lead to utterly absurd behaviours. For instance, say I have formed an attachment with Person A. I have found myself taking ridiculous detours on any journey to pass an exact point or location I know that Person A will be at, at that exact time in hope I will bump into them, whether I know that they will be going for a cigarette break or to buy their lunch etc. It may not even be a detour, it may sometimes even have been my only intention. I have stood outside Person A’s house if I haven’t seen them in their usual locations for a while just to ‘make sure they’re okay’. I have made excuses to book appointments to see Person A or ask for help with a problem which doesn’t even exist, just to spend time with them. I have checked all forms of their social media precisely every 30 seconds when in a conversation with them, torturing myself if Person A does not respond to my message instantly. I know that all of this is absurd and I know that it is bunny boiler behaviour and this is why it is so shameful to admit, but it is a massive characteristic of the borderline diagnosis and requires effective treatment techniques. I feel it is important here to highlight the fact that if anybody is now panicking over whether I have or previously formed an attachment with you, I can reassure you I have no current attachments whatsoever and if I did, you would most definitely have realised so before now – it would not take this post to make you consider so.
Another key criterion in the set used to make a diagnosis of borderline personality disorder is impulsivity and recklessness in ways of which can be self-damaging. This can involve engaging in activities such as reckless driving, over spending, gambling, substance abuse, binge eating or unprotected and unplanned sex. This aspect of BPD is one of the most stigmatised by the media; although Girl, Interrupted will always be one of my all time favourite films, it is just one instance where a BPD diagnosis is associated with ‘slutty’ behaviour. Not every individual with the diagnosis prances around having sex with whoever they want, whenever they want so if this is your current view of a borderline, please erase and rewrite it. Yes, this may be a difficulty for some but even if it is, it is a serious aspect of a serious condition and therefore has no reflection on their personality or morals. Impulsivity within BPD can be extremely destructive and something I suffer with quite significantly. Combined with a diagnosis of anorexia nervosa of the binge/purge subtype, it goes without saying that binge eating has been problematic for me, again being a major reason why personality disorders have a high rate of comorbidity alongside other mental health conditions. In bouts of immense happiness and confidence, I am also prone to overspend. This is because during this time I have zero financial concerns due to not having a care in the world, thus money becomes no object. I spend money on things I do not even need which only brings heightened anxiety relatively soon after due to the impact this spending has had on my financial situation. This impulsivity also arises in other forms for me; most notably this has manifested in my tendency to abuse medication. Of all of the overdoses I have taken in the past three years, only one of these was premeditated. The others were always acts on impulses and are much more highly dangerous. The consequences are less well thought through and thus the impact is always greatest.
Self medication is classified not only as an impulsive act, but as a form of self harm. Currently in the DSM (the diagnostic manual used in the UK), BPD is the only mental health condition for which self harm is a recognised symptom and a criteria for diagnosis. My self harming acts began at a very young age of 12 with scratching myself with the end of a bobby pin; these scratches were nothing but superficial and produced at night, would have disappeared by the morning. Like any mental health condition however, as my both my BPD and depression escalated, my self harming became increasingly severe, eventually evolving into deep gauges requiring medical attention and leaving permanent scarring over the majority of my body. Self harm serves different purposes for any person with borderline personality disorder whether this may be a release or punishment to themselves and this is very personal. It has taken a very long time to be able to identify the mechanism behind my self harming behaviours and it is a relief to have finally reached this level of understanding. When experiencing an extreme bout of depression, emptiness or despair, I am aware that there is no justifiable trigger for my emotion and therefore inflicting pain on myself justifies the pain I am experiencing. It provides a physical cause for the pain and therefore I can finally justify my emotions. Furthermore, the aftermath of scars across my body provide a sense of control. Unless you have been in my shoes, self harm is most likely very hard for you to understand, but the urges to do so are very intense and very real and I would not wish them upon anybody. For a huge percentage of us suffering with this disorder, unfortunately with self mutilating behaviours also comes suicidal thoughts and gestures. Personally, I have attempted suicide numerous times through actions such as life threatening overdoses or tying of ligatures around my neck. This is another aspect of the disorder which is entirely and frustratingly misunderstood – suicidal behaviours are not for attention, they are the result of extreme, but genuine feelings and thus the view that borderlines are manipulative must end. Of course, some with the diagnosis will use their behaviours to control others but this is to no greater degree than many members of the general, healthy public do. This does not make it a symptom of the diagnosis but simply a human trait so please do not tar us all with this brush.
A lack of self identity is a further characteristic of borderline personality disorder which although is one not bringing any physical damage, can have a large emotional effect. We can often experience a complete lack of self awareness. This can lead to dramatic shifts in all aspects of our personality; the way we dress, the types of people we associate ourselves with, how we speak and ultimately our goals and ambitions in life. The confusion can be really draining and lead to feelings of emptiness and a lack of purpose on this world. Although I am slowly beginning to understand myself, it may also mean that I act differently depending on who I am with and whilst to many people this may seem like “acting sheep-like”, for a person with BPD it is entirely unintentional and a genuine reaction to a shifting sense of identity.
Finally, a terrifying symptom of this personality disorder which I have experienced is dissociation under high levels of stress. Dissociation means different things to different people and thus my experience is very personal and cannot be applied to all. When my mental health had it’s most dramatic and most rapid decline in the third term of my first year at university this Easter, I experienced dissociation for the first time. For me, this meant a complete lack of awareness of both myself and my surroundings – effectively blacking out leading to complete loss of memory of huge chunks of time. On multiple occasions, I came conscious of my surroundings in novel situations with no recollection of how I had got there and this put me in significant danger. For example, I found myself sitting on the edge of train station platforms, covered in self harm I did not remember acting on or miles away from home in early hours of the morning with no money or sense of direction. This feeling is similar to the fleeing experience I have during a panic attack, however there is a precise difference. With panic attacks, I can highlight the trigger of the attack and the exact moment I lost awareness; with episodes of dissociation I could not. I could not pin point the moment in which I lost consciousness and I would not even remember feeling even slightly on edge before I did so. They occurred randomly without any warning and left me in far more dangerous situations, as well as leaving me with entire chunks of my day for which I had no memory of. Luckily, over the numerous years I have been diagnosed with or identified with a BPD diagnosis, I have only had one period of around six weeks where I suffered with symptoms of dissociation and I am incredibly grateful for this; I cannot sympathise enough for those for whom dissociation is a daily part of their disorder. I sincerely hope that these are symptoms I never experience again.
The extensive account of information I have provided above depict only a very small glimpse into the life of a person with borderline personality disorder. There are other symptoms of which I have failed to describe as they are not something I have suffered with but if you are interested in educating yourself around these, please visit the following page from Mind’s website:
Unfortunately, even mental health professionals agree that personality disorders are the most difficult mental health condition to treat and it is generally accepted that rather than ‘curing’ a person of their disorder, the aim for treating BPD is to help the sufferer be able to manage their symptoms. It is not about removing impulsivity or anger but teaching techniques to better understand and thus manage how we deal with these emotions or urges. Nevertheless, I must clearly express that this does not mean that treatment is not worth reaching out for but in fact the opposite. If you suffer from borderline personality disorder, this does not mean that the condition must control you forever. With extensive education, therapy and a little bit of help from medication we can learn to effectively manage our condition so that eventually, we are in control. And more so, although recovery is more difficult, this does not in any circumstance mean that complete recovery is unattainable.
In my own journey to understanding my condition, I have found the information provided by Mind to initiate a major turning point. The self care tips provided on the following page (http://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/self-care-for-bpd/#.V5E8tPkrLIU) have been the most helpful methods of self care I am yet to find and I use some of these techniques on a daily basis.
Mind, the mental health charity are doing an amazing job of removing the stigma attached to this particular condition by raising awareness and this is one of the many reasons why I feel so strongly about supporting the charity. However as with any service provided, raising awareness and breaking stigma relies upon charitable donations. Thus I beg that if you are yet to do so, you donate towards my skydive today to help allow Mind to continue the amazing job they are currently already doing.
As always, thank you for reading x x x