Borderline Personality Disorder
By Estelle Curiel 12th February 2021
Image courtesy of Wix
Warning: This article is about mental health touching on subjects such as, self-harm and suicide
Borderline personality disorder, or BPD, is a highly stigmatised mental illness.
As a personality disorder, it is characterised by stable and enduring personality traits (thoughts, feelings, and behaviour) emerging in adolescence or early adulthood which deviate from the norm of one’s culture and are prevalent and inflexible across many aspects of one’s life, leading to distress or impairments.
According to the DSM-V, tobe diagnosed with BPD, the 5 following criteria must be met in the context of a personality disorder:
1. Impairments in self functioning (a or b):
a. Identity impairments characterized by markedly impoverished, poorly developed, or unstable self-image / sense of self (often associated with excessive self-criticism; chronic
feelings of emptiness; dissociation.)
b. Self-direction impairments characterized by an instability in goals, aspirations, values, or career plans
2. Impairments in interpersonal functioning (a or b):
a. Impaired empathy characterized by a struggle to recognise the feelings of others associated with being prone to feel slighted or insulted. Perceptions of
others negatively biased.
b. Impaired intimacy characterized by intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with
real or imagined abandonment. Close relationships are often viewed in extremes of idealization and devaluation with alternating between over involvement and withdrawal.
3. Negative affectivity, characterized by:
a. Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
b. Anxiousness, often in reaction to interpersonal stresses.
c. Separation insecurity: Fears of rejection and/or separation, associated with fears of excessive dependency and complete loss of autonomy.
d. Depressivity, including thoughts of suicide and suicidal behavior.
4. Disinhibition, characterized by:
a. Impulsivity: Acting without a plan or consideration of outcomes, difficulty establishing or following plans. It can also be characterized by a sense of urgency and self-harming behaviours under emotional distress.
d. Engaging in risk taking behaviours through dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences. These include but are not limited to: unsafe sex, drug and alcohol miss-use, excessive spending, binge eating.
5. Antagonism, characterized by:
Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
BPD is highly stigmatised, with people thinking those with BPD are manipulators, abusers, dangerous. The fact of the matter is that people with BPD are not any more dangerous than the general population. Some of their behaviours may seem manipulative to someone who does not understand the illness but there is no intent to be manipulative. People with BPD are often very raw and honest about their feelings and emotions which can be disarming. They are thus labelled as attention seeking drama queens, but the illness is extremely serious and has one of the highest rates of death by suicide. Suicide attempt rates for people suffering with BPD are 80% with 10% of people with a BPD diagnosis dying of suicide.
Adding insult to injury, late November saw Instagram ban #BPD, showing instead a message saying the hashtag was associated with posts encouraging harm and suicidal behaviours, with no option to see the posts unlike other partially banned hashtags. This only added to the existing stigma surrounding the illness. The hashtag had been a form of support for many people, offering a safe space to learn about the illness and find a community of peers who understood each other. The campaign #HASHTAGBPD was created by mental health advocates on the platform to raise awareness to the issue as well as the illness with weekly subjects covered such as ‘why ending the stigma is so important’ and ‘how to support someone with BPD’. #hashtagbpd reached over 2000 posts and Instagram partly reinstated #bpd. The message about the posts in the hashtag encouraging harm is still present, but people can chose to see the posts. Unlike other hashtags, there is no option to view popular or recent posts, but it is a step in the right direction.
A misconception about BPD is that people cannot recover, but with effective treatment recovery is possible. Therapies such as Dialectic Behavioural Therapy (DBT) and Mentalisation Based Therapy (MBT) have high efficacy rate at treating those with BPD. It is important to note however that those who recovered from BPD are still neurodivergent, feeling emotions more intensely than neurotypicals.
My personal journey with BPD has been a rocky one. I started suffering from mental ill health in my teens and got misdiagnosed until I was 19, in August 2019, when I was told I had BPD by a psychiatrist. I had very little knowledge about the illness but was very offended. I knew about the stigma and thought my psychiatrist was calling me abusive and manipulative, but when I looked up the DSM-V Criteria for it, it all made sense.
I started getting treatment from the NHS in the form of STEPPS (systems training for emotional predictability and problem solving), a group therapy inspired by CBT. Our group was composed of 12 teenage/young adult girls and a really unhealthy dynamic soon formed. I ended up having to stop less than halfway through due to being bullied.
After a few months of my mental health plummeting without any support, my mother convinced me to get private therapy in the form of mentalisation based therapy (MBT). Before that, I always felt too guilty about the cost to get it. I still struggle with feelings of guilt around the monetary aspect of therapy but it has saved my life.
My experience living with BPD is not an easy one. The illness is draining and debilitating at times, making everyday tasks feel insurmountable. I have struggled with depression and anxiety alongside my BPD since I was a teenager, as well as with an eating disorder in more recent years. It is very common for people with BPD to have comorbid disorders like those as living with BPD can be a traumatic and triggering experience in itself. My chronic feelings of emptiness and intense emotions often led me to self-harming behaviours. Harming my body was a way for me to get some relief, but it was always followed by guilt, shame, and more depression. With therapy I have learned better coping mechanisms and haven’t deliberately injured myself in 3 years. I also experience a lot of dissociation, that is a feeling of disconnect from thoughts, feeling, memories, or surrounding. Dissociation can also feel like extreme numbness, or a complete disconnect from the world. I would sometimes describe it as being in a film where the soundtrack just slightly out of sync, or those scenes in action films where the camera pans around a character and the rest of the world is out of focus. These feelings can be extremely isolating, especially during social situations. I have very little sense of self due to my BPD, which is not help by my continuous depersonalisation – a form of dissociation which means I feel disconnected from myself and my body, often feeling like my body is not a part of me. My relationships are also greatly affected by my fear of abandonment, requiring reassurance that people actually like me and won’t leave me.
I have had some very negative experiences with people misunderstanding the illness and gaslighting me, as have most people with BPD. We are often told we are overreacting, and as it may seem like that from the outside, I can assure you our reactions are completely proportionate to the turmoil inside. BPD is linked to childhood trauma, and we often struggle to process triggers which leads us to being a pot about to boil over. When in this state, we often ‘mask’ very well so that people don’t realise how much we are actually struggling, so they are shocked when we have a meltdown because we haven’t properly washed the conditioner out of our hair (real story).
On the subjects of meltdowns, people with BPD can often experience meltdowns very similar to people with autism. BPD meltdowns are often due do emotional triggers whereas people with autism usually experience them as a result of overload. My meltdowns look like a toddler having a tantrum, which explains why my parents just thought I was a difficult child and did not realise the distress I was in. I don’t get many anymore, but when I do they are mostly the result of extreme anger. I do want to point out that during them, and in general, I am only a danger to myself and no one else. The best thing to do if you know someone experiencing a BPD meltdown is to stay out of their way and stay calm. Try to stay with them if you can and speak with a soothing tone. Do not raise your voice at them or try to grab them as that will make matters worse.
I’ve been getting MBT for 3 years now with the same therapist and am on my way to recovering from BPD through learning more about the illness and how to manage it, as well as, dealing with past traumas. Alongside my MBT therapy, my personal mindfulness practice has helped immensely in my recovery, teaching me to create space between the triggered emotion and the outcome. One of the most life changing lessons from my therapy about BPD is that we 'feel our emotions through others', which means that instead of thinking "they haven't responded, I feel abandoned" we think "they haven't responded, they hate me, they suck" which may lead to lack to recognition or others’ feelings. Knowing this has allowed me to take a step back and question the veracity of my thoughts.
I’m still not recovered and still struggle with anxiety, depression, and disordered eating, but I am very hopeful about the future and no longer meet the full criteria for BPD. I am miles from that girl who sat shaking through her entire appointment back in 2016, stuck in an abusive and extremely dysfunctional relationship with no idea how to get out of it - or indeed that I needed to get out of it!