What do you know about borderline personality disorder? Today’s guest contributor, Natalia Hero, shares her personal insights into the often stigmatized mental illness, usually referred to as BPD. If you have BPD, please comment below and tell us about your experiences.
May is Borderline Personality Disorder Awareness Month – it’s also my birthday month, and the month during which I was diagnosed with the disorder. I like to think that that reinforces the connection I have with my illness – that BPD is very much a part of me, to be accepted and even embraced rather than demonized or ignored. To me, this has been an important part of the healing process. But the way BPD is perceived by others is another matter entirely. The disorder is highly stigmatized even within the field of psychiatry – it’s been described in some of the literature I’ve read as “incurable” while its sufferers are often labelled as inherently “treatment-resistant.” There was even a Time Magazine article from 2009 that called BPD “The Disorder That Doctors Fear Most.” Things are slowly changing as researchers learn more about the illness, but once a stigma or stereotype is out there, it can be tough to turn the tide. There is a general lack of empathy embedded in most people’s understanding of the disorder, which can be extremely harmful to those of us who suffer from it.
Borderline Personality Disorder is a chronic mental disorder of hypersensitivity and emotional dysregulation, characterized by unstable moods and relationships. Basically, borderlines are highly sensitive emotionally, and any emotion experienced will quickly spiral into a chaotic extreme. When we’re happy, we’re euphoric, ecstatic; when we’re sad, we’re devastated and depressed. Added bonus: we swing between those extremes several times a day, provoked by the slightest external trigger – something as benign as a rude bus driver can have me spiralling into intense despair like I’ve just had my heart broken. Dr. Marsha Linehan, a leading figure in the research on and treatment of BPD, describes the disorder thus: “Borderline individuals are the psychological equivalent of third-degree burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
To make matters worse, one of the main diagnostic criteria for the disorder is chronic suicidal thoughts and behaviours. What that means is that these emotional extremes are quite literally unbearable – 8-10% of people with BPD commit suicide (more than 50 times the suicide rate in the general population), and 70% of us attempt suicide at least once. So contrary to popular belief, BPD sufferers have more of a tendency to fold into themselves rather than lash out at others. Other fun symptoms of the disorder include paranoid delusions, dissociative episodes, depression, mania, psychosis, self-harm, and intense impulsivity in areas that are often dangerous – all things I’ve experienced myself. It’s my mind’s way of coping with these emotional extremes, of trying to make sense of it as best it can. But I need to develop new coping skills in order to shut those symptoms down before they impede my ability to function and burn every bridge in sight – and that is the basis of Dialectical Behavioral Therapy, which was designed by Dr. Marsha Linehan (who has the disorder herself) to treat BPD specifically. The treatment has a high success rate, but is often costly and difficult to access, and recovery can take ages – leaving a lot of us feeling discouraged and hopeless.
To add insult to injury, BPD is commonly misunderstood and even vilified. We’re often associated with the ‘crazy ex’ trope in media representations – think Fatal Attraction. And then take this recent tweet by J.K. Rowling, in which she engages with the unfortunately popular and extremely ableist #DiagnoseTrump hashtag, suggesting that the U.S. president’s hateful policies fit the diagnostic criteria for a personality disorder – essentially equating racism and straight up evil with mental illness while also implying that people with PDs are inherently unqualified to hold public office. But this tendency doesn’t only manifest in public discourse. Most of the resources available concerning the disorder are aimed at friends and family members of the borderline, which sends an implicit message that BPD is something that happens not to the person suffering from it, but to the people that have to put up with them. And so BPD is – let’s say unconsciously – seen as an illness affecting society at large, rather than individual sufferers. Try your best to imagine what it’s like to already suffer from chronic thoughts of suicide, and to frequently see first-hand the negative effects your symptoms have on your loved ones. Now imagine that when seeking help, the literature focuses mainly on people surviving you, rather than you surviving at all. We do a huge disservice to a demographic that is suffering tremendously with the way we frame the narrative surrounding mental illness and recovery.
Because the reality is that people with BPD and other mental illnesses are well aware of the effect they have on others. We’re not walking around innocently thinking it’s up to everyone else to adapt to our needs with zero effort on our part, and we’re not seeking absolution from all our harmful behaviours and denying any personal responsibility. We didn’t ask to be this way, we’re not hard-wired to hurt people, and we’re likely doing a lot more work than you are at figuring out how to exist in society without being a danger to ourselves and others. When I’m stable, I’m either spending my time doing damage control for my last episode or trying to figure out a plan to avoid my next one. No one is more concerned about the harm I’m causing than I am, just trust me on this one. And yet, because of prevalent ignorance, BPD is treated by many as a character flaw rather than an illness.
And that’s a serious problem. Ignorance isn’t innocence – it can harm people who are clinically vulnerable. For one thing, public perception of the disorder is intensely gendered because the majority of those diagnosed are female. This stems from that classic stereotype of women as hysterical and needy; of emotional sensitivity as a strictly female trait. Furthermore, the suicidality experienced by borderlines is also very misunderstood, not only by the public but also, until recently, among mental health care practitioners. Because of the intense and frequent mood swings presented in BPD, threats of suicide are often not taken as seriously, because they don’t resemble other suicidal cases – the way suicidal thoughts manifest in Major Depressive Disorder or Bipolar Disorder, for example. Because of their frequent extreme mood swings, a person with BPD will often spontaneously bounce back from a serious crisis episode and seem totally fine mere minutes later, which can be really confusing for someone unfamiliar with the disorder. These kinds of misconceptions lead to a general dismissal of the pain that BPD sufferers experience – it gets written off as dramatic or attention-seeking instead of being treated as the serious condition it is. It’s worth noting that a significant number of people with BPD have suffered trauma and have co-occurring PTSD – so many in fact that it’s been suggested that BPD may be an extended form of PTSD.
It felt important to me to write something about this awareness campaign, because the harm that stigma causes can be devastating. While borderlines are certainly capable of harming others – we’re human, believe it or not – there seems to be a pervasive idea in people’s minds that we are inherently abusive and manipulative. I’m not saying it’s easy having a relationship with someone who has borderline, but having the disorder definitely isn’t a walk in the park either (and also, let’s be real, exactly zero relationships are easy). I do plenty of hard work to manage my disorder and its symptoms – I read every book about it, go to therapy, take meds, and am on an ongoing journey of learning about my specific behavioural tendencies and the way in which they affect my interpersonal relationships.
To me, awareness alone doesn’t scratch the surface of how we should be talking about mental illness. People can do their basic Google homework and get the general idea of my disorder and its characteristics, while still viewing me through a lens of resentment that’s informed by deep-rooted, harmful beliefs. My own diagnosis provided me with more understanding of myself, and with the tools to manage my illness. It allowed me to be honest with those close to me about my needs and boundaries, which for the most part successfully improved the relationships in my life; however, some people inevitably read my openness about my disorder as me trying to make some blanket excuse that absolves me of all accountability for any harmful behaviour on my part. And that kind of accusation is really hurtful when you’re trying your best, every day, to cope with your pain and heal on your own without being a burden to anyone.
Research actually suggests that people with BPD are hyper-empathetic – a study showed that sufferers can detect a change in someone’s facial expression and corresponding mood significantly earlier than someone ‘healthy’ can. Without taking it to that level (because being that sensitive to other people’s moods isn’t fun, believe me), I invite you, this month, to consider adding a little empathy to your current view of BPD sufferers and of people with mental illnesses in general. Since BPD affects 5.9% of adults at some point in their lifetime, it’s entirely possible that someone you know is struggling with it. But even if that’s not the case, having an illness should not disqualify anyone from being deserving of empathy and understanding.