This is by no means comprehensive, but I thought I’d throw a little information out there.
What is a personality disorder? Most people could define a mood disorder like Bipolar I, at least in general terms. They understand that BPI has extremes of depression and mania, and sometimes people go psychotic or try to kill themselves. Often they are great artists and great sufferers. It has classically been the most recognizable psychological disorder to the point that it has been used colloquially to describe simple mood swings that everyone experiences. Despite our awareness, mental illness is still stigmatized and misjudged. I have Bipolar II, for instance, which presents differently (I don’t get full blown mania with psychotic symptoms usually), but simply by saying Bipolar, a lot of people just assume you’re “nuts.” Maybe I am, but I don’t swing cats around or believe in tinfoil hats or eat dryer sheets, and I don’t hurt anybody. We all have our own kind of nuts. Borderline is a lot like BPII, with mood swings and suicidality, but it is classified as a personality rather than a mood disorder.
Personality disorders are often misunderstood. The DSM-V says this: “A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (DSM-V 645). The name “personality disorder” is itself a remnant of earlier psychiatric academia as is the name Borderline. “Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity” (DSM-V 645). And in “Cluster B…individuals with these disorders often appear dramatic, emotional, or erratic” (DSM-V 646). I think the name Borderline came about because they thought it was a crossover of psychosis and neurosis. People have suggested changing the name to “Emotion Dysregulation Disorder,” but at this point it may be too stuck. The sad thing about BPD is that it is so vilified in both media and by the general public. When I was first doing research about BPD I came across some disturbing forums and book titles. These are all titles from Amazon.
- “Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder.”
- “Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying your Relationship”
- “Stop Caretaking the Borderline of Narcissist: How to End the Drama and get on with Life”
- “Borderline Disorder: 50 Solutions for Surviving Someone with Borderline Personality Disorder”
- “Personality Disorders: Borderline Personality Disorder: Beauty Queen or Emotional Terrorist?”
- This one is so good I have to quote the Amazon “blurb”: “People who suffer from BPD aren’t the only one in distress. Needless to say, those who surround them, including friends and family are affected, too. Borderline Personality Disorder is a tough nut to crack. The drastic shifts from one emotion to another, an abrupt change in decisions and episodes of identity disturbances are what you have to deal with. Are you in love with a beauty queen one minute and an emotional terrorist the next? Does he or she adore you one minute and then seem to despise you just as quickly for seemingly nothing? Are you damned if you do and damned it you don’t? You may be dealing with Borderline Personality Disorder (BPD). BPD is a serious, exhausting and sometimes soul-sucking personality disorder. Borderline Personality Disorder Beauty Queen Or Terrorist will help you face everyday life with somebody who has it. You can still develop a healthy relationship and provide support for these people if you have a deeper understanding of BPD. If you are at wit’s end and seem to be at the edge of the rope, hang in there, this book might just be the book you’re looking for! Discussion Includes The Following: • What Is Borderline Personality Disorder? • What Causes Borderline Personality Disorder? • How Is Borderline Personality Disorder Diagnosed? • How Is Borderline Personality Disorder Treated? • How To Cope With Someone Who Has Borderline Personality Disorder Learn the 10 Steps on how to cope with BPD! Don’t suffer anymore. Purchase Now!”
When I was first diagnosed, a friend I met with BPD told me to stay away from Borderline forums because they are full of angry significant others who just want to bash their partners because of their BPD. I understand better than most how frustrating BPD is, and I also understand how frustrating it must be for the people around me, but I am certainly not an emotional terrorist, nor do I think anyone with Borderline is.
Borderline Personality Disorder DSM-V
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self mutilating behavior covered in Criterion 5.)
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
Recurrent suicidal behavior, gesture, or threats, or self mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
This is a particularly great breakdown of it: NIMH: BPD. Winona Ryder’s character in “Girl, Interrupted” was supposedly borderline and it is actually believeable. Marsha Linehan is the current BPD guru and her book from the early ’80s Cognitive Behavioral Treatment of Borderline Personality Disorder is still the standard text. She pioneered Dialectical Behavior Therapy, the most accepted method of treatment for BPD patients, but it is also being used for a huge variety of different issues that standard therapies haven’t treated. They recently released a second edition of her companion handbook that has been updated and is very useful.
DBT teaches four main modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. These seem to be the most difficult issues for someone with Borderline. Mindfulness is useful for all humans, but it is particularly useful for people who tend to dissociate or feel empty because it is a concrete way to bring you back to your body and focus on the world at hand vs. the world in your head. I try to meditate a couple times a day. I am not always successful, but when I am I feel much more grounded. Handling distress is like drowning. People with BPD have extreme emotions, and distress can feel like it’s the end of the world, every time. Distress can be caused by minor issues too but because we react so extremely, what might have been a small concern becomes something large we have to work through. For instance, if you’ve lost a job it might trigger a spiral of depression, feeling worthless, guilt, shame, self harm, and potentially suicidal ideation or action. Learning to sit with the feelings associated with disappointment and hurt is the goal of distress tolerance, and DBT offers lots of fun advice on how to do that. I will share some of that in a different post.
Interpersonal skills may be the most complex and complicated issue someone with Borderline has to face. I know for me I am always questioning my relationships. They can be extremely volatile, I can fixate on people, I get incredibly angry, I don’t listen properly, I get so focused on being “bad” and the root of the cause that I don’t actually hear the other person. My pdoc at the last psych ward said this was my main issue. At the time I wasn’t sure, but he may have been right. People affect me intensely. Somebody simply not responding to me can send me into a spiral of guilt and self-loathing that is truly incredible. When Husband and I argue I tend to catastrophize and imagine that our relationship is over and that I should probably kill myself. As soon as we make up though, those feelings dissipate.
Emotion regulation is a big problem. I have mood swings (usually long lasting ones unless I’m rapid cycling) because of the BPII, but I have quick and intense mood swings because of the BPD. I can be screaming, fighting, and crying one minute, and then a few minutes later I’m fine and can carry out my day. It shocks Husband when that happens. It’s the only way I know how to function. I can’t handle staying with the bad emotion so I have to change it to something new.
Self-harm and suicidality are huge issues for people with BPD. I’ve been a cutter since I was 13. I’ve done some major damage, requiring stitches on at least a handful of occasions because I cut too deep. I was never trying to slit my wrists to die, just to feel the pain. That has a lot of motivations: sometimes it’s because I was numb and wanted to feel anything, sometimes I felt like I hated myself and deserved to hurt, sometimes it was so spontaneous and impulsive that I don’t really know the motivation other than anger and the inability to sit through difficult emotions.
Suicidal ideation has been my life. Since I was a teenager my mind has been preoccupied with suicide for a predominant amount of my mental life. There is a difference between ideation and intent, I should note. It’s like fantasizing vs. making a plan to actually commit suicide. I have attempted suicide on a few occasions. Clearly none of them worked, thankfully. The last was the most serious and hopefully the last time that it happens. I’ve never been more serious than trying to break my neck, but there’s lots more on that in my journal.
Borderline is a condition of extremes. Happiness, sadness, frustration, pain, confusion… and it is very misunderstood. I hope that the more the media addresses these issues and people educate themselves, that treatments can improve and people will actually seek them out.
This post may be updated as I do more research.
Someone on Reddit wrote a great blurb about “the spotlight effect” and BPD: Spotlight Effect.
The spotlight effect is the idea that you are the centre of attention during a single moment. It’s when a waiter drops all his plates and the whole cafe turns to look. At that moment, the waiter is in reality, the centre of attention in that moment. However, after a couple of minutes, the spotlight fades and he is no longer being looked at. For people with BPD, I find that we often feel the spotlight effect is nearly always on us, even when it’s not. It’s when we’re at a social gathering and we feel like we need to be ‘on’ all the time because everyone is taking notice of us. It’s narcissistic, but not in the form of we think we’re being noticed because we’re so great, it’s just-we think we’re being noticed just for no reason, just because. We both love and hate it. We love it when we’re telling a good story and people are laughing, and hate it when we think we look like shit and no one likes us.
The spotlight effect also goes on now when we’re home alone and on social media. It’s when we start caring a lot about a bad photo that our friend has of us on their facebook and we believe that the whole world is going to see it-when in reality, it may only be a handful of people who will see it and then forget about it after. It’s when we try so hard to take the ‘perfect’ selfie because again, we feel like the world and it’s mother will look at it.
Always being in the spotlight is exhausting, as we can see from celebrities who always get followed around by paparazzi. I find that in life, I almost feel that same sense of someone is always looking at/watching me. I try to hide my face a lot in public, or look down, because I think that. When I’m in a queue, I try to look like I’m thinking of something interesting because I don’t want people to realise I’m anxious because I think they might be looking at me.
The spotlight effect is very annoying but I find it’s hard to shake. It’s the thing that makes me worry a lot about how I look or what I’m saying or what I’m doing when I’m around strangers. It prevents me from relaxing when I’m in any kind of crowd. Anyone else feel this?