WTF is BPD?
I’ve been struggling all day. This is hardly uncommon for me, but previous struggles mostly involved “How many chocolate chips can I eat and still weigh 93 pounds?” or “Should I cut myself again today or just burn my legs with matches?” But this struggle is different, unfamiliar, and possibly more difficult, because I’m trying to convince you that I’m not a monster.
The face of pure evil.
So. Let me give you a tour.
Welcome to Borderline Personality Disorder, my friends! Never a dull moment, I say. Well, said. I’m technically recovered now and I can eat not only chocolate chips but the whole cookie - perhaps even two! And self-injury seems like a lot of work. Plus there’s the cleanup (oh trust me, there’s cleanup) and housekeeping isn’t my thing.
Oh, fuck the levity. Let’s get down to business. I’m writing this because so many articles are written by so many people who have never experienced BPD firsthand, and this seems like a bit of an oversight. And there’s a reason for that. Being borderline is something you hide and hide carefully. Recovering from BPD should be celebrated, but instead it’s often tossed away like your ex’s naked Polaroids, say, or your high school CD collection. It’s something bad, and you should be ashamed.
I was ashamed. I’m still ashamed. Writing this is marginally easier than operating a forklift, but I’m still worried I’ll crash horrifically.
Eh, let me crash.
It’s late 2012 and I’m a year into (mostly) recovery, six months out of therapy, three weeks into a romantic relationship, two drinks into me. I tell my new boyfriend, both casually and carefully, that I used to have Borderline Personality Disorder. And although he knows the stories, has seen the scars, a certain caution creeps in and sits between us.
Are you sure?
He knows about the cutting and burning, the suicidal gestures, the unstable relationships, the hospitalizations, the mood fluctuations, the rage, the emptiness, the splitting, the dissociation. He knows it all, but the actual words leaving my actual mouth make me different than I was a few minutes ago. Oops.
Then I wonder if I should help others understand this better. Indeed, I vow to do it tomorrow, and then the next day, and then on New Year’s Eve, and then sometime before Valentine’s Day, and now it’s nearly two years later and I’m still hiding myself. Fuck that.
Few emotional disorders (and BPD is a disorder, not a disease) have a stigma so down-and-dirty-awful as Borderline Personality Disorder. No matter how much comfort is offered (Princess Diana had it!), the mental image mostly swings toward Fatal Attraction. Wrist slitting, obsessive stalking, a little touch of bunny boiling: these are the hallmarks of BPD, according to people without BPD. Since this seems acceptable, let me add that as non-diabetic, I know for a FACT that people with diabetes clearly deserve to suffer because all of them brought it upon themselves. I’m onto you, diabetics. I was borderline, and therefore I know everything.
So! Step right up, ladies and gentlemen! If there’s one thing I do know about, it’s Borderline Personality Disorder! Why, I’m practically a walking Wikipedia of psychological bullshit. Please, do allow me to translate the medical jargon into English for you. Keep reading or I’ll kill your rabbit.
The Numbers Game
Borderline Personality Disorder is, well, a personality disorder (for the record, there are 9 others) that affects between 1 and 2 percent of the population. Telltale signs of BPD are severe emotional instability, self-harming behavior, frantic fear of abandonment, extreme difficulty managing personal (especially romantic) relationships, intense and inappropriate anger, recurrent suicidal gestures, and, in extreme cases, paranoia or dissociative symptoms that feel like “out of body” experiences and can last from a few minutes to several days. At least 75 percent of people with BPD self-injure, and approximately 1 out of 10 die by suicide. (source: National Alliance on Mental Illness)
To meet the criteria for Borderline Personality Disorder, 5 out of the following 9 symptoms must be present. It cannot be stressed enough that each case of BPD is different, which makes stereotyping difficult, harmful, and pointless. There are 151 ways to be borderline. (source: The Borderline Personality Disorder Survival Guide.)
Let’s get started (with a little help from psychcentral.com, which has an excellent rundown of borderline symptom manifestations).
Borderline Personality Disorder Diagnosis: DSM IV Diagnostic Criteria
1) Frantic efforts to avoid real or imagined abandonment.
Let me begin by saying that almost all people with BPD think they are inherently bad or even evil, and the slightest of triggers is all it takes to get the “I hate myself” ball rolling. “Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are bad.” (psychcentral.com)
Translation: If you cancel plans or don’t come home for dinner, that means you hate us, which confirms that we’re worthless, which makes us remember how much we hate ourselves, which makes us sad, which makes us angry, which snowballs into extreme behavior such as self-harm. “He doesn’t want to see me, and he never wants to see me again because I am an awful person and I deserve to be punished - and [possibly] so does he.”
2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
This behavior is called “splitting”, for the record, and people with BPD are often only able to see things in black (evil) or white (perfect). If a friend or lover mistreats them, a person with BPD may collapse because they previously saw that person as flawless and entirely trustworthy, and now they have to re-evaluate the whole relationship and therefore themselves. Again, if someone close to them goes from white to black, this is probably because the person with BPD is evil. Self-injury time.
3) Identity disturbance: markedly and persistently unstable self-image or sense of self.
You may notice someone with BPD deciding one day to be a nurse and deciding the next day to be a skydiving instructor and the next day wanting to move to France and make cheese. Lacking a true sense of self, borderlines may have “sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all.”
4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
Borderline Personality Disorder tends to appear in one’s late teens to early 20s, when this kind of behavior is common, even expected. However, someone with BPD may not be able to control their impulses, nor care. When you think you are evil, there’s little reason not to have sex for money or die of an overdose. Combine that with chronic feelings of emptiness (we’ll get there in a minute), and you become a human vacuum, sucking up whatever will fill the void. Even if it’s dangerous. Especially if it’s dangerous. No one gives a shit about you, right?
5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Self-mutilation (or self-harm, as it’s preferably called) is one of the most appalling and baffling symptoms of BPD, and one of the most hidden, embarrassing, and shameful. So why do people do it? Two major reasons: dissociation and self-punishment.
People with BPD sometimes experience dissociation with their physical selves, and often describe the feeling as “floating” or watching from above instead of being present in their body. Sometimes this is due to past trauma, such as child abuse or rape, when the only escape was to mentally detach from the experience. Unfortunately, certain sights, sounds, smells, or experiences (e.g. someone yelling or a friend’s band going on tour, both of which I am guilty) can bring back difficult memories and the impulse to “go away.” Generally people with BPD find this very uncomfortable and (obviously) horribly inconvenient, so one of the quickest ways to reach reality is to inflict enough physical pain to feel again.
Self-punishment is yet another physical manifestation of the belief that one is bad or evil. The slightest misstep (breaking a dish, upsetting a friend, being late for work) is acceptable if one is “normal”, but people with BPD do not think they are normal. They think they are terrible and worthless to begin with, so they must pay a price for, say, forgetting to unplug the toaster. This feeling of enhanced evil and self-hatred intensifies until the only way to relieve it is punishment, usually in the form of cutting their skin with razor blades or burning themselves with lighters, although of course there are many other methods. (Some people with BPD prefer to actually hit themselves until they leave bruises - literally giving themselves a spanking as if they were a child who gravely misbehaved.)
To an outsider, self-harm seems absolutely insane, but it’s one of the easiest ways to explain how excruciating BPD can be. Sometimes the only way to achieve (temporary) relief is to set one’s skin on fire or pour bleach into self-inflicted open wounds because that is less painful.
6) Affective [mood] instability.
People with Borderline Personality Disorder are often misdiagnosed as bipolar because of their rapidly shifting moods. However, manic and depressive episodes last far longer with bipolar disorder; someone’s who’s borderline can go from ecstatic to suicidal in a matter of minutes. After awhile the good moments may seem meaningless and even frightening, because they’re so often followed by crushing depression for no apparent reason.
7) Chronic feelings of emptiness.
People with BPD are easily bored. (I know, cry me a river.) But borderline boredom (borderdom?) rarely goes away, making even seemingly enjoyable activities feel pointless. Eventually the person may just give up and spend all of their free time in bed, since it really feels no different than the ice sculpting class they registered for after deciding to quit the bowling team. And the equestrian club. And the baking class and the hiking group and every other hobby they eagerly pursued and then tossed aside because it failed to fulfill them, just like everything else.
Somewhat mercifully, manic phases may last long enough to finish a painting or enjoy some tap dancing lessons, although this sometimes makes the emptiness feel even worse when the manic phase is over.
8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Ain’t no anger like some borderline anger. People with BPD are sometimes called “emotional children” because while their physical selves grew into adults, their emotional selves never got that far. Again, this can be due to child abuse, persistent invalidation of strong feelings (“Stop crying! You have no reason to be crying!”), or no perceivable reason at all. But unlike a seven-year-old, an adult with BPD deals with both a childlike grasp on emotions and the expectation to deal with them correctly. This is incredibly stressful and the repressed feelings, if triggered, can seem inappropriate and even scary. This is not present in all people with BPD, but it’s a major contribution to the disorder’s negative stereotype.
However, it should be noted that most people with BPD are far more angry with themselves than the external world, and they are much more likely to hurt themselves than to cause physical harm to other people. The disorder makes the slightest misstep seem like a grave personal failure, and borderlines are often desperate for people to like them so they won’t be “abandoned.” BPD does not cause delusions, so they’re well aware that stabbing you with a fish knife is a shitty way to keep you from leaving.
Well, that, and people with BPD are no less empathetic or intelligent than the general population, and stabbing someone is a very bad thing to do.
9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
This is fairly rare with BPD and, as mentioned earlier, tends to occur infrequently and only when under extreme stress. Intense therapy sessions, for example, may cause people with BPD to dissociate if faced with bad memories. If the intense feelings stem from childhood trauma, they may even seem as though they are inhabiting a different body or talk in a childlike voice.
More later, maybe. I have to go out there and be manipulative!