I don't know if there are many mental illnesses that are as widely misunderstood and stigmatized as Borderline Personality Disorder. And it's not surprising, really – even the name is confusing. It's a little like those sentences in conversation that trail off in the middle, leaving the other person to fill in the implied ending. Borderline insane? Borderline psychotic? Whatever it's implying can't be anything good. The few people outside of the mental health profession who have heard of BPD tend to associate it with frightening images from Fatal Attraction, Girl Interrupted, and Mommy Dearest. Clinginess, manipulation, violent outbursts – that's what popular culture thinks defines BPD. The literature available on the subject doesn't help either (I'm looking at you, "I Hate You…Don't Leave Me" and "Understanding the Borderline Mother"), usually painting the afflicted person as an emotionally abusive monster. I want to share my own journey to diagnosis and what I've learned through those experiences about this incredibly confusing disorder.
When I was 19 and coming off my first stint in a psychiatric hospital, a doctor from the day program I had to attend took me into his office, sat me down, and told me that he thought I had Borderline Personality Disorder. And, of course, my first thought was, "That's ridiculous." I wasn't borderline. I was depressed. Maybe even bipolar. But borderline? People with borderline are legitimately, certifiably crazy. But, being polite, I asked him nicely to explain why he thought I was insane. What he told me was this: BPD isn't just manipulation and rage and instability. Sure it can take those forms sometimes. But what truly defines BPD is a difficulty in regulating intense emotions. That difficulty often results in unhealthy coping mechanisms, such as self-harm, substance abuse, and (occasionally) violent outbursts. BPD isn't necessarily caused by a chemical imbalance like depression or anxiety or inherited genetically – it does typically occur in individuals who have experienced some kind of trauma and/or unstable relationships and regular invalidation from loved ones.
I didn't have an abusive childhood. I wasn't neglected, beaten, degraded, or denied affection. As far as I could see, I hadn't experienced any trauma. But my doctor disagreed. He explained to me the concept of the "parentified child," wherein the parent never learns how to set healthy boundaries and ends up placing adult responsibilities on the shoulders of his/her child. In my case, it was emotional. I was an only child who, after a divorce, became the sole confidant to both of my parents. I took on their moods as my responsibility and, because they didn't know better, they allowed and encouraged me to do this. I grew up far faster than I should have, because my parents needed me to be an adult. And in my bid to grow up quickly, I stumbled headlong into situations that I wasn't ready for. By the time I turned 15 I had already gotten busted twice for sexting. All the while, my mother had rediscovered her youth with her new boyfriend and spent the weekends partying with the neighbors and my father was sinking ever deeper into his own depression. My job at my mom's was to be the sober supervisor and the designated babysitter of the neighborhood while the adults got drunk; my job at my dad's was to cheer him up relentlessly and listen wholeheartedly to his complaints and worries. Just a few months after my birthday, the depression set in.
It started innocently enough, but it escalated quickly. I was tired and weepy all the time. I had no appetite. I didn't want to participate in anything. I didn't care about my schoolwork anymore. I went to a therapist and she diagnosed me with depression – simple. I went to a psychiatrist and she prescribed me a low dose of Prozac. My body disliked the Prozac and I had to try a different medication. And then a different one. And a different one. She added an anti-nausea pill to combat the side effects of the SSRIs. She added a sleeping pill to take care of the insomnia. Nothing helped. I discovered cutting. I discovered restriction and purging. Meanwhile, I was entrenched in a severely emotionally abusive relationship.
About a year later I worked up the nerve to end that relationship. And while it was good that I got out, the damage was already done. Within a month of ending the relationship, I decided to kill myself. I made a plan, I wrote a note, and then I set out the pills I would need. I didn't have the nerve to go through with it. In the coming years, I would reach this point of almost-attempts multiple times. Because I couldn't bring myself to end my life, I directed my anger, my hurt, my sadness inward. My flirtations with restriction and purging became a full-fledged eating disorder. My brief interludes with cutting turned into tally-mark scars on my hipbones and words carved into my skin. My previous ambition to succeed grew into an all-out obsession with perfection. Even when I wasn't actively suicidal, I wished that I could fade out of existence or that I had never even been born. I hated myself with a passion I never even knew I possessed.
Four years after my first diagnosis of depression, I reached my lowest point yet and I moved beyond ideation. I wrapped a belt around my neck, but in my desperation, I couldn't find anything strong enough to hang myself from. I wasn't physically strong enough to strangle myself. But my attempt scared me so much that I told my boyfriend, who convinced me that admitting myself to the hospital was the wisest decision I could make. And that hospital is where I was diagnosed with BPD. Through the hospital, I did two years of Dialectical Behavior Therapy, which allowed me to find new coping skills to deal with my emotions and gave me the courage to confront my parents about my childhood. It wasn't some kind of magical cure, though. I still struggle with my disorder every single day, and here's what it looks like for me:
I have a really hard time sleeping, which also makes it difficult to wake up. I have to be careful not to schedule anything for early in the morning, because I won't be able to make it. I read negativity in the faces and words of everyone around me – this is a pretty common thing with borderline – and I have to remind myself constantly that the negativity that I'm perceiving is probably not really there. My emotions come in crashing waves. Sometimes I'm really happy, or I'm so sad that all I want to do is cry, or I'm nervous, or angry, or something. Whatever it is, I feel it with my entire being. Those feelings get so overwhelming that sometimes I have to stop whatever I'm doing and go home just to recuperate. I often forget my daytime medication and that throws everything out of whack. Because my coping mechanisms led to an eating disorder, I'm constantly preoccupied with thoughts of food and calories and weight. When I'm having a particularly bad day, I struggle with the urge to cut. When the world becomes too much for me to handle, I lapse into a dissociative episode.
Borderline Personality Disorder is so hard to explain and it's so different for everyone who suffers from it. I know people who succumbed to substance abuse, but never had the eating disorder behaviors like I did. I know people whose anger would turn outwardly violent, but I also know people whose anger would turn inward like mine. The point is that everyone experiences it differently and exhibits different symptoms. But just a little understanding can be enough for someone who is suffering.