Borderline Personality Disorder (BPD) also known as Emotionally Unstable Personality Disorder (EUPD) is a mental health disorder in which you feel strong emotions and struggle to regulate them. It can cause impulsiveness, black and white thinking (things are all good or all bad), also known as ‘splitting’, unstable relationships, fear of abandonment, self harm and suicidal tendencies. It is often comorbid with other mental health conditions such as Major Depressive Disorder, anxiety disorders, Bipolar and other personality disorders such as Dissociative Identity Disorder (aka Multiple Personality Disorder).
The Diagnostic and Statistical Manual 5 (DSM-5), the mental health bible, is used worldwide to diagnose and classify mental health disorders. This manual states that there are nine criteria of which five must be met to be diagnosed with BPD.
The nine criteria are:
• Frantic efforts to avoid real or imagined abandonment, reflecting intolerance to be alone
• Unstable and intense relationships marked by abrupt and extreme shifts between idealization and devaluation
* Identity disturbance, seen in an unstable self-image or sense of self.
• Marked mood reactivity.
• Chronic feelings of emptiness.
• Frequent displays of inappropriate or intense anger.
• Stress-related paranoid ideation or severe dissociative symptoms.
BPD is strongly associated with childhood trauma, sexual abuse, domestic violence etc. I do have a history of sexual abuse and am able to access ACC funding for therapy which will hopefully address the trauma and poor coping mechanisms.
When I was first diagnosed in 2016 I met all nine criteria and was constantly in crisis. I felt worthless, hated myself, was extremely reactive to the smallest life challenges, was impulsive, self harming, taking overdoses and putting myself in risky situations (walking the streets in the middle of the night hoping I’d be mugged or run over, driving fast and hoping I’d crash etc.). I was labelled as high risk of suicide. I had many supports put in place, a case manager and psychiatrist though I only remember seeing the psychiatrist in person once. I saw my case manager at least weekly, more often when in crisis. I had a community support worker and a peer support worker who was an amazing lady.
Despite all the supports in place, my mental health continued to decline. I did not have access to a psychologist through CDHB mental health but because I was under an income protection insurance claim (wasn’t able to work) my insurance company paid for some psychology sessions. I didn’t really click with that psychologist.
So I moved to Auckland for DBT treatment and by the time I left Auckland three respite stays, two suicide attempts and 20 months later I had improved enough to no longer met the criteria for a BPD diagnosis. With the help of proper therapy and the right medication (continuing Amisulpride and ceasing Venlafaxine) and coping skills I was able to manage my moods and my irritability had reduced. I still struggled with black and white thinking, poor self image and fear of abandonment but was no longer a risk to myself.
Fast forward 18 months to now, despite having the DBT skills under my belt I have relapsed. I think my medication was a big part of me feeling OK and keeping my moods even despite dealing with a lot of stress.
I had to come off my medication due to side effects (will write another blog post on this) and was experiencing major life challenges at the same time, this was not a great mix and I couldn’t cope. Whether that was a normal response to the stress or the effects of stopping my medication I don’t know but a lot of my old thoughts and behaviours have returned.
I fell back into self harming, mostly cutting and burning and took a mild overdose of a prescribed medication. I have tried recalling my DBT skills and practicing them but they have limited use when I’m feeling at my wits end with life and also I find myself just not caring if I harm myself because it makes me feel better. The only problem with that is that people who care about me don’t like it and I have to hide the visible marks it leaves behind.
I still struggle with fear of abandonment. I have lost a lot through this illness, my marriage (which probably would have happened anyway), my children, who I still see but they can’t live with me and was a huge loss, my job (when my mental health first declined to crisis point) and one of my best friends. My partner who has been by my side since before he was my significant other remains by my side. I have put him through a tonne of stress and he continues to be there for me. I am terrified he will eventually get sick of it all and leave too. I know it’s a lot to deal with, if I feel hopeless how can I expect him to feel any different. He tries so hard to make my life worth living that I feel tremendous guilt for not just feeling better. I’m easily irritable and snap at him which he doesn’t deserve and I believe in my heart that he deserves a lot better than me though I don’t think I could survive without him.
So I don’t know where I stand now as far as diagnoses go. I guess diagnosis doesn’t really matter in the grand scheme of things and also a BPD diagnosis comes with a bucket load of stigma attached to it both in the community and in the professional mental health sector. I am definitely back to feeling depressed and hopeless, though I’m not sure if this is biological or caused by my new medication. I have had increased anxiety for a wee while now which goes hand in hand with the irritability in the sense that it feels the same (like I need to get out of my skin) and I definitely have a return of a lot of the BPD symptoms. It sucks to be back here and feeling like I need external help especially as it seems impossible to get that help or know what it is that I need.