Who knew?

When I linked to antisocial personality disorder in the last post, it contained a link to another disorder for which I am intimately familiar with, borderline personality disorder. It's an interesting article (among others, it discusses the aspects of BPD in relation to Anakin Skywalker). But I thought it interesting also that in 2008, the US House of Representatives designated May as Borderline Personality Disorder Awareness Month.

Borderline personality disorder (BPD) is a personality disorder described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the disorder often manifests itself in idealization and devaluation episodes, as well as chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.

BPD splitting includes a switch between idealizing and demonizing others. This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. BPD disturbances also may include self-harm. Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.

There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline, and some have suggested that this disorder should be renamed. The ICD-10 manual has an alternative definition and terminology to this disorder, called Emotionally unstable personality disorder.

There is related concern that the diagnosis of BPD stigmatizes people and supports pejorative and discriminatory practices. It is common for those suffering from borderline personality disorder and their families to feel compounded by a lack of clear diagnoses, effective treatments, and accurate information. This is true especially because of evidence that this disorder originates in the families of those who suffer from it and has a lot to do with Axis IV factors, rather than belonging strictly in Axis II. Conceptual, as well as therapeutic, relief may be obtained through evidence that BPD is closely related to traumatic events during childhood and to post-traumatic stress disorder (PTSD), about which much more is known....

Numerous studies have shown a strong correlation between child abuse, especially child sexual abuse, and development of BPD. Many individuals with BPD report to have had a history of abuse and neglect as young children. Patients with BPD have been found to be significantly more likely to report having been verbally, emotionally, physically or sexually abused by caregivers of either gender. There has also been a high incidence of incest and loss of caregivers in early childhood for people with borderline personality disorder. They were also much more likely to report having caregivers (of both genders) deny the validity of their thoughts and feelings. They were also reported to have failed to provide needed protection, and neglected their child's physical care. Parents (of both sexes) were typically reported to have withdrawn from the child emotionally, and to have treated the child inconsistently. Additionally, women with BPD who reported a previous history of neglect by a female caregiver and abuse by a male caregiver were consequently at significantly higher risk for being sexually abused by a non-caregiver (not a parent). It has been suggested that children who experience chronic early maltreatment and attachment difficulties may go on to develop borderline personality disorder.

Which is nice and clinical, and really doesn't convey how devastating this can be. It has taken many years, a good solid course of dialectical behaviour therapy, counseling, medication, and a lot of support from friends for me to become emotionally stable and generally happy with my life. I used to have these things I called emotional storms. It was almost like a seizure, lasting, oh, about 20 minutes each time. They were marked by a good deal of emotional lability and often very hurtful words as I struck out at people around me, usually my best friend, who bore it with a lot of logic and patience without taking abuse. If I were home, I'd go to bed and ride it out. Unfortunately, it often happened in the car while I was driving; conversations would trigger extreme emotions and I'd have an episode. I haven't had one of these in years, mind you. But they were very scary, especially because for at least that brief time I was often suicidal and liable to hurt myself. Fortunately it was mostly feelings; I never actually tried to commit suicide. I did have times when I did things that were not good for me, things that still haunt me to this day. And I've also been diagnosed as bipolar, although they overlap so much it's hard to tell if it's really a co-morbidity or if the BPD just mimics it. But regardless, that diagnosis got me on a combination of medicine, Lamictal (an anti-seizure medication) and Abilify (which is actually an atypical anti-psychotic), that work well to stabilise my mood. I had over a year of dialectical behaviour therapy, which I really think would be useful for just about anybody but is crucial for those with BPD.

If you think you may have BPD, or if you're 'walking on eggshells' in a relationship with someone who sounds like they have it, there is help available. Numerous books have been published. Many counselors are familiar with the work of Marsha Linehan and DBT. I was lucky enough to find a programme at my university (it wasn't limited to students), which operates on a sliding scale in terms of cost. I also found that although this disorder impacts so much of my life, I'm actually what is considered 'high-functioning'. It really helped me a lot.

It is important to remember two things. One, BPD has become one of the 'it' diagnoses, much like multiple personality was for awhile. By that I mean it's a popular subject in psychological circles, is an area of intense study, and may sometimes be over-diagnosed. On the other hand, it is a stigmatising diagnosis. BPD patients are seen as needy, clingy, and downright annoying to deal with, and many counselors, at least in the past, tried to avoid them. Plus, it's never good to be known as the person whose emotions are totally out of whack. I'm probably doing myself no favours in terms of writing about this in an open forum where anyone (employers, family, etc.) can read it, but I've never made a secret on this blog about my diagnosis (on the other hand, I haven't written about it in awhile because it affects me less than it used to).

On the other hand, I'm also an example of someone who is stable despite the disorder because I sought help, and there are a lot of people out there who have no idea why their lives are so messed up. There's a lot of stigma to mental illness, and BPD, being a personality disorder, is both pervasive and difficult to treat. It's not just a simple matter of brain chemistry. There are a lot of factors--inheritance, experience, etc.--that come into play. But there is help available, and if you or someone you love have the symptoms of BPD, please seek help. It can make an immense difference in your life. I was lucky to have a friend who recognised the signs (he'd worked in psychiatric health care) and urged me to seek help. I've seen sources that say 10% (that's 1 in 10!) borderline sufferers will succeed at suicide. If you have BPD, your life may very well depend on seeking treatment. Please seek help. It really is worth it.