You think?

Borderline Personality Disorder May Be as Disabling as Bipolar Disorder

People with borderline personality disorder (BPD) tend to suffer similar deterioration of their psychiatric and physical health as those with bipolar disorder, according to new research published in the British Journal of Psychiatry.

“Despite the clinical and public health significance of both of these disorders, it sometimes seems as if BPD lives in the shadow of bipolar disorder,” said researcher Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital.

“Bipolar disorder is a widely researched, well-publicized, well-funded topic. By contrast, BPD is seldom discussed and it is not included in the Global Burden of Disease study, a comprehensive registry that quantifies diseases by cost, mortality, geography, risk, and other factors.”

About 1.6 percent of the U.S. population has been diagnosed with BPD, compared with 2.6 percent of those with bipolar disorder, according to the National Institute of Mental Health. The study is the largest comparison of patients who have been diagnosed with BPD or bipolar disorder.

Diagnoses in mental health are very hard to come by accurately. In my life I have been diagnosed with depression, social anxiety, obsessive-compulsive disorder, premenstrual dysphoric disorder, and bipolar II disorder. I have never actually been diagnosed by a practicing health care professional as having borderline personality, but I do fit the clinical criteria, and went through a very successful round or two of dialectical behavioural therapy, which is useful for BPD. So as to what my real diagnosis is, I couldn't tell you. My current psychiatrist, who has just starting seeing me, tells me that I do have a mood disorder of some sort, particularly because of how I have reacted to medicine in the past (Lortab and Paxil both made me manic, something that happens in people who are bipolar, for example). But regardless of what the diagnosis really is, me off my medication is not a pretty thing, although I am fairly high-functioning. Fortunately I am very compliant with my meds, and so I (mostly) stay on an even keel, although sometimes my hormones stir things up, like yesterday. My fear is what happens in two years if I have not found another job with health benefits, as mine is going away, and between the diabetes and the mental health issues, it is imperative I stay on my meds. I've also known others with the clinical signs of BPD, and having a relationship with someone with those issues is not fun. It is often described as 'walking on eggshells'--there is even a book on BPD with that in the title. Mix that together with someone who is either suffering from BPD and/or bipolar disorder, with two people with issues, and you get a very unstable relationship, indeed.

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.

In the course of the last ten years

I've been given a plethora of diagnoses in an attempt to figure out my psychology. Obssessive-compulsive disorder, generalised anxiety, social phobia, borderline personality disorder, and bipolar II, all possible pieces of the puzzle. I guess it just comes down that I'm a little bit nuts, although high-functioning nuts, and with medication and counseling I do much better. I don't know if they've ever figured out what's really wrong with me, which diagnosis should stick, or if they're all right. But I do know one thing...

Of all of them, borderline personality is the most difficult, intractable of them all. It won't just go away with a pill, although they can help. It isn't simple brain chemistry. Some researchers suggest that along with a genetic predisposition, environment can have a lot to do with it, especially abuse in childhood or even more nebulous but certainly no more damaging, neglect of emotional needs where the child is constantly told that things are not as he or she perceives them to be and that his or her feelings are invalid.

Some people with BPD cut themselves or otherwise do self-harm, just to feel alive, because they're empty inside. A goodly proportion kill themselves, more than in the mood disorders, which I'm assuming includes depression. BPD patients tend to swing radically emotionally and have black-and-white thinking where something is all good and then all bad depending on the moment. Their relationships are very rocky. Get two of them together and it's much worse. They tend to do damaging behaviours like spend money, break laws, drink or do drugs, etc. And they're absolutely the worst patients because they tend to be needy, roller-coaster bundles of emotion who are draining and often drop out of therapy when the real work begins.

I got to thinking about all this again because of a Time article called The Mystery of Borderline Personality Disorder.

It provides an excellent overview of BPD (better than I could do here) and talks about the hope of a particular course of treatment called dialectical behaviour therapy (DBT). DBT was created by therapist Marsha Linehan. I spent a year or more in it a few years back, and I must say, whether it's BPD or bipolar disorder that I actually have, it really helped. DBT works on mindfulness (being in the moment and being aware of what you're doing so you can have better control over it) and distress tolerance as a couple of its main aims. It helps brings the emotions under control. It gives the tools needed for people who didn't get the coping mechanisms in the first place to learn how to deal with their lives better and reduce the drama. It's quite often a life saver. I would actually suggest anyone would benefit from DBT, especially children.

Of course, having been diagnosed and having gone through DBT, I knew about the subjects covered in the article, and was just admiring what a decent job they did, when they brought Linehan in the picture. She is apparently (as I believe the saying goes) 'one tough broad'. My favourite quote from the article runs like this:

If the patient says, 'I'm going to kill myself,' the therapist might reply, 'I thought you agreed not to drop out of therapy.'

I really admire that.

If you think you have BPD, read the article, and please see a professional. It can be treated. You can get your life back again. There are lots of resources and support groups online, too.

Maybe this will encourage mental health programmes

1 in 5 young Americans has personality disorder: Fewer than 25 percent of college-age suffers get treatment, study finds

Almost one in five young American adults has a personality disorder that interferes with everyday life, and even more abuse alcohol or drugs, researchers reported Monday in the most extensive study of its kind.

The article also mentions that '[a]ccording to the National Institute of Mental Health, an estimated 1 in four U.S. adults suffers from a diagnosable mental disorder in a given year.'

The study also looked at anxiety disorders, bipolar disorder, and other non-personality disorders. Personality disorders are especially difficult to treat, because they are complex.

College counseling programmes need to really work at reaching those in need. Also, since those 18-25 tend to work in lower-paying jobs, it is also important that programmes be made available to young people outside of colleges who may no longer be on their parents' insurance and otherwise could not afford treatment. Let's face it--psychiatric treatment is expensive, even with insurance. If you meet a counselor every other week even with a $10 co-pay, that's $260 a year, plus the cost of medications. Without insurance it would be more like $75-150 a session. Treatment of the young is also important because untreated mental disorders tend to worsen as we age, plus this is a time when students and others are establishing themselves in terms of education and career.

I am fortunate to have access to decent health care--but even I struggle with medical costs. This coming year my co-pays have doubled, so I'm having about $3000 taken out of my pay for my flexible spending account. Much of that has to do with mental health. That's about 13% of my salary at the two jobs. I wish I'd had access to it when I was younger--if I had been treated for my various issues at an earlier age I might have succeeded in getting a PhD in mediaeval history like I planned. My anxiety at doing the oral exam/thesis defence was so great, but I didn't realise how bad it was until I was put on medication once it was too late to use my credits for the degree. I have a mix of illnesses that really make my life difficult sometimes, but treatment has helped immensely. My anxiety, social phobia, and obsessive-compulsive disorder are much improved. I'm also had a year-long intensive group dialectical behaviour therapy for borderline personality disorder and am on medicine for bipolar II disorder. Throw in medicine for attention-deficit disorder, too, although I don't know if the researchers in this study would consider that a mental disorder. I still have a lot to deal with in terms of childhood issues and other topics for counseling, but my brain chemistry is much better. :) Anyway, you can see I have a personal perspective on this issue.

(I know, I sound absolutely crazy if you go by my diagnoses. But hey, I'm what they call 'medically managed', and I'm working and paying taxes and all that, plus I'm not living on the street. Yet, anyway. I know I've had some close calls on that front. My point is there's a stigma attached to mental illness, but people being treated can lead productive lives. It's when they go off their medicine or stop counseling that they tend to go off the deep end before they know it.)

Bizarre

Sounds to me like a classic case of borderline personality at work, but that's just my opinion...

One heart, one widow connect suicides of 2 men

Self-anihilation is something I do with relative ease

When I was married, I moulded my entire personality to what I thought was expected of me. I did that with my parents, with my schools, and finally in my marriage. It was only after that was over that I slowly recovered the buried personality that was me.

And yet, I'm still an incredibly passive person who doesn't feel that she deserves anything good in life. I'm not sure I'll ever escape that mindset, although I've made it my life's work to do so.

What I do know is that for months now--a year or two, even--I've been doing great emotionally. Now with the stresses of bills and Cerys' death and the continued strain my psychology places on my everyday interactions, I feel like my life is unravelling rather quickly. I realise it will get better. But in the meantime I'm having thoughts of just giving up and obliterating everything about me. I'm crying uncontrollably often. In other words, I'm slipping back into depression, and it scares me. I don't want to go down that road again. If it continues much longer I'll see about having my meds adjusted. The last couple of days have been particularly bad, and I didn't have my Lamictal. I have that now and can get back on track. But it scares me how thin a barrier there is between doing fine emotionally and suicidal thoughts can be. And the fact that the days are shortening isn't helping particularly.

The best course of action is, of course, action--action to meet my problems head-on to dispel the anxiety I'm having. That's so hard for me, though. But it's something I'm going to have to do, or I'll spiral right down. At least I did start back at the store tonight--although I was slow, we got everything done for truck night, so that was an accomplishment, mostly due to my direction. So maybe I'm not a total screwup. I'm just having a month where I feel like everything I do is for naught. I can't seem to get things right the first time, except at work, where I'm still doing fine. But I always did better in that arena than my personal life would indicate. I don't want a return to having depression drain the colour not only out of life, but endanger my livelihood as well, as it did before.

Oh, well. Here's to feeling better tomorrow. One good thing about being bipolar/borderline--emotions are like Kentucky weather, just wait a little while and it'll be completely different.

It amazes me sometimes

how fast my emotions can turn. I've been basically happy all day, and now I feel like a failure because my attention wandered (it's bad when your ADD medicine wears off late at night) and I did the wrong thing as a result and looked stupid.

Not that I shouldn't be used to that...

You think it's frustrating dealing with someone who's brain chemistry is messed up? Try being that person. With me I'm usually either dealing with inattention issues or the emotional rollercoaster that is bipolar disorder. The medicine helps (I've been on an even keel emotionally for many months now, for example), but it's not really a cure. Throw in some obsessive-compulsive issues and borderline personality, and I should be one huge failure, and scary to boot.

But you know what? I'm mentally healthier than at any time in my life. I have a therapist who really explores my past and how I feel about it. I'm on a good combination of medications. So things are looking up. And one thing I've realised of late is that I'm not a failure. A late bloomer, perhaps, but not a failure. I have lots of accomplishments under my belt.

Plus, I've known quite a few people who make me look quite sane, and happily, they are behind me and I have no reason to have anything to do with them these days, though I do sometimes keep tabs, and it seems to me that the general trend is they become mad freaks who seem to spend all of their time in their heads rather than in the real world with the rest of us. I have that tendency too, but I'm trying to eradicate it, and I know where the holodeck's arch is, thank you very much. I don't have many friends, but they're people I can count on and who honestly care for me. Certainly that's part of my criteria for being a friend as well. You can't get much better than that.

Just some ideas late in the evening. :)

I'm feeling morose tonight

I didn't get the job. And it's my own fault. They re-evaluated the job offer based on my background check. Back when I was more than slightly crazy and writing cheques out of desperation and anxiety and hoping deposits would hit first, I never really considered how far-reaching the consequences would be.

That part of me that doesn't want to take responsibility for this is very angry. After all, it says, it's not like my past has anything to do with my ability to do the job. But it does speak about my character. Which brings me to the overwhelming sense of disappointment I have in myself right now. I don't want to continue to be that person.

Earlier tonight I was having a lot of trouble deciding why I should keep struggling to be a good person and not just give up, slit my wrists, and be done with it all. (That's the borderline personality talking). How many other jobs is this going to screw up? And beyond that, maybe I'm just reacting strongly because I'm premenstrual, but it's been a difficult Valentine's Day. I can usually ignore it. But I keep getting reminders that I'm not in a relationship. I haven't celebrated Valentine's in 15 years. I'm nearly 40, I have no partner, lousy credit, not a snowball's chance in hell of becoming financially stable and maybe someday getting a house of my own. I usually try to convince myself that I have a full life of friends and accomplish a lot on a daily basis. But I'm not sure I'm winning the battle for myself, or even really contributing to the betterment of the world around me.

But I also realise it's easy to fall into the trap of those kinds of thoughts. And I realise that although I make mistakes, I am basically a good person, one who has a very level learning curve sometimes, but is very loyal and always struggling to become a better person. And I suppose that really does matter in the scheme of things.

So, I feel a little better about how it went. And writing here helps, too. At first I was so numb, then I let the emotions flow, and then, although I'd put it off for awhile, I cried. Now I'm in reflection mode.

At least I know my schedule now and can plan my doctor's appointments and such. And there will be other jobs, I hope.

Good night. I think I might seek out a quiz and then go to bed.

PS I found out that while misdemeanours can be expunged from a criminal record in Kentucky, there's a catch. You have to wait until after five years have passed from the time you completed whatever you needed to do as a result of the conviction (fine, probation, jail, etc.) to file for expungement, without any other convictions, felony or misdemeanour. You also have to be free of them for five years prior, as well. Misdemeanours do not automatically fall off a criminal record at all. But since I have a cluster of several in about three or four years, I can't have them expunged, any of them. I can have the ones dismissed erased, though, and I will try to do that. That's my understanding of the legal jargon I've read, anyway. If it continues to be a problem in getting jobs, I may consult a lawyer.