For Mental Health Awareness Week, I’d like to write about borderline personality disorder (BPD).

(If you are looking for information on what BPD is, I find these webpages from Mind and NHS webpages informative and may help to contextualise some of what I’ve written.)

I first found out I’d been diagnosed with BPD when I was discharged from a psychiatrist. It was 2012. I hadn’t known I had this new diagnosis; before that I was diagnosed with cyclothymia – a condition not many people have heard of.

There was no information about BPD with the letter, so I typed it into Google and saw the name Jeffrey Dahmer. I immediately thought I was fated to become a serial killer.

Since then, I’ve done quite a bit of reading about the disorder and have talked about it with people who work in mental health. There are mixed feelings about whether BPD is a real condition or a kind of label that is given to people who don’t quite fit in with other diagnoses. Mathematically, there are over 200 ways in which BPD can present – there are nine symptoms and you need to have a minimum of five of them. These are the nine symptoms:

• Impulsivity/risky behaviours
• Self-harm
• Intense and extreme mood swings
• Anger/explosiveness
• Fears of abandonment
• Unstable sense of self/self-identity
• Feeling of emptiness
• Difficulty making/keeping stable relationships
• Experiencing disassociation in times of stress

I’ve not read anywhere that you must experience a certain symptom as well as others (adding to that minimum of five criteria). And yet, the image of a borderline is an intense person with rapid mood swings. You do not need the mood swings criteria for diagnosis. I’ve repeated that point twice there because BPD has another common name – Emotionally Unstable Personality Disorder (EUPD). You don’t need emotional dysregulation for the diagnosis.

That is one of the issues I have with the name EUPD. The other is I think it makes it sound like a woman who is due on her period. Periods/hormones don’t help the moods, but they aren’t the cause of BPD.

My theory for why the name of EUPD has become prevalent is because it is the symptom which is most disruptive for those not experiencing the condition. It’s the one of the nine symptoms most likely to catch your eye and piss you off. It’s the symptom most people have tried to address with me. It’s also a symptom that if we were of a more Mediterranean mindset, it likely wouldn’t be as much of an issue. In Britain we don’t have emotions unless we are watching sport. For others to display emotion when frustrated, sad, happy, annoyed, panicked… there must be something clinically wrong with them.

When experiencing those mood swings when you are diagnosed with BPD, you know there is more than a societal issue at play. I can discover a communication oversight (something I should have been told and it was forgotten – no actual harm done) and I’ll feel like I’ve been punched in the gut. It will be a literal physical response. Frustration feels like I’m trapped and am beginning to suffocate. I can feel pure grief at a character death in a book. When something slightly irritates me, I physically shake. When I’m in a good mood it can feel like walking on clouds. Some emotions feel like actual burns. Feelings are dramatic and intense. That’s not ‘normal’.

Suppressing those emotional states compounds on the emotion and makes it much harder to get a handle on. When I can display what I feel it can pass quite quickly. The extremity can fade in 10-15 minutes sometimes. Other times that intensity can last hours. My thoughts are not the same as the feelings in those moments. I’m usually thinking clearly and berating myself for the emotional response, which only makes it worse. I advise people around me to ignore what I say when I’m having an emotional response and to listen to what I say when it passes.

“If not the emotions, then which symptom is the worst for you?” I hear someone ask. Thanks for asking. Unstable sense of self is probably the big one for me. I wrote about that here. The abandonment fears are difficult but have improved over the years. Self-harm I’ve written about too. Disassociation – this may be the trickiest symptom for me.

Disassociation is something I can’t control and just appears. At times it’s like I’m observing myself – kind of an out of body type deal. Other times I’ll be unsure if my hands belong to me, for example. I have no recollection of some public speaking I’ve done – I literally just disappear and often come back mid-sentence and not have a clue what I’ve been talking about (I often say something like “I’m not listening to myself and I’ve lost track of what I was saying” as I desperately try to cycle back and retrieve a memory of what was happening). It’s not a horrible experience for me, it’s just very odd and can be unpleasant when I know I’ve been speaking but have no clue what I’ve said/told people. Disassociation is something most commonly known as a symptom of Post Traumatic Stress Disorder (PTSD).

That brings us neatly to the inspiration of this piece. An article in The Guardian:

Is this actually PTSD? Clinicians divided over redefining borderline personality disorder | Mental health | The Guardian

There are interesting points made about the gender split between people diagnosed with BPD and the treatment of men and women with similar symptoms. There are aspects of what that article contains that ring true to my experiences. There is also something which makes me feel uneasy. You don’t need to have experienced trauma to have a diagnosis of BPD. I used to attend a support group where someone there had the diagnosis and had clinicians telling her she must have supressed memories as she could recall no childhood trauma. Won’t meshing the two diagnoses compound this?

BPD is a bit of a clusterfuck of a diagnosis. The symptoms are real but everything else associated with it is a mess. It can’t really be medicated as it is a reactive disorder not chemical (in conditions like depression there can be a chemical imbalance and that’s why antidepressants can help to regulate them). There is stigma around it as people with the diagnosis are seen as emotional, manipulative and unpredictable.

I find it the best summation of what I live with of the various labels I’ve had pinned to my file. I’ve experienced all of those symptoms at various times. The five I’ve written about are the ones I experience most.

I’d like more awareness and research into the condition because listening to all the debate is adding confusion attached to a messy illness. Or let’s drop the names entirely. I could say ‘I experience a, b, c, x, y, z and I’d like help with them as they stop me experiencing a full life.’ Instead of what I find myself wanting to say to people – ‘I’m diagnosed with borderline personality disorder, please don’t treat me like an attention seeking sociopath.’

And let’s teach everyone how to deal with other people’s emotions so we can better experience our own. You being uncomfortable with somebody’s emotions is your problem not theirs – their problem is what caused their emotion. Stop expecting people with an illness to adapt to your discomfort.