Monday, 30 June 2014

Borderline Personality Disorder - A blog post

Many of you may or may not already know that this year I've been coming to terms with a diagnosis of Borderline Personality Disorder (BPD). I was officially diagnosed with this illness 2 years ago and after refusal to find out what it was or what it actually meant, after a stint in therapy this year I discovered after plenty of research and speaking to other sufferers that being diagnosed with this illness actually helped to explain many different traits about myself which I was unable to fathom, and has largely helped me to understand myself. BPD is an illness rarely spoken about - and for that reason it is highly stigmatised.  It is for this reason that I'm finally choosing to blog about BPD today and hopefully address key facts and symptoms of the illness - relating them also to my own experiences which may help those without knowledge of the illness, those interested in discovering more about personality disorders in general, or carers and friends of those with BPD.

Borderline Personality Disorder is, as the title suggests, a personality disorder, which immediately becomes a difficult concept for the diagnosed to grasp. There are a range of different personality disorders, including Paranoid Personality Disorder, Dependant Personality Disorder, Narcissistic Personality Disorder and various others, also including Obsessive Compulsive Personality Disorder (another illness I too am diagnosed with and will be blogging about in due course). Yet the label initially becomes problematic for sufferers as the term 'personality disorder' would imply a defect or fault with the sufferers personality. Whilst illnesses such as depression or generalised anxiety disorders may have been triggered by life events, being diagnosed with a personality disorder makes it all too easy to place yourself at blame for your own illness. The illness also falls under the label of 'Emotionally Unstable Personality Disorder' - which I quite honestly find to be a worse label than BPD.

BPD is diagnosed by the sufferer presenting a majority of these characteristic/symptoms which have an impact on day-to-day functioning. These tend to be the main presenting symptoms although there are more.

  • Extreme fluctuation of emotions/emotional dysregulation. When I attempt to explain this symptom to people, I am always greeted by the same response 'oh but we all have our up and down days!'. Yet BPD sufferers have a much higher emotional sensitivity than most people and tend to feel each emotion they experience far more intensely then the average human. These emotions also tend to change extremely quickly, without warning, and in one day, I in particular can go from smashing personal items across my room and physically threatening those closest to me, to feeling optimistic and confident about my future, going out and seeing friends and feeling content, to suicidal ideation, crying constantly and experiencing extreme feelings of worthlessness. Because of this I can be extremely indecisive with who and what I want in life, when at one stage I can feel like I can have a future and the other feeling like I don't have a future at all. Feeling happy = feeling on top of the world, feeling sad = feeling severely depressed, and feeling simply frustrated leads to impulsive and uncontrolled anger. These shifts in mood/emotion can be as frequent as every hour in some cases, to every day or few days.

  • These emotional extremities mean that BPD sufferers find it extremely difficult to maintain relationships. I've never found it difficult to make friends, but I've always struggled to keep them. Even despite being bullied in primary school/secondary school I've never in my life remained with a solid friendship group, and the friends I do have either end up drifting apart from, I convince myself they're better off without me so I ignore them, I get intensely jealous of them and perceive they're once again better off without me or they are simply unable to handle me as a person. One of the friendship groups I was in towards the end of my first year in Sixth Form begun to fall apart because my friends couldn't handle how much of an 'emotional roller-coaster' I was at times (genuinely put that way to me). Of course, I never knew I had BPD at the time, but even I understood why I lost most of my friends. I go through weeks at a time of anxiety-busting mania, wanting to go out and see everybody and go out for drinks with friends and the next I'll reject every invitation I receive and as you can imagine, this results in those around me getting inpatient extremely quickly. I'm very lucky however, that my relationship with my boyfriend Nathan, of just over five years, has lasted for so long. I place the success of our relationship with my BPD down to his patience and understanding more than anything I've done. I wholeheartedly believe that any other man would have found me unbearable to be with so I've been extremely lucky with Nathan. However, a large majority of relationships with a BPD sufferer are emotionally challenging and trust me, it has meant that I have attempted to push Nathan away from my life so many times even though rationally that's never what I want. Due to a severe fear of abandonment which many BPD sufferers experience (and will be discussed later) this may appear strange to some. Yet my relationships, with family, friends and Nathan, tend to fluctuate from extreme attachment and in some cases clinginess to the individual, to attempting to push them out of my life as I no doubt at some stage have decided that these people are better off without me in their lives. It sounds like an awful place to be in and is challenging, but is never deliberate and it is important to stress here that I'd never inflict this deliberately on anybody.

  • BPD sufferers often also have an unstable sense of who they are. Personally I occasionally struggle to come to terms with the idea that I am a living existing human individual, never mind that I have a name, a family, and an identity. I struggle to perceive who the real 'Amy-Louise' is (I believe I've discussed this in my blogs before) and am unable to distinguish between the part of myself that I put on for others or who I really am. It can make situations such as thinking about the future, and decisions that can impact them extremely difficult. It means that my interests, goals and values can shift very impulsively and many people will notice that I very much out of the blue make plans to make changes in my life in an attempt to shift parts of my identity. I often look at others and crave their identities, even if it's negative, and easily can find myself manipulating it without even realising it. Alongside this comes a strong feeling of emptiness about the person I am. I believe that this part of the diagnosis has helped me to understand why I'm so concerned with pleasing others and feeling like I need to satisfy others expectations of myself. My sense of self is so skewed that throughout my life I've lived adhering to others expectations as I can never seem to figure out what I truly want. I have no idea what I want my career to be or even if I have a future career at all, even through looking in a mirror I have no true sense of what my body or face truly looks like and I was always that kid at school that tried so desperately to fit in somewhere but never quite made it. I was the sheep kid who always followed the lead but have never been the leader of my own self as I can't quite make out what that is.

  • BPD sufferers also have a higher tendency to self-injure or to inflict pain on themselves, sometimes as a way of helping to regulate these intense emotions. The sudden bouts of severe depression that I have experienced have indeed made self-harm a coping mechanism. I begun to self-harm at the age of 12, as many of you know, on many different areas of my body and only very occasionally now return to it, the last being a severe overdose triggered by an impulsive episode in July last year. Over the years I have succumbed to a variety of self-harming acts. Even now I still struggle with self-harming thoughts and although I do not act on them, I occasionally have thoughts that I shouldn't be alive or that I'm better off harming myself in some way. Some BPD sufferers also may experience delusions or hallucinations, although I am unable to speak from personal experience.

  • Many BPD sufferers also engage in impulsive behaviours, more often than not dangerous ones. These can include binge-drinking, self-injury, unsafe sex, abuse of substances, committing crime, reckless driving, and binge-eating (extremely prevalent in those who have an eating disorder in combination with their BPD such as Binge Eating Disorder or Bulimia Nervosa). Whilst I would argue that my self-injury, when it occurs, is impulsive, my impulsivity manifests itself in other forms, such as making big life decisions and not thinking before I say or do certain things. I will stress that it is not essential to match every single one of these characteristics to be diagnosed with Borderline Personality Disorder.

  • As mentioned previously, BPD sufferers also struggle with a strong fear of being abandoned by those around them. Which sounds bizarre if you consider one of my previous points being that we also tend to push away those closest to us. This fear can be triggered by anything in particular however I personally believe that my fear of abandonment has a close connection with the relationship with my Dad and also the strong fear of death of those closest to me - such as close family, friends and Nathan. These intense fears of abandonment mean that we tend to emotionally attach ourselves quicker than usual to new people, especially if we can sense connections with them straight away. Yet when the sufferer is abandoned or experiences a loss, it perpetuates the negative emotions and provides us with opportunities to engage in destructive behaviours, as, in my case especially, I lead myself to believe that everyone will walk away at some stage as I'm useless, I'm a failure, I'm a rubbish friend, etcetera. BPD sufferers can also be very dependant and may appear needy. They will struggle to trust those around them as all that runs through their mind is that they'll leave - again this may be triggered by an abandonment event in childhood as mine was. They'll feel a constant need to be perfect and to please people so others won't abandon them, and in my case especially, need to hear constant praise so they feel like they are pleasing others and almost like a reassurance that the voice that tells them they're not good enough is wrong. Unfortunately, even when praise is received, the sufferer will look for even more ways to belittle themselves and will convince themselves that the person praising them must be wrong/lying. The fear of abandonment is also a reason why I find the concept of death extremely difficult.

These are just some of the main characteristics/symptoms associated with Borderline Personality Disorder, but many other traits associated with the illness also include:
  • Psychotic episodes
  • All or nothing thinking
  • Overgeneralising
  • Self-blaming
  • Dissociation
  • Tunnel vision
  • Magnification of your negative qualities.

It is estimated that around 1% of the UK population is affected by Borderline Personality Disorder, which doesn't seem like a lot but I know for a fact it affects far more people than we could ever realise. It is often an illness linked with violence and violent outbursts and it is for that reason that it is rarely discussed. It is a difficult disorder to live with, certainly, and the constant internal conflicts that occur within the illness make it a difficult one to treat. 

It is suggested that the most effective form of treatment for Borderline Personality Disorder sufferers is Dialectical Behavioural Therapy (DBT) - a treatment in which I am engaging in at the moment. Designed specifically for those with BPD, it takes the traditional Cognitive Behavioural Therapy method of treatment and adapted it so that the therapy over time enables you to change your thought processes, but also works with the patient in helping you come to terms with acceptance of yourself at the same time. DBT also has a strong emotional regulation focus, using techniques such as mindfulness, distress tolerance, self-soothe, and interpersonal effectiveness. I am currently undergoing individual treatment for this, but have also experienced DBT whilst being in a group.

I'm speaking out about my diagnosis because it's a scary one to receive. It's often confusing and is never really explained to the individual upon diagnosis, and the representations of BPD sufferers you often see are negative. It's never talked or spoken about, mainly because of it's complex nature, belittling the sufferer into believing they're 'mental' or that there's something wrong with them. I'm struggling so much to write this post as I know full well that the complexities of living with an illness such as BPD can never be summarised into a blog post, or a video, as it exhibits such a range of characteristics between each individual and also has varying degrees depending on the person. Interestingly, many sufferers of the illness are high-functioning for the most part, like myself, and can hold down jobs and other life events (although personally for me I think that is possibly to do with my perfectionism also). I just feel too much. Any compliment, insult, criticism or life-event feels like being plucked at the skin with tweezers, we have the tendency to experience every single emotion to the fullest and to indulge in that emotion for the amount of time it takes until another creeps in and takes over. We care, some would say too much, about others, so much that we want to hold them close to us and keep them there. Yet because we are so full of self-hatred, we also feel that these people are so good that they won't want people like us. So we sink further into our own bubble and can only allow ourselves out when it's to push someone back who tries desperately to get in. Our bubble makes us more likely to turn to the first self-destructive outlet possible, once we've adhered to the isolation that we never really craved but that it seems like we, without meaning to, created for ourselves. The other people that you thought defined you are now gone, so you lay, struck with the boredom of the lack of your own identity. And you're nothing once more.

For me, BPD feels like a consistent cycle and at times my thoughts can feel rather hypocritical towards each other. It's confusing, isolating, and for most, a consistent struggle. If I have taught one person today about Borderline Personality Disorder in at least from one persons perspective, then I can say I have done something right.

I must stress that this blog post should not be used to relate to every individuals personal experiences, I've tried to relate it as close to mine as possible whilst also being open minded to others. There are a variety of other symptoms which I have no experience of and therefore cannot comment on - and if you are interested in learning more about BPD I'm going to suggest that you check out some websites such as these.

Thank you.