Photo: pawel szvmanski on Unsplash
As written by someone with BPD.
By Rae Meghan — Written on Apr 28, 2019
Imagine getting a really bad sunburn. You sit out in the sun for too long, and suddenly your skin starts to sting. You can’t touch the affected area without feeling excruciating pain, and even brushing it against fabric or bumping into another person on the street can cause it to ache.
This is what living with Borderline Personality Disorder (BPD) feels like. Only instead of actual skin, it's your metaphorical “emotional skin” that is much too thin and painful for it to actually protect anything.
I know, because I live with BPD.
What is Borderline Personality Disorder?
The National Institute of Mental Health (NIHM) defines BPD as “a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”
For someone to receive a clinical diagnoses of BPD according to the standards of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), they must show "a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following [symptoms/criteria]:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as 'splitting')
- Identity disturbance: Markedly or persistently unstable self-image or sense of self
- Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
- Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms"
The National Alliance on Mental Illness (NAMI) estimates that "1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9%. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD but are commonly misdiagnosed with PTSD or depression."
The aforementioned lack of a protective emotional skin means that any sort of event — positive, negative, big, small — can hurt someone with BPD in ways those who don’t live with the disorder will never understand.
And sometimes, in ways they won’t even try to understand.
As a person with Borderline Personality Disorder, I am reminded of this fact every single day.
Whether I’m freaking out because someone told me something with an unusual inflection in their voice, or I’m obsessing over a mistake I made weeks ago, having BPD is not something I can simply “get over” — as some people may suggest — especially when the annoying little voice in my brain does everything in its power to insist that I am unlovable and that everyone hates me.
To understand more about the ways BPD symptoms affect me and others living with Borderline Personality Disorder, I spoke with several mental health experts.
Mia Najor, LMFT, a therapist in San Diego, CA, explains, “One might feel a chronic sense of emptiness and might push people away or become very close to someone. A person’s identity might change rapidly because there’s confusion on who they identify as. Patterns of emotions go up and down and certain coping mechanisms might be used to numb out temporarily.”
I know how that feels.
Every single day, I worry about my social standing. I fear that all of my friends are secretly out to get me. I get accusatory, asking them if they hate me, and I genuinely feel like I have no one that cares to listen to me about anything.
As you can imagine, this damages my friendships and my intimate relationships.
Any kind of relationship can be challenging for someone with BPD, as they can deeply affect our self-esteem and overall ability to function as a person.
For instance, in the beginning of a new relationship, it's common for the affected person to give themselves completely away emotionally, telling the new person every fear and secret as a way to keep them close. When that person does not reciprocate by sharing such details about themselves, the person with BPD may quickly spiral into hatred and anger, feeling as though the other person isn't doing “enough”.
This often leads into a behavior called splitting, defined by Bill Eddy, LCSW, Esq. as "the tendency of those with [personality] disorders to view others as all-good or all-bad."
As Marcia Kraft Goin, MD, writes in Psychiatric Times, splitting is considered a defense mechanism, albeit an unhealthy and self-destructive one.
"Splitting," she explains, "acts as a powerful unconscious force to protect against the ego's perception of dangerous anxiety and intense affects. Rather than providing real protection, splitting leads to destructive behavior and turmoil in patients' lives, and the often confused reactions manifested by those who try to help."
In relationships, it's not uncommon for a person with BPD to go from fawning over someone and saying how wonderful they are to suddenly considering them to be evil and mean the moment they do something the person with BPD perceives as the slightest bit hurtful.
On a personal level, I have definitely experienced this issue with people I've been romantically involved with. If they showed me the “proper” attention, I believed they were the greatest person in the world. If they ignored me or turned me down, I suddenly believed they were horrible and not worth my time.
Relationship problems are nothing new for many of us living with BPD.
“From the bio-social model perspective," Najor elaborates, "BPD stems from having a highly sensitive temperament and growing up in an invalidating environment.”
“The environment one grows up in might give one the message that there is something wrong with the individual. The individual then might use maladaptive coping [strategies]. With the sensitive temperament, the individual might experience life more than others. They may also be more emotionally in tune with others due to their sensitive nature.”
My own experiences with social interaction have been rough since I was a kid.
I grew up in a complicated household, as other members of my family, particularly my dad, also experienced mental health issues. It got to be very stressful as a kid, and I frequently felt like I had to walk on eggshells.
This, paired with social trauma that still haunts me to this day — childhood bullying, abusive relationships, frequently being left out of things — made life feel invalidating. I grew into a highly sensitive person, and had ways of coping that ranged from healthy to self-sabotaging.
Luckily, I have a great support group of people who also live with the disorder. They understand what living with BPD is like, and help me feel less alone.
One of the hardest things about living with BPD is facing the negative stigma attached to it.
Common stigmatizing words and labels used to describe people with BPD range from “manipulative” to having “poor boundaries” to being “unreasonable” — and even to being considered “scary”.
Personally, I have chosen to talk about BPD less in the past few years, but I used to bring it up a lot. The problem is, people make assumptions almost immediately.
“It can feel like a roller coaster, and not a fun one," says Dr. Angela Klein, a licensed psychologist, as well as the founder and director of Centered Ground (where Najor is also on staff).
"Because cardinal features of BPD include interpersonal intensity and difficulty with anger," she continues, "this can be an extreme challenge to receive and shape towards more skillful behavior. Wary of their boundaries being crossed and experiencing emotional backlash, many professionals do not treat BPD.”
On a personal level, I find it unfair that BPD isn’t as readily accepted as many other mental illnesses are.
Depression and anxiety have become increasingly normalized, which is a wonderful thing, but many illnesses still have that stigma attached to them.
I see it happen all the time— not just for me, but for almost all of my BPD friends.
We form a new relationship, then slowly watch it wither away once our disorder rears its ugly head.
The good news, however, is that there are situations in which having BPD can actually strengthen relationships.
Once you’ve found the right group of people who have accepted you for who you are, you might begin to see higher empathy levels, and a much-needed level of validation from all parties.
The challenging and traumatic experiences from when I was younger made me a stronger person. And because I am stronger, I am able to be there for people in their times of need.
I am not a mean or angry person, because I myself am sensitive, and I know how awful it feels to be mistreated. This makes me strive to be positive and kind, and to provide validation to my friends when they need it, especially my friends who also live with Borderline Personality Disorder.
And as I become stronger, so do my relationships.
What helps is surrounding myself with positive people who, while maybe not fully understanding the extent of what it feels like to have BPD, are still able to provide validation and love.
I’m extremely lucky to have the partner, friends, and family that I do, as I have no shortage of people who I am able to talk to when needed.
Of course, this only came after the seemingly endless parade of people who I felt “abandoned” me when things got tough.
A lot of people do not, and from my perspective, even refuse to, understand.
So when a person with BPD is able to hold onto a really good support group, it can be the best thing in the world.
From some perspectives, it might seem justified that loved ones of someone in a friendship or relationship with a person with Borderline Personality Disorder would leave.
People with BPD will sometimes test others’ love and loyalty, unintentionally applying undo pressure and leading to them feeling driven away. Sometimes, that's the healthiest thing their partner could do, as asking that of someone can be emotionally and physically exhausting, not just for the other person, but for the person with BPD as well.
We don’t want to put that kind of pressure on others, but sometimes it’s the only way we can figure out to feel validated.
For my part, I'm aware that I don’t always realize it when positive people in my life really do care about me.
I frequently split, especially when it comes to situations like not receiving a text back, or someone getting annoyed with me, or having a tough day in general.
The idealizing and devaluing that goes along with splitting or "testing" others is a trap that's easy to fall into, and it can spiral quickly into feelings of loneliness and isolation.
Fortunately, there is treatment available for people with Borderline Personality Disorder.
Depending on the patient, their symptoms, and whether or not they have co-occurring issues, medication may or may not be positive and helpful.
According to the Mayo Clinic, the six types of therapy that have been found to be most effective for treating BPD include:
- Dialectical behavior therapy (DBT): "group and individual therapy designed specifically to treat borderline personality disorder [using] a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships."
- Schema-focused therapy: "can be done individually or in a group [to help you] identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life."
- Mentalization-based therapy (MBT): "a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation ... [emphasizing] thinking before reacting."
- Systems training for emotional predictability and problem-solving (STEPPS): "a 20-week treatment that involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment."
- Transference-focused psychotherapy (TFP): "Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist."
- Good psychiatric management: "This treatment approach relies on case management, anchoring treatment in an expectation of work or school participation [focusing] on making sense of emotionally difficult moments by considering the interpersonal context for feelings."
Many people I know believe dialectical behavioral therapy, or DBT, is the most effective of these options.
According to Psychology Today, DBT provides therapeutic skills in four different areas:
“First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.”
DBT can be utilized to treat emotional dysregulation, self-harm, and suicidal ideation through mindfulness exercises and teaching distress tolerance skills — similar to practices associated with Cognitive Behavioral Therapy (CBT).
As Dr. Klein explains, “We can experience the exact same situation, but if we think about it differently, we can feel differently and, consequently, respond differently.”
Additionally, “it is about finding the balance between two extremes,” according to Najor. “This modality was created specifically to treat BPD, but I believe it could potentially be effective for any individual.”
Overall, living with Borderline Personality Disorder can be both a blessing and a curse.
The stigma attached to the disorder is real and painful, and it can be easy to fall into the trap of believing you are simply manipulative, irrational, or crazy.
But between finding a positive support system, and getting the right treatment, it can absolutely be manageable.
“The main goal of DBT is to create a life worth living,” says Klein. “And this is absolutely possible.”
Rae Meghan is a Providence based writer, performer, and mental health advocate whose work has been featured on Funny or Die, LoveTV and Rue Morgue, among others. Follow her on on Twitter for more.