Almost a decade back, when I accidentally opened a diagnostic envelope meant to be opened only by my medical professional, and found that one conclusive statement, ‘Borderline Personality Disorder’, I instantly felt the ground completely shifting from under my feet and my world going pitch dark. I wanted to shred the paper and run away to another reality where this didn’t exist, where I with clinical diagnosis of BPD never happened. Years of several clinical mistreatments later, finally a fortunate encounter with the right kind of mental health caregiver and a few years of psychotherapy, today the name Borderline Personality Disorder no more terrifies me. Don’t get me wrong. My symptoms still now persist, albeit much lesser and more manageable, so I probably am clinically still a Borderline. BUT BEING A BORDERLINE IS NO MORE SCARY NOR A TABOO TO MY MIND. And today to be able to do an article on my own biggest clinical issue is just my way of telling each one of you struggling with BPD – It’s Ok. BPD is Serious BUT NEITHER Shameful NOR the hopeless end of your world.
What is BPD?
It is one of the most complex personality disorders. Precisely because its layers and manifestations are multidimensional. From identity to perception of reality to interpersonal interactions, BPD distorts all of it. It’s hence important to correctly diagnose this often underdiagnosed or misdiagnosed disorder.
According to DSM-IV-TR 2000 (Diagnostic and Statistical Manual for Mental Disorders – almost the Bible for Mental Health practitioners) Borderline Personality Disorder can be diagnosed as (with my own notes in italics wherever needed.)
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Do you constantly live terror-struck about loved ones abandoning you? So you either cling to them like hell or push them away before they abandon you. You even go through hysteric panic fearing you’ve been abandoned while perhaps the other person isn’t even aware of any reason to do so.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (From overt hero worship to a sudden cold void of disinterest – BPD sufferers forever struggle between strongest attachment to stronger aversion – back and forth like a pendulum.)
3. Identity disturbance: markedly and persistently unstable self-image or sense of self. (We often don’t know who we are! Angels with broken wings or lunatic antisocials in croc leather? Most often we feel it’s the second, with tremendous guilt and self-loathing for the same.)
4. Impulsivity in at least two areas that are potentially self damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Inner void and self-loathing initiates self-harming. To punish oneself feels deserving and relieving.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. (But yes! Not every cutting is suicide. BPD sufferers go through such inhuman pain that they often end up inducing physical pain on themselves as a distraction to subdue the nightmarish mental pain.)
6. Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress related paranoid ideation or severe dissociate symptoms. (Most BPD sufferers go through Depersonalisation or Derealization bouts. Sense of reality is frequently and painfully distorted.)
In the more recent DSM-5, 2013 not many drastic changes have been made. You can get hold of a pdf version easily on the Internet if interested.
From the gamut of these symptoms it’s obvious why closest friends and families completely fail to understand a BPD sufferer so often. The manifestations are so multilayered that to a layman it appears plain ‘nutcase’ or ‘nuisance’. BPD sufferers get stigmatised, abhorred, feared and given up on much more than sufferers of other disorders. BPD bouts of aggression are often met by family members with counter-aggression and physical violence to curb the ‘bad behaviour’, heaping additional trauma. If you suspect yourself or any of your loved ones showing any five of these personality traits that you can’t really explain then please DO NOT TRY SELF-HELP. Please seek professional advice immediately.
Psychiatric drugs or Psychotherapy?
Although I am no professional expert to decide the answer to that yet both my personal tryst with BPD (and a severe one) and my own researches and readings make me more inclined towards Psychotherapy for the treatment of BPD (of course, if needed, aided with some amount of psychiatrist drugs) than only medication. Since BPD is rooted in and operates from the cognitive levels of perception, self-image, thoughts of perceived abandonment, hostility and trauma, CBT or Cognitive Behavioural Therapy often proves to be a very effective help. Personally speaking, anti-depressant ended up causing more depression and low self-esteem over weight gain, drowsiness and impaired speech and speed of work. Anxiolytics proved acutely addictive inducing drug dependency and hence more anxiety. What worked for me was what my psychotherapist calls Integrated Behavioural Therapy, blending CBT with quite a few other therapeutic approaches, such as Dialectical Behaviour Therapy and Schema Focused Therapy and even other Alternative Therapy modules that’s together almost a tailor made approach for each client according to their unique psyche and background.
How Psychotherapy Disarms BPD
Again, I can only tell you how it disarmed mine. Depression understood with regard to the perceived notion of must have-s and never-have versus faulty sense of entitlement taught me to challenge my inexplicable blues and existential despair. Understanding how our Mind uses fear and panic to survive through manipulations under perceived threat of abandonment helped me lighten my uncontrollable hysteria and anxiety. It helped me reduce my terror of Abandonment by working on being rooted in my own Self, taking responsibility, slowly reducing the need and grip of external validation in people and social approval. Perceptions of hostility and Derealization were helped by learning to question the Mind’s perceived notions of just and unjust and thus dropping judgments and also and using Mindfulness to find centered-ness and meaningfulness in the Present Moment. NOW. I DO NOT KNOW IF ANY PILL CAN EVER ACHIEVE ALL OF THESE. Please know that I am NO WAY reducing the need of Psychiatric medication wherever it’s absolutely necessary. In moments of severe panic, hysteria or acute depression, bursting pain threshold, urging self-harming, one DOES need medicinal support (I too at some point had been on them and in extreme relapses still use them) but to my understanding that probably Can Never be the all-pervasive cure for BPD. Psychotherapy is a must. And there is NO shame in seeking professional therapy support for BPD.
Surviving the Stigma and Trauma
If you have BPD, I have immense respect for you. You’re still alive, coping and reading this. BPD is no joke to survive and that itself makes you a very strong and brave person, even if you often feel burnt out or suicidal to end this nightmare. So please Do Not let anyone.. ANYONE.. shame you or make you feel any lesser. BPD is serious, not shameful. Also, BPD is Not Armageddon of your life. It is treatable. Healing IS possible. Just be brave and dedicate yourself sincerely to long term psychotherapy. When you recover, you might become a testimony for million others. Who ever said BPD made you a loser? If at all, it just opened another path for you to be a hero.
Take Care, dear Mind.
© & Author : Nivedita Dey, 2016
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