Recovery Part 3: Getting Rid of the Stigma - A Brief Guide to BPD
What is BPD?
BPD isn't Bipolar Disorder, as is sometimes thought, but Borderline Personality Disorder (or the more recently named Emotionally Unstable Personality Disorder (EUPD).
I never did like the new name. I'm not quite sure why.
Unstable...it almost sounds like a volcano waiting to blow.
Except volcanoes are beautiful and an "unstable" person is usually one you'd want to avoid.
The rationale behind the new name was that BPD was too sitgmatising - to say that individuals were on the border between neurosis and psychosis.
And the fact that it was a "personality disorder" meant (or was believed for a very long time), that there was no hope for sufferers.
And there is a stigma...let me tell you.
This isn't something I've personally experienced a lot of in a very direct manner because I've kept much of it hidden, though I have been called "crazy", "a bitch", "mad", "nuts", "cold", "weird" and worse.
And of course there's no way of knowing what people may have said about me when my back has been turned.
I have read articles stating that some clinicians still refuse to treat BPD individuals.
Yes, you heard correct...refuse.
Yet, if one were to say that they have a serious illness that causes both chronic and acute pain, isn't curable and they have a 1 in 10 chance of dying from it, most people would probably feel some compassion.
"What disorder is that?", they ask.
"Borderline Personality Disorder."
"Riiiight. See ya."
Perhaps that is a bit harsh but I know that this represents at least some public perception.
I've seen a number of websites set up to help people who have been affected indirectly by BPD. Here, recovery methods can involve simply labelling BPD individuals as inherently toxic, painting them in a manipulative and unfixable light to be avoided at all costs.
I get that this information exists to help protect others. But much of the info is very damaging - not only BPD individuals, but to relationships of all kinds that could have perhaps overcome difficulties relating to the disorder with appropriate guidance and support.
And now, there is now relatively large body of research over the last decade to show that BPD isn't a personality disorder at all, but a heritable brain disease.
Does it make any difference to me? I'm really not sure it does. The symptoms are the same after all.
I just want to get better.
The World Health Organisation (WHO) describes BPD as follows:
A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or “behavioural explosions”; these are easily precipitated when impulsive acts are criticised or thwarted by others. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.
If someone read that description to a friend of mine, they would most likely say "But that doesn't sound anything like Louise!".
And by the most part it doesn't.
I'm never violent or break things when angry. I'm also a pretty good planner, to the point of bordering on obsessive when I'm passionate enough.
Indeed, there are actually around 150 possible subtypes of BPD based on differing combinations of symptoms.
Here's the list from the DSM-V, of which you need 5 out of the possible 9 to meet a diagnosis:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- Identity disturbance: markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
- 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)
- 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
So as you might expect, there is no "classic" type.
It's a simplification, but groups of symptoms can sometimes be categories as either inward-acting, or outward-acting.
And BPD stereotypes do exist.
The type that gets portrayed in media is the really extreme outward-acting type (think the "Bunny Boiler" in Fatal Attraction as probably the most famous example). It makes for better entertainment.
The closest character I've been able to relate to is Clem in Eternal Sunshine of the Spotless Mind, with my changes of plans, substance abuse, impulsivity and hatred of feeling trapped.
Generally-speaking, I'm an inward-acting type.
In my 20s, I was considerably more outward-acting. I'm not sure whether my behaviour changed after seeing people's reactions and getting myself into trouble, whether it was a natural result of ageing, or whether depression meant some of those behaviours were less likely to manifest.
Unfortunately, repeated suppression of emotions, and in particular for those with BPD, can cause far more serious problems long-term.
You might see how this suppression leaves you in a bind. Speak out, upset others and be ostracised, or keep quiet, protect others and get worse.
Driving your anger inward is extremely destructive - physically, psychologically and spiritually. It can result in self-harm, or what has been generally more common for me, particularly as I've got older, self-neglect.
BPD roughly affects 1 in 100 people and is rarely diagnosed before the age of 25. I received an initial diagnosis in 2016 at the age of 35, confirmed recently. The psychiatric nurse also suspected possible Bipolar Disorder alongside, but I'm really dubious about that
There's quite a symptom crossover between the two.
While I can get a little manic and talk very fast, needing little sustenance, I'm pretty sure I've never experienced full-blown mania. I probably just sound like I'm getting a little carried away when I'm excited (vs. the silence when I'm bored or numb).
I also don't see things or hear voices, though I have a close family member who has.
And it's rare to find someone with BPD who doesn’t have at least one other comorbid disorder, whether it’s addiction problems, eating disorders, depression or something else.
And, you know...you have your good days and your bad.
By the time you get around to actually seeing a therapist, you may seem better or worse than what you perhaps are.
This can make diagnosis for a lot of people very difficult, resulting in them being given the wrong medication or therapy.
Nature vs. Nuture
There is still something of a debate surrounding the cause of BPD, but in many cases physical, emotional, sexual abuse, and/or neglect is common.
Some of my experience has most definitely been due to issues in childhood.
Although my parents split before I was 2, and I didn't grow up with either of them as my primary caregiver, there are very striking similarities between all three of our behaviours - so similar it's as if we'd been living together the entire time, which has been both a source of amusement and tragedy.
Some examples are neglect, spontaneity and impulsivity, hoarding, and erratic and eccentric behaviour, though each of us seems to have an individual "specialist branch" of additional issues.
But in spite of their own mental health battles, they are also both extremely creative so I got their artistic genes as something of a trade off!
Sadly, it's precisely because of these difficulties that their creativity has never been used to its potential so I've been determined not to go the same way.
And as for differences in brain chemistry, MRI scans point to three different areas which can be under or over-developed:
- The Amygdala: this is the part of the brain responsible for our "fight of flight" response - so things like fear, anxiety and aggression
- The Hippocampus: the part that regulates behaviour and self-control
- The Orbtifrontal Cortex: the part involved in planning
However, there's still an unknown about whether these brain changes are present at birth, or whether very early trauma changes the brain chemistry to create these conditions.
I'll talk about how the disorder affects me personally, including how it impacts on my ability to create art. I'll also share with your some of my behaviours which can make relationships with others rather challenging, and possible treatment options I'll be exploring.
If you'd like to find out more about BPD, there are lots of helpful resources, but this one here is a good place to start. If you suspect you, or a loved-one, has BPD, please don't try to diagnose on your own and ensure you or they are assessed by a licensed professional.
Thank you for reading!