The emotional turbulence of borderline personality disorder

SBS asks people with the condition to reveal what life is like when “every emotion is turned up to 100” – and why the stigma associated with it can hurt most of all.

 

A stigmatised mental illness
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“Getting my diagnosis was like a conversion experience. I’d been looking for two years for somebody to make sense of this hell I’d been going through,” says Andrew*.

Following a near-mental breakdown last year, the 38-year-old was diagnosed with borderline personality disorder (BPD). “There is a reason for this pain and anger,” his voice conveys wonder as well as relief, “I’m not a bad person or a lazy defective person who can’t just think positive and get over it.”

Speak to people with BPD and it quickly becomes apparent much of their suffering stems, not from the condition itself, but from what other people think about it.

“I’m not a bad person or a lazy defective person who can’t just think positive and get over it.”

“It was a scary diagnosis,” Tegan Churchill, a 29-year-old Queenslander who blogs about her experiences, tells SBS by email. “The information I found on the internet made it sound like I was a monster.”

Thirty-two-year-old schoolteacher Louise* keeps her diagnosis a secret, terrified of losing her job, “I live in constant fear of being found out and abandoned by friends and loved ones,” she says.

Louise has good reason to worry. BPD is one of the most stigmatised mental illnesses, partly due to inaccurate films like Fatal Attraction, but also because of the mental health system’s attitude towards it.

(Note: *surname withheld for privacy reasons)

The truth about personality disorders
All mental health conditions attract stigma and stereotypes but few are more misunderstood than personality disorders.

“Don’t tell anyone you have that..."
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Once considered a hopeless case, the lack of effective treatment saw those with BPD treated as “problem patients” who didn’t want to improve. Eventually, explains clinical psychologist Tony Merritt, a BPD diagnosis became a means of writing “difficult” patients off.

However, thanks to the advent of Dialectical Behavioural Therapy (DBT) in the 1980s and, more recently, Schema Therapy, it is now the personality disorder with the most promising prognosis.

“The idea that these people can’t be helped,” Merritt tells SBS, “is just not the case”.

Unfortunately, the image of BPD has yet to catch up to the reality. “Don’t tell anyone you have that,” a doctor warned Andrew, “in the medical profession, it’s still considered the worst thing to have”.

Tegan shares a similar experience. “One crisis worker told me to cut myself and get it over with,” she confides, “I was seen as a time waster, too hard and attention seeking”.  

Twenty-five year-old Kat from Melbourne says the stigma isn’t limited to the system; some friends and family reject the validity of her symptoms, viewing her as “just a horrible person”.

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BPD criteria
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That “borderlines” are still associated with Glenn Close’s obsessed stalker in Fatal Attraction isn’t helped by the name itself; BPD was once wrongly thought to straddle the border between psychosis and neurosis.

There are nine criteria associated with BPD with a diagnosis requiring at least five:

  • Rapid mood swings;
  • Feeling “empty”;
  • Frantic attempts to avoid abandonment;
  • History of unstable relationships;
  • Intense or disproportionate anger;
  • Impulsive and reckless behaviour (for example: overspending, substance abuse);
  • Unstable self-image;
  • Suicidal threats and/or self-harm; and
  • Paranoid thoughts or dissociation.

If some of these sound like traits many of us share, that’s because they are. “We’re all a bit borderline,” Merritt explains. “Where it becomes a ‘disorder’ is a matter of degree in how problematic it is for the individual.”

With over 100 possible combinations of symptoms all with varying degrees of severity, people with BPD behave in vastly different ways. However, all share the same core issue: heightened emotional responses and low distress tolerance. For this reason, many clinicians prefer a less stigmatising name such as Emotion Regulation Disorder.

“We’re all a bit borderline. Where it becomes a ‘disorder’ is a matter of degree in how problematic it is for the individual.”

The contention over the name, and even whether it is a ‘disorder’ at all, is worthy of further reflection. Merritt says it is helpful to think of “BPD” only as a term to describe a cluster of long-term symptoms and self-defeating behaviours that negatively impact a person’s life.

Annabelle McMillan calls herself a “stigma fighter” and especially chafes against the perception that BPD impairs mental functioning. “I can form perfectly coherent thoughts and sentences. I can relate to the world as a whole and interact with ideas and politics and so on,” the 27 year-old tells me in the commercial kitchen of the successful vegan bakery she co-owns in Sydney’s inner west.

“My issue is interpersonal relationships. It’s when I’m dealing with other people on a smaller scale…that’s where things fall apart.”

Emotional rollercoaster ahead
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Things tend to “fall apart” for people with BPD for the simple reason they feel things more intensely than others. “I’m so frustratingly emotional,” says 34-year-old Sarah. “Sadness, frustration, anger, fear, anxiety; I don’t really experience waves of positive emotions.”

These intense emotional experiences leave them, as Andrew puts it, “exquisitely sensitive to rejection,” sometimes seeing it when it’s not there; a friend not calling when they said they would can spark a total loss of trust and lead to splitting – a tendency to see others as either all good or all bad.

“Sadness, frustration, anger, fear, anxiety; I don’t really experience waves of positive emotions.”

Such distraught reactions to small slights may seem dramatic, but these individuals experience lives of emotional fluctuations they lack the skills to regulate. These fluctuations are tied to triggers that bring back painful past experiences that, explains Merritt, are usually (but not always) rooted in childhood experiences where their feelings were repeatedly invalidated.

As adults, this might leave them feeling defective or unlovable, and they are hypersensitive to the slightest sign that those around them may see them that way too. “When you consider the amount of pain people with BPD are in,” Merritt says, “their reactions make sense”.

That this makes relationships difficult, if not impossible, is a cruel irony given intimacy is exactly what many crave. “You know that feeling of being in a crowd and still feeling all alone? That’s what my brain feels all the time,” Heather, 24, explains. Her illness eventually drove her boyfriend away.

“I’m running around the block having downed three whiskeys trying to find a front yard I can lie in at midnight and ball my eyes out with fear,” she continues. “It tore him apart watching me disintegrate and knowing he couldn’t help me.”

The desperation for relief from emotional pain can lead to social isolation or to self-harm and suicidal thoughts. Although often dismissed as ploys for attention, suicidal threats by borderlines are rarely empty. While Australia does not have official statistics, BPD has one of the highest mortality rates of any mental health disorder in the US, those diagnosed with BPD are 50 times more likely to die by suicide than the general population. Around 80 percent express suicidal intentions, with 70 percent attempting it at least once. Ten percent will die by suicide.

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Beyond the stereotype
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Andrew, an adult ESL teacher, bucks many of the stereotypes associated with BPD, most obviously being male with what is still widely (but wrongly) considered a ‘female disorder.’ His diagnosis also came as a surprise because he doesn’t exhibit the most outwardly visible signs, “I don’t show anger or (negative) emotion. I push it all inside.”

Some friends dismissed his diagnosis calling him “too nice to be borderline”. That, he tells me, “is the stigma of borderline personality disorder in a nutshell”.

My 8 'selves': Living with Dissociative Identity Disorder
Marcela Del Sol is one of eight people living inside her mind and body. Two of her personalities are male, two are twins. They all come and go whenever they please and after they leave, she can barely recall what they did.

He challenges stereotypical ideas of what BPD is: “I don’t feel the women I do (therapy) with are any of those things people associate with borderline, like manipulative or narcissistic. Yes, they have big emotions and a lot of pain but they’re not manipulating”.

Some sufferers on the extreme end of the spectrum do display chaotic - even violent - symptoms, but are far more likely to hurt themselves than anyone else. “When I was 19, mental health workers were preparing my family for my eventual death,” admits Tegan, who has been hospitalised several times. “I was hell bent on destroying myself.”

Others can manage their symptoms so well few people ever see them. But that doesn’t mean they aren’t suffering. Andrew and Annabelle fit the description of “high-functioning borderlines,” people who struggle with the same emotional dysfunction but whose lives appear productive and stable.

Annabelle shocked her friends by beginning the year in a mental health hospital following a breakdown sparked by the end of a relationship. “So many people told me they never thought I’d be the type of person to end up in hospital,’” she confides. “But I have this coping mechanism of just working and distancing myself by staying focused on work.”

For others, masking their symptoms is impossible. “I have great communication skills but suck at dealing with people,” confesses Sarah. “This makes me a great lawyer but terrible employee.

“I experienced crushing depression, self harm and suicidal ideation while working at legal aid,” she continues. “I seem to have nuked my legal career by being too much of a loose cannon for too long.”

Ironically, her unemployment means she can’t afford the expensive treatment she knows she needs, but without treatment she will struggle to be well enough to return to work.

Treatment and remission
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"If I didn’t do Dialectical Behavioural Therapy, I’d have been in hospital this year a number of times.”

BPD often exists with other conditions, including depression and anxiety, and mood stabilising medications can alleviate the worst of these symptoms – Louise credits medication with keeping her mood swings and suicidal thoughts at bay – however, the primary treatment for all personality disorders is psychotherapy.

Dialectical Behavioural Therapy (DBT), created by US psychologist Marsha Linehan, herself hospitalised for BPD as a teenager, is still the most popular treatment in Australia. A group therapy, it consists of weekly meetings that run for six months, and are then immediately repeated.

“DBT is dealing with what is happening in the moment,” explains Andrew, who has just finished his first six-month cycle. “It’s about learning skills (for) reducing distress, regulating emotions, and being effective in interpersonal relationships. If I didn’t do DBT, I’d have been in hospital this year a number of times.”

It is, however, a slow process. “I would have liked to progress to more than where I am now. I still have extremely bad days where I feel like I’m never going to get better.”

One particularly bad day was brought on by a dark film about the poet Emily Dickinson. “It triggered my fears of rejection and not fitting in. I saw myself dying a bleak, horrible, painful death.”

Andrew’s thoughts turned to suicide, tempting him to overdose on his medication. “I contacted my DBT group and told them, ‘This is what I’m thinking but I want you to know, I’m not going to do it’.”

Recovery: An exception or norm?
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Despite its reputation, recovery in BPD patients is not the exception but the norm. “We are on a mission to change the way BPD is received and treated in Australia,” Anne Reeve, founder of BPD Australia, tells me. “BPD is a good prognosis diagnosis. Remission often comes with age and very few patients require lifelong treatment.”

According to statistics supplied by BPD Australia, 10 percent remit after six months of therapy, 45 percent within two years, and by the 10- year mark, 85 percent will be in remission.

All eight of the BPD sufferers I spoke with reported significant reduction in their symptoms following therapy, with two no longer fitting the criteria for a BPD diagnosis.

“The first step in my new life was rebuilding a sense of self-esteem,” Heather explains. “I have more confidence to walk away from situations that are detrimental to me but also the maturity to admit my own faults. I am taking responsibility for myself in a way I never even knew I was allowed to.”

Tegan still struggles with the day-to-day impacts of BPD but has not been hospitalised in nine years. “I’ve only self-harmed three times in the last eight years (and) my reactionary valve is a lot longer,” she says, “Where once I would cut someone off without a backward glance, I’m now better equipped to deal with day to day stresses.”

But empathy and a strong support network are as vital to recovery as therapy itself. “We need people to understand our actions when unwell come from a place of hurt,” Tegan implores. “We don’t mean to hurt those we love or who are trying to help us. It’s scary when every emotion is turned up to 100, it feels like nails down a blackboard.”

For support or more information
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If you or someone you know is in need of support:

Two-part documentary series How ‘Mad’ Are You? airs over two weeks, starting Thursday 11 October at 8.30pm on SBS and SBS On Demand.