This post is part of the series Family and mental illness
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This post is part of the series Personality disorders
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Historically, the border of Borderline Personality Disorder (BPD) refers to the edge of neurosis and psychosis. That unstable area which is always hysterical or mad. It is classified as a personality disorder. Personality disorders are considered fixed throughout life and not amenable to treatment. Unlike psychiatric illnesses such as schizophrenia or bipolar mood disorders, which are considered chronic but responsive to treatment.
It is a very bleak view of BPD. Because of this, when I was doing my specialist degree, many psychiatrists felt that it was pointless telling a patient of their BPD diagnosis, that it would just add to distress.
In the last two decades, we have learnt much about the disorder. We have realised that the borderline patient’s brain is wired differently; they are not just “badly behaved”. We have discovered that BPD responds well to correct treatment and management. Our perceptions were challenged by a study which showed that six years after being hospitalised for serious borderline problems, 70% of the patients in the study no longer met the diagnostic criteria for BPD. In all, BPD is looking more like a mental illness which can be managed, than a pervasive personality defect.
With this in mind, I do tell my patients when I suspect that they are suffering from BPD. Their most typical response has been one of relief. Through the BPD-patient’s psychiatric career they often pick up many diagnoses: PTSD, depression, anxiety, dissociative disorder, eating disorders, bipolar mood disorder, substance abuse, maybe even a psychotic label or two. While these disorders often occur in addition to BPD, the patients typically feel that the core problem remains. With the BPD diagnosis, they feel that it “fits” and that they finally had something with which they could work.
I spend a lot of time in my practice containing the fall-out of a borderline patient’s behaviour. Loved ones burn-out by capriciously being loved and hated, often in the same day. Bosses have enough of promises not being met and drama constantly being stirred up in the office. Emergency rooms get tired of sewing up the same person, who keeps harming themselves. It’s very hard having a BPD person in your life.
It is hard being a BPD sufferer. Somebody suffering from BPD truly suffers.
They are excruciatingly sensitive. This sensitivity, when properly harnessed, often makes for a very effective therapist or inspires great creativity. Which often makes things worse, because when we see a gifted, intelligent person, we expect a lot from them. The nature of a severe personality disorder is that the sufferer never lives up to their gifts. They constantly undermine mine themselves and destroy whats good in their lives. And they know it, which adds to the despair.
Of all the things Borderline sufferers are sensitive to, rejection can make them completely crazy. (In psychiatry we even have a term for it: a micropsychotic episode.) We are all rejection sensitive, but a BPD person takes it to a new height. To be so rejection sensitive makes for tricky relationships. They often spend too much time in unhealthy relationships because they fear to be alone. Or they get into pathological cycles of rejecting good relationships because they anticipate rejection, so they get in first and reject before they get rejected.
Thus BPD sufferers have a chaotic relationship history and often end up alone. Loneliness is not just a normal, albeit unpleasant, experience for them. It is devastating. Loneliness is this endless pit of emptiness where they can feel like they don’t exist. One of my Borderline patients described to me that if she posts an experience on Facebook, and no-one “likes” it, then she doubts it ever existed. The internal core of a BPD patient is very fragmented and fragile; they feel that they exist only as a reflection from others.
It’s not a wonder that with this poor sense of self and with career disappointments and unstable love lives, that the sufferer often ends up seeking solace in pathological behaviours. Like harming themselves or substance abuse.
Breaking these pathological cycles of living and relating takes hard work and commitment. I think that even with the correct therapy the deeper feelings of emptiness still haunts. But I have seen how patients can get to a place having loving relationships and satisfying careers.
Unfortunately, not all patients have the financial resources to get the help they need. Sometimes, they do not have the will or the commitment to get better. Borderline Personality Disorder still does a lot of damage to its sufferers and in those around them.
Continue reading this series:
People who will destroy your life (and how to avoid it)