An article that resonates with me about BPD.
Updated: Aug 25, 2022
5 Candid Confessions About Borderline Personality Disorder I won’t boil your bunny, but I will text you 13 times to ask if you’re mad at me for no good reason at all. Note: I refer to sufferers of BPD as “borderlines” in this article. Though this isn’t the ideal terminology, it’s a form of shorthand that I believe makes the piece more readable. I also talk about borderlines using feminine pronouns for the sake of consistency and because they are self-referential. It should be said that men suffer from this disorder, too, and their experiences are not to be discounted. In 2006, I was diagnosed with borderline personality disorder — a highly stigmatized and misunderstood mental illness — but I’m currently in recovery. I’m not cured, of course, but my attachment issues have improved significantly after a lot of hard work in therapy, and the future looks pretty bright for me. I guess you could say I’m in remission, but I can’t get complacent about my treatment — the work must go on. To me, being borderline feels a lot like a never-ending case of PMS — I cry at the drop of a hat, scream in frustration when I can’t find something in my purse, and get severe stomach cramps when I’m anxious. I’ve suffered in relative silence for thirty-two years, but I’m finally ready to go public with my illness; below are five totally candid confessions about my experience with borderline personality disorder. Buckle up, y’all — it’s gonna be a bumpy ride. I’m afraid to share my diagnosis with mental health clinicians.
Many therapists and psychiatrists will not take on borderline clients because we’re labeled as “treatment resistant” and “difficult to work with.” Clinicians may also be wary of the risks involved in treating BPD — symptoms of the disorder include chronic suicidality and self-mutilating behaviors, which can overwhelm even the most experienced practitioner and result in recurrent hospitalizations for the patient. Additionally, borderline clients are more likely to file complaints or lawsuits against therapists due to their hypersensitivity and, in rare cases, their ability to elicit boundary violations in treatment — sometimes of a sexual nature. Despite these reservations within the medical community, however, borderlines still need help or we won’t get better. I’m reluctant — no, scared — to disclose my diagnosis when seeking therapy because it could limit my access to treatment. The catch — and there’s always a catch — is that my BPD can’t be treated effectively if my therapist is unaware of its existence; personality disorders are approached differently than cognitive or mood disorders, and therapy needs to be tailored to the diagnosis for the outcome to be successful. For a borderline, treatment should include a focus on boundaries and interpersonal skills — not exactly standard fare in the bipolar therapy hour. I know what you’re thinking — wouldn’t my condition be blatantly obvious to a skilled clinician? Possibly so, but borderlines often suffer from comorbid disorders like depression and substance abuse, which can muddy the diagnostic waters, and some symptoms of BPD overlap with those of bipolar disorder; in fact, borderlines are often misdiagnosed as bipolar in the early stages of treatment — I know because the research says so, but also because it happened to me. All this being said, it’s critical for me to keep my therapist in the loop when it comes to my BPD diagnosis — which means I’ve got a first-class ticket right back to Square One. I fell in love with two consecutive therapists — or so I thought.
Borderlines are known for being needy and overly dependent; we display a “pattern of unstable and intense interpersonal relationships” that fluctuate suddenly between idolatry and extreme hatred — usually based on a perceived infraction or expected abandonment. Though my “extreme hatred” looks more like total indifference, I’m not immune to full-on bouts of hero worship, especially when it comes to my therapists. When I first met “Heather” back in 2012, I was at my worst. I’d been drinking a bottle of wine almost every night, curled up in my room watching Law & Order alone. I’d recently dropped out of school after disclosing to a professor that I’d been mixing alcohol and Tylenol PM to “blot out the pain,” and I’d overdosed once on antidepressants. But suddenly this sweet, sympathetic woman waltzed into my life, and I latched on to her like a tick. I would’ve been crazy not to, right? (Don’t answer that.) Well, it didn’t take long before Heather became my flotation device, and I clung to her for dear life, which wasn’t all that “dear” at the time, really. I plotted out our future conversations. I wondered if she ever thought of me outside of the office. I imagined enduring heinous acts of torture to prove my affections to her, and I cried when she got married — why couldn’t she want me, instead? I felt like nothing more than a number on the docket, a check to be cashed. I confessed my attraction to her on numerous occasions, and she remained, in my eyes, totally unaffected. I was too emotional to take into account the fact that we were both women and she wasn’t a lesbian. Or maybe I thought I could somehow “convert” her — borderline idolatry isn’t exactly rational. She moved her practice to another city in 2014, however, and to say I was heartbroken is an understatement. I grieved that loss for two whole years, seeking temporary comfort at the bottom of a bottle. During that time, though, I came to see what I was blind to at the height of my devotion — I couldn’t have been in love with her because I didn’t actually know her. I knew her name, and the layout of her office, and where she earned her counseling credentials, but I didn’t know how she took her coffee, what emotional wounds she carried with her, or how it felt to hold her. I didn’t know her sexual proclivities, or pet peeves, or political preferences. I loved the idea of her as my savior but not the reality of her as an autonomous woman with her own thoughts and feelings. I figured these things out with the help of a new therapist; we’ll call her Emily. It took some time for me to bond with Emily. I was still reeling from the “breakup” with Heather, convinced that no one else could fill her shoes. But Emily stood by me as I clawed out of the “black hole of borderline,” and the dependency slowly solidified. I didn’t seem to notice, though, ‘til I was in the throes of “love” yet again. I wrote Emily notebooks full of letters outside of therapy, confessing my feelings for her; there were times my obsession felt so crippling, I could barely hold the pen. I sent email after email to her work account before she told me that text-based communication isn’t an appropriate avenue for discussing suicidal ideation. As sessions came to a close, I grew increasingly hysterical, sometimes experiencing full-on meltdowns when my time was up. I often dissociated in her office, forgetting who she was entirely as the room swam around me. I ached for her touch, but therapeutic boundaries forbade physical contact — she said it was a “slippery slope,” especially since I’d hinted at a sexual attraction. “Loving you is hell,” I once told her — and I fucking meant it. Early on in my treatment, Emily offered me a smooth, round rock; she told me that she sometimes gave them to clients to help them feel connected to her outside of sessions. I knew by “clients” she really meant “children,” but I didn’t care if I was the emotional equivalent of an eight-year-old. I took the rock and wore it in a leather pouch around my neck — my prized possession. But, for a second time, the “undying love” I harbored for my therapist softened into a quiet affection as my life took me in new directions. I explored “outside” relationships with the tools she taught me, eventually getting married and moving across the state to be with my wife. About three years after meeting Emily, I took off the pouch with the rock in it, tucking it safely in my sock drawer. I think of her fondly, but I’m not in love. I never was, really. She was my life buoy, just like Heather had been — of course they were all I could think about when I was drowning. But I don’t need floaties anymore. Thanks to Emily, I now know how to swim. I have no idea who I am.
Borderlines tend to have an unstable sense of self, which is actually a key component of the disorder. Though there are some things I’m totally sure of — my affinity for felines, my pervasive inability to say “no” to cheesecake, the fact that I suck at even pre-school level mathematics — other pieces of my identity are prone to fluctuation. I struggled with my sexuality as an adult, for example, coming out as gay at 26 only to wonder later on if I were possibly bisexual. I stopped searching for a label after I married my wife, though I primarily identify as “gay” or “queer” these days for ease of communication. I just know I’m not straight. It’s also common for borderlines to jump from job to job.
In my case, I went off to college in 2003 with the hope of becoming an English teacher. I emerged six years later with a master’s degree in anthropology, a field I soon quit in order to enroll in law school — which I dropped out of after completing two years of study with a 3.0 grade point average. I worked hard for each potential career — I wrote a thesis, studied for the LSAT, completed research projects abroad, and argued in moot court competitions across the country. These were not frivolous pursuits; they were honest dreams that I simply woke up from, usually after an emotional crisis or mental breakdown. I’m the same way with hobbies — I was an avid runner for a summer and a bicycle enthusiast for about two weeks. I downloaded interval training apps, researched cycling gear, and even paid $1,200 for a shiny new ten-speed bike. I convinced my dad to buy me a treadmill and signed up for a 5K race with a friend. I never ran in that race, of course. I sold the bike and the treadmill and moved on to the ukulele and, later on, the electric piano. Those were also sold in short order, though I sometimes miss the ivory keys. And it doesn’t stop there — who I think I am often correlates with the environment I find myself in. Take me to a Michelin-star restaurant in New York City and I’m all about that escargot. But buy me a hot dog at the ball game and suddenly a reservation at Le Bernardin is too stuffy for my humble country tastes. I’m not even gonna talk about how I tried to change my name three times in high school. My BFF still won’t let me live it down. Treatment is expensive — and priceless.
Back when I had health insurance — insert ugly crying here — my therapy copay averaged about $65 per session. For a few years, I was sick enough that I went to therapy twice a week. That adds up to $563 a month — enough money to cover a car payment or two. Not to mention my monthly insurance premium of $250 — a prerequisite to treatment with most doctors and therapists. Then there were the psychiatry copays and costs of prescription medications. I saw the doctor once every three months — as required to get refills on my Xanax — and each visit cost me approximately $150. I took five medications daily, dropping about $80 per month at the pharmacy for the little orange bottles I carried in my purse in case I forgot a dose — we don’t want any of those pesky withdrawal symptoms, now do we? These were all “maintenance” costs, of course; therapy and medication were required to keep me afloat during the Dark Days. But we must also take crises into account when computing my expenses. I spent a single night in the emergency room a few years back, and it cost me about $1,000. I was able to negotiate my release once I sobered up and was no longer feeling suicidal, so I saved myself a nice chunk of change in the end. But the crisis center that referred me to the hospital required transport by ambulance — easily another $800, and they didn’t even turn on the sirens. Bummer. I’m going to omit extended inpatient hospitalization, intensive outpatient programs, and group therapy from our calculations because I have no idea what their price tag was. I just know that the bills over the past few years were enough to cause me to file for medical bankruptcy in 2016. RIP, halfway-decent credit score. So that brings the grand total to $13,120. That’s enough money to rent a one-bedroom apartment for an entire year. That’s enough to pay cash for a brand new vehicle and drive off the lot debt-free. That’s enough for 6,560 McDoubles, 136 years of Netflix, or even a 14-day cruise to Antarctica — hey, a girl can dream. Of course, all of this arithmetic assumes that your clinician knows how to “game” the system to get your therapy covered; insurance companies don’t always pony up for BPD treatments, you see — likely due to the myth that the disorder is intractable and, consequently, a waste of their precious dollars — and therapists must bill insurance companies for a patient’s comorbid disorders in order to get reimbursed for their services. This sounds bad, I know, but it’s totally ethical to bill for a different disorder if the client actually suffers from it. It’s not ideal when it comes to accessing treatment developed specifically for personality disorders, however. None of this matters if you don’t have health insurance, though. That’s the crappy old fishing boat I’m in now; I lost coverage earlier this year because Medicaid wasn’t expanded in my state. When I was in therapy, I drove a beater car and lived at my dad’s house in order to afford the treatment I found necessary to survive — my previous therapist saved my life over and over, and she was worth every fucking penny. I’d make the same sacrifices again if it would help me secure treatment, but I only found one therapist in my current city willing to take on borderline clients without an insurance policy. She charges $140 a session. If I were to schedule sessions once a week, it would cost me around $7,280 per year. That’s enough money to buy 145 Japanese body pillows that I could cry into. So it’s lose-lose, really. I am not a bad person.
“Caroline is not manipulative,” swears her wife, Crystal. “She made me say that.” The stigma surrounding BPD is palpable. I can’t research my disorder without stumbling across blogs and articles critical of borderlines, denouncing us as “inherently narcissistic,” “manipulative,” and “abusive.” These characteristics, however, are not symptoms required for diagnosis according to the DSM-5 (basically the Diagnostic Bible); while “intense anger” does make the list, having a bad temper does not necessarily correlate with abject cruelty and violence. Self-help books about the disorder don’t do much better, offering advice to friends and relatives on how to “stop walking on eggshells” and “get on with life.” Many books offer solutions on how to “survive” a BPD sufferer and “avoid that hell.” (These are all real quotes from titles and subtitles.) The book Faultfinders: The Impact of Borderline Personality Disorder goes so far as to include photographs of Adolf Hitler and Jeffrey Dahmer on the cover, arguing in the Amazon blurb that “each person with this disorder adversely affects the lives of five others.” Yeah, but I’m pretty sure I’ve never killed anyone or committed any crimes against humanity. And this book was written by a dude with a hot cup of alphabet soup after his name — he’s a doctor and a lawyer, so his voice is likely to hold weight with the public. I find fault with this cover.
While I don’t discount that the friends and family of borderlines have their own unique struggles in relation to the illness, there are relatively few resources available on the bookshelves for the sufferer herself — ones that aren’t hypercritical, anyway. And while I concede that there are links between BPD and violence, these correlations aren’t necessarily causal; aggressive behaviors could be due to comorbid disorders like antisocial personality disorder and substance abuse. I want to be clear that I’m not making excuses for borderlines who’ve engaged in violence; I’m merely pointing out that the diagnosis alone is not enough to write a borderline off as “dangerous.” I’m personally of the belief that subsets of diagnostic criteria for BPD would be beneficial; many of us are empathetic, nonviolent individuals with no anger issues whatsoever. In fact, only five of the nine criteria listed in the DSM are required for diagnosis, though a borderline may present with six, seven, eight, or even all of them. Consequently, there are 256 possible configurations of BPD criteria, and many of those don’t include hostile personality traits. Theodore Millon, a noted psychologist and author, proposed four subtypes of BPD, two of which — the “discouraged borderline” and the “self-destructive borderline” — don’t include externalized aggression as a criterion. I think these subtypes should be worked into the DSM-VI (when it comes out in, like, a billion years) to account for the wide variety of BPD presentations. We must then raise awareness about the subtypes and promote public education — no easy feat, of course. On that note, the public needs to avoid adding unsubstantiated criticism to the discourse — too many negative comments come from romantic partners who have “self-diagnosed” their (usually female) lovers as borderline. This is problematic because it lumps all problematic behavior into a “diagnosis” that’s likely based on faulty assumptions and a skewed perception of the disorder — thanks a lot, Fatal Attraction. BPD has practically become a synonym for “crazy bitch syndrome,” an unfortunate coupling that fosters more erroneous self-diagnosis and thereby perpetuates the borderline stigma.
Remember — we are more than our diagnosis. Look at our actions, not at our labels. Look in our hearts, not in our charts. We are not blameless, but we are learning. Let’s learn together. Let’s adore what we really are and heal together.
Rene Mill orginal article here
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