Coming Out

A diagnostic disclosure I could go without making.

Having a complex mental health history sometimes feels like I’m carrying around some sort of secret. I am pretty open about having schizoaffective disorder, bipolar type—which I often just refer to as schizophrenia since everything about the boundaries of this are contested. While it’s true that schizophrenic symptoms are highly stigmatized in our society (along with bipolar disorder, depression, PTSD, etc.), I have another diagnosis that is perhaps more stigmatized than those disorders in many circles including among mental health professionals themselves. And this is why I do not write about being diagnosed with borderline personality disorder.

This is also why I haven’t read any of the popular texts on BPD. There are literally more resources that have been created and are available to family members and loved ones of individuals with Borderline Personality Disorder than there are resources for those of us who have been diagnosed and are living with it. Read the reviews of classic bestsellers such as Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder (implying that my loved ones have to “take their lives back” from me) and I Hate You, Don’t Leave Me: Understanding the Borderline Personality Disorder (with its totally non-stigmatizing cover art) and you, too, will likely come away with the impression that people with BPD are to be avoided at all costs. Many psychiatrists and therapists will not treat patients and clients with BPD, due to their reputation as “troublesome,” pathological liars who will stop at nothing to manipulate anyone and everyone in their lives.

bpd i hate you don't leave me book cover

In order to talk about BPD, an official description of the disorder is necessary. For this, I refer to the National Institute of Mental Health’s definitions of BPD. The NIMH page lists the DSM-V’s (DSM = Diagnostic and Statistical Manual of Mental Disorders, the psychiatric “bible” found on every psychiatrist’s bookshelf) official criteria for the diagnosis about half way down the page.

Borderline personality disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. These experiences often result in impulsive actions and unstable relationships. A person with BPD may experience intense episodes of anger, depression, and anxiety that may last from only a few hours to days. Some people with BPD also have high rates of co-occurring mental disorders, such as mood disorders, anxiety disorders, and eating disorders, along with substance abuse, self-harm, suicidal thinking and behaviors, and suicide. While mental health experts now generally agree that the label “borderline personality disorder” is very misleading, a more accurate term does not exist yet. People with BPD may experience extreme mood swings and can display uncertainty about who they are. As a result, their interests and values can change rapidly. Other symptoms include:

    • Frantic efforts to avoid real or imagined abandonment

    • A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
    • Distorted and unstable self-image or sense of self

    • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating

    • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
    • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
    • Chronic feelings of emptiness
    • Inappropriate, intense anger or problems controlling anger
    • Having stress-related paranoid thoughts
    • Having severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body,
    • or losing touch with reality

A lot of BPD stigma stems from the fact that its symptoms aren’t as palatable or acceptable as people would like them to be. They exceed the limits of a lot of people’s so-called sympathy and compassion for mental illness. What’s absolutely certain though is that stigma does not help anyone with a mental illness; it especially does not help those prone to suicidal impulse or, as the NIMH puts it, “completion.”

BPD makes me more philosophical than any other diagnosis about what this disorder means about me. I spend a lot of time worrying about how I can separate myself from it. What parts of my personality are me as an individual and what parts are just the pathology? Are they one in the same? When you structure your identity around an illness, you are unable to resist asking yourself: who am I without it?

The more awareness I develop about BPD and myself, the more I practice mindfulness and DBT, the more I realize that the worst symptoms are in remission. I still find myself doing BPD-ish things in my current life, especially in relationships, but not at all to the degree that I had done in the past. I find that getting older helps (research actually shows that BPD symptoms tend to decrease with age so that’s something to look forward to). In the past, my urge to sabotage my relationships with others and, ultimately, myself stemmed from a desire to be heard and to feel respected and cared for. I wanted attention and love. For example, It’s humiliating to admit that I used to think that if I became sicker, others would take me seriously. So, I’d try to deteriorate my health in violent and dangerous ways—or I would lie about having an illness—in an effort to illicit sympathy and love from others, the people who already loved me. It was pure selfish spectacle and never once had the intended effect which was to prove (to me) that I was worthy of love. At the time, it made perfect sense to do this, but it ended up costing me many friendships, important relationships, and put unfair strain on the few who stuck around. As I age and learn more about myself and this disorder, I realize that the greatest thing I can do for myself is to care for myself as best I can. Acceptance and love are revolutionary acts. This is not easy. It’s hard to love yourself when you’re not even sure you like yourself. But prioritizing self-preservation over self-destruction has been my good first step.