Monday, August 5, 2013

THE TRUTH BEHIND BORDERLINE PERSONALITY DISORDER



Lets get real about mental illness right now. Like, really real. Like, the kind of real that makes most people uncomfortable but is also a total game changer... because that's just what honesty does. Ready? Okay then.

Borderline Personality Disorder.
I gotz it.

Remember how I talked about Bipolar Disorder and how it's the easiest name for the public to recognize and consequently then have a conversation about? Yeah, this is not the same thing. Borderline Personality Disorder (BPD) is a misunderstood and misrepresented mental enigma that really doesn't have the floor as much as it should. Common misconceptions are as follows: 1.) BPD is rare. It's not. It has been diagnosed in one person out of every 50. I believe it's more than that, but until we take the "scary" out of mental illness, people can't seek the help they need. But that's another diatribe for another day. 2.) There is a myth that it's "un-curable". That is also false. I stay away from the concept of "curing" anything because it doesn't really ever apply... ever, but I suppose it should be noted that there are a lot of really successful solutions that improve and help heal the lives of those who experience these symptoms. 3.) Common thought is that those with BPD are attention seeking, relationship destroying, manipulative assholes. Yeah, no. We struggle with emotional regulation more than others but if you take the simplistic approach that we are just trying to ruin everyone's life, I'll slap you. And not because of my issues, but because you deserve it. 4.) Those who are unfamiliar with BPD tend to confuse it with "Multiple Personality Disorder" (which is now called Disassociative Identity Disorder) but those are nothing alike. And 5.) people believe that only women develop this, when in actuality it comes down to the simple fact that men are socially pressured to refuse help when it comes to emotional imbalance. BPD is grossly under-diagnosed, and sadly the consequences of this mean that many are not getting the support they need. Legitimate sad face.

So what the hell is Borderline?

First and foremost, it is a learned disorder. This sets it apart from a lot of other mental illnesses that are purely based on neurological makeup. There are recent studies that have discovered that a person with a particularly sensitive disposition can develop BPD a lot easier which then creates a genetic link. BPD is most commonly developed when a person is raised in a severely invalidating environment. The latest DSM-5 has categorized it as a form of PTSD, which I find to be a great way to explain it; it's emotional PTSD. There is no definitive box that applies to everyone, but in my case it was all of the above. My family has a history of illness and my make-up left me sensitive and predisposed to my surroundings. I have a co-morbid diagnosis of depression (hereditary) which also contributes. Add on top of this: a childhood filled with emotional abuse from a father figure and you've got one fucked up Jes. But fret not. The ending isn't tragic.

"What are the symptoms of Borderline?" you ask? I could easily drone on in an academic fashion OR I could cover the common symptoms through my genuine experiences IN PINK. Whaddya think? Boring? Or not as boring in pink?

That's what I thought.


Oh hell yeah. This is often why individuals are misdiagnosed with Bipolar I or II. The ups and downs can skyrocket and crash without warning. It's quite exhausting.

This can be crippling. Like "why do I even try, whats the point of getting out of bed, everything is hopeless" crippling. Anyone who experiences severe depression knows what I'm talking about. In these vulnerable moments, the other symptoms can appear in full form.

For me, this might surface as road rage. Or it will appear when I'm waiting in a long line and the dumbfucks in front of me can't figure out how to move up when there is a gap. *Wink wink* Y'feelin' me? This is only occasional nowadays and requires a lot of breathing to get over. But I do, and it passes.

Destructive behavior, aware of but sometimes feeling unable to change it. Self sabotage anyone? Physically, mentally, emotionally. I've seen lot of it.

Also called Splitting, or Dichotomous Thinking. This is a common symptom and can also be recognized as an "all or nothing" mentality. You can read more about it here.

I absolutely hate this outdated and shame based book for the sheer reason that it portrays those with BPD as manipulators that often lie about their needs even in regards to suicide. This is bullshit across the board. Never, is someone, anyone, who has suicidal ideations faking it. The fact that the ideations exist is a concern in and of itself regardless of follow through... and the rates of follow through are tragically high. 10% diagnosed with BPD do die by suicide, and I have been trained to treat any talk resembling this as a life threatening issue. I wish everyone would do the same. Often, suicide is attempted as a cry for help. For me, this has happened several times and is often associated with several other symptoms combined. I didn't necessarily want to die, but I absolutely didn't want to live. My efforts were futile (obvs), but still decidedly dangerous. Copious amounts of "how to commit suicide" research consumed the larger part of my darkest days, and I'm glad that there was no ending of my life; I have a lot to do y'know? No matter the outcome, this amount of emotional pain can be catastrophic for the person experiencing it and really needs to be addressed. National Suicide Prevention hotline here.

This often includes things like risky driving, unsafe sex, binge eating, compulsive spending etc. I'm shocked that I made it out of the years filled with these things unscathed. Binge eating and compulsive spending still occasionally arise, but I am remarkably more cautious these days. Part of this has to do with my recovery work, and part of it has to do with growing up a little bit. *smirk*

A frantic fear of abandonment and being alone as well as feeling misunderstood, neglected, alone, empty, or hopeless. This is one of the symptoms that is still painfully present in my life. This often appears in my relationships, specifically the intimate ones. It's hard for me to understand why this is so powerful when I least expect it, but it can really make maintaining relationships difficult. I've been able to master the reworking of these issues when it comes to friendships, but the LTR issues continue to get me. It's a work in progress, and it's getting better.

The most sorrowful part of this is that no amount of success can change this. Even now, with everything in my life going splendidly, I am my own worst enemy. I find the flaws, I see the mistakes, I ruminate on the "could haves". This is better than before, but something I'll be learning to overcome for a long time yet. Building self-esteem when you were belittled your entire life is a journey for the decades. I was fortunate to have an incredible mother who counteracted some of this, but the damage was done and the reversal of this will take me years.


You can see how so many of these overlap and seem to fall underneath the category of "life skills". But the magical part of all of this is that because these behaviors are uniquely learned... they can be unlearned. We can physically re-wire our brain to override these emotions and in many cases (through several solutions) they disappear completely. The most effective form of therapy that we have today for this specific diagnosis is called Dialectical Behavioral Therapy or DBT. It was developed by Marsha Linehan (I want this shirt madly badly) in Seattle and has shown incredible success. It is taught in a group setting and focuses on learning new positive behaviors in order to replace the detrimental ones. The group setting is crucial, as it allows for commiseration, validation, and a conversation about how each individual copes with their symptoms. It offers solutions created by a community of those who understand. You simply cannot recreate this with one-on-one and it changed my life. I personally believe that life is indiscriminately cruel and that every single person alive could benefit from this, diagnosis or not. But again; another diatribe for another day.

Another solution is medication. I promise to write a thorough post about this someday, but because this post is longer than it should be I'll leave it at this: medication is not the only answer but it can however, be a helpful tool. By being on both an anti-depressant and mood stabilizer, I am now able to get out of bed and work on the other important aspects of my mental health. For me personally, these are absolutely necessary and after three days of not taking them I see a drastic change in my ability to cope with everyday stressors. Psychotropic medication is not a magic cure, but it sure is a fucking wonderful contributor to my happy, healthy life. As a mental health professional and a person with lived experience I can promise you this: meds are not a cop out. It is an implementation of an available tool and it changes a lot of peoples lives.

It's interesting to note that BPD was not my first diagnosis. I was fortunate to have a mother who was dedicated to my mental health, and after yet another night of crisis, she took me to a center to see what support was available. After a psych exam, I was diagnosed with Dysthymia. After medication trial and a reevaluation, I was instead diagnosed with Major Depressive Disorder (Chronic Depression). After medication trial and a reevaluation I was instead diagnosed with Biplorar II Disorder (commonly misdiagnosed as the symptoms can be similar) . Even in this day and age, we still aren't able to put mental illness into clean cut boxes. Both evaluations and prescriptions rely heavily on an artistic endeavor; finding the combination that works for your brain. It wasn't until a few (painful and rocky) years later that I found a psychiatrist who in the initial meeting suggested I read about BPD to see if I identified with the research. What I found was transcendent. THIS made sense to me; THIS validated all of my experiences. We tried one final medication that would either work if the diagnosis was Bipolar II or wouldn't if it wasn't. There was no improvement and so we proceeded with our new found assessment. That was the moment my life took a radical turn for the better.

All of that being said, I think it's important to realize that a diagnosis isn't gospel. It's not the end all, it's not set in stone, and it's not a death sentence. Diagnoses have been created to give us a starting point. A group of pre-explored patterns and historical data that shows possible solutions. It can also offer a significant amount of validation which is often needed. It was able to show me that what I was experiencing was normal; I was not alone. I think that we often get caught up in the finality of it all; we're scared to look that psych exam in the face. But in reality, its just information. It does not encapsulate our entire worth as a being, or even predict our future. It is just information with a suggestion attached. And for me, that information was transformative. For me, it started a lifetime of healing. For me, looking Borderline Personality Disorder in the eye was the first step of progress.

I wish I could issue a Public Service Announcement to everyone who identifies with mental illness symptoms that says: IT IS NOT YOUR FAULT. We are all, yes all, a sum of our experiences and genetic makeup. You are not responsible for anything that has happened to you, or the way you were born. As humans, we instinctually do what is needed to survive and for those of us who experience an extreme diagnosis, our survival instincts may look strange to others. This is okay. When to change? That's your decision. If the repercussions from your coping mechanisms have started to affect your life negatively, you deserve the option to seek assistance. Every person deserves a balanced, happy and fulfilling life, you included. Fortunately for us, today we have resources that are helpful and effective. YOU DESERVE ALL OF THE HAPPY. The end.

I've done years and years of intensive work with this diagnosis, and I've seen an incredibly positive shift in my quality of life. Through finishing a through DBT program, staying consistent with the medication that works for me, and continuing with the same therapist I've had for five years, BPD doesn't affect my life in the ways that it used to. I'm accomplishing magnificent things, forming incredible relationships, and reaching goals I never thought I could. This is not to say that I don't have downward cycles, because I do. I have them less often than before, but more often than I would like. When I find myself spiraling downwards, that is the time for me to look at my lifestyle choices: am I taking medication? Am I eating correctly? Am I exercising enough? Am I using my creative outlets? Am I getting enough sleep? Am I surrounding myself with positive people? All of these things contribute to my well being; all of these components are necessary for a well balanced life.

Yes. I have really terrible, horrible, no-good, very bad days. Even still. But I must acknowledge how incredible it is that I'm still here. Still writing. Still changing lives. Still working a demanding job and succeeding like nobodies business. There is this misconception that coming out as an individual with a mental illness means that you're broken. Not enough, to be pitied, or that you're weak. On this, I call bullshit. To acknowledge that you have a biological imbalance is one of the bravest things that you can do. It is a sign of strength, not weakness. So you have that extra barrier and you STILL get up in the morning? Baby, that makes you miraculous. You deserve a standing ovation and a certificate for your stunning survival. You are my hero. Never give up. I sure as hell wont.

I'll say it again:

I'm right here with ya. Now lets go show the world whats up.
xo.

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