Being a Borderline, stigma, and what you might not know

Over the past few years mental health awareness has boomed and campaigns have appeared everywhere promoting awareness and destigmatisation of mental illness, creating platforms for people to share their experiences and stories with others - like the Time to Change website. Whilst all of this is obviously very positive, just how much more aware are people of the implications and severity of mental illnesses? 

If I was to mention the term 'mental illness' to you what would be your first thought? Depression? Anxiety? These are terms we are all familiar with, illnesses that most people will no doubt encounter or experience at some point in their life - with depression affecting 2.6% of the population, anxiety affecting 4.6% and a combination of the two affecting 9.7%. But aside from being able to list a few other known disorders just how much do you actually know? Schizophrenia, bipolar, personality disorder - these terms bring to mind for many an image that is, sadly, terrifying - and damaging. But how much of it is real? How much is the cliched stereotypes portrayed in TV, film and literature.

Representations of these disorders in the media are perpetuating the notions of fear, danger and even romanticise the most severe mental disorders - trivialising their severity. I used to think that depression and anxiety were more talked about because they were more common, but this is in fact not the case. Other disorders such as Schizophrenia and Bipolar Disorder affect 1-3% of individuals over their lifetime and Personality Disorders 3-5%, so why is their so little information on them? Why are we so much more aware of some illnesses and not others? 

Winona Ryder as Susan Kaysen in 'Girl, Interrupted' is a perfect example of the damaged, hypersexualised, problematic version of mentally ill women the media portrays.

These are questions I have asked myself a lot over the last few months; about a month ago, I was diagnosed with Borderline Personality Disorder (BPD). I Had been 70% sure I had some form of personality disorder for several months before that, and prior to my knowledge of what a personality disorder was, I had been convinced that there was at least something ‘wrong’ with me. Even as a young child I held a firm belief that I was 'different' or 'wrong' - in fact, it was probably one of the only things I was ever certain of. But like most people, I was uneducated on mental health and told, even by my parents, that I was simply going through puberty and that my hormones were changing.

This was not the case; as I grew up, these behaviours did not settle as was expected. At the age of 15 I was still throwing tantrums like an oversized toddler, screaming and shouting until my voice was hoarse. Volatile, aggressive, a tense ball of fluctuating emotions, writhing and kicking, barely in control of myself, it scared both myself and my parents. I couldn't process my feelings - always overwhelming me, bursting out through tears in my thin emotional skin. I vividly remember asking my mum for anger management therapy only to be told that I was being stupid and overdramatic, and yet they would still tell me how horrible I was - selfish, manipulative, nasty, vindictive, evil. Words I became desensitised to after several years. I accepted them as fact and each day I looked in the mirror I hated myself just that little bit more, internalising the idea that I was exactly as they described me to be - a monster. 

Fast forward to today, and I now understand that these were the emerging symptoms of my disorder, unfortunately my parents probably helped to nurture  and feed them. Borderline Personality Disorder is characterised by emotional instability, disturbed thought processes, impulsive behaviour and intense but unstable relationships. Marsha Linehan describes the etiology of BPD to be both biological and environmental, and either one can be more important depending on the individual. Both my psychiatrist and I feel that personally I developed BPD due to a combination of being genetically predisposed and experiencing trauma and neglect throughout my childhood. 

BPD has been a controversial subject among clinicians for years; some refuse to acknowledge it as an illness, and some argue that it should be reclassified as a form of complex PTSD due to the overlap in symptoms and the frequency of BPD being comorbid with PTSD - however, in doing so, this disregards the 25% of people who develop BPD despite having experienced no trauma. Some clinicians even refuse to work with Borderlines, branding them ‘untreatable’; they’re often assumed to be difficult, manipulative, selfish and even abusive… words I have heard a thousand times before, words which are dangerous and damaging to brand an entire group of people with, a it is not the case.

BPD is a complex disorder: the diagnostic criteria specifies that only five out of the nine symptoms need be present to be diagnosed, and thus each individual experiences BPD completely differently from the next ,with there being over 250 combinations of said criteria. This can make the specifics of the disorder hard to wrap your head around. Below are the 9 symptoms listed (and if you want to look into each of them in more detail I suggest you read this blog post):

• Fear of abandonment
• Very intense emotions
• Uncertainty around identity
• Difficulty in making and keeping stable relationships
• Impulsive actions
• Suicidality and self-harm
• Feelings of emptiness and loneliness
• Issues with anger management
• Paranoia, psychosis, or disassociation

The symptoms of BPD vary greatly and this is one of the main reasons I feel that disorders like BPD are set apart from clear-cut illnesses like depression and anxiety, they have a much more pervasive nature and affect. For me, BPD affects my responses to almost everything: my brain processes everything completely differently to a neuro-typical individual, from the way I handle social interaction to my perceptions of reality. With depression and anxiety, these are heightened emotional states that people understand more readily (whether or not they comprahend the severity of the illness), thus making them ‘easier to swallow’ in a lot of ways (though I am not trying to undermine the severity or suffering of people with either).

Although, it's also easy to look at the symptoms of BPD and say 'oh but everyone feels like that at some point' and though you're not wrong, what you need to consider is the intensity, duration and consistency of these feelings. Yes you may have felt one or more of these symptoms before, but was it every second of the day? Every emotion on the spectrum electrified? From the most despairing sadness to the most ecstatic happiness to uncontainable rage within seconds? Did it affect your ability to function day to day? You may have experienced impulsivity or been unsure of your identity or even paranoid before, but has it driven you to a point of questioning your own reality? Questioning whether or not you are real, whether anything is real? Has it left you lying in bed or crouched in a corner desperately clutching at yourself as something squirms, writhes and claws at you inside. The answer, for anyone not experiencing a mental disorder, I assume will be no. 

The reason I assume no is because studies have shown a 10-20% hippocampus size reduction (an important part of the limbic system, the region of the brain that regulates emotions) in individuals with BPD and a 22% size reduction in the amygdala (the region of the brain known to process emotional arousal) compared to control groups without the disorder. These results are similar to those conducted on people suffering with PTSD, furthering the connection between the two, and trauma exposure and hippocampus size have shown to be related. Though like I mentioned earlier BPD isn't classified as a traumatic stress disorder because it does not always develop due to the presence of trauma and I know several people who have no history of trauma or neglect that have developed BPD, proving that genetics also plays a key role in its development. But the key thing I wanted to point out in using these statistics is that it isn't an imagined illness, it isn't someone being overdramatic.

If you encounter someone with BPD and you cannot fathom why they act in a certain way, consider this - it is not just in their head. Their brain is physically different to yours, and just because the symptoms are behavioural does not make them any less valid and does not mean that they can necessarily help them. The likelihood is that they are trying every day to function as 'normally' as possible, take it from someone who knows firsthand just how hard it is to rationalise your thoughts when your brain is so irrational. At the end of the day, who would choose to behave like this?

For anyone who doesn't have BPD, I can only imagine how hard it is to deal with and understand, but on that same merit it is just as hard to live with and understand, because even I am sat here half the time trying to wrap my head around why my brain responds in whichever way it might. I feel I am an incredibly fair minded, rational person, but my brain is the literal opposite. I work every day to understand myself, my illness and its affects on the people in my life more so that I can work on it and develop the healthiest coping mechanisms I can. But - with no available therapy or real medication at the moment - still I have hurt and lost more people than I can count and a quick google search on relationships and BPD will reveal a plethora of articles all screaming the same message to anyone thinking about dating or befriending a borderline - 'RUN'.

But it isn't all as bad as it might seem. Despite stigma, borderlines are not all manipulative, selfish, awful, evil monsters. If anything, our intense emotions mean we are more empathetic than the average person; we are caring, creative, incredibly self aware, and not every impulsive action leads to a bad situation - some of my best stories come from impulsive decisions. We deserve happiness and health just as much as the next person and the majority of the time that is all we are trying to work towards. However, funding to mental health services is scarce, medication can take years to get right and getting even a diagnosis, yet alone therapy and support, can take months or even years. Many people being misdiagnosed due to the stigma and contempt some clinicians hold towards BPD, landing them in the wrong therapy with the wrong medication, so trust me when I say its no quick fix and there are no shortcuts on the path to mental wellbeing.