Do I Have Borderline Personality Disorder?
Borderline Personality Disorder is not easy to diagnose. It is primarily characterized by an inability to properly regulate one’s emotions. Of course, the full picture is far more complex. In making an assessment, clinicians analyze an individual’s adherence to a cluster of symptoms. This can require not only interviewing the individual themselves but occasionally their friends and family, as well as conducting a comprehensive review of their psychiatric history. Borderline Personality Disorder, from its infancy in the psychiatric community, has been one of the most highly stigmatized conditions. It has been used punitively as a label for ‘difficult’ or ‘uncooperative’ patients. When I initially received my diagnosis I became defensive.
My personality was not a disorder.
My long-standing, familiar diagnoses are Generalized Anxiety Disorder, Major Depressive Disorder and Acute Stress Disorder. I have come to accept them and know them well. They are old friends, and I experience no shame in their presence. I discuss them openly and honestly with others. Borderline Personality Disorder was sprung on me relatively late into my career as a mentally ill person. I thought all the analyzing and dissecting had been done. The conclusions had been drawn. There were no more mental mysteries to be solved. Apparently I was wrong. One more doctor wanted to bring his unique perspective to bear on my case. To this day, I wrestle with whether he was right or wrong in his diagnosis. In this piece, I’m going to attempt to use my own experience and personal insight to once and for all decide for myself if I have BPD.
The diagnosis was made while I was inpatient at a psychiatric hospital. I was there for two weeks. My doctor obviously thought he had seen, heard and read enough in that time to feel qualified diagnosing me. Maybe he was. I tend to wear my heart on my sleeve, and I can articulate my thoughts and emotions with precision. But from the start of our clinical relationship a tension existed between us. We got along fairly well, but we hit some rough patches along the way. I thought he could be arrogant and condescending. He thought I could be an egotistical bully.
Nevertheless, one day during a meeting he handed me a pamphlet and announced that he believed I had Borderline Personality Disorder. I was initially of two minds on the matter. One part of me recoiled, fully aware of the stigma and feeling like this diagnosis was not an assessment of my mental status but an attack on who I was as a person. Another part of me jumped for joy. I like being exotic. A personality disorder felt exotic.
But was it true? Mental health as it stands today, with our relatively limited understanding of the brain, is a field prone to subjectivity. So who knows? Who gets the final call? Do I accept the opinion of this one doctor, or do I rely upon the opinions of the slew of doctors I had seen prior, and the ones I would see subsequently?
To this day, Borderline Personality Disorder is not on my official record. But as I’ve read and studied it over the years I can’t help but wonder if maybe, in fact, that doctor at the hospital was on to something. And if he was, the diagnosis should have done more to guide the course of my treatment. For instance, I would have given Dialectical Behavior Therapy, proven to be effective in the treatment of BPD, a real shot.
Let’s see if we can figure this out once and for all by examining the symptoms associated with Borderline Personality Disorder and seeing if I align with any of them.
Efforts to avoid real or imagined abandonment
I am terrified of being alone. I have one close friend and a small family circle. I couldn’t bear to lose any of them. I worry constantly that because of my mental illness and lack of financial resources that the day will soon come when I find myself homeless on the street. That being said, I don’t think I go out of my way to avoid being abandoned. My loved ones have been with me through thick and thin, and I have faith that whatever I do will always be good enough for them.
A pattern of intense and unstable relationships
Unfortunately, this fits. My feelings about you can change on a dime. I may love you, but then if I feel you’ve slighted me I’m instantly ready to cut you out of my life forever. I find myself having to take frequent breaks to let myself cool off when I know I’m being unreasonable and irrational.
Distorted and unstable self-image or sense of self
Oh, yes. This is a big one. I’m working on this, but for the most part I loathe myself. I struggle to find myself good, decent or worthy of love. My faults and my inadequacies, real and perceived, consume my attention.
Impulsive and often dangerous behaviors
I drive too fast. I’ll purposely swerve towards parked cars and then jerk the wheel away at the last second, looking for a rush. I will binge eat sugary crap. I’m currently sober, but I’ve been drinking and drugging to excess for the entirety of my adolescence and adult life.
In remission at present, but I have self-harmed since the age of ten with frequency and severity. My body is a canvass of scars. I’ve hurt myself in every way I could think of, gravely injuring myself on several occasions and putting my life at risk.
Recurring thoughts of suicidal behaviors
I rarely have a plan, and even less often have any serious intention of carrying it out if I do have one, but thoughts of not wanting to exist are never far from my mind. I do fantasize. Images of self-annihilation come and go. I’ve arrived at the point where I accept my passive suicidality as a normal part of my every day life.
Intense and highly changeable moods
Not so much. I’m an emotionally intense person by nature, but that intensity tends to simmer. It doesn’t start off cool and then suddenly rise to a raging boil. My moods follow the same pattern. I’m largely depressed, though I’ve become accustomed to functioning outwardly at a level disproportionate to my inner state. In other words, I can fake it pretty well. But I’m not giddy one moment and grim the next. I’m just depressed.
Chronic feelings of emptiness
Absolutely. These feelings of emptiness are what fuel the substance abuse and the self-harm. They are painful in the extreme. They make it feel like nothing in life will ever satisfy me, ever bring me true happiness. The emptiness might be the most distressing symptom of my mental illness. It cuts so deep it feels more than mental, it feels spiritual. Like a wound on my soul that has never mended.
Inappropriate, intense anger
I’m a very angry person. And I direct all of it inwards. I remember when I was a child I was fumbling with the zipper on my jacket. I just couldn’t get it to work. Instead of taking a moment to readjust and figure out what the issue was, I flew into a rage. That general mentality exists in me to this day. I’m easily frustrated and have difficulty self-soothing. And, at times, I’d like to crush the world in the palm of my hand.
Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions
I don’t trust other people, and I tend to assume the worst about them. I don’t let them get close, lest they try to do me harm.
Feelings of dissociation
I live in a dreamworld. Nothing ever seems fully real or solid to me. It’s all a bit hazy. This is exacerbated by peaks in anxiety. And I’ll even have flashes where all of a sudden I become entirely unmoored in space and time. I don’t know who or where I am. This is frightening, to say the least.
So that’s the standard criteria for assessing whether or not someone has Borderline Personality Disorder. I am not a mental health professional. This was an exercise conducted purely for my own curiosity and enlightenment. Based on my responses I would say that the diagnosis most likely fits.
Should I bring this to the attention of my current doctor? Get his take?
Maybe I will. I think it’s an avenue worth pursuing. My case has proven resistant to treatment to date. There’s a chance tailoring a treatment plan specifically to target BPD could provide real benefit.
I’d be willing to give it a try, stigma be damned.