BPD and Me

This week we hear from our lovely treasurer, Jemima.

The rather ambiguously named ‘Borderline Personality Disorder’ (BPD) is a chronic psychiatric disorder affecting approximately 2% of the population1. This makes it twice as prevalent as schizophrenia2 yet is a condition that few people know much about. According to my very scientific and incredibly representative Instagram survey, 13% of people hadn’t even heard of BPD. Of those who had heard of the condition, they didn’t feel very confident about explaining BPD to someone else. This score sat at roughly 4/10. I’m hoping that by the time you’ve read the next few paragraphs, this will be closer to 10/10!

It was also the subject of our PsychSoc film night a couple of weeks ago (Girl, Interrupted), however, in my completely unqualified opinion, I didn’t think it was an accurate portrayal of the condition and wanted to expand on it a bit more.

I spoke informally to people with personal experiences of BPD when writing this article and some of their comments will be touched on in later paragraphs, as well as my own.

Borderline personality disorder is a psychiatric condition which has characteristic patterns of unstable behaviour. This includes difficulties involving regulation, impulse control, relationships and self-image3. For example, someone with BPD may have very intense feelings towards someone that they love, perceiving the person as perfect and placing them on a pedestal. This all comes crashing down if this person does even the smallest thing, like forgetting to reply to a text. Suddenly their opinion will invert, and they may feel anger or hatred towards this person, causing them to lash out in violent or verbally explosive displays. This person may also feel an extreme fear of being abandoned by their loved one, which further fuels the emotions behind their outbursts. These are just two examples however, and thus cannot be generalised to everyone with BPD.

There are 4 main groups of symptoms:

• Emotional instability (affective dysregulation)

• Disturbed patterns of thinking or perception

• Impulsive behaviour

• Intense but unstable relationships with others

People with the condition can also engage in self injuring behaviours, or may have suicidal tendencies4, with up to 10% committing suicide. This is 50x higher than the figure for the general population and underscores the importance of diagnosis and treatment for these individuals4. Treatment, such as dialectical behaviour therapy (DBT), can be very effective and should therefore be sought out wherever possible. In a 10-year study, 86% of participants receiving treatment achieved a prolonged remission of over 4 years symptom free6, allowing them to regain control and cope with their symptoms.

Speaking to two people with BPD allowed me to gain further insight into the disorder. One of these described struggling particularly with impulsive behaviour and unstable relationships, saying that their emotions feel ‘far more intense than the average person’ and that they can quickly go ‘down a rabbit hole’, getting swept up in negative feelings when

they were fine only moments before. They also found rational thinking difficult. The other experienced more extreme mood changes, feeling manic at times before plunging into depression. This person also struggled with destructive behaviour, turning to drugs, alcohol, sex and theft as a way to cope and ‘numb’ these intense feelings. Neither of these people were on medication for BPD as they felt like it wasn’t the right choice for them. One of them found that just having the diagnosis had positive effects for their ability to cope with their symptoms as they now understood why they had the feelings/behaviours that they did. This person also had a good experience with psychotherapy and counselling.

I asked if they had any advice for friends/family of people with BPD. These are some of the things they came up with:

• Be aware of triggers.

o These will be personal to the individual.

• Understand that impulsions can cause irrational behaviour.

• Talk out any issues calmly.

I don’t have BPD myself, but I do have a first degree relative with the disorder. It has made my relationship with this person very difficult at times, however by educating myself about BPD I developed the skills that were necessary to navigate the condition. Growing up, I often had to balance the trials and tribulations of my own life with the tumultuous nature of BPD, which could be isolating at times. Despite this, our relationship has improved drastically over the last few years and goes to show that hard work and compassion can go a long way.

If you are in a similar situation, here are some of the things I found that helped me:

• Reaching out to others for help.

o Social services, counsellors, friends, other family members, teachers, trusted adults.

• Reminding yourself that this person is unwell and needs help from a psychiatric professional.

o Avoid placing too much burden on yourself.

• Being kind and compassionate.

o Breathwork, removing yourself from highly emotional exchanges.

• Writing out/expressing my feelings.

o Journaling, art, music, creative writing.

• Setting boundaries.

o Knowing when to walk away or leave a conversation if you are not being treated with respect.

I also spoke to somebody who had a best friend with BPD, who described their friend as ‘the most important person in [their] life’. Their advice was to always be understanding and supportive and to have open conversations with the person with BPD to ensure that you know the best way you can help them with their symptoms.

In this article I have only touched briefly on BPD. In no way do I mean to encapsulate every experience of those with the condition, the aim of this post is merely to serve as a brief

introduction. Nor do I intend to increase the stigma around mental health disorders. People with BPD are perfectly capable of attending school, going to work, making friends, falling in love, and should not be viewed any differently to those without it. They just might need more support to do those things.

If anyone would like to explore this further or would like more advice/a chat, feel free to get in contact with me. Contact your GP if you’re experiencing any of the above symptoms or need directing to any mental health advice as I am not a professional!

My email is j.perrott-jones@uni.bsms.ac.uk. I hope this article taught you something! J

References:

1. Torgersen S, Kringlen E, Cramer V. The Prevalence of Personality Disorders in a Community Sample. Archives of General Psychiatry. 2001;58(6):590.

2. Saha S, Chant D, Welham J, McGrath J. A Systematic Review of the Prevalence of Schizophrenia. PLoS Medicine. 2005;2(5):e141.

3. Lieb K, Zanarini M, Schmahl C, Linehan M, Bohus M. Borderline personality disorder. The Lancet. 2004;364(9432):453-461.

4. Overview - Borderline personality disorder [Internet]. nhs.uk. 2021 [cited 21 October 2021]. Available from: https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/

5. Oldham J. Practice guideline for the treatment of patients with borderline personality disorder. Washington, DC: Am J Psychiatry; 2001

6. Zanarini M, Frankenburg F, Reich D, Fitzmaurice G. Time to Attainment of Recovery From Borderline Personality Disorder and Stability of Recovery: A 10-year Prospective Follow-Up Study. American Journal of Psychiatry. 2010;167(6):663-667.