After a teary yet surprisingly speedy 45 minute assessment with a Community Psychiatric Nurse, who later would become my Care Co-ordinator whilst I was under the care of the CMHT (Community Mental Health Team), I left the treatment centre branded a Borderline. Little did I know how that one conversation, with someone who I am pretty sure is unqualified to diagnose at all, would change my life forever. I didn’t know too much about Borderline Personality Disorder. At first I was relieved to finally have an answer and explanation for all my past behaviour, but then I began to believe there must be something wrong with me, as a person. I started to think it must be in my personality, deep within my soul – the name is pretty clear. Now I had the label to prove it. This is what I had always thought about myself anyway, that I was born damaged and defected. But I was wrong. Nobody is born that way.
The stigma is real
I became curious and did some digging on my diagnosis, boy did I dig deep. I began to realise just how much stigma sufferers of BPD actually face; being branded ‘attention-seeking’, ‘manipulative’ and ‘incurable’. Most of all what is worse is the stigma Borderlines face is often institutionalised. It just takes a quick Google search to find articles, posts and tweets about the discrimination Borderlines are facing from their own GP’s, psychiatrists, nurses and other mental health staff; the very people who are supposed to be looking after them and should know better.
Often I see stories shared bravely online of staff at in-patient treatment centers treating suicidal Borderlines with less care and compassion to other patients who also may be suicidal but have a different diagnosis. Not long ago it was reported that a senior judge had to rule for a suicidal teenage girl with BPD to be moved onto a secure unit, totally shaming the NHS and the system as a whole. Many times I have read recollections of Borderline’s suicide attempts that are taken to A&E are not taken as ‘seriously‘, due to the nature of their diagnosis. It is widely known that many NHS staff see Borderlines as being a ‘pain in the ass‘ or simply feel like they are ‘putting it on‘ when they talk about suicide or even attempt to commit. Some Borderlines even describe stories of therapists refusing to work with them after becoming aware of their diagnosis. This is all backed by studies showing that mental health professionals carry the most stigma towards patients with BPD more than any other mental illness.
Hearing these accounts and seeing the statistics for myself troubles me deeply. Even I have faced stigma for my illness so often I play it down to professionals, but what if I am in need? Will anyone listen to my cry for help – or has my character been defamed by my diagnosis?
Almost everyday I trawl through some troubling reports on personality disorders. Most recently it was The Guardian who posted an article titled “Personality disorders at work: how to spot them and what you can do“. Catchy headline, right? Well unfortunately if you missed this highly prejudiced piece it has since been removed, but see below for a snippet of stigma from said article.
Clearly this was an opinion piece that has no place in such a highly regarded paper. I was grateful to see a response from the experts published detailing their concern and disappointment over the article. As a Borderline who has managed to successfully finish university and work in a profession ever since graduation despite my mental illness I find it extremely frustrating to read articles likening people with BPD to psychopaths, sociopaths or narcissists. Sometimes I feel lucky to be where I am today; to have completed school and university, to have gotten good grades, be in a stable job and hold valuable relationships. I know this illness can take a hold of you and I have seen it first hand, but we are not monsters and we are not evil. As the experts say in their letter to The Guardian: “people with this diagnosis live, love, laugh, work, have children and spend their lives trying to make it all work and to do no harm to others.“
Criteria for Borderline Personality Disorder
So how does one gain such a prestigious title of a Borderline? Well, a diagnosis can usually be made if you answer “yes” to five or more of the following questions:
- Do you have an intense fear of being alone?
- Do you have a pattern of intense and unstable relationships?
- Do you ever feel you don’t have a strong sense of your own self/are unclear about your self-image?
- Do you engage in impulsive activities in two areas that are potentially damaging, such as unsafe sex, drug abuse or reckless spending (but not including self-harming or suicidal behaviour)?
- Have you made repeated suicide threats/attempts in your past and engaged in self-harming?
- Do you have severe mood swings, such as feeling intensely depressed, anxious/irritable, which last from a few hours to a few days?
- Do you have long-term feelings of emptiness and loneliness?
- Do you have sudden and intense feelings of anger and aggression, and often find it difficult to control your anger?
- When you find yourself in stressful situations, do you have feelings of paranoia, or do you feel like you’re disconnected from the world or from your own body, thoughts and behaviour?
So there you have it. The checklist that changed my life.
What do you think of these questions?
Female hysteria and PTSD
Shockingly 75% of those with a BPD diagnosis are female, astonishing for a mental disorder. The reason for this screams “female hysteria“. For if a male showed up to a psychiatrist presenting the same symptoms, evidence shows that they would most likely be diagnosed with PTSD (Post Traumatic Stress Disorder).
I am not ashamed to say that I am an emotional person, but upon reflection I do believe that showing my emotional side and possibly coming across as hysterical at my “assessment” allowed my CPN to instantaneously brand me a Borderline (within 45 minutes!). In my opinion this stopped her from seeing what was really going on inside my head, and I was even denied a second opinion with a psychiatrist.
People who have experienced traumatic events are more likely to struggle with their emotions, rely on substances and possibly act on impulse. Many studies have shown direct links between people who suffer with PTSD and BPD, though it is Borderlines whom are mainly female that get told they have a fatal flaw ingrained within their personality. That they are ‘incurable‘.
Often people with BPD have suffered a great deal of trauma and I believe this should be taken into account before labeling an individual with a highly stigmatised disorder and chucking them back into the system. I know my diagnosis was not at all thorough, so I wonder how many other Borderlines have been diagnosed through matter of opinion rather than fact?
I’m not even sure if Borderline Personality Disorder should be a diagnosis. Who does it really serve? Many psychiatrists are reluctant to give out this diagnosis and now I see why. The other name professionals sometimes use for BPD is Emotional Unstability Personality Disorder (EUPD), while I find it just as stigmatising. For me, its not about the name its about what goes with it. I am sick and tired of the stigma and the shame attached to this mental illness.
We can recover
The most/only positive thing I have got from my BPD diagnosis is the specialised treatment for the condition, which is DBT (Dialectical Behavioural Therapy). This is a talking therapy that can be done on a 1:1 basis or in groups. It is based on CBT (Cognitive Behavioural Therapy) but has been adapted to help those who experience emotions intensely. It focuses on acceptance and mindfulness which I have found to be extremely useful throughout my 12-week group sessions.
Gaining access to a 1:1 DBT course proved to be extremely frustrating and seemingly impossible after coming into contact with numerous GP’s who hadn’t even heard of DBT and many who were unsure how to refer patients at all. If any of this sounds familiar to you, but you do wish to access treatment contact your local Mind and they may be able to put you in the right direction and help you with any referrals.
Despite Borderline being known as in ‘incurable’ illness, I believe we can recover. To receive an initial diagnosis you must only meet five of the criteria (a bit sketchy IMO). I was told that I would have this title for life, ‘once a Borderline, always a Borderline’.
However I must disagree, even since I got this diagnosis I have seen myself grow and flourish. My personality is not flawed. I was not born a monster. We can recover and we do recover. If we are given the correct treatment, medication and treat with some dignity and respect there is no reason why we cannot be fully functioning members of society.
What do you think about Borderline Personality Disorder?
Have you ever faced stigma or shame for your mental illness?
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