Borderline Personality Disorder is Complex, Not a Stigma

(Trigger Warning: Mentions of suicidal thoughts and substance abuse.)

"Feeling safe was not something that happened often, and feeling comfortable happened even less. My household was filled with yelling, fights and occasional violence from a young age. It didn't occur to me that this was unusual for families until I was older.

"As I grew out of childhood, my panic disorder got much worse. I began having panic attacks multiple times a day, every day. My father began drinking heavily to cope with the trauma he had faced. Throughout my teen years, I developed an intense need for external validation and anger towards the world-at-large, deep-rooted insecurities, and a fight or flight response that was quicker and harder hitting than most."

The Citizen in conversation with Harris Rollit, 27, from Toronto, Canada, got a first account of his journey and personal experience with Borderline Personality Disorder (BPD). He is a basketball coach, peer counsellor and mental illness advocate.

"When I was 18, I reached a breaking point. I was working nights selling sodas at an amusement park. Every night I would cry on the bus home and wish I did not exist anymore. One day they did not let me know my shift was over at 11 pm, so I kept working until about 2 am before someone finally asked me what I was doing there," said Rollit.

"I broke down again, this time worse than the previous night and told my partner at the time and my mother that I was going to kill myself in the near future if I did not get help," he added.

He was "initially only diagnosed with Major Depressive Disorder, Panic Disorder, Generalised Anxiety Disorder, and Obsessive Compulsive Disorder." He said, "like many folks with BPD, my mental state got worse in adolescence. Drug addictions, risky sexual behaviours, impulsive petty crimes like shoplifting, and a spiralling eating disorder were some of the things I dealt with in those coming years.

"Relationships were harder than ever. I burned more bridges than I ever imagined I could. I self-harmed frequently and overdosed on drugs, both prescribed and illegal. I spent lots of time in the hospital emergency room.

"When I was finally diagnosed with BPD around the age of 21, things started to click. I always felt there was something more holding me back than my prior diagnoses. I was right."

Catherine Humenuk is a Licensed Clinical Social Worker and Certified in Dialectical Behaviour Therapy. In her private practice, she works with "folks who struggle with addiction, complex trauma, and borderline personality disorder."

She had "two answers" to what Borderline Personality Disorder could be most accurately described. She said, "first, from the outside looking in, I'd say: intense and hard-to-regulate emotions, which leads to distorted thinking and impulsive behaviour. Second, from the inside looking out, I'd say: extreme difficulty establishing a sense of self, which leads to difficulty maintaining relations and unpredictable behaviour to self-soothe."

"What causes BPD? We don't have a single answer to this question. The current prevailing theory is that people who grow up to have BPD are born with a genetic predisposition to feel their emotions more intensely than average, and they are raised in environments that do not teach them how to manage these emotions effectively.

"People with BPD are more likely than average to have a trauma history, because traumatic environments are inherently invalidating. The more sensitive someone is to emotions, and the more their experiences are invalidated, the more likely they are to develop their ineffective behaviours to try to regulate these emotions, like impulsive actions, emotional outbursts, or self-harm," said Catherine Humenuk.

Harris Rollit shared an insight into how life with BPD is. He said, "it's really difficult. You have to be conscious of your emotions and how you deal with your reactions to those emotions or things will spiral out of control. It's a little like living life on a tightrope.

"You will burn bridges with many people, for good reasons and not so good ones. You will find yourself overwhelmed and need to take steps away from the world at times. But is it impossible to live with BPD? Absolutely not."

"BPD is lesser recognised than other mental health disorders. For example, schizophrenia affects less than 1% of people but it is widely known yet BPD impacts somewhere between 2-6% of people and the general population knows very little about it," said Humenuk.

"There are so many misconceptions and misunderstandings about BPD. When we look at the historical context, there was no effective treatment known for BPD until the 1990s. Therefore, many mental health professionals believed it was 'untreatable'. Although we now have several evidence-based treatments, they are not always widely available. Many of today's mental health professionals are still under the impression that it is untreatable," she added.

Harris Rollit said, "there are no medicines specifically designed with Border Personality Disorder. As it is a disorder that is so often comorbid with others, taking medication to address symptoms like depression, anxiety, nightmares, insomnia, mood regulation and blood pressure can all be effective in treating BPD."

"Another source of stigma is that a lot of BPD symptoms show up in relationships. Although, the symptoms are just the person with BPD trying to cope with overwhelming emotions. The behaviour can appear unreasonable to observers. Since there is so little understanding and help available, people with BPD are often assumed to be manipulative, rather than in pain," said Humenuk.

Elaborating on Catherine Humenuk's thoughts on the misconceptions and stigmas surrounding BPD, Harris Rollit added, "People believe we are not able to improve our behaviour when in fact, working through programs like Dialectical Behaviour Therapy can increase our ability to communicate, empathise and regulate emotions effectively. Often people who are not far along on their BPD journey can be manipulative. However, it is not a permanent trait. It's usually something people don't even realise they are doing. With the right therapy, clients can realise they are about to act in a manipulative manner; take a step away to think and then make a better choice."

Catherine Humenuk agreed, "I think anyone who cares about someone with BPD would say that even if their behaviour is sometimes confusing or harmful, they are deeply caring and creative people who want the world to be a better place."

People living with BPD are often stigmatised as people who are unable to sustain their relationships. Harris Rollit explained, "a relationship with a person with BPD will have unique challenges but it is not impossible. Things that make typical relationships work effectively are the same things that make relationships with people with BPD work effectively.

"Both partners need to work on and exhibit strong patience, balance and communication skills. Things like knowing when to step away and give each other space, and also knowing when to comfort and validate are so important. In every relationship, there will be unique challenges. A relationship with someone with BPD is no different."

Generally, many mental health professionals are not exposed to or educated enough on BPD. It is easier for BPD to be misdiagnosed as something else, often with Bipolar Disorder. Catherine Humenuk elaborated, "BPD is often misdiagnosed. Another thing that often happens is that people with BPD are diagnosed only with a mood disorder, such as depression or anxiety, and the BPD diagnosis is missed entirely. It can be missed because the clinician simply does not think to check for the symptoms. After all, it is relatively uncommon.

"It can also be missed because of clinician stigma. Many clinicians have a stereotypical view of BPD as a woman who is out of control when in reality, men and women have BPD at equal rates and many people with BPD are extremely successful at school, work, or home life."

Harris Rollit concurred, "scientists believe BPD affects both sexes equally. It is just much more likely for women to seek out help and much more likely for men to resort to isolation and suicide."

Rollit shared his diagnosis. He says, "the tricky thing is, I wasn't misdiagnosed. All of those diagnoses were correct and stand correct to this day. BPD was a missing piece to the puzzle. Throughout the years, I've talked to thousands of folks with BPD, and the amount that only has a diagnosis of BPD are few and far between. Comorbidity is almost an assured dilemma for people with BPD. It can be a difficult juggling act."

He added, "I will always emphasise focusing on symptoms rather than labels, though, because there is so much crossover between the diagnoses. The treatments for BPD will help with depression, anxiety and PTSD, among other things. The same is true in reverse."

Harris Rollit's encounters with the most common misdiagnoses "are with women who have been misdiagnosed with BPD but are actually autistic, and both men and women who are misdiagnosed with Bipolar Disorder, actually, have Borderline Personality Disorder."

Due to BPD being lesser recognised, people tend to formulate misconceptions, stigmatisation and misunderstandings about it. It also leads to misdiagnosis. It is so important to educate people to reduce these stigmas so that the disorder will be brought to light, where there is so much hope for recovery.

Catherine Humenuk said, "research shows that the majority of people experience symptom remission in their lifetime. It is also possible for people to experience a much better quality of life while managing the occasional symptoms. There are multiple treatments available like Dialectical Behaviour Therapy, Mentalisation Based Treatment, Schema-Focused Therapy, Transference-Focused Therapy, and many others."

Harris Rollit added, "Having BPD is bittersweet; it's a weakness and a strength. No matter how much work we put in, feelings of impulsivity, emptiness, invalidation and so on will always be there. The difference is the ability to manage them and live a life worth living."

The excerpt from Mollie's podcast is inspired by Dr Anita Federici's article, On the outdated and stigmatising term 'borderline'. Mollie is a BPD label survivor, and podcaster of a BPD recovery podcast called Back from Borderline. She said, "It is time to throw the BPD label in the trash. BPD is probably the most misunderstood diagnosis in the existence of psychiatry, and it's outdated as hell. The term 'borderline personality' was coined in 1938 by a group of elite male psychiatrists; in an attempt to describe patients that just wouldn't fit into their favourite little boxes; psychotic or neurotic.

"Even at this point, nice clinical guidelines admit that the term 'borderline' was born out of what they call conceptual confusion. Many of us are being slapped with a stigmatised label that's widely known to be born out of the confusion of a few dudes in a room nearly 100 years ago.

"These guys just didn't know what they were observing or how to describe it best, so they just said, cool let's say they are on the borderline of neurosis and psychosis and call it a day. But here's a more accurate picture that's reflective of current research; people who identify with symptoms of BPD have a hard time regulating their emotions and their impulses.

"The most up-to-date research shows that struggles of this are tied to bio temperament and then reinforced over time through growing up in an environment with continuous emotional invalidation, and this causes someone to have a really hard time identifying, expressing and regulating their emotions.

"So, when we have trouble identifying and expressing our feelings, this leads to identity issues, attachment troubles, and chronic feelings of emptiness that make us wonder what's the point of this life. Is it even worth it?," she asked.