polaroid with quince branch

The following is the first in a series of posts about mental illness called, What ______ Really Is, in which I, and perhaps some guest posters, tackle a variety of mental illnesses and disorders with stigmatizing stereotypes. This series, or anything I write about mental illness, is not meant to replace information from a mental health professional, and simply reflects my own experience and/or research. I hope you like this first one.

I’m pretty open about having schizoaffective disorder, bipolar type on this site, which people have called me brave for. It’s true that psychotic/schizophrenic symptoms are highly stigmatized in our society (as well as depression, bipolar disorder, etc.) — but what I’m about to write about today is perhaps more stigmatized than any of those disorders in many circles, including in the medical community. And this is why I do not write about being diagnosed with borderline personality traits. 

This is why my psychiatrist, whom I know respects me a great deal, continually refers to it as “your personality” or “your Cluster B symptoms.”

hateyouThis is why, when my friend ranted about his “crazy ex-girlfriend,” whom he was sure was an “undiagnosed borderline,” and referred often to owning the classic bestseller, I Hate You, Don’t Leave Me: Understanding the Borderline Personality, I didn’t say anything about having been diagnosed by at least four different psychiatrists with borderline personality disorder (heretofore referred to as BPD) since 1999. Check out the awesome, totally non-stigmatizing cover art of the book at left, which has barely changed since the book’s release over two decades ago. (Credit: Amazon)

This is why one of my oldest friends, K, who is a formerly BPD-diagnosed person herself, asked me if she should stop seeing her therapist, whom she liked, because the therapist had suggested that she might have BPD — simply because my friend mentioned “cutting” as a younger person, and then K asked — rhetorically — who didn’t cut as a younger person? (She also commented, later: “A borderline diagnosis just means the psychiatrist is calling you an asshole.”)

I have questioned my diagnosis, which began when I was too young to even be diagnosed, since I was 16. People aren’t supposed to be diagnosed with personality disorders until they are at least 18 and therefore “adult,” but Dr. C didn’t seem to care about that particular nicety. At Yale, I went to Sterling Memorial Library and checked out feminist books about the feminization of BPD, a disorder that is controversial by its very nature and diagnosed in women far more commonly than it is in men; at the same time, I was lying down in fMRI machines for studies conducted by one of my professors, a neuropsychologist, to examine vulnerabilities in the brain of those with BPD when exposed to neutral faces. Years after I was hospitalized twice in the same facility, I requested my records — and discovered that “borderline traits” was part of my diagnosis, alongside bipolar disorder.

I denied that I had borderline traits for years. After all, any manipulative behaviors I engaged in had stopped in college. I’d ceased to self-injure, although that particular behavior would return in graduate school. I chalked my association with BPD up to “youthful psychiatric indiscretion.”

Before I go any further, I’d like to refer to the National Institute of Mental Health’s definitions of what BPD is (link). The NIMH page lists the DSM-IV’s (DSM = Diagnostic and Statistical Manual, found on pretty much every psychiatrist’s bookshelf, if not their desk) official criteria for a diagnosis about halfway down the page; because I, and even the NIMH, who has pulled their support for the upcoming DSM-V, have doubts about the validity of the DSM, I will refer primarily to the NIMH’s opening paragraphs:

“Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

“Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.

“Most people who have BPD suffer from:

  • Problems with regulating emotions and thoughts
  • Impulsive and reckless behavior
  • Unstable relationships with other people.

“People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.”

Did you see the part about how people with BPD have brief psychotic episodes? If someone had heard of BPD before, do you think that this symptom, which is mentioned in the very opening of the page, is what they were thinking about?

The brief psychotic episodes under stress is what happens to be, along with self-injury, my primary symptom of BPD. This is unrelated to the fact that I have schizoaffective disorder. When I have a psychotic episode due to schizoaffective disorder, the episode lasts for weeks, or if I’m particularly unlucky, months. When I have a psychotic episode due to BPD, the episode lasts for hours, and is usually gone by the next day.

If you need a refresher on what “psychotic” means, i.e. not “homicidal maniac,” please refer to my series, What I Talk About When I Talk About Psychosis.

It means that I can be running late to something, arrive, have one or two more stressful-but-minor things happen to me, and wind up crying in a conference room because I think that the government is trying to invade my brain with rays spread by a man whom I saw carry computer parts up the elevator — and be totally fine four hours later.

It means that I can be at the office, feeling “normal” stress from a workday, and start hallucinating phantom creatures running around by the kitchen.

I am not a manipulative person. I am not “that evil girlfriend.”

And yet Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder is one of the most popular books about BPD in publication. Apparently, C has to “take his life back” from me. Poor guy! Read any one of the reviews about any of the most popular books about BPD, and you, too, may be convinced that people with BPD are to be avoided at all costs. Many psychiatrists and therapists will not treat patients/clients with the BPD label attached to them, due to their reputation as “troublesome” clients who will stop at nothing to manipulate anyone and everyone in their lives. Threatening suicide! Going to the ER more than once!, etc.

Stigma does not help anyone with a mental illness; it especially does not help those prone to suicidal impulse or, as the NIMH puts it, “[completion].”

And that’s my coming-out story.