Following my last post, where I wrote about my recent BPD episode, I thought I’d clarify how Borderline Personality Disorder makes itself felt, the difficulties sufferers face, and the ways in which those close to them can help.
“The way I explain BPD to people is, ‘feeling everything too much’”
BPD is all about high levels of emotional sensitivity. I rarely watch a movie without tears springing into my eyes; I can’t stop myself acutely feeling other people’s distress. Growing up, I was always sensitive to melancholy and I’d sometimes get rushes of pure joy that made me feel I physically couldn’t contain that much happiness. When I think of BPD I remember this scene from American Beauty where Ricky shows Jane what he considers the most beautiful thing he has filmed: a plastic bag, dancing in the wind in front of a wall. He says capturing the moment was when he realized that there was “an entire life behind things”; he feels that “sometimes there’s so much beauty in the world I feel like I can’t take it … and my heart is going to cave in.” I know exactly what he means, and it applies both to the beauty and the ugliness.
While emotional sensitivity is genetically determined (some people are more emotional than others) those with BPD are among the most sensitive. Coupled with growing up in an invalidating environment, where feelings were responded to inappropriately or where emotional expression was punished, it’s like being in a runaway car with no idea how to bring it under control – terrifying.
Anyone experiencing this level of emotional intensity needs to learn how to regulate it and that’s where the problem lies for sufferers of BPD. Who can teach you? Most of us grow up around people with a considerably lower emotional baseline: say the average person’s emotional baseline is 20 on a 0 to 100 scale, then people with BPD are continuously at 80. No one else is accustomed to dealing with that level of emotion so not only are they unable to teach you the skills, neither can they understand what it’s like to experience it.
“The first thing they ask is ‘What’s the matter?’ and you can’t tell them because you don’t know.”
Often, the person with BPD can’t explain or doesn’t know what triggered an episode. This makes it difficult to communicate their needs to those around them until they’re right in the middle of one, and by then it’s ten times harder because of guilt and/or fear of recrimination. How can you effectively communicate when you’re at such a low ebb in your own level of functioning and belief in your abilities? How can you get someone to understand depression when they’ve never felt it? It’s as though a sheet of bulletproof glass stands between you – everything’s visible, but they’re insulated from the pain, and without understanding the pain all they see is apathy and self-pity. They ask for reasons – Why’s and How’s – and you don’t have any to offer.
To better understand BPD it helps to know how it manifests. According to Dr Marsha Linehan, people with BPD experience dysregulation in a number of areas:
- Identity — not knowing who you are, what your role is, being unclear on values, goals, sexuality, likes and dislikes
- Cognition — problems with attentional control and focus, dissociation, sometimes even brief episodes of paranoia
- Emotion — extreme emotional responses, especially with shame, sadness and anger
- Behavior — impulsive behaviors like suicide, self-harm, alcohol/drugs, binging/purging, gambling, shoplifting, etc.
- Interpersonal Skills — chaotic relationships, fear of losing relationships coupled with extreme behaviours to keep them.
“It takes a while to get back to normal.”
BPD sufferers have a hard time calming down. Research has shown they experience a slower return to their emotional baseline. To help someone experiencing a BPD episode, there are four things you can do:
- Ask what’s happened but don’t be critical if explanations aren’t forthcoming – the main thing is to have a dialogue.
- Listen, don’t contradict, judge, or accuse of overreacting.
- Find something in what happened that you can understand and relate to; say what that is. BPD sufferers are frequently made to feel their emotional response is wrong because it’s not the norm, your validation makes it easier to discuss.
- Ask if you can help, not to solve the problem but to get through the moment. BPD is extremely isolating, just having someone there unconditionally is a huge comfort. If they say no, give them space and remember the emotions of emotionally vulnerable people last longer.
BPD is not something you recover from – it’s something you learn to manage. Sufferers need professional help to learn how to cope. Through hard work and effort they can develop the skills for managing extreme emotions – treatment like CBT, DBT and Mindfulness are all areas to look into, but first you need a diagnosis. It took me many years to get diagnosed – I wrote a piece for Black Dog Tribe, a UK mental health organization, describing the journey – but once I got the treatment and support I needed it made a HUGE difference to my life. I probably wouldn’t be here today without it.
Author’s note, June 2014: Since the time of writing I’ve been re-diagnosed with Aspergers and Bipolar II. I no longer meet the criteria for BPD and given the existing cases of Aspergers and bipolar in my direct family I have to admit this re-diagnosis seems a more accurate explanation for my symptoms. Oh, the beauty of hindsight…