How do I tell someone I think they have Borderline Personality Disorder?

Borderline Personality Disorder - Winona Ryder and Angelina Jolie in Girl, Interrupted

BPD anyone?! – Winona Ryder and Angelina Jolie in “Girl, Interrupted”

This is one of the questions I get asked a LOT. It’s also a search term that leads people to my blog a lot. “What can I do when I suspect my friend or someone I otherwise care about has BPD?” or alternatively “How do I tell […friend’s name…] that I think s/he has BPD?”.

So I am going to write about that. That said, I do feel a bit overwhelmed with the question, because I feel like it is not my place to give people advice on something that can potentially have an effect on other people who I don’t even know, which is why I put this post together with the help of my mom (not the dysfunctional mother I grew up with, I might add, but the mom who’s my mom now, after adopting). She is a psychiatrist. Not my psychiatrist, obviously, because that would be just weird, but that’s her profession anyway. So she knows what she’s talking about and I feel more confident doing a ‘how to’ piece on this matter having discussed everything with her first.

So here we go: How do I tell someone I think they have Borderline Personality Disorder?

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1. Diagnosing someone is not a layperson’s call. Psychological conditions can be tricky. Symptoms overlap. It can be hard to diagnose someone with the right thing even for trained professionals whose job it is to know ALL the symptoms of ALL the disorders. Unless you are a trained professional who is seeing this person in a professional context, you can not diagnose anything and even if you are convinced BPD is it, you might be awfully wrong. Even professionals can get it wrong – and so you can, too. Always keep that in mind.

2. Before you tell anyone anything, stop and think about yourself for a moment. Why do you want to suggest to someone they might have BPD? Why is it important to you, if you are completely honest to yourself? If the answer to that is anything that comes from a place that is not solely genuine care and concern and love for the other person, then you are about to start off into an unhealthy direction anyway and should not go ahead with it. If there is anything at all that causes you to get own positive feelings out of telling someone, then stop reading right now, get the idea of telling the other person out of your head and start to deal with and take responsibility for your own feelings that put you on this path instead.

3. Keep in mind that self harm is not BPD. I have seriously seen people who thought that everyone who self-harms must automatically have BPD. That is totally not true. If your only clue is that someone self-harms, then you have an extremely thin case to go on and should not go ahead suggesting s/he has BPD at all.

4. Do not drop a label on anyone. If you carefully considered all of the above things and still feel like you want to let someone know you think they have BPD, then consider now that dropping a label on someone can be extremely harmful. Borderline Personality Disorder is a label with a lot of stigma attached. How would you feel if someone suggested you have something that people generally feel strongly and very negatively about? Therefore going ‘hey, I’m quite convinced that you have Borderline Personality Disorder’ is a really bad idea. After all if you come from a place of genuine care, concern and love – which is the only case in which you should still be reading this – you do not want to freak anyone out or harm them, or do you? Therefore you should be extremely cautious with dropping labels. Properly inform yourself instead and learn all you can about what BPD is and what it not is before you proceed.

5. Check if your relationship is one where suggesting someone has a psychological condition is appropriate. That’s a biggie. Are you a concerned friend or partner? Then you’re probably good. Are you just a co-worker, classmate or an acquaintance? Chances are it’s not your business to get so intimate with someone as to suggest they have a psychological problem. Are you a mother, father, sibling or other relative? Please go back to #2 and re-assess it. Carefully. Family – especially family of someone who might have BPD – is often a playground of hidden agendas, underlying power or mind games, wanting to tell someone for the sake of feeling superior or making the other feel inferior, etc. If you feel like you’d get any kind of personal satisfaction out of telling your family member they have BPD in the guise of being concerned, then don’t go ahead. If that is the case it’s quite likely you have just as much of an issue as the person you suspect has BPD and speaking up will only end up in your respective issues playing off of one another in an unhealthy way. Suggest you as a family have things going wrong instead and try to find professional help for the family as a whole – yourself included.

6. Always present what you are suggesting as your own opinion, because it’s not a fact and you might be wrong. If you have come this far and still want to go ahead, before you say anything at all, be aware of the relativity of your perception and thoughts. Even when you feel very convinced that you are right, you might still be wrong. What you are about to say is just a suggestion based on your own impression and opinion. State it as that: a possibility, not a fact.

7. Suggest it in a helpful and respectful way in a suitable moment.Suitable moments are moments where everyone is calm, when there is enough time to talk, even if it should turn into a longer talk, where you feel reasonably close to the other person and where you can make very clear that genuine care, concern and love is the place you’re coming from. Never talk in a place where others could overhear you, because that makes people generally uneasy. Suggesting something in a helpful and respectful way includes asking if the other person wants to hear your thoughts. You could say something like “I noticed you are struggling with a couple of things and I feel sad for you, which is why I am wondering if you would like my opinion/thoughts on it.” If you are actually friends and your friend or partner feels safe and positive about your relationship, chances are s/he will want to hear your opinion or thoughts. If s/he does not want to hear it, respect it, because if your thoughts are not welcome to start with, your thinking they have BPD is probably not going to go down well either.

8. Don’t say it in a way that suggests they have a bad personality or are a damaged person. If your thoughts are welcome, be careful to suggest your suspicion in a way that does not make the other person feel awful about herself. BPD is not a death sentence. It’s not a terminal, unalterable thing. It is simply a pattern of unhealthy ways of relating to people and the emotional issues that cause it are treatable. BPD isn’t the result of someone being a bad person either, but most of the time it’s a perfectly normal person who has experienced things that were really hard on him or her and made it necessary for her to develop these now unhealthy strategies to live their life somehow. Oftentimes they have survived things you have not and that’s something that deserves respect, not making the other person feel bad for themselves. That the ways of feeling and thinking and the behaviour are maladaptive now in normal contexts is all that is wrong, and that can be very hard. But there’s treatment available, people with BPD can be good people. Don’t feed into any misconceptions about BPD. And don’t use judgmental language and vocabulary.

9. Be prepared for the consequences. Even if you suggest it out of concern and love in a respectful, helpful way you might still trigger a response you didn’t want to trigger. The other person might get defensive. Or angry. Or sad. Or desperate. Or discard what you said. That you felt you needed to suggest to them that they might have BPD might temporarily damage your relationship. Or permanently. Be aware of that. If you are right about your suspicion, then the other person having BPD means that her relationship patterns follow their own dynamics to start with and those might include effects you didn’t want to cause. There’s little you can do about it. Knowing your own boundaries, staying calm yourself and not taking the response too personally (if you were actually coming from a place of concern and did not follow a hidden agenda) are the best things you can do. Ask if there is anything you can do for the other person. Be there for them if they want to. Give them space if they want space. You can’t force anything upon them.

10. Leave reacting upon it or not to the other person. You might think the other person should seek help, but whether or not they do it is their decision. Keep in mind that you have been thinking about the whole issue for a good while now, but to the other person your suggestion has suddenly caused a new situation. They might need time to think. They might come to a different conclusion than you. And that’s okay. You can point out options regarding what can be done, but no more. The rest is up to them. Respect their reaction. The only case in which you should intervene is if their reaction poses an immediate danger to themselves or other people. Everything else and they’re good, even if you don’t agree with it.

~ ~ ~

So much for my suggestions about how to deal with telling someone you think they might have BPD. My mom and I did our best to try and consider all the aspects. We hope you find it helpful and wish you all the best. Feel free to let me know what you think.  🙂

In hiding

Hey there, y’all, and thank you for your comments. I just want to say that I’m not ignoring you, but rather I’m in hiding today. The last couple of days took a strain on me, more than I realized probably, and I’m unwell today, physically and emotionally. So I’m recovering from recovering or something. I don’t know. I hope tomorrow will be a better day.

No right to feel bad

I’m feeling increasingly crap these days. I’m having a much harder time eating. I don’t sleep through the nights anymore. I’m even more touchy than I usually am. I spend a large part of the day crying. Small things set me off. A constant feeling of trepidation closes in on me. It’s really unpleasant. It exhausts me. I feel bad.

And at the same time I am terribly reluctant to post about it, because I feel like I have no right to complain or even feel a little bit bad at all. I’ve been reading blogs of people who really struggle. So much they don’t want to live anymore. That’s serious. And while I have had flirts with the feeling, I’ve never been that bad. Depression isn’t so big a part of my lucky bag of mental health conditions.

I also have a mom who’s not working, but is only doing the household and helping me get better, a dad who earns enough that the family is nowhere near financial want and siblings who are quite understanding and don’t look at me funny (most of the time) when I am being difficult. I really lucked out with the life I have now. I feel awfully guilty for struggling. Guilty for not being better. Angry at myself for wanting to write that I’m not feeling good, because it’s illegitimate. Because it only shows how ungrateful I am. That I don’t deserve any of the good I have. I feel like a sham for saying I’m struggling, even when it’s true, because I’m just too thin-skinned and have no right to feel sorry for myself.

That’s how it feels. Like I ought to be ashamed of myself for even writing this post. Like I should give my life and the good things I have to someone who would use them. Not whine, or struggle or feel bad despite everything. It makes me want to hurt myself and punish myself by NOT doing it at the same time. Because not doing it is more torturous. Which I deserve.

Feeling awful and guilty about not feeling bad enough, yet considering it bad already. I kind of notice it’s a sick and twisted thought, but I can’t get rid of it.

I can’t think

Just what the title says, really. I can’t think. Since days I feel like my ability to think is getting slowly snowed in. Just now my mom asked me how I would feel about going to the mall later today. And what does my mind do? It goes “mall . . . mall . . . mall . . . shopping . . . mall . . . do I want that . . . mall . . . “ and that’s it. Insert me pulling the thought back up from a black, sticky bog every time you see the tree dots.

I want to pull my thoughts together so bad, but it’s so hard. Has gotten increasingly harder for some days now, actually. Same with writing for my blog. It takes me so long to write a post, it’s ridiculous. Whenever I think I have found a good thought, it slips away again, back down into muddy, murky waters and I have to stick my arm back in and grope around in the dirt until I get a hold of it again and can pull it up for another brief moment to look at it.

I guess it’s some kind of dissociation going on. Or maybe not. I don’t know. I want it to stop.  😦

Feeling inadequate

 

Feelings of inadequacy are something I continually struggle with. Whatever I do, I can’t help comparing it to what other people do and feel like I don’t measure up to that. I use other people’s reactions as gauges too, and somehow they never (seem to) react as positively to me as they do to others. And if I do, by exception, get a positive feedback, I only wait for it to go away again, for the other person to see she was wrong.

My conclusion is that I must be stupider than most people, with less interesting things to say, less abilities, less charms, less charisma, less personality, less value and less worth. That whatever I do, I will only ever be at the bottom of the pile. That there I have an aura of ‘she’s laughable, ignore her’ around me that other people will recognize before long. Even when I compare myself to other people with mental health problems I come off badly. Like even by those standards I am inadequate.

Sometimes I wonder if those feelings are the direct result of rejection and abandonment. My mother cut ties from one day to the next, surrendered her parental “rights” (burdens) and that was that. I meant nothing to her. She jumped at the first chance to get rid of me. And while I know – in theory – that that says more about her than about me, my feelings are not as easy to convince. Even as a daughter I was inadequate. So much so, that my mother, who I had lived with for 15 years by the time, didn’t hesitate to throw me away like trash.

I guess that is probably why I can’t get past feeling inadequate. Why whenever I compare myself to others, they come off so much better. Why so many things come across to me as evidence that people think badly of me and wish I wasn’t bothering them, even when I try to be nice and helpful. Then I withdraw, because my feelings are hurt and at the same time I don’t want to bother them with my presence anymore, knowing they will be happier when I’m gone. And if someone wants to reconnect, I make it hard for them. Turn them down. Try to drive them away and alienate them with all my might. Make them hate me. To validate the way I feel, and to keep myself from getting hurt again. Unless I am beyond caring and offer myself as a willing victim for whatever it is they think I deserve. Easy prey.

The results of feeling inadequate.

Having BPD and dealing with the world – dos and don’ts as I see them

After yesterday’s post about dealing with someone who has Borderline Personality Disorder and vwoopvwoop’s clever questions about people with BPD who are not actively trying to heal, I started to think: hey, yeah, it’s important to know what’s helpful when dealing with people with BPD, but the other way around it’s just as important. What works and doesn’t work when you *have* BPD and need to deal with the world. Or more specifically, with the meaningful people in your life.

So I figured today I’d summarize my own personal take on what helps with dealing with the world as someone who has BPD. Again, they are only my personal experiences and everyone is different, but in case it might help someone else, too, I’ll write it down. 🙂

  1.  allow healthy people into your life – it made one hell of a difference for me to be able to watch healthy behavior up close. People who model healthy coping strategies and healthy emotional regulation skills in perfectly normal everyday situations. People who treat each other respectfully, who communicate well and who are healthy, functional adults. If you have the chance to allow such people into your life, do it. Surrounding yourself with people who are equally screwed up, or screwed up in different ways on the other hand isn’t the smartest plan. Consider reducing or even discontinuing contact with people who add too much negativity, trouble and crap to your life.
  2. commit yourself to your own recovery – while there is help available, and support is important, too, nothing and nobody, no therapy, no pills, no other people and no circumstance can make you better if you are not committed to getting better. Cancel “I’d be better, if only…” from your vocabulary and stop comparing what you do to get better to the effort other people in your life make. Instead of making excuses for why you don’t work on yourself, figure out ways to stay motivated. Personally I like to compare it to all those pro-ana people with anorexia, who commit themselves wholeheartedly to not eating. That’s the kind of willpower I mean. Only instead of directing it at something stupid like making yourself more sick in order to feel better, use this kind of commitment for a useful goal, for true recovery. Do things that help you stay committed. Blog. Journal. Art. Anything that gives you inspiration will work.
  3. educate yourself about BPD – knowledge truly is power. Become your own expert. Learn about BPD as much as you can. Find out what parts apply to you. Everyone’s BPD looks different. You are living with it, so you might as well know what exactly it is. Educate yourself about as many angles on it as possible. There isn’t just one point of view, but many. Find out which ring true to you, which opinions about BPD you share and which you don’t share. Don’t rely solely on what doctors or therapists tell you, but form an own educated opinion, and always keep your mind open to learn yet more.
  4. learn about the biology behind BPD symptoms – what has helped me a lot was getting those things explained to me. How past experiences have shaped my brain, have altered my biochemistry and what happens to the brain when I stress, when I am calm, why it is, on a biological level, impossible for a brain to learn when it is stressed, all those things. Understanding what the brain needs in order to make new connections helps with telling useful attempts at recovery apart from unhelpful ones, and generally eases the guilty feeling somewhat. It also helps to know that a brain is capable of improving its own biochemistry according to the experiences it makes, like the effect a pill has – not as quickly, but without the side effects and with a lasting result.
  5. understand your symptoms – behavior has meaning. Simple as that. If you have BPD you don’t behave in unhelpful ways simply because you’re sick, but because the behavior is motivated by something. Chances are, you wouldn’t have wasted energy on behavior that was not useful, once upon a time. It can help to find out what the original use was. Often I still react in ways that were useful in the context the behavior originated in, but are no longer useful now. Trouble is, the brain doesn’t know that. So to find out what motivates your behavior helps. Personally, I found out that fear is at the bottom of LOTS of my behavior. Doctoring around at the behavioral level can work short term, but it helps me a lot more to be aware of the level below the behavior and to try and make changes there.
  6. learn about (healthy) childhood development – the way I understand BPD, it is a very early relationship disorder. Which means it is influenced a lot by childhood experiences with caregivers. Learning as much as you can about what kind of experiences children need in order to form a secure attachment helps with becoming better at recognizing the many faces of neglect and childhood trauma. It can happen in families where there is no open violence, no open neglect, nothing tangible at all. Understanding exactly what you might have missed out on as a child can help with understanding your BPD symptoms now. It can also give you ideas what you might need in order to overcome those symptoms.
  7. communicate openly with the people in your life – I know this one can be a hard one, and it’s something I continually struggle with, but each time I am successful it works wonders. Talk about your BPD symptoms, about where you are at, what you are trying to do, what you find hard to deal with and why, and maybe most importantly what you feel. I have found that often my BPD behavior has communicative value. I lash out at someone because I am hurt or disappointed or angry or confused or scared, but often I don’t say it but just put that person in the “you’re mean, you caused me emotional pain, so go to hell!” category. Saying what’s up instead is more helpful. I often don’t manage to do it in the situation, but doing it afterwards when I am calm again often works. It also helps with working together towards the same goals, instead of playing tug-of-war.
  8. be aware of what works for you – everyone ticks differently, so there are no general solutions. Finding out what works for you, personally, and why is important because you are the only one who can tell.
  9. try to put yourself in the shoes of others – it’s an important skill to have, so practicing to see things from other people’s point of view is a good thing. Living with someone who has BPD is hard. Being able to see how BPD behavior looks from their end can be quite insightful. I find it helpful to practice this ability by randomly trying to figure out how the world might look from the eyes of others. Quite literally, by imagining what the other person sees from the point of view he has, but also figuratively by considering the background and experiences this person has.
  10. be aware that you are going to make mistakes – lots of them, even. And since they are unavoidable anyway, you might as well use them to learn. Take time to analyze them. Why didn’t it work? What went wrong? What do they say about yourself? Any ideas to make it work better the next time around? Mistakes are only mistakes if you make no effort to learn from them. If you learn from them, they are not mistakes, but just another part of getting better. And yep, maybe you are going to make the same mistake a hundred times before you have learned all you needed to learn from it.
  11. be patient – it’s going to take time. It’s not going to be a linear learning curve. Good phases will be followed by bad ones. There will be improvements and setbacks or times when you feel like nothing is moving at all. It’s not because you suck, because that’s simply the way learning works. Who knows what happens inside of yourself while you see no progress at all or even a setback. As long as you stay patient and keep on learning and trying, you are still on track.
  12. try to find more healthy alternatives – appreciate your BPD behavior for what it is: attempts to cope with life, with feelings and with relationships. Try to figure out what kind of coping each behavior provides you with and then try to find healthier alternatives.
  13. look for and accept help and support – the journey towards recovery is hard and rocky and if I were all by myself, I’d probably get lost. What kind of help is beneficial is probably a bit different for everyone. Not every therapy is for everyone, psycho-drugs are not for everyone, family is not for everyone, friends are not for everyone, support groups are not for everyone, etc. Figuring out what kind of help is good for you is important.
  14. make good memories and take time to enjoy the things about you that are perfectly normal – just what it says. Making good memories and enjoying everything that’s healthy about me is a good way for me to keep perspective and a positive outlook. Not everything is terrible and hard. Having good and healthy fun along the way helps with keeping me going.

Okay, so far so good. That’s all I can think of now. If you have thoughts or want to add something, please drop me a comment! 🙂

Sex from the perspective of my troubled mind

I have been avoiding this topic, because it’s triggering for me, but I feel like I am in a good place today and it’s been on my mind lately. So I figure since it is a vital part of my struggles, I’ll write about it. The good thing about writing myself is that I’m in control over what I write. Even so, there will be mention of some unpleasant aspects of what is part of my sex experience, so if you are sensitive to that, please read with caution and stay safe.

Okay, so I guess what I’m writing about is what a sick puppy I am in regard to sex.

Sexual abuse was an ongoing part of my family experience growing up, and that’s all I’m gonna share about that for now, because I’m still uncomfortable facing those experiences more close up than just knowing they are there. What this is about is the mess I am in now in regard to sex. An inventory of where I’m at, so to speak.

When I’m in a good place emotionally, having a good day, I am not interested in sex at all. I don’t have sexual feelings, I don’t flirt, I don’t think about sex, don’t want to think about it. I even feel repulsed by it and like I’m going to be happy ever after if it never becomes a part of my life again. I shy away from thinking or talking about it.

When I’m in a less good place, however, it’s one very different story. Negative emotional upheaval is dangerous for me with regard to sex. I find myself nursing thoughts of sexual scenarios and they all include things that I feel repulsed by when I’m in a good place. Violence, humiliation, punishment, pain, getting used and dominated – that’s what I think of then, and what I get aroused by. It’s hard to describe it, because it’s not even a positive kind of being aroused, but a form of self-harm, I guess, similar to the desire to cut. Only instead of a razor blade, I go looking for destructive, degrading sex, because I feel turned on by it, even when that’s sick. Sex with repulsive guys, old lechers, creeps who are into sick shit, fantasies that involve family members and impulses to act upon them . . .  everything, whatever opportunity comes along.

I have come to a point where I don’t act upon those desire anymore, but it’s still very much there, and a really terrible thing, because being very sexually aroused yet knowing I mustn’t act upon my sick fantasies to stay safe is awful. And afterwards the shame and guilt and self-hate for feeling aroused by those sick scenarios in the first place is overwhelming.

It is one more reason why I really should tackle that stupid basement of mine, as I guess all the unresolved childhood trauma and the sick connections it left in my brain play a big part in this mess. I literally feel like two people about it. One side, the side when I’m well, wants to have nothing to do with sex, feels repulsed and everything and does not have any sexual feelings whatsoever. And the other side, when I’m unwell, gets up to no good in the blink of an eye, aroused by the sickest sexual shit. That’s a conflict that’s really hard to live with.

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