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.  🙂

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Mind Reading

In some past DBT sessions I learned that I ought not mind read, because nobody can read minds and I’m getting it wrong anyway, making myself miserable. But I beg to differ. It is possible to read minds. My mom can. You don’t believe me? Because nobody can read minds? Well, trust me, she can. And does. Now don’t get me wrong. She’s not a psychic, nor has she swallowed a Magic 8 Ball and I’m quite convinced that she can’t read people’s minds at random. (Reassuring, isn’t it?)

That said, she still IS a mind reader. And whose mind does she read . . . ? No brainer. Mine. And while she gets it wrong now or then, the times when she reads my mind only too well outweigh those errors. Massively.

For example with any given silly thing one could get up to, there is a certain probability that I won’t do it:

With a likelihood of 95% Lola won’t use that blade on herself.

With a likelihood of 75% Lola won’t dissociate in the supermarket.

With a likelihood of 30% Lola won’t feel rejected when the answer is no.

With a likelihood of 82% Lola won’t resort to inappropriate, suggestive behavior.

With a likelihood of 99,8% Lola won’t try to kill herself.

Just the same that leaves us with a certain probability that I will. So considering the above things, there is a 5% chance I will cut myself, a 25% chance of dissociating next to the fruit display, a 70% chance of feeling rejected when turned down, a 18% chance of behaving inappropriately towards others and a 0,2% chance of a suicide attempt. And that’s only a small sample of all the things that I might or might not get up to.

The mind reading comes in REAL handy here. I don’t quite know how mom does it, but she usually knows what I’m up to before I’m up to it. For example she lets me roam the supermarket aisles freely on most days, but some days are ‘hands on the cart’ days or ‘no chatting up strangers’ days. Similarly on most days the kitchen knife drawer is unlocked. But then on other days it’s locked. Plenty of knives when I don’t plan on using them, but real hard to come by one when I feel like I need one. Creepy when you think of it.

She also knows what I want to say before I even say it. Like this morning. Picture my mom in the kitchen and me dragging my feet down the stairs. I walk up to her, look at her and she looks back. I still think about good reasons for asking her to cancel my doc appointment and she already raises her eyebrows and shakes her head no. I ask “What?!”, indignant that she anticipated the question, and she just smiled and replied “It’s not negotiable, honey. We agreed on it, you and me both. I’ll help you if you feel stressed, but we’re going.” Me, I mutter: “Make me and I’ll hurt myself”, to which she simply replies: “I love you and we’re going. Would you like toast or cornflakes?”

On another day this whole conversation might have taken a different turn, she might have taken my threat seriously or we might have even stayed home. But today she knew I was just talking and not really too stressed to go nor going to hurt myself. She also knew that today I wouldn’t feel rejected over her turning my request down. Not to speak of the fact that she knew what I meant to ask in the first place.

So I’m going. Stupid mind reading. At the same time, if I am honest, I couldn’t feel more happy. She notices what’s up. She cares. She’s paying attention. She understands. She loves me. And she won’t make me do things when I can’t do them. Because she can tell when I can’t. Though the flip side is that she makes me do stuff when I actually can. So I guess I’m off to some stupid health exam. Whatever. See ya.

Borderline and self-awareness, self-confidence and self-esteem

I grew up believing that there is nothing I can do well. The only thing I believed I was useful for was to give other people sexual pleasure. That’s sick, obviously, because I was a child.

Awareness of who we are grows through the kind of feedback we receive about ourselves. As a social species we use others as a mirror to see ourselves. By how they react to us, verbally and through behavior, we draw conclusions about ourselves.

My mother was unable to be a good mother. My needs usually went unmet. She was unpredictable, angry and often aggressive towards me. I concluded I was unimportant, unlovable, unable to do something right and that I deserve punishment just for being there.

My step-father’s interest in me centered solely around the sexual abuse. If I didn’t do what he wanted me to, he became violent. My mother often said that she only kept me around because I had made him “addicted” to me. I concluded that I had to earn my right to exist by making myself available for abuse.

At school I got held back because I did not learn. Teachers used to say that they are not sure that there’s anyone actually at home inside of my head. “The lights are on, but nobody’s home.” I concluded that I must be really dumb.

In the institutionalized years that followed people became annoyed with me very often after what had always looked like promising starts. I concluded that I may look worth saving on the outside, but that there was nothing inside of me that would keep anyone going.

As you may imagine, my self image was real bad. I didn’t like myself. Like, at all. The feedback I had received painted a very unlikable picture of me and I was convinced that it was true. Because as a social species we tend to take social feedback seriously.

Unfortunately we’re also not born with a way to tell whether the person who reflects an image of us back through feedback is a good mirror, or one right out of a fun house. Imagine you had looked into a distorting mirror all your life. How would you like the way you looked? And if you had grown used to always looking a certain, distorted way in the mirror because you never saw yourself in any other mirror, would you believe the reflection if it suddenly were different?

I went through a lot of unhappiness and trouble with the positive feedback I received after I met my family and came to live with them. Lots of fear that once they discover how terrible I really am, they will want to have nothing to do with me anymore. In lots of ways I have tried to force them to hate me and be repulsed by me. Sometimes I could not stand their presence. At the same time I am and always was mortally afraid of losing them. But I wanted to have it happen, because I was convinced that it was what I deserved and what was going to happen anyway. When things don’t match up, when everything is a mess, when you don’t know who or what you really are or are not, that’s what happens.

Lots of tears, tantrums, hugs, yelling, cuddling, passionate hating, ardent loving and most of all lots of patience later, I am pretty sure that my “self” I have been aware of, was really not very realistic but just the reflection of other people’s mental issues. I don’t feel horribly unlovable, useless and dumb anymore most of the time. I am starting to allow the thought that there are things I might be good at, that I can be a kind person who others like and some even love. That this is not just some con act, but actually part of who I am.

At the same time I do not have a lot of practice thinking those things and old habits die hard and I have moments where I get very confused and find it hard to assess who I am. What I am. What I can. That I am important to someone.

It helps that my family are aware. Sometimes my mom sings the Lumineers’ “Ho Hey” chorus to me. You know, the “I belong to you, you belong to me, you’re my sweet-heart” part. She does it just because. Just because she wants to. I really like that because it feels like she means what she sings and wants me to know.

What also helps is actually DOING something useful. I have started volunteering at my mom’s former psychiatric ward. She used to be the head psychiatrist there or something and it’s a kids ward. That they know my mom and trust her judgment is probably the only reason why they agreed to let me volunteer. Anyway, I am going there once a week to just be with a little girl they assigned me to and play. To just do normal stuff with her, so she gets to just play and relax and laugh. We’re friends. She loves my long blond hair and says that when she grows up she wants to be just like me. I always laugh and tell her to pick someone else to be like, not a girl who’s way too old to not have an education and stuff. But deep down I am starting to think that maybe it’s not the worst thing. Being me, I mean. Maybe not by everyone’s standards, but my own standards are modest. Or maybe not modest, but different. But my life is different from that of many other people, so what do I need their standards for, right? 😉

I think finding the right mirrors for myself and the right standards to assess my behavior and my “self” with is one of the keys for a better and more realistic awareness of myself and for becoming more confident and stuff. Also, it helps to actually DO things that I can then assess. After all, staying on the borderline isn’t much fun. Lines are narrow. Borders are boundaries. And while boundaries are not necessarily bad, I don’t want to live ON them, but within them. And maybe sometimes beyond. In a good way. And a feeling good about myself way.

So that’s where I want to get. Slowly but surely.

Ear Acupuncture Experience

So I summoned all my courage and went for an ear acupuncture appointment yesterday. I had already met the lady at a previous appointment, where she did all the explaining and stuff. I have some pain issues that need dealing with, but I am really 100% NOT fond of doctors and physical examinations. Besides, I already know that there is no strictly physical reason for the pain anyway. So what appealed to me was the possibility to try and treat the pain with no physical examination other than examining the ear and getting the acupuncture done. Anything that I can do fully clothed and that that doesn’t require people to touch me all over is a good thing in my book.

The downside was that the lady already told me that the ear examination and the acupuncturing does hurt a bit. She said it’s an okay to tolerate kind of pain, but still. So I was quite a bit nervous and felt very brave that I decided I want to give it a try nonetheless.

Mom went with me (of course, because without her I don’t go anywhere anyway, LOL) and it was good to have her along, as it soon turned out. Anyway, we went in and first the lady asked stuff like was I feeling alright today and did I still want to give it a go and did I want to have some tea. I said yes before the courage left me, but no to the tea, because I couldn’t focus on anything other than the acupuncturing anyway.

The first challenge was to lie down on the treatment table. I really don’t like it very much at all to be lying on my back in such an exposed spot in the presence of other people. So very quickly I felt like I didn’t want to do it after all and mom asked the practitioner lady to give us a moment alone in the room. The lady was quite good about it, told us to call her when we were ready, and went to the other room.

That made the lying down part okay. With only Mom around I’m good. So I lay down and got halfway comfortable. I also held on to Mom, just, like, you know, in case. After a while to get used to the awkward situation, I was good enough that mom could call the lady back in.

When she entered the room again she was carrying a blanket and gave it to mom. Somehow the lady had the good sense to stay away from the table while mom covered me, so that was good and I felt okay. Mind you, far from calm and relaxed, but okay enough that it was tolerable. So it was time for the ear examination part.

During the examination the practitioner lady poked the acupuncture points with a slim rod, one after the other, asked me to tell her when a point was tender and painful to poke, and made notes which points those were. That part was surprisingly okay. Mom was still by my other side, held my hand and smiled at me and while some points were quite painful, it was in the “ouch!” way like pinching, not real bad. And it was also okay because it didn’t require a lot of touching, besides the ear.

Then she was through with all the points and got the needles. What I liked was that she went real slow and asked me to tell her when I was ready. For a moment I panicked, because I didn’t want her to pierce me with a needle, even if it was a really thin one. It was good that mom was there and helped calm me down, reassuring me that I was in control and that if I didn’t want it to happen, nothing was going to happen, and all that. Which helped. And I figured that if I can cut myself with a razor blade, I can probably take the pain from the thin needles, too.

So the lady went ahead and first placed a needle at a neutral point, which didn’t hurt at all. I felt it, but it was not painful. She said that’s how neutral and healthy points feel and said the others will be more painful, because those are more active. And yeah, they WERE more painful. A very weird kind of pain, sharp and piercing, but surprisingly it didn’t feel like I needed to flinch or pull away. The lady asked me to focus on breathing out while she placed a needle, and that helped. She also waited until all the pain had subsided before placing another needle. So one by one, she poked ten needles into my ear in total, including the neutral one.

Then I needed to lie and wait for 20 minutes, during which the lady left me and mom alone again, but stayed within calling distance and checked in twice to see if everything was alright.

The waiting part was weird. Not painful at all anymore, which was good, but it was weird to be lying on the treatment table, waiting for time to pass, knowing ten needles were sticking out from my ear! LOL! But it was okay. Mom told me a silly little story and held my hand and stroked my hair and the wait ended up not even feeling all that long.

Taking the needles out was a bit painful again. More so on some points than on others. Some points wouldn’t even let go of the needle the first time around, so the practitioner lady left those a little longer and tried again until they would yield. Quite weird. I have no idea what inside the ear would be able to hold on to a needle, but some points definitely did!

Anyway, that was the whole procedure. Once the needles were out I could get up again and we were on our way home. At night I could still see the points where the needles had gone as red little dots, today they have mostly disappeared, but my ear still feels a bit tender and sore to the touch. Other than that, I feel fine. And a bit proud of myself that I went without much fuss and without drama!

If the ear is fully back to normal by then, I’ll go for the second appointment on next Tuesday. I really hope it’s going to work and will help against the pain! I remained pain-free yesterday, so that was a good start!

To This Day ~ a beautiful, powerful video-poem

Just found this on youtube. Loved it and wanted to share.

Situation #1739 I can not cope with

Hello everyone. I have not dropped off the face of the planet. I just haven’t been in any mind to blog. Situation #1739 I can’t cope with is when mom is sick.

Last Thursday my mom came down with a stomach bug, right away, early in the morning. It was nasty. I panic when mom is not her usual, healthy self. Not just feel annoyed or unhappy, but serious panic. I start to worry that she will die. That she will be unable to be there for me. Like, ever again. I feel like I am going to lose her. I know it’s unreasonable, but my emotions don’t care and react anyway.

So when mom started to be unwell, I went into panic mode. Mom said she needed me to be a big girl. And I think I managed, after a fashion. Biggest three year old ever. Crying and refusing to leave mom’s side, unable to focus on anything other than the fact that mom was sick. Helpless, afraid, alone, abandoned, angry, panicky… Not pretty.

Stupid stomach bug is hanging on like for dear life, the fierce fucker. Fifth day now, and mom is still struggling with it, but at least she is better than during the past days. And my sister came home on Friday to help take care of things at home a bit, which helped. But it was still a horrible weekend. Awful bug. I really can’t cope with mom being sick.

PS: thanks for the comments everyone. I’ll reply once mom is better and I am in right mind again. Or in whatever resembles my right mind the closest.

Personality

Over on Wikipedia personality is defined as “the particular combination of emotional, attitudinal, and behavioral response patterns of an individual.” I must have read that sentence thirty times now and kept trying to figure out if I have a particular combination of emotional, attitudinal (is that even a word?) and behavioral patterns that make up my personality.

If so, does having a personality disorder mean that is it faulty? Broken? Defective? Or that it got lost? Or was never even there in the first place? For all I know, I might just be randomness in human form.

I just spent some time over on YouTube watching videos of young people who vlog or upload videos of themselves singing, doing stuff, sharing their opinions, anything… They seem to have no lack of personality. Most people don’t seem to. I can see their personalities quite clear. But my own? I draw a blank. Like I don’t even really exist outside of the moment, changing with it, constantly.

I wish I didn’t find myself so hard to grasp. 😐

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