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.  🙂

How I Met My Mother

Not many people can remember how they met their mother. Just like them, I can not remember how I met my biological mother either. But I remember how I met MY mother. Mom. And this is what I remember:

I was living at a girls’ residential group at the time. I was sharing a room with another girl who didn’t like me. To be fair, I didn’t like her either. Or rather I didn’t like anyone, period. Everything sucked.

When my social worker knocked I didn’t answer. Didn’t have to because she entered after knocking anyway. No doors were to remain closed to staff. House rule. And when I say no doors, I mean NO doors. Whatsoever. Anyway, she came in and looked at me over the rim of her glasses – but only after she had given the newly-messed-up room a critical once-over.

“They’re here, Lola. They’re waiting for you.”

I remember that I shrugged. So what? So what if I had agreed to check out some family care project? I had changed my mind. I didn’t want to be part of anyone’s research study-crap. I didn’t want to be anyone’s guinea pig. So I looked the other way and pretended she wasn’t there.

The social worker grew impatient. I could tell by the way she inhaled dramatically, held her breath for a second and then let go of it in this sharp puff that said “you’re being impossible!” like that was news.

“If you’re not going to come, Lola, I will send them to your room! They didn’t come all the way out here for fun. You agreed to see them, so that’s what you will do!”

I didn’t care. Like I ignored my social worker I would ignore them. They would leave sooner or later. Being with people who didn’t talk was annoying, after all. They would try to be nice people at first, they would try to make conversation – in vain – and in the end they would look at each other, would realize their mistake and would be happy to leave and never come back.

Little did I know that this was not what was going to happen. At all.

The first surprise was that they didn’t enter together. I expected this middle aged couple, all prim and proper, suburban, well-off, being basically all the things that I was not, coming in to examine me like I was exhibit A at the Museum of Sad Deranged Individuals. That was what I was prepared for. And they would be getting quite a good show, too. Messy room. Girl with long blond hair and way too much dark makeup in skimpy clothes, forearms freshly slashed. To make absolutely sure they would see, I removed the bandages from last night’s wounds as soon as my social worker had left. Now, see, on another day I might have tried to please everyone, covered up nicely to be a pretend version of the ever-smiling good girl next door, but on that day the world was a black place and I was in a fuck-all mood.

It knocked again. “This is her room”, the social worker told them. “She’s waiting for you.” The exaggeration of the year.

Instead of entering together, this lady came in alone. I only glanced at her casually, and she was pretty average looking. A bit older than I had expected, but by far no granny. Shoulder length brown hair with some silver in it. A smile.

Scowling, I looked the other way. She closed the door behind herself.

“Hello Lola. I am Samantha, but most people call me Sam. It’s nice to finally get to meet you.” She looked around the messy room. “Can I sit down somewhere?”

I ignored her and stared out the window. An idiot-proof method to get rid of people.

“Say so if you mind I make room for myself and sit down on this chair”, the woman said and politely waited a moment before she relocated a mess of clothes.

Her nasty little trick hadn’t slipped from my attention. Instead of asking whether she may sit down – to which I would have remained silent anyway – she had put it the other way around: Speak up if you mind. Not too stupid. Which irked me. I kept on ignoring her, knowing this was a game I was better at than anyone else. So I simply waited. For her to try conversation starters. Several if she was persistent. But most of all I waited for her to grow desperate, irritated and finally helpless in the face of my passivity so she would leave.

But instead of saying something, she remained silent as well. I didn’t turn her way, but in the way you notice things from the corner of your eye I could tell that she was looking around the room, studying things. Studying me. Calm and collected.

“Honey, I don’t meant to be intrusive but those cuts on your arms are bleeding. You might want to have them taken care of before sitting here with me.”

As much as I would have liked to ignore her words, I couldn’t. I wasn’t aware the darn cuts had started bleeding again, but stealing a glance down I saw that she was right. So much for my genius idea of taking the dressings off of fresh wounds to go for the shock-effect. Shit. And she hadn’t even sounded particularly shocked. More like it wasn’t a big deal.

I shrugged and there went my resolution not to talk because some switch in me had just been flicked the other way. “So what?! Not like anyone cares what my arms look like around this place.”

Sam had looked at me and smiled a little. Friendly, but I couldn’t tell whether she was buying it or not. In hindsight I know the answer, but back then I couldn’t tell.

“How about we go and get them cared for?”

Have I mentioned that I am a sucker for attention and getting fussed over? Yeah, well I am. So once I had started down this road, I couldn’t resist. I ended up going to the nurse with her. Ended up talking with her. And quite unlike I had planned, I ended up liking her after this first visit. Or rather I ended up thinking she was the only person in the world who was good. My day had turned from black to perfect. Yay for idolization and all that. At least it made coming to live with her and her family a lot easier some weeks down the road.

Of course thereafter it didn’t take long until I got disillusioned. Hated her. Lots of drama. But we solved it. Loved her. Hated her again. Loved her. Hated her. And loved her. But it always ended with loving, even the bigger episodes of drama. And now she’s my mom. The greatest mom I could ask for. In a real way, not an idolizing one. Or maybe a little idolizing. But just because she is.

Mom&lola4

mom and me

Stupid heat and self harm scars

Okay, so in itself it is trivial. Or should be. People come with all kinds of skin. Different colors. Freckled. Hairy. Smooth. Uneven. My arms are stripey. Self harm stripey. So what. It shouldn’t be a big deal. I mean it’s just skin. And who cares what people think anyway?

Now some people who have scars on their arms from self harming, they actually like being out in the public in short sleeves better than being around family because the people outside are just strangers who’ll be gone soon enough and whose judgment doesn’t matter. The family’s judgment you have to deal with every day. That makes sense to me. Obviously when family don’t understand, that’s real hard.

In my case I’m lucky it’s not an issue at home. Everyone knows about the scars. Nobody looks at me in disgust or disdain or some other ‘dis’-word because of it. Even when I sometimes accuse them of doing so, they aren’t. Not outside of my head. So that’s good. I wear pretty much anything I please at home.

But outside. I hate it. I hate the heat. I hate that long sleeves make me feel like an arctic explorer in a scorching desert. And I hate short sleeves as well. I feel like everyone notices and stares and I feel like I’m being observed by everyone all of the time. It’s unnerving and real stressful. I used to be cooler about it, but that was before I loved my folks. Back when noting mattered. Now it sucks.

I just wish the heat would go away. I like summer, but the heat . . . I’d happily do without it.

Rant over, I guess. Kinda angry at the moment, so I better not write any more but get busy excercising self control and shit. Whatever.

Day After

The night was a restless one. Woke up countless times with my heart beating like crazy, frightened, feeling like someone had touched me, actually feeling the warmth of the hand that was there only in my mind. Woke mom, snuggled up with her and cried until I fell asleep again, only for the whole crap to start over soon thereafter. After many repeats got up feeling tired. Mom, too.

Now I’m feeling on the verge of tears all the time. Arms still wrapped up in bandages. Put some on Little Lola, too.

LittleLolaDayAfter

I think my little me feels the way she looks a lot of the time.

 

Self Harm Morning **Triggering**

SelfHarmIf you’re familiar with self-harm, you’ll probably tell what’s missing from the picture sooner than I can even type it. It’s a sharpener I found around the house. Minus the blade. Because a little earlier today, after breakfast, I gave the missing piece to my mom. And my day unraveled.

I don’t know what even happened, but I wanted to cut myself real bad. Or didn’t exactly want to, but felt like I absolutely needed to. Like I was going to implode or something if I didn’t. Pressure-control.

Mom hugged me and said she was proud of me for giving her the blade. She put it away. Said the sharpener blade is rusty and ragged already. Said if I absolutely needed to cut, she’d give me a clean razor blade, but can I think of alternatives? Can I talk about what’s up?

I couldn’t tell her because I didn’t even know what was up. I just knew that I wanted to cut. So I just cried and told her all I could suddenly think about was cutting myself. Just like that. For no good reason at all. Cause I’m just fucked up like that.

Mom asked me to take her through my thoughts with me, to tell her what I visualized when I thought of cutting, so she could understand better. So I told her that all I wanted to do was slice my skin open. Big, bad, deep wounds. Wreak havoc on myself. Real bad.

And then?, Mom asked. I hadn’t really thought about the ‘and then’ part, because my focus was more on the inflicting wounds part. But she insisted. What should happen then?

I thought about it and realized that what I really wanted to happen thereafter was for her to find me, all bloody and sliced open, and then to be concerned and take care of the wounds and of me. But I was too embarrassed to tell her and felt miserable because I thought about what a nasty, manipulative person that made me and how she should just leave me to bleed to death instead to teach me a lesson or something. Which made me want to cut even more. More crying. An attempt to shove her away by hurling insults her way. And did I mention more crying? A little screaming, too. Ugly and embarrassing.

Long story short, mom wormed my little fantasy out of me eventually. And said it’s alright. That’s exactly what she’d do if I cut myself. But also if I didn’t cut myself and how about we pretended I did, because it’s probably hurting bad enough without cutting anyway.

True, that.

So that’s what we did. Mom got dressing and bandages. Then she let me explain to her what I’d done to myself with the blade and cleaned, taped up and dressed the wounds according to what I described. No mockery. No derision. No making fun of it. She’s still behaving like I actually cut myself for real, keeping me close, making sure I’m alright, making sure I keep the dressing and stuff on.

I feel better. The pressure went down. I don’t feel like I need to cut anymore. In fact I feel like I did, except that I never have. Weird how the mind works. Strangest self-harm experience ever.

The ‘If I Were’ Game

I found the game in a self-harm workbook that I have. It’s an exercise to get a better idea of who you are, apparently. The rules are easy, you just try to figure out what you’d be if you were any of the following things. Here are my answers:

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If I were a politician I would be

the politician who wouldn’t get enough votes because she’d not care about the traditional policitian-y things, but would try to make positive changes for minorities like people with mental health issues.

If I were a pop star I would be

Pink. Because she gets it. And because she rocks.

If I were a film star I would be

Hm, difficult. Angelina Jolie, probably. Because she appears to be a wild child who eventually found a purpose in her life. I’d love to be able to say the same about myself.

If I were in a soap opera I would be

the character who’s adding the drama, or the misunderstood misfit. I can play that role perfectly.

If I were a writer I would be

the writer who never dared to publish a single book, because she’s consumed with self-doubt.

If I were a book I would be

a diary, with lots of pages already written, new stuff on each page, and lots of pages still empty.

If I were a TV show host I would be

Ellen DeGeneres, because she’s funny and self-confident and makes people happy and pranks people, but never in the mean way (or at least never in the really bad mean way where the joke is on someone else whose feelings get hurt).

If I were a criminal I would be

hm… like Robin Hood maybe, stealing from the rich and mean to give it to those who need it.

If I were a religion I would be

a colorful religion that values love and virtues, and people thinking for themselves, and excluded all dogmatic directives that tell people how to behave and punished them for wrongdoing or thinking or living outside the box.

If I were a mythical beast I would be

a Phoenix, who burns up, but then rises from his own ashes.

If I were a Disney character I would be

Tinkerbell’s unruly sister. In black and hot pink.

If I were a drug I would be

a mood-destabilizer. LOL

If I were an animal I would be

a big cat. Cuddly towards those she loves, but with claws that won’t be messed with.

If I were a piece of food I would be

haha, silly question. Okay, let me think. I’d be… a… magical surprise fruit. Each bite might taste different.

If I were an illness I would be

the annoying cough that doesn’t go away.

If I were a mood I would be

unpredictable.

If I were a holiday resort I would be

an adventure resort where around every corner you’d find new challenges waiting for you.

If I were a pattern I would be

chaotic.

If I were a tree I would be

the crooked tree that grows at the edge of an abyss, digging its roots into the rock and trying its best to still grow upright, but never quite managing to make it back up over the edge properly.

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There you go, my ‘if I were’ answers. Feel free to play, too. Let me know if you do, so I can come and read your answers.  🙂

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.

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