The first time I was diagnosed with BPD “traits” I went to the nearest Starbucks and cried so hard the barista gave me a free drink. It wasn’t the diagnosis that made me feel this way – it was the way it was delivered. Offhand, out of the blue, as a resolution to a terrible interview. The interview consisted of a balding psychiatrist with a giant Bernie Sanders sticker on his laptop asking me vague questions about my mood and appearing displeased with my inability to form coherent sentences. Emptiness. A core symptom of the disorder that makes answering questions like “how are you feeling” and “what has been bothering you” a shapeless mist, edges blurred and indescribable. I was failing at this interview, as I had failed at living.
In his assessment, the psychiatrist wrote that I had minimal rapport and moderate accessibility. His “most striking finding in the interview was [my] mentioning concerns that would cause great anxiety and never telling [him] what they were”.
I found myself at the Mood Disorders Association after seven years of acute illness. Two government-provided therapists who moved to Squamish and had a baby, respectively. One year of moving across the world and pretending I was healthy. Dozens of doctors who had never heard of my unnamed disorder. All this time spent trying to see myself in depression, anxiety, bipolar disorder, post-traumatic stress. Never feeling as if anything could explain the mess of symptoms tangled in my mind. I came up short against most criteria: my depression never lasted long enough to be considered depression, my angry outbursts and hyperactive manic energy never lasted long enough to be considered mania.
And when it came, the answer was an email from a psychiatrist who had known me all but sixty minutes. It came as a footnote, at a Starbucks, without a definition.
We don’t have language for the experience of BPD. We make do with approximations: depressed, anxious, suicidal, attention-seeking. We make do with simplifications: emptiness, impulsive behaviour, anger, fear of abandonment. Here are my words about the symptoms that have touched me. These symptoms are from the dimensional model of BPD – not the classic 9 criteria. The dimensional model is in the “appendix” of the DSM-5, and the symptoms can be viewed here.
Identity & Self-direction
It took me a long time to understand my symptoms of identity disturbance. I have always been passionate, stubborn, and confident in my personality. Growing up, I was liked by adults for my sense of self and strength of mind. I was passionately committed to my goals: dance, violin, spelling, making everyone like me. And that’s where it starts. For individuals without BPD, goals are a pathway to fulfilling a cohesive sense of self. Each attainment adds to a concrete set of roles, likes, dislikes revolving around the self and identity. For me, goals were set out of a frantic attempt at feeling valued, cherished, special. I learned to climb the monkey bars to attract the attention of the recess monitor. My goals developed as a route to validation, usually mimicking the person I had fixated on during a given point in my life. It was hard to recognize what was happening, because the things I did made me happy. When I danced, I loved it with every part of me. I loved things even more because they were tied to someone I loved. My love for the teacher and the subject became inseparable, but at the top of the mountain I had devoted myself to climbing there was just me. And without these teachers and the things they taught me to love, I had no idea who I was or what I wanted. In my first years of diagnosis with BPD, I trawled the internet, books, and movies for any representation of my illness. My illness became my identity. In my post on self-injury scars, I talk about how I clung to my scars as a mark of my self when I was at my sickest. Now, I know when I am sick because the parts that make me whole fade to the background, and I am only a Sick Person.
In her memoir, The Center Cannot Hold, Elyn Saks writes:
“There were three different lenses through which I viewed myself. One me was Elyn, one me was Professor Saks, and the third me was “the lady of the Charts” – the person who was a mental patient. Many days I believed I was nothing more than the Lady of the Charts – a crazy woman who had faked her way into a teaching job and would soon be discovered for what she really was and would be put where she really belonged – in a mental hospital. Either I was mentally ill or I could have a full and satisfying personal and professional life, but both things could not be equally true; they were mutually exclusive states of being.”
This excerpt perfectly describes the fractured and impoverished identity of my BPD: an inability to see oneself as a cohesive whole, to fuse different facets of self into a single mind.
Empathy & Intimacy
First of all, I would like to emphasize the differences between empathy, emotional intelligence, and kindness. Stigma tells us people with BPD are manipulative, that they do not care about the feelings of those they use for validation or attention. For me, this symptom has never been about a lack of empathy; it has been about a dysregulated and unfiltered empathy superpower. Because I feel everything, I am easily able to imagine (or feel) the feelings of others. In popular culture, “emotional intelligence” has become code for “being a decent person” – meaning those with emotional intelligence deficits are assholes, unkind, or indecent. In actual fact, “emotional intelligence” is a complex construct describing the ability to identify, describe, and understand a diverse set of emotions in oneself and in others. It is a mix of empathy and emotion regulation skills. My empathy becomes problematic when I am too good at imagining others’ feelings, or when I imagine others’ feelings through my own emotional lens. I am hypersensitive to praise and criticism partly because of the Identity and Self-Direction symptom described above, and partly because I imagine others’ feelings to be as intense and overwhelming as my own. The symptoms of BPD are interrelated, for example: emotional dysregulation intensifies feelings of love, which intensifies anxiety about the subject of my love becoming unavailable, which leads to mistrust or fear of abandonment, which leads to impuslive behaviours like asking the subject of my love for reassurance. In turn, this impulsivity typically results in feelings of shame and low self-worth, which intensifies paranoia and mistrust of those who love me.
Emotional lability is arguably the core symptom of BPD, a construct involving four interconnected components: emotion sensitivity, heightened negative affect, and insufficient or maladaptive emotion regulation strategies. People with BPD have both a biological propensity to experience heightened emotional reactions to stimuli and difficulty managing these emotional reactions. I developed the maladaptive emotion regulation strategy of non-suicidal self-injury (NSSI) out of sheer desperation to quiet the intense and rapidly cycling mood swings. There is an episode of the TV show Angel where a demonic psychoanalyst poses as a Sensitivity Trainer who destroys an entire police precinct by causing the officers to feel every emotion all the time, at the highest intensity. No joke, this is what it feels like most of the time. In a typical day, I will often experience both overwhelming elation and suicidal depression.
The symptoms of anxiousness and depressivity contribute to the misdiagnosis of BPD as persistent depressive disorder, generalized anxiety disorder, panic disorder, or “pure O” obsessive compulsive disorder. Intrusive thoughts about myself, my actions, and my loved ones plague me daily. Uncertainty is unbearable, it is a void to be filled with catastrophe and worst case scenarios. I am often convinced someone I love is dead, I am fabricating my identity, or that someone secretly despises me. This symptom naturally exacerbates the symptoms of separation insecurity and relationship instability.
Depressivity is like my first best friend. It is my baseline, when there are no emotional stimuli to react to. It is how I wake up and how I fall asleep. It is the constant beckon of suicidal ideation, the constant feeling of damp socks, the absolute fatigue and inability to concentrate. It gets worse with stress, or when I am too tired to be a rollercoaster. It is hopelessness and shame, a constant knowing that I am worthless, a liar, a fraud. It is the tears that come so easily to my eyes when I am quiet, alone, when I stop moving.
I am very creative. I can find rejection in the subtlest of facial expressions, the most benign of brush-offs, or just in silence.
Sometimes it feels like impulsivity is a tiny monster who sits in my brain and drives it around. It drives me to hurt myself when I feel overwhelmed, it drives me to call someone I barely know for support, it drives me to turn up uninvited at someone’s front door to feel loved.
Hostility is the consequence to operating every day with all the symptoms outlined above. Sometimes I snap like a rubber band. Sometimes the way the air feels pisses me off. Sometimes I can’t handle the way drivers don’t look when they turn left into a crosswalk, so I slam my hands down on their hood. Sometimes every fabric is rough and brittle, every person is making my life more difficult on purpose, and I also missed the bus.
It is my hope that discussing these symptoms will contribute to a better understanding of the complex thoughts, feelings, and behaviours that characterize Borderline Personality Disorder. It is my hope that this small peek into my mind will grant you empathy (for yourself or others with BPD) through this understanding.