Having borderline personality disorder helps me in my NHS job
I was diagnosed with borderline personality disorder (BPD), one of
the most stigmatized mental health conditions. People suffering with
BPD are often described as manipulative, violent, attention-seeking
and impossible to treat. The label itself is a problem, appearing to
suggest someoneís personality, who they are, is inherently
disordered. Growing up in an invalidating environment or
experiencing prolonged trauma in your early years doesnít mean you
are untreatable. Offered the right treatment, those who have been
diagnosed with personality disorder can get better.
I grew up in a house
blighted by domestic violence. At 15 I was in a sexually and
emotionally abusive relationship. At 18 I left him and managed a
year at university. Then my mental health deteriorated
significantly. Intense emotions appeared, seemingly out of nowhere,
and kept me in a state of intense fear and hopelessness. I felt like
my body was about to explode and that my terror and shame would kill
me. To cope I would self-harm or take overdoses; these were rarely
life threatening, more an act of desperation in not knowing how to
cope with my suffering and the empty void in my chest that was
unbearably painful. The depths of the hopeless desperation are
difficult to convey in words.
Trips to A&E (Accident &
Emergency Departments) occurred frequently. I was often treated as a
nuisance. Some staff were very kind, but overall I experienced a
shocking lack of compassion, an experience shared by many. For five
years I was passed from one mental health professional to another.
These appointments were months apart, often less than half an hour,
and I wasnít offered any treatment. I was asked to remove my
clothing, and a nurse called me fat. I was told I was being ďa silly
little girlĒ and was untreatable, a hopeless case.
After my mum demanded help
for me I was eventually offered dialectical behavioral therapy (DBT),
designed to treat BPD. I still donít know why the decision was made
to refer me. BPD was never mentioned. I feel it could have easily
been a lucky guess.
Everyone diagnosed with a
personality disorder deserves to have access to appropriate
treatment. Nice recommends that NHS trusts should have
multidisciplinary specialist teams to provide joined-up services,
psychological interventions and peer-support for personality
disorders. However, accessing these is a postcode lottery. When they
are not available the most likely result is falling into the gap
between primary and secondary care and receiving nothing.
Alternatively you can be offered short-term therapy or medication.
Steps are being taken to bridge this gap, the recovery colleges
being rolled out are a step in the right direction, but they donít
replace specialist services.
People with personality
disorders are often the most vulnerable in society, but providing
adequate treatment isnít cheap or easy. However, helping people stay
well would reduce the significant financial costs to social
services, the healthcare system and wider society.
Iíll be forever grateful
to the NHS (National Health Service in the UK) as DBT saved me and
utterly changed my life. Iíll always struggle with the consequences
of being traumatized, but Iím able to manage my life and my
emotions, my suffering is significantly reduced. Mental health
problems still carry stigma and personality disorders are
stigmatized even further, both within the general public and mental
I love working for the NHS
and I am lucky to be in a fantastic service that offers excellent
supervision and support. However, I am selective in who I tell at
work. A few people have said it is a career death sentence.
Furthermore, I feel the assumption can be made that I could cause
harm. Who would trust a ďmanipulative, violent, attention-seekingĒ
person to provide decent, beneficial care? But I feel that my lived
experience of suffering, the mental health system, and therapy makes
me a more compassionate clinician. No patient has ever complained
and I discharge people every week who have benefitted. No one can
ever fully understand someone elseís unique experience of suffering,
but I can relate and that puts me in a position to empathize,
validate and have a non-judgmental attitude towards my patients, so
we can work together on helping them feel better.
We need to keep breaking
down the ďus and themĒ barriers. We all suffer at times, there is no
divide between Ďillí patients and the Ďnormalí professionals.
Thursday, May 17, 2012
Does Borderline Personality Disorder improve with Age?
Does BPD ever get better? Will everything always be the devastation
and earth shattering crisis that it seemed to be in my teens and
Yes, it does/can get better. No, things do not always have to be
this way. This is based entirely on the individual though. Iíve
received correspondence from many people in their 40ís, 50ís, and
60ís that still suffer with the more intense problems of Borderline
Personality Disorder. These are often people that havenít received
any help, sufficient treatment, or had trouble acquiring any kind of
treatment or support at all.
From my experience I canít say that Borderline Personality Disorder
will just spontaneously get better on its own. Over time the
severity of symptoms is likely to diminish but they may not go away
entirely. I think this is due, in part, to life experience. When a
person reaches a certain age, by virtue of experience and having
lived through so many situations they can recognize that all the
traumatic feelings that they experience are feelings theyíve had
before, and despite how they feel, see the pattern that things donít
turn out as terribly as they feared, or that they are in fact,
capable of coping with the results of what do happen.
Then thereís also the fact that the human body and psyche can only
handle so much. It can only deal with so much constant bombardment
of adrenaline boosting anxiety and pain before it starts to wear
down. Or build up a tolerance. When youíve been exposed to something
for so long, the body adapts. Itís a basic principle of existence.
Adapt or die.
Constantly fighting the pain, tears, and trauma is exhausting.
Eventually the body builds up a little tolerance to all the things
that create such distress and while things may still cause anxiety
and panic, the intensity of those emotions no longer reaches the
same heights. The body, the mind, the spiritÖ gets tired. And
Like scar tissue for the mind. Itís not to say that the pain wonít
eventually come through, but it doesnít penetrate quite as easily.
Which still doesnít sound incredibly encouraging.
However! Thatís the theory for those with BPD that have never
accepted or found support or tried to work through the disordered
thinking that we have to deal with. The odds of having your
Borderline Personality Disorder improve rises drastically and
dramatically when you are able to admit there is a problem, seek
help, support, and/or therapy, and actively work to tame the wild
beast that is the Borderline Personality.
You donít have to tell me that this is easier said than done. You
donít have to tell me that there are times when therapy feels futile
and it seems like nothing will ever improve. Trust me, Iíve been
there. I still have those days. But those feelings pass. Youíre kind
of on this journey with me. I still have my bad days. I have a lot
of my bad days. But I have many more good days as well. Days without
panic, without anxiety, without depression. Days with happiness! Or
just contentment. Those feelings are so foreign to me that itís hard
for me to recognize them at first. By the simple fact that I have
had days like that, days where my world wasnít shrouded in darkness,
proves to me that even though things may not be perfect, things most
certainly can get better.
The choice is yours. Thatís the important thing to remember. Blaming
our parents, blaming our exes, blaming the world around us,
regardless of whether or not our circumstances are our fault, does
not help. I certainly blamed my Evil-Ex for the years of trauma and
unhappiness I had to deal with when I was with him. But blaming him
isnít going to make my situation better. Blaming him isnít going to
suddenly make him take it all back and try to fix my life for me.
Thatís never going to happen. It wasnít fair, but life usually
isnít. The only one that can decide to make my life better, is me.
It sucks that things have to be so hard. Itís a shitty hand to be
dealt, but itís the only hand we have. We can let the murk mire us
in thoughts of self-pity, blame, and loathingÖ perpetuating a cycle
of dismal depression and anxiety, or we can decide to make a change.
In time, things may get a little better on their own, but frankly,
Iím sick of waiting, and I donít have a lot of faith that the world
is suddenly going to smile on me and decide that Iíve dealt with
enough shit for one person already. Borderline Personality Disorder
can absolutely improve with age, but the amount of improvement is
directly proportional to the amount of effort you are willing to put
Iíve seen a lot of ďstudiesĒ and read a lot of testimony from
therapists and social workers that say in X amount of years theyíve
never seen improvement for BPD. There are a lot of reasons for this,
including the fact that these people probably were not skilled or
trained in the very recent developments that create real change for
those with Borderline Personality Disorder. Therapists/clinicians
are people too, and certain types of people are simply not equipped
to deal with someone that can be more difficult to pinpoint their
problems. Thatís why we have specialized therapy now. Major, MAJOR,
strides have been made in therapy specifically meant for us. Donít
let these limited perspectives discourage you. They usually donít
have the kind of knowledge or experience to give an inclusive
The other thing that Iíve noticed people focus on is the distinction
between what improves. Many say the Ďsymptomsí of BPD often improve;
the self-harm, the suicidal ideation, the paranoia, impulsivityÖ but
how about the instability in relationships? Thatís a different kind
of symptom. That first group of symptoms are internal to the one
person suffering with BPD. However, relationships take two. It seems
more broadly agreed upon while the individuals symptoms may improve,
things like abandonment and dependency issues are longer lasting.
Again, this is all dependent on the individual, what kind of help
they seek, and how much effort they put into their own recovery.
canít promise that all symptoms of BPD will eventually go away. I
canít promise that everything will one day be healed and no longer
any issue at all, even with therapy and dedication. I can say that I
am entirely optimistic that these things can all become manageable
and not the monsters we know them to be.
BPD is not something that is going to get better in days, weeks or
months. Hell, even years may be an estimate that is too
conservative. Iím going on a year and a half of intense therapy and
medication and Iím far from Ďrecoveredí, but my Therapist tells me
every week that she can see improvements. Whatís more though, is I
Without acknowledging the issue that is BPD there may be little to
no improvement for decades. Even with active acknowledgement and
intense effort improvement can take years. I donít mean to be
discouraging, but I do mean to be realistic. You know me. I donít
sugar coat anything. Thatís not why I do this. Think about this: In
a world where it is now common to live into our 80ís and 90ís, isnít
taking a year or two to really focus on ourselves, worth it? If we
can have 40, 50, 60 years of living that is more content and happy
than what we currently know, isnít the long term pay off worth the
struggle and introspection?
Taking care of our mental health is no different than taking care of
our physical health. If you eat nothing but junk food, load up on
soda, and smoke 2 packs of cigarettes a day your body is going to be
pissed and reward you with a heart attack by the time youíre 40. If
you eat healthy, exercise, get a good amount of sleep and donít
abuse your bodyÖ in other words; work on taking care of yourself,
your odds of living a long and productive life vastly improve.
Whether Borderline Personality Disorder improves or worsens with
age, is up to you.
Recovery probabilities in varying
degrees from BPD.
Relationship: Your Partner with Borderline Personality Disorder
By Kate Thieda
If you have a partner with
borderline personality disorder (BPD), your relationship may look
something like this:
ēYesterday, in the eyes of
your partner, you could do no wrong. Today, everything you do is
ēTen minutes ago, your partner was smiling and happy. Now, they are
screaming at the top of their lungs about a perceived snarky comment
from you, which was not meant in the way it was interpreted, and
household objects are being thrown. You hastily leave to go to work.
ēBy the end of today, you will get 15 text messages, eight phone
calls, and 10 emails from your partner that ask if you still love
them, and threatening suicide if you end the relationship.
According to the National Institute for Mental Health, two percent
of Americans are diagnosed with BPD, which equates to about six
million people, although some estimates are as high as six percent,
or eighteen million people. Women are more frequently given the
diagnosis, but that may be because they present for psychiatric
services more often than men, or because of provider bias, with men
being diagnosed with antisocial personality disorder instead of BPD.
Obviously, having a
relationship with someone who experiences BPD is a challenge. At the
beginning of your relationship, there may have been a honeymoon
period where you were idealized by your partner. But now you may be
experiencing the darker side of BPD: fears of abandonment, impulsive
behaviors (gambling, unsafe sex, spending sprees, binge eating, drug
use), emotional instability, and suicidal gestures or attempts.
What does the partner of
someone with BPD do?
Helping your partner find the
right treatment is crucial. Convincing them to first try treatment,
and then stick with it, however, is a whole other issue. BPD clients
are frequently considered the ďtoughest to treatĒ by mental health
professionals because of the instability they present. Remember,
what happens in the ďreal worldĒ also happens in therapy offices:
the same patterns your partner with BPD does at home happen with the
But there is hope. Dialectical
behavioral therapy (DBT) is considered the most effective treatment
for BPD. There are a ton of resources online about DBT, including
the blog Dialectical Behavior Therapy Understood here on
PsychCentral, so I invite you to check them out to learn more. There
are other treatments that are beginning to receive more attention as
well, such as mentalization-based therapy (MBT),
transference-focused psychotherapy (TFP), schema therapy (ST), and
cognitive behavioral therapy (CBT) tailored specifically to BPD.
Next, finding a therapist to
help you is vitally important as well. Even if your partner is in
treatment, the instability and uncertainty around their mood and
behavior will not resolve overnight. Treatment for BPD is a long
process, and if you and your partner are going to get to the other
side with your relationship intact, you are going to need
It is important for you to
learn about DBT as well so that you can participate in your
partnerís recovery. One way to do this is through DBT Family Skills
As for day-to-day ways to
support your partner during the recovery process, some tips include:
ēDo not ignore your partnerís
threats to harm themselves. After a while, family and friends can
become desensitized to the threats of the person with BPD. However,
it is common, especially when someone is in treatment, for things to
actually get worse before they get better. Statistically, around
9-10% of people with BPD complete suicide, and it is often by
accident. Donít take chances: call 911 or bring your partner to the
emergency room if they are threatening suicide. Let the mental
health professionals decide the level of actual threat.
ēLearn how to validate your partnerís experience. One of the
theories behind DBT is that the person with BPD grew up in an
invalidating environment, which means they were consistently told
that their feelings were bad or wrong, or may have even been
physically punished for showing emotion, even if their reaction to
the situation was perfectly appropriate.
ēUse good communication skills to set boundaries with your partner.
Another hallmark of the experience of people who have BPD is that
their lives have always been unstable. Having boundaries in place in
their adult relationship, and especially having those boundaries
remain in place when tested, helps to provide your partner with a
safe environment that they know will not fail them.
ēTake care of yourself. I say this in practically every post: if you
are not caring for yourself, you are not in a position to help your
partner get better.
What is the prognosis of
people with borderline personality disorder?
from MedicineNet.com website
As with any illness, an
appropriate question about BPD is if it is curable. While
improvement in any personality disorder is not synonymous with being
cured, the symptoms of BPD do tend to diminish with time. How well
or poorly people with BPD progress over time seems to be influenced
by how severe the disorder is at the time that treatment starts, the
state of the individual's current personal relationships, whether or
not the sufferer has a history of being abused as a child, as well
as whether or not the person receives appropriate treatment.
Simultaneously suffering from depression, other emotional problems,
or a low level of conscientiousness have been found to be associated
with a greater likelihood of symptoms of BPD returning (relapse).
Conversely, having steady employment or school status once symptoms
of BPD subside (remit) tends to protect BPD sufferers from
experiencing a future relapse.