As you may have heard, this month is Mental Health Awareness Month. It is also Borderline Personality Disorder Awareness Month. They have neatly coincided to allow us to raise awareness and be more informed about one of the most complex, and often misunderstood, mental illnesses. So I thought that I would shine a light on this issue from a practitioner’s point of view, but also from someone who has met and supported many individuals with this illness closely. So let’s break it down.
First off, what is a Personality Disorder?
Personality Disorder is a term used to describe a number of mental illnesses pertaining to complex difficulties within a person’s personality. There are ten personality disorders in total, but often you will have only heard of one or two. They are split into three clusters; Cluster A, Cluster B, and Cluster C. Each cluster is an umbrella term for specific types of personality disorder. Cluster A is named ‘odd, eccentric’, Cluster B is ‘dramatic, emotional, erratic’ and Cluster C is ‘anxious, fearful’. Borderline Personality Disorder is found in Cluster B, personality disorders in this cluster feature emotional instability and difficulties regarding impulse control. The other disorders in this cluster are Narcissistic, Histrionic, and Antisocial Personality Disorder. If you would like to learn more about each personality disorder, check out this website which covers the diagnostic criteria and individual factors of many mental health problems.
If there are so many, why don’t we hear about them?
Stigma will always be somewhat to blame for lack of knowledge and the spreading of myths about mental illness. People fear what they don’t understand, and unfortunately there are still people around who think mental illness is something to be ashamed of.
However, it isn’t all that simple to be diagnosed with a mental illness. It is highly unlikely that a 6 minute consultation with your GP (UK national average) would be anywhere near enough time for a professional to diagnose a severe mental health problem. Psychiatric assessments can take anywhere between 45 minutes to several hours and can often require the input of several professionals. There are also many people who believe a diagnosis isn’t all that useful, as we as therapists like to treat the case and the person in front of us, not a list of medical criteria from a textbook. Borderline Personality Disorder, as the name might suggest, is even harder to spot. It does not fit in with a specific type of problem and often is co-morbid with a variety of other illnesses such as (but not limited to) anxiety, depression, and Eating Disorders.
“I don’t necessarily tell people I have BPD because I don’t like labelling myself, I just say I have depression and anxiety because it’s easier. But I know I have BPD. I feel things so intensely sometimes it means I lose control of all my senses. It’s one of the worst feelings, but I have learnt how to cope with it.”
One of the biggest misdiagnoses comes from another severe mental health problem: Bipolar Disorder. These two disorders are very similar in nature and are equally as difficult to catch. Bipolar Disorder requires patients to experience, and be observed in, periods of mania and depression for weeks at a time, and it can be that someone has been in mania for 12 months. It is unlikely that they will think they need medical attention or support, and that anyone around them will think their mania is anything other than their personality.
So, what is Borderline Personality Disorder?
Borderline Personality Disorder is a very difficult illness to live with. It has another name, Emotionally Unstable Personality Disorder, due to the main difficulty of being unable to regulate emotions. I have heard practitioners liken it to having ‘no emotional skin’ or ‘buffer’; those with BPD feel everything more deeply and more painfully than the rest of us. Imagine just how draining and terrifying that must be. The mental health charity Mind features some amazing stories from people who have been diagnosed with, and treated for, BPD.
“Everything in the world hurts more than it seems to for everyone else and any ‘thick skin’ [I am] supposed to have just isn’t there”
How do you know all of this?
Research and experience, simply put. I did a degree in Psychology which featured a two hour lecture on all ten personality disorders. So no, I am not an expert. Resources I have used to write this can be found at the bottom of the page.
I did then, however, go on to work in a Children and Adolescents Mental Health Services (commonly known as CAMHS) inpatient hospital as a Health Care Support Worker. There I met dozens of young people aged 12-18 who were hospitalised for severe, complex mental health difficulties. I worked on an Eating Disorder Unit for most of my time there and this is where I came across lots of cases of ‘suspected PD’. We say suspected, because at fifteen you are still developing. Biologically, emotionally, socially, you are still becoming a person. We cannot ethically label those developments as a disorder when your personality is still changing and adapting. That is like saying at six years old you have dwarfism. Yes at six years old your height probably fits the criteria, but you haven’t gone through puberty yet and your bones aren’t done growing. Come back again at sixteen and see if you are any different.
Unfortunately, this does mean that these young people I was supporting would have to wait three or four years to be told what we already knew. At least in this case the idea was more conceivable as they were already at the highest and most secure level of care for another complex mental illness. Thankfully, it was here that they would likely receive the appropriate care for anything else we discovered during treatment.
I have seen BPD be treated with talking therapies and psychiatric care, it is something a person can learn to manage. More importantly, this doesn’t take away all the amazing things a person can be or become. I have known many with Personality Disorder, Borderline or otherwise, go on to be great artists, writers, listeners, carers, and professionals.
How can I help?
Charities like Mind and Samaritans are always looking for volunteers to raise awareness and support others. Shout is an organisation that is running a Crisis text line for individuals struggling to keep themselves safe and are looking for volunteers right now! If you want to learn even more and be able to support people with a variety of difficulties, look into Mental Health First Aid England and their training.
If support or clinical work isn’t for you, keep spreading the word. Use your blog or social media to raise awareness even further. Speak to friends and family, 1 in 4 people has a mental health problem and you could be the gateway to somebody getting the right support. GPs, Talking Therapy NHS services, and mental health charities are the right direction for anybody struggling.
If this article has raised sensitive issues for yourself, or you feel you want to reach out, please call Samaritans on 116 123 for free. They are trained volunteers who can help support you.
I do not claim to be an expert in anything, but I am certain that BPD is something we could all do with understanding. I have supported strangers and I have supported friends with these difficulties and I can only imagine what it must be like for a parent, or partner, or friend who has none of this knowledge or experience. So for the rest of May and beyond, please reach out with your stories and experiences! Did I miss anything, did this article help you or a loved one? Let me know here or on social media.
Lots of love