Understanding Borderline Personality Disorder
Progress has been made in reducing the stigma surrounding mental health, but some mental illnesses — such as borderline personality disorder (BPD) — are still misunderstood. Negative stereotypes of people with BPD are depicted as "the truth" and symptoms are often misinterpreted. It's time to change these prejudices: to educate people about BPD and share positive stories.
What is BPD (borderline personality disorder)?
Confession time: when people ask me "what is BPD?" I struggle to give a succinct answer, despite being diagnosed over 7 years ago. Explaining is problematic because the majority of people I meet have either never heard of BPD or have a narrow (and usually negative) impression of it, garnered from the media. I feel a responsibility to penetrate this ignorance and to provide a full explanation.
People tend to make assumptions based on the name "borderline personality disorder" so they frequently interpret BPD to mean that there is something intrinsically "wrong" with someone's character. There is a conflict between the medical language and common understanding of the word "personality". Personally disorders are not about who someone is, but how they think. Mind provides a very clear and detailed explanation, which it summarises: "Personality disorders are a type of mental health problem where your attitudes, beliefs and behaviours cause you longstanding problems in your life."
BPD is diagnosed by a psychiatrist when a person experiences a certain number of symptoms across 4 key aspects of thoughts and behaviour: emotional instability, disturbed patterns of thinking, impulsiveness and unstable relationships. These symptoms may include: feeling intense negative emotions, such as rage, shame and panic, intrusive thoughts, hallucinations, self-harm, compulsive spending, binge drinking, a chronic sense of "emptiness" and a weak or shifting sense of identity. Please note that this is not a complete list and the NHS website has lots of information on symptoms of BPD and how to get help. Because people with BPD may experience a wide range of symptoms, including many which seem to be opposites, we tend not to fit a single profile.
People who have BPD are often diagnosed with other mental health problems. The most common are depression, general anxiety disorder, eating disorders, bipolar disorder, alcohol and drug misuse and other personality disorders. While there is no definitive cause of BPD, it appears to result from a combination of genetic and environmental factors. There is also a strong association with childhood trauma, including neglect and physical, sexual and emotional abuse.
Challenging misinformation and stereotypes.
When I was diagnosed with BPD, I went home and sought out as much information as I could. I had heard of BPD, but I wasn't sure what it meant or how it could be treated. I hoped to find some supportive forums, but I was shocked to discover that even forums which claimed to provide support were filled with posts which labelled people with BPD as "nightmares". According to these posts, having BPD automatically meant that I was manipulative, selfish and a bad person.
I have since read widely and discovered that these claims are untrue, but whenever organisations like Mind or Time to Change post a blog about BPD on Facebook, the same stereotypes and discrimination appear in comments. Some people still insist that those of us who have BPD are incapable of being supportive friends and partners, that our contribution to the world is wholly negative. These comments are not only hurtful, but damaging: they perpetuate stigma and seem to confirm our negative beliefs about ourselves and our ability to create a life worth living.
I acknowledge that many of my own BPD symptoms are difficult for other people to cope with, but the same is true of my anxiety and depression symptoms. The difference is that people tend to have a better understanding of anxiety and depression. There are more positive depictions of people with anxiety and depression than people who have BPD. If someone accuses people with anxiety and depression of being selfish and manipulative, other people are more likely to criticise this viewpoint and demonstrate empathy. In contrast, it appears that it's still considered acceptable to stereotype and discriminate against people with BPD.
Unfortunately, the negative voices seem to be louder than the empathetic ones. The reality is that people who have BPD can build stable, mutually beneficial relationships. We can contribute to our families, friends and communities in positive ways. We can establish and maintain successful careers. It won't always be easy, but it's possible and it's happening — I see many examples on Twitter — yet these positive portrayals are often absent from mainstream media.
If someone who has BPD is exhibiting behaviour which is difficult to cope with, they need support rather than condemnation. We don't choose to have BPD. We don't choose to hurt ourselves and the people we love. We can manage BPD — and even recover — if we are given adequate treatment and support. This might include medication, talking therapies, self-help and other strategies.
The type of support needed may vary over time, especially as people with BPD can be very sensitive to changing external circumstances. Unfortunately many of us are limited by the NHS services available in our local area and may struggle to access the support which is available, but these challenges don't mean people with BPD deserve to be stigmatised. Instead of characterising us as "nightmares" and condemning us to a life of misery, why not try to understand and seek help?
Sharing positive stories.
I believe we should all make more effort to tell the positive stories about people with BPD, just as positive stories about other mental health issues have become more prevalent in recent years. We need to encourage education and understanding to stop the ignorance and prejudice which perpetuates stigma. The continued prominence of negative BPD stereotypes only encourages silence. People who have BPD are afraid to speak up because they fear they will be judged, despite having positive stories to share.
Living with BPD can be a struggle, but I have seen numerous examples of people with BPD making a (positive) difference to their own lives, their loved ones' lives and beyond. People who engage in activism to increase understanding of mental health issues, who raise thousands of pounds for charities and advocate for mental health and disability rights. People who share their experiences, knowing that it might draw criticism. People who lead meaningful lives, whether they find meaning through their careers, relationships or something else. Let's share their stories.