I’m taking a deep breath and telling the truth now.
Sitting in a hospital interview room wearing my boyfriend’s oversized hoodie and a pair of 15 year-old boxer shorts I refuse to throw away, I’m about to get the biggest reality check of my life.
“It appears you have many of the traits of Borderline Personality Disorder,” a male psychiatrist informs me, barely glancing up from the clipboard he’s been furiously taking notes on for the past half hour.
The assistant sitting to his left immediately begins typing something on his laptop.
“I’m recommending a combination of medication and DBT – Dialectical Behavior Therapy.”
The nurse sitting to his right gives a knowing, stern nod.
Then everything goes mute…
The psychiatrist continues to mumble from behind his clipboard, but his words run away like an overzealously poured glass of soda; fizzing over his notes and chasing across the floor in disparate puddles.
‘But…I’m not sick?’ My brain urges.
Except that everything else seems to indicate otherwise.
The intricate artwork of incisions etched over my left arm with a disposable razor. The dark rings that have made a home under my bloodshot eyes. My unkempt appearance. The police officers who escorted me to the ambulance two nights earlier, despite my insistence I was “honestly okay, I don’t need to go to hospital”. The fact I’ve spent my weekend in a psychiatric ward, a nurse shadowing me to the toilet to ensure I don’t attempt to finish off my macabre handiwork.
Or maybe the most stinging indicator is the fact this isn’t even my first time in a psych ward…
It’s estimated that, at any one time, patients with Borderline Personality Disorder, or BPD, make up six percent of a hospital population of primary care patients, and roughly 15 to 20 percent of inpatients in psychiatric facilities. The most common cause for the visit is self-harm, or suicide attempts, and these worrying symptomatic traits will see the same people repaying the ER a visit an average of once every couple of years.
The psychiatrist is indicating to the nurse to his right now, giving her instructions, as if I’m no longer present in the room.
“She can be discharged this afternoon, provided she can take some time off work to rest, and there’s someone there with her. I’ll write a prescription for Prozac.”
I’m ushered back to my room, which more closely resembles what I’d imagine a prison cell to look like. Everything is gray and stripped bare. Even the bed looks barren; a single sheet and limp pillow the sad frosting on the unforgiving rubber mattress. In the corner of the room, a locked drawer holds all my belongings, which I’m told I’ll get back when I’m discharged.
I reach to close the door behind me.
“It’s preferred you leave this open,” the nurse insists, her lips pursed tight as if to reinforce the fact she’s not really giving me an option.
And suddenly everything becomes painfully real.
BPD is most commonly recognized as a mental illness characterized by a pattern of emotional dysregulation and unstable interpersonal relationships. Sufferers are often referred to as “moody” or “dramatic” by well-meaning friends and relatives, but in reality, the disorder is much more than a simple case of oversensitivity.
“People with BPD are like people with third degree burns over 90 percent of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement,” explains psychologist and author, Marsha M. Linehan, a recovered BPD sufferer who pioneered the leading treatment for Borderline patients; Dialectical Behavior Therapy.
In order to be classified as having BPD, you need to meet at least five out of the nine criteria for diagnosing the disorder. These include: frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense relationships, identity disturbance, impulsivity in at least two areas that are potentially self-damaging such as binge eating, reckless sex or drinking; recurrent suicidal or self-mutilating behavior, acute emotional instability, chronic feelings of emptiness, inappropriate or intense anger; and transient, stress-related paranoia or dissociation.
In my gray cell-like room in the psychiatric ward, various nurses continue to ask me, “What happened before you did that?”, shooting interrogating glances at my bandaged arm.
The answer, now with the weight of hindsight behind it, stings as the words hang in the air in front of me, dripping in shame and disbelief. I’m here because my boyfriend had rushed away for an interstate work meeting without letting me know until I rang him some moments after he hadn’t arrived home at his familiar time.
He’s usually careful not to leave me alone without advance planning and notice. He knows I begin to go into what my therapist would later refer to as my “red zone” when I fear he’s pulling away, in any slight – albeit often imagined – way.
My “red zone” is my biggest secret, something I bend over backwards to prevent anyone from seeing or even suspecting exists within me. It’s best described as an out-of-body-type experience where my entire circuit system overheats, and I unravel catastrophically. I’ve self-harmed, pulled apart my kitchen – smashing every piece of crockery I could get my hand on into millions of tiny shards, screamed and cried hysterically for hours while pulling at my skin like a toddler having a temper tantrum. I’ve used men and sex like drugs, in a vain attempt to fill the bottomless pit of my need for constant validation. And I’ve said horrific things to the people I love most. Things I’m not proud of; things that sicken me. Things intended to hurt. And I’ve done things intended to hurt.
On reflection it’s hard to even grapple with the fact that person is me.
I typically pride myself on being calm, in control and able to handle whatever comes my way. On being a loving partner and a caring friend, a dedicated employee and a confident, well put-together person. These episodes throw all of that into disarray. And despite the fact they’re always triggered by the same thing – an overriding fear my loved ones are at any given second, going to leave me – I’m completely at the mercy of them.
I am beginning to learn this fear is not based in reality, but rather, is a hallmark feature of my BPD; and the one that’s had the most devastating impact on my relationships. In fact, the disorder takes such a toll on loved ones, it prompted Randi Kreger, who grew up with a Borderline mother, to pen what’s now become somewhat of a bible in circles of BPD sufferers’ families, Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder.
“We all make compromises in relationships. But the sacrifices that people make to satisfy the Borderlines they care about can be very costly. And the concessions may never be enough. Before long, more proof of love is needed and another bargain must be struck,” explains Kreger in her best-selling book.
Nowhere else is this clearer than in romantic relationships. A 2015 study into the relationship between BPD and marriage satisfaction, published in the Journal of Abnormal Psychology noted couples where one or both spouses displayed BPD traits, reported lower levels of marital satisfaction, long-term.
It probably shouldn’t be particularly surprising then, that my own marriage imploded spectacularly after just six years. In one of our last conversations, I asked my husband, “Do you think I’m a bad person?”, to which he responded, “No. You just do really bad things sometimes. And now you need to live with the consequences.”
Unfortunately consequence prediction isn’t a skill available to most BPD sufferers, Rather, one of the disorder’s hallmark traits, marked impulsivity, can often completely blind Borderlines to being able to consider their actions in the moment at all. It may explain why self-harm, threats of suicide, risky sex and binge drinking are so familiar among the BPD community.
Back in my room in the psych ward, there’s a visitor at the door now. A man who resembles my boyfriend, but who, thanks to my BPD, I can’t recognize as such. I’m ‘splitting’ in reaction to what I’ve been through the past two nights. It seems silly, embarrassing even, to acknowledge I do this after the dust has settled on my emotional turmoil, but it’s a common BPD trait in which the sufferer – in an almost painfully infantile manner – simplistically categorizes people into ‘good’ or ‘evil’ boxes. There is no gray zone, no in-between, no option for human error; a person is simply idolized, or dead to me; any joyful memories we shared spontaneously unavailable, as if they never happened.
I can see my boyfriend walking toward my bed, but I can’t remember the feeling of warmth toward him; only a strange detached numbness as his figure slips into the thin slices of light escaping from the blinds behind me, an eery experience Linehan relates to.
“My whole experience of these episodes was that someone else was doing it…I felt totally empty, like the Tin Man,” she told the New York Times in a 2011 interview.
My boyfriend kneels beside the bed and doesn’t speak, lowering his head and placing his arms across the mattress so his hands rest on my stomach, to let me know he’s here. Then he raises his head to look at me, his eyes thick with tears that begin to quickly escape as he lets out a primal sob I’ve never heard from him before.
His face is pained, his hand, trembling on my stomach now. He takes a long, slow breath between sobs and whispers, “I’m so sorry”.
But this is not his fault. None of the things I have done or said since meeting him are his fault. Or even my ex-husband’s fault.
This is my reality check. My ah-ha moment.
Because I’ve been here before. In this same ward, in this same bed, in this same scene; my ex putting on the stoic, emotionless mask he always leaned on to push through tough times; a nurse watching on in the background as I swallowed the secret of my diagnosis into the pit of my stomach. My broken brain certain everyone was conspiring against me, plotting my downfall by forcing me to endure the shame of publicly unveiling my self-inflicted wounds, having to confront doctors while my face was still swollen from crying hysterically for hours earlier.
“It will help with the intensity of the emotions and the impulse control,” the nurse had assured me, sliding a cup containing the ominous pill in it across the table as if offering a stick of gum. Me, begrudgingly choking it back in an effort to be discharged; then tossing the rest of the pack in the bin back at home, bitter at the very suggestion I required chemical help.
But this time it’s also hard to ignore the fact I’m lying back on the same unforgiving mattress, the same green-and-white pill rattling about inside the same plastic cup in the nurse’s hand at the door as she intrusively eavesdrops on our interaction.
This is no coincidence. No plot against me by my loved ones. This is my chance to change course and forge a new future for myself, even if it means truly facing myself, and the pain I’ve inflicted, for the first time.
I grab my boyfriend’s hand and squeeze it tightly, the tears now escaping from my eyes too as I mouth out “You have nothing to be sorry for”.
The nurse senses her moment and intervenes, thrusting the plastic cup toward me.
I take the pill and gulp it back, feeling something click inside me.
“Can you leave us for a moment?” I ask.
The nurse nods silently and scurries out as quickly as she burst in.
“I have something to tell you,” I tell my boyfriend.
I hesitate, take a deep breath, and let it out.
“I have Borderline Personality Disorder.”
And suddenly my secret is set free.
But instead of being on the borderline of another breakdown, I’m on the borderline of breaking ground.
Images via shutterstock.com, tvovermind.com.
Comment: Do you or a loved one suffer from Borderline Personality Disorder? How has it affected you?