Borderline personality disorder
September 29, 2014 5:45 AM   Subscribe

What's it like to have borderline personality disorder? What helps?

My 21-year-old daughter (who lives with me) was diagnosed Tuesday with borderline personality disorder, and was prescribed Seroquel. I have looked it up online, and I can see why she was diagnosed with it, but I don't really understand it.

I thought that some of you might have personal experience with this disorder, and could help me understand what my daughter is going through. What is it like, to have BPD? Did medication help you? How did you feel differently, as your condition began to improve? What did someone close to you do that helped, or what could they have done?

Thanks for any help you can give me. If you want more info, or to reply anonymously, here's an email for that:
posted by anonymous to Health & Fitness (13 answers total) 27 users marked this as a favorite
Though I have had several people in my life with borderline personality disorder, I myself do not have it. The book that best help me to understand what it must be like was Merri Lisa Johnson's poetic memoir, Girl in Need of a Tourniquet.
posted by Lieber Frau at 5:50 AM on September 29, 2014 [4 favorites]

Not long before her death, my mother was finally diagnosed with BPD. The book, "I Hate You, Don't Leave Me," was recommended by my psychiatrist. It helped me stop feeling guilty about her behavior.
posted by Carol Anne at 6:06 AM on September 29, 2014 [5 favorites]

BPD is not something that is "cured," in the traditional sense. It is a set of personality characteristics that can be very painful for people with BPD and those who love them. It's characterized by wide swings in the way you experience your relationships with others, from feeling a close, overidealized connectedness, then changing to feeling alienated, alone and hopeless when those perfect relationships falter (as all do). As you can imagine, this is incredibly painful and disorienting and often leads to feeling suicidal, to substance abuse and to other very upsetting, difficult behaviors. The good news is that people with BPD can learn to manage these expectations and emotions, but it is a long process and it is very hard work. Dialectical Behavioral Therapy is the treatment that works best. More information is available here . The books "I Hate You-Don't Leave Me" and "Stop Walking on Eggshells" may be helpful to you and those who love your daughter. The best bet is finding a DBT practice who can help all of you through this process. All the best to your daughter and to you.
posted by goggie at 6:11 AM on September 29, 2014 [7 favorites]

Goggie got it ahead of me. I hope her doctor has suggested Dialectical Behavior Therapy? this type of therapy was developed by Marsha Linehan who is a highly-regarded scholar.
posted by mareli at 6:15 AM on September 29, 2014 [2 favorites]

Borderline personality disorder is actually one of the most treatable mental health conditions if--and this is a big if-- the person who has it acknowledges that they need help and will participate in treatment. Additionally, a good number of people simply mature out of the more extreme behaviors as they get into their late 20s. So don't lose hope!

Will write more later.
posted by the young rope-rider at 6:23 AM on September 29, 2014 [10 favorites]

As an aside, Marsha Linehan is one of my personal heroes; I thought this NY Times article on her a few years back was very interesting:
posted by whistle pig at 10:55 AM on September 29, 2014 [3 favorites]

I'd like to second Carol Anne's suggestion of the book, "I Hate You, Don't Leave Me." Another one that a friend found very helpful is "Stop Walking on Eggshells."

The old way of thinking on the part of mental health professionals was that people with BPD are manipulative, selfish, and rarely able or willing to change. The more enlightened view today is that they are usually very anxious and otherwise sensitive emotionally; they experience emotion very strongly; the behavior that makes them hard to deal with stems from their emotional pain and their efforts to protect themselves from that pain.

Psychiatric labels are useful only when they contribute to helping the patient/client. One BPD person can be extremely different from another. The main thing for family members is usually learning to create boundaries for themselves and to respect those boundaries. For example, "I'll talk with _________ as long as she keeps her tone calm; if she starts yelling, I'll end the conversation." You can change your own behavior and let your daughter know what you will and will not tolerate when she's interacting with you.
posted by wryly at 10:58 AM on September 29, 2014 [7 favorites]

I don't have BPD, but I know someone (or possibly two someones) with it, and they staunchly believe that they are the world's biggest and only victim. They volley between feeling like everyone is there to save them, and then everyone is out to get them. Everything is an extreme for this person and "evidence" is pulled out of thin air to justify the rapid shift from love to hate and back again. It's not a rational thing, basically, and the person I know with BPD isn't self aware at all, so they're trapped in the victim mindset and cannot take responsibility for their actions or their own life, but they do know they're unhappy a lot and can't understand why. This is just one manifestation of BPD, though, so your daughter may be experiencing other things that only time will reveal.
posted by Hermione Granger at 1:11 PM on September 29, 2014

Also, please take heart that it's not just "bad news." There are some other quite lovely associations with BPD. People with it tend to be very intelligent and articulate and have a very good sense of empathy.
posted by mermaidcafe at 3:46 PM on September 29, 2014 [7 favorites]

I work with quite a few teenage girls diagnosed with BPD. From my experience, they're wonderful kids. They're funny and smart and hugely empathetic and tuned into others. So these are great things but the kids are spinning into more Borderline states of being, they strongly feed off others' emotions.

One thing that helps me, in any case, is remembering that these kids truly have very little personal sense of self, so they glom onto others. If their friends are sad, they're sad. They have intense high and lows with peers, often teary one minute and laughing hysterically the next. Its hard for them to hold steady, but with patience and practice, it can be done.

They get DBT at my school and the girls who actively work to overcome the more distressing aspects of BPD can do very well. None of them are on meds and every day, they work hard and they face the issue and get a little more perspective. The girls who are stuck in "the world is out to get them" feelings and have violent swings in mood...they struggle a lot.
posted by kinetic at 3:56 PM on September 29, 2014 [8 favorites]

I've been diagnosed as having "small-b Borderline"-- some of the characteristics, but able to form long-term and satisfying relationships and without the tendency to demonize people. What I do have is intense attachments, a strong focus on romantic relationships in order to combat a sense of emptiness and worthlessness, and an on/off switch on my emotions. It's either Best Ever or Worst Ever, no in-between. I've been working on it.

My experience of my version of it also includes a feeling of helplessness, like the world doesn't want me and there's no place I can be valued. It comes with the feeling that I *should* be special, but I'm not, and that's the only thing in the world I really want to be. Special and important. It also comes with a disconnect between my judgment of myself and others. I can see how my friends are amazing, wonderful, and worthwhile people, but I can't accept that the same might be true of myself, because I am not perfect and brilliant and I have, in my opinion, not done anything with my life. I've waffled and been terrified to try, to try anything, in case I fail and it proves all the more that there is nothing worthwhile here in my head and soul. I've followed men I become obsessed with around the country, not really making places for myself, just doing what I think they need me to do. Not, mind, men I'm just stalking who aren't interested in me. These are people I'm in relationships with, who usually just love me less than I love them.

The worst one, probably, was when I was involved with a man who had serious full-on Borderline. Oh god that was intense, and in some sick sad way he's still the love of my life, even though he cheated and lied and drank too much (so do I, by the way) and I occasionally realize even now, nine years later, that some thing or other he told me about his life was a lie designed to appeal to me, sometimes lifted from someone else's life entirely. He followed women who seemed to love him, travelled to be with them, and created a persona he thought they would want. But the real him always came out, in the end, and he couldn't maintain the fiction forever. Upon getting the real opinions of my friends after I left him, I began to describe it thusly: it was like he was an extremely realistic cardboard cutout. If he was facing you, directing his fictions at you, it was very believable. But from any other angle, you could see the edge of the cardboard, and tell easily that what he was spinning wasn't real. But, both of us being that way, we created our own pathologically addicted little world, and nothing else mattered, for a while. He did do the demonizing thing, and occasionally I wonder how he describes me to the other people he's been with since. I know that somewhere I am an Immortal Monster of Fiction.

The positive aspects include enhanced creativity, and the aforementioned strong emotions. It's a much more intense experience of the world, and, as with hypomania, when it's good, it's REALLY good. Of course, for me that usually comes with romantic love. Since I got divorced (four-year marriage and six years together, and we're still friends and he's a fantastic human being-- don't let 'em tell you relationships with BPD people can never work out), I've been trying very hard to avoid doing that. I was single for a year, the first since I started dating at 16. I now seem to be drifting, like normal people, into a nice and less obsessive Thing, but I deeply fear the idea of never falling in love as I understand it again. That high is the only thing that's ever really mattered in my life. Academia was great, and I miss it. Creating is also great. But I leave it all when I fall in love. And even though this one is a slow drift for me, I think it's the most intense relationship-beginning that the gentleman involved has ever experienced. (He's quite enjoying it.)

I don't know whether I would change my past experience of this aspect of myself. I know that now I am definitely trying to dim it. It's not easy. But it is intense. And, since it's a very deep part of one's personality, it's hard to get around some parts. While I would love to feel like I am an okay and worthwhile human being without doing something that matters a lot to a whole lot of people and makes them love me, I don't know whether I ever will. I don't know whether I'll ever feel whole. But I'm better, lots better, than I was. I'm on Lamictal and Buspar, because SSRIs and SNRIs were tried and didn't help, and these do. I've also pretty much always been clinically depressed, as far back as I remember, and I've been diagnosed in addition to that with dysthymia and generalized anxiety. I have aspects of Dependent Personality Disorder, and sometimes also Avoidant, though I think these may come with the way I experience my partly-Borderline.

My advice: try to help her feel independent. Try to make her see that she *is* special, as I guess (they tell me) everyone is, and she *is* worthwhile (which I know everyone is). You obviously care about her, so you've tried already. But that's the only way to stop the insane attachments and volatility which are the hallmarks of BPD. She probably won't stop being creative and intelligent, and the emotional highs may still be there even if much of the crazy goes. But the worst of it, in my experience and my evaluation of my ex, is the feeling of emptiness, and the need to subsume oneself in another person in order to feel real, and to feel loved. I'm sure she knows you love her. I am equally sure that she doesn't *feel* it. We are SO good at rationalizing the good things away.

Encourage any professional or academic success she may acquire. Try to make her believe that that's important. Try to help her focus on the people she loves who love her back-- not romantically, NOT romantically. Not in the creepy one-on-one sense we're prone to. But friends. I was going to attempt suicide-- yes, over a boy-- last year. I decided to post one cry for help on Facebook, and if no one responded to help me in a couple of hours, to get on with the pills and the whiskey and the bathtub and razors. But they did. They saved my ass, and they took me to the hospital, and I will never, ever forget that. Pets help too-- something you love which depends on you can often snap you out of such feelings. I myself have an old cat with a thyroid disease and snakes, so I know perfectly well that no one would want to take care of them, no one would love them as I do, if I left them. And, yes, suicide risk is often part of Borderline. Take that shit seriously if it's threatened. It may be just a threat. But it may very well be serious. Because we really feel, on a gut-level, that no one would miss us that much, no matter what our brains may say.

But yeah. Knowing people love you, even if you don't really understand why they would, helps. And, again, not romantic obsessions. Love is fine, love is great. But it can't be the only thing. And, for many of us, it becomes so.

Ha-- this was kind of fun to write. The idea that my experiences might help someone else is really, really nice. And, seriously, it's not all bad at all. It's a superpower, if you look at it right, like anything else. We feel more. Which can be good or bad. But that I don't want to trade.

Watch the meds, too. She may need something nontraditional like I do. Lamictal is a mood-stabilizer as well as an anti-epileptic, and it's the only thing that's helped me. The Buspar helps the anxiety, and it doesn't work for a lot of people, but my Ativan consumption is way down since I started it. In that way, we are all Special Snowflakes. Brain chemistry is weird.


If you have any questions, MeMail.
posted by Because at 8:02 PM on September 29, 2014 [23 favorites]

I have BPD, and coincidentally I'm (finally) starting therapy tomorrow for it.

Up until last year, I thought I was just an asshole who was reckless about a lot of things and very emotional. Turns out I am an asshole who is reckless about a lot of things and very emotional, but the latter two things are part of a disorder and can be managed.

It's not easy to live with, but I'm going to leave aside most of the doom and gloom stuff as that's going to be covered in all the suggestions above. My diagnosing psychiatrist said it's not all bad. Took me a while to come to terms with that, but it's true. People with BPD are often very passionate about things they do, careers, what have you. Partly this seems to be a function of how we attach to things, and partly it seems to function as self-soothing; being passionate about and invested in something makes you feel good, which helps to iron out the negative swings somewhat. According to her, one of the best outcomes from therapy--and echoing the DBT recommendation; it's the gold standard, developed by Marsha Linehan who created it as a way to treat her own BPD--is learning to harness the various problems associated with the disorder for good results. So that's something to work towards.

Not too much doom and gloom, I said, but: one of the more insidious and difficult things about BPD is its cyclical nature, especially if comorbid with depression. A major hallmark of the disorder is reckless and impetuousness, especially with regards to sex, money, substances. Problem is, once a set of reckless behaviours impinges negatively on the consciousness, we feel guilty or bad about them, and then we react to the emotional storm by... indulging in more reckless behaviour because we can't process the emotions in a more adaptive way.

One of the biggest things she can do to help herself, in or out of therapy, is to start practicing mindfulness. I've commented about it elsewhere on the green, and there are a gazillion resources online for getting started and maintaining a practice. Basically, it's a way of simultaneously detaching from emotion while being in the moment to make healthier choices.

As for medication, I was on Wellbutrin for the depression (have weaned off, under doctor supervision, to see how I am able to handle things. So far so good), and clonazepam for anxiety and some of the Wellbutrin side effects. My psychiatrist told me (and independent reading bore out) that there aren't really any medications that help with BPD per se. Most mood stabilizers work on smoothing out longer cycles than we tend to experience. Medication can help with some symptoms--e.g. Ativan for sudden mood swings--but it's worth remembering that pills don't teach skills, and long-term use of benzodiazepenes is dangerous. NB, I am not a psychiatrist or any kind of medical professional and you should defer to the judgement of experts; I am repeating only what experts have told me. I took Seroquel once and once only and dear fuck, never again will I willingly put that in my body, the side effects were awful.

What Because wrote above is... well it hits really close to home, and seems to be pretty typical of experiences with the disorder.

Honestly, just knowing you have the disorder goes a million miles towards helping to manage it. Feel free to contact, email in profile, if you need.
posted by feckless fecal fear mongering at 8:41 AM on September 30, 2014 [6 favorites]

I was diagnosed when I was around your daughter's age. Having BPD is really painful. Not all the time and everyone is different but for me the hardest thing about it is just being in pain that other people do not understand and see no reason for. It's often really isolating and lonely. Sometimes I feel really hopeless and desperate without really knowing why, and my moods will fluctuate and again, I won't understand why. Sometimes I know that I am saying or doing or feeling irrational things, or sometimes I'm not sure whether my feelings are rational or not, but even knowing this doesn't make me stop feeling bad about things and then I'll feel bad about feeling bad. It's exhausting. Sometimes it's unbearable. This has led to reckless actions. But at the same time you don't feel like you can really talk to anyone about it because it's difficult to articulate and sounds SO DRAMATIC and people really don't understand.

I've found it very difficult to get any help for this and have never been in treatment (NHS is happy to prescribe pills but not therapy and I have not wanted medication for this) but I will say that over the years things have gotten better. Not easily, and not really with my emotions but the way I behave and deal with things has improved. I had to be aware of the problem and it has been a lot of work, a lot of being very mindful of my behavior and resisting impulses, which doesn't always work but I am more stable now than I was 10 years ago. I think part of this has to do with the natural maturing as adults that we all do and some of it has to do with getting into a good and stable relationship (for me, being in bad relationships would trigger my borderline behaviors and make me worse. Most of my relationships have been chaos). I've also been able to accept that sometimes things just will affect me in ways that seem disproportionate to other people. It doesn't lessen my feelings but knowing that the feeling will pass is helpful.

Obviously I can't speak to your daughter's needs specifically but generally the only person who sees me in pain or "acting borderline" is my partner. I don't have a close relationship with my mother and she has no idea that I have this diagnosis or that I have any issues at all. I never discuss my diagnosis (disclosing it to a partner is a big deal for me) and to most people I seem incredibly well-adjusted, capable, and so on. But if you are dealing with this with your daughter in general what helps for me is having constant support and reassurance. And compassion. Also being truthful and upfront. My partner had a tendency to just not tell me about things because he was afraid they'd upset me and didn't want to set me off. This was (barring telling me I'm crazy or rolling his eyes at me (which he does not do) the worst thing because when I would find out (which inevitably I would because I'm suspicious and often seeking to either confirm suspicions or reassure myself) I'd then feel like I couldn't trust him and that caused more problems. So don't try to protect your daughter but don't let yourself be a doormat, either. Structure and constancy help.

There is so much more to this and I could go on and on but I want to recommend Reasons For Hope published by Johns Hopkins Press. It's the best and most helpful book on BPD that I've read (and I've read loads of these). This gives the most accurate description of BPD that I've read while also explaining a lot of how it works, eg how the brain works differently and so on. Another one that I related to moreso than others is The Borderline Personality Survival Guide.
posted by Polychrome at 5:38 AM on October 1, 2014 [6 favorites]

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