Author: personalityordered2739

What is Borderline Personality Disorder?

A crash course in one of the most common, yet misunderstood of the personality disorders

When I went away and looked into Emotionally Unstable Personality Disorder, more commonly know as Borderline Personality Disorder, I made sure I was looking at Australian and reputable medical sites. All pointed me towards the DSM-5 (American Psychiatric Association Diagnostic and statistical manual of mental disorders 5th edition), which appears to be the most commonly used diagnostic tool for personality disorders (also the World Health Organisation International statistical classification of diseases and related health problems 10th Revision (ICD-10)). The DSM-5 outlines the criteria for which, if a person is experiencing a certain number (or all) of, then it is likely they will be diagnosed with that disorder.

I explained in my post about being diagnosed with BPD and OCPD that, my psychiatrist very quickly reassured me that many people can identify with having some of these traits, and that being diagnosed doesnt mean there’s something wrong with you – just that some parts of life might be harder, or require certain attention such as therapy. More than anything I’ve found it’s knowledge to help understand me myself better.

So the DSM-5 states the criteria for BPD as (taken from Australian BPD Foundation Ltd:

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
^DSM-5 p663

Also taken from Australian Borderline Foundation Ltd is the ICD-10 diagnostic criteria

Emotionally unstable personality disorder is characterised by:
• a definite tendency to act impulsively and without consideration of the consequence
• unpredictable and capricious mood
• liability to outbursts of emotion and an incapacity to control the behavioural explosions
• tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored.
Two types may be distinguished: impulsive type and borderline type.
The borderline type is characterised by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicidal gestures and suicide attempts

*Source Clinical Practice Guideline for the Management of Borderline Personality Disorder (NHMRC 2012) p44

Personally, I identify with most aspects of this diagnosis to varying degrees (except for anything related to suicidal behaviours/self-harm or self-mutilation, which I’m grateful to not have experienced). Some are still, more confronting then others. Some more surprising than others. All track back to confirm for me that something wasn’t quite right – but I thought it was all a big secret that I was hiding from everyone and that I was all alone. This, along with the OCPD diagnosis (which I’ll define in a later post) have helped me gain huge insight into myself and realise that a) there’s nothing “wrong” with me and b) there are ways I can get help which will make my life easier to manage. Of course – getting that help and acting on it is actually incredibly difficult to do for all the reasons listed above, but I’m more aware now and I’m doing my best to find the right course of treatment – it’s trial and error and it’s long haul – which I find outrageous because I want everything fixed NOW!

In the meantime, research and learning continues to be a big part of my therapy and I find the following really useful sources – let me know if you do too, or if there are other sources you utilise and would like to share!

National Education Alliance for Borderline Personality Disorder
Australian BPD Foundation
Health Direct – Borderline Personality Disorder
Sane Australia – Borderline Personality Disorder

What are Personality Disorders?

A brief introduction to what personality disorders are, from the perspective of someone who had limited understanding before they were diagnosed with two.

I’m going to preface this post with the obvious disclaimer that I am not a doctor, psychologist, therapist or expert in any way shape or form in the area of personality disorders. Since being diagnosed with BPD and OCPD, I have done lots of reading and also explaining what it is to others – so I’ve got a bit of a spiel that I am comfortable is factual, concise and helps me and others understand in layman’s terms what personality disorders are. I encourage anyone who relates to any of this information, or who wants to know more to do their own research, or reach out to a trusted medical professional.

I mentioned in my last post how my psychiatrist helped me understand what having a personality disorder means, but what actually are personality disorders? Psychology Today defines personality disorders as “deeply ingrained, rigid ways of thinking and behaving that result in impaired relationships with others and often cause distress for the individual who experiences them.” Basically, as I understand it – when a group of personality traits starts negatively impacting the way you live your life, you may have a personality disorder. There are ten commonly identified disorders, sorted into three clusters. You can read more about these in detail in the Psychology Today article linked above but they are:

Cluster A – Paranoid personality disorder; Schizoid personality disorder and Schizotypal personality disorder

Cluster B – Antisocial personality disorder, Borderline personality disorder (BPD – also known as Emotionally Unstable personality disorder), Histrionic personality disorder and Narcissistic personality disorder

Cluster C – Avoidant personality disorder, Dependant personality disorder, Obsessive-compulsive personality disorder (OCPD)

As I’ve mentioned, I have been diagnosed with BPD (along with an estimated 1-2% of Australians according to Head to Health, who also report “about 6.5% of the adult population in Australia live with a personality disorder.” ) and OCPD. I also suffer from high anxiety which Head to Health note can be common to personality disorder sufferers.

Rather than go into any medical and scientific detail, I’m going to link below the sites I found really useful when learning about personality disorders. They are Australian sites, as that is where I live, but I also explored sites from the UK and US so there will be resources local to you if you prefer.

Please comment below if you have any other resources which have helped you better understand personality disorders.

Well, who am I then?

My experience with being diagnosed with personality disorders.

In the first meeting with my psychiatrist, she didn’t come straight out and say to me “you have borderline personality disorder (BPD) and obsessive compulsive personality disorder (OCPD) – here’s some medication”. If ever I needed an example of fate, it’s having been assigned Dr Elbaky when I arrived at Northside Clinic. She has seemed to understand me right from the start, and I’m incredibly grateful to have her as part of my treatment.

Instead, Dr Elbaky suggested I look up and research as much as I could “emotionally unstable personality disorder” (another name for BPD) and OCPD, and told me we’d talk about it more in our next session. So instead of the disorders becoming a label someone else had placed on me, they became somewhat of an agreed diagnosis that I was a part of. Because when I first started researching – boy did I feel seen. Like, here was all this information that blatantly described who I was – but not the parts I let others see. All the things I kept hidden (or thought I did, more on that another time!), that I worried about, that I questioned – did other people think like this? Behave like this? Why do I struggle with this? And so on.

A thought had struck me in the middle of my research. If all of these things are me, and they are a disorder – is there something wrong with me?! Is everything I know about myself bad and something that needs to change? And if I treat it – who will I be? Because basically what I’m hearing here is all the little strange, quirky things about me are a disorder that needs fixing.

Of course, that’s absolutely not how it is and Dr Elbaky had an excellent way of explaining it to me. Everyone’s personality is made up of different parts – strengths and weaknesses, positives and negatives. Personality disorders are sorted into three “clusters” (which I’ll talk about more in my next post), and everyone has a tendency to at least some of these traits throughout their life. When someone carries more than just a tendency to multiple traits within these identified disorders, they are considered to have that disorder. It doesn’t mean they are bad, or their personality is wrong – it’s information that can help that person understand why they do, say, think a certain way and why they struggle with certain things.

I don’t carry all of the traits of either of my personality disorders – but I do carry most of them. Reading up on the technical definitions of BPD and OCPD was like reading a checklist of myself, but reading more and more widely from different sources, people with similar diagnosis and experiences and different treatment options has been invaluable in me learning more about myself and accepting that BPD and OCPD are a part of me, not who I am.

What was your experience of being diagnosed with a personality disorder like? Please comment below – I’d love to hear from you.

Nicole xx

Cracked Open

An introduction to my mental health journey and why I think it’s important to talk about it.

All the buried seeds crack open in the dark the instant they surrender to a process they can’t see.
Mark Nepo

A month before my 38th birthday, I had a breakdown. A nervous breakdown, as they say. I burnt out. I couldn’t cope, couldn’t function, couldn’t see a way forward within my life. I’m a pretty anxious person at the best of times, but I wouldn’t say I was suffering from depression – and it turns out I wasn’t. But I did have a crisis, a depressive episode which saw me spend 24 days in a private mental health hospital, and not return to work for six weeks.

I am on the other side of that particular time in my life now. I’m gradually returning to work, I have a treatment plan and I’m moving forward. But now that acute period has passed, it’s almost like things get harder as I navigate my life with the changes and lessons now installed in me. My room and house are the same. My friendships are the same. My job is the same. But I, am different. Different in a good way. Calmer, more ordered. Two things I’ve been craving to be for such a long time. I’ve been on the “self-help journey” (it’s cliched but it is what it is!) for nearly six years. I’ve been questioning myself and exploring and working on finding out “who I am” for all of that time. I’ve learnt and done a lot – but I don’t feel much differently about where my life is, where it’s going and who I am. For a long time, I couldn’t categorically say I love myself anymore than I did when I started this whole process. And isn’t that the point?

November 2014 is when I can mark a real beginning in the search, through an email I wrote to two lovely entrepreneurial women I discovered by accident, and who’s work really lit me up at the time (and still does!), mostly for the fact they were doing amazing things for women and for themselves (thanks Claire Baker and Alana Wimmer!). Below is an excerpt from that email:

There are days where I’m really not sure how I’m going to get through the mud of stress and expectation and obligation and that general feeling that it’s just never going to get any easier. But the thing that always keeps me going is the blind faith that one day, I will work it out and one day, I will find my passion and meaningful contribution to the world, and that’s when it will become clear, and life will be about living, not waiting and suffering through…

Up until a couple of months ago I felt EXACTLY the same as this. That I couldn’t find what I was looking for, but that I trusted I would. As helpful as it is to have this indicator of where it all started, it’s almost soul crushing to think I still felt the same after such a long time. When I’d identified the need for change, and more, and a different way of life – but hadn’t really put it into action. Of course, that’s not entirely true – my life changed hugely in that six years, and much for the better. What has persevered was a constant inability to acknowledge my achievements, my strengths and to love myself for who I am.

Then, I lost the faith. I stopped believing it would get easier, that I’d work it out, that I’d be happy. The word I used to a friend was “untethered”. I became untethered. And despite the multiple warning signs physically, mentally and spiritually, I kept pushing in the wrong direction. And now I know exactly where my limit is – because I passed it. The details deserve their own space. I imagine a breakdown is different for everyone who experiences one, while essentially being the same – the end of the way you were. It’s impossible to return to the feelings and doubts and fears you had because you know what the worst is and you don’t want to return. The difficulty, as always, lies in the action. All the action you must now take – there is no other choice. The appointments, the talking, the therapy, the drugs, the books, the tidying, the truths you must face.

I am incredibly lucky to have, and grateful for, an amazing support network. My family and friends who love me unconditionally and with whom I couldn’t have made it through. Who I didn’t lean on before it got too much but who I will never forget to call on again. A supportive workplace, incredible doctors and therapists. An exceptional private health policy which covered it all. Not everyone has this. Not everyone recovers as quickly as I seem to be. Not everyone gives themselves a second chance.

So, while I’m nervous about sharing the things that went wrong, my diagnoses, my dreams – I know it is valuable that I do – both for me and for others with whom these feelings and experiences might resonate. Because I’m very sure I’m not alone. And that realisation has been the biggest learning and relief of it all.