TW: Self-harm, thoughts thereof
I stood in line at Steel City Con, a comic, toy, and celebrity convention in Monroeville PA (right next to the famed mall that served as the set for George A. Romero’s Dawn of the Dead). In front of me stood a volunteer in a blue shirt, heavily covered in greyscale tattoos. He had a stack of post it notes in his hand, and he started to peel one away as he asked, “Do you want Katey to personalize your autograph?”
I didn’t hesitate. Of course I wanted the autograph personalized. While such a thing can theoretically devalue the signature, I wasn’t in this line to help launch my eBay store. I wanted Katey Sagal to write my name, right in the space next to Peggy Bundy’s towering hairdo. For that moment, I just wanted a microcosm of acknowledgment.
Who let the narcissist in here anyway?
Speaking of such things, Narcissistic Personality Disorder is also a cluster B disorder, as per the DSM-5. This makes it a close cousin of Borderline Personality Disorder. A diagram would show several overlapping symptoms, but all of that is just a blah blah blah to us.
My desire for personalization was not about narcissism, but about affirmation of who I was in the moment: a 40 year old male who deserves to have a nice time at a celebrity convention. Some people ask for inscriptions as a gesture; I ask for them as a way to help me further cement a sense of the authentic Nathan. Whoever that is.
It is time to stop and reorganize things a little. I confess that I haven’t planned out this blog very well at all. I keep going on and on about this thing that I have, yet I haven’t properly identified the thing in the first place.
So, it’s time to walk backwards a little and stop the action. Imagine showing up at a theatre and getting a backstage tour of what makes the production tick.
Here, on Mentally, Nathan, we need a closer look at what makes the production tick.
If I asked my students to develop a blog as a project, I would certainly say something to them if they did not define some of their key terms right away. This is writing 101: if you introduce a concept that might be new or only vaguely familiar to the reader, you should probably outline the words that really make your topic unique. This is necessary because readers have a much more difficult time with nebulous concepts. I confess that I have been a bit fuzzy about the nature of BPD, at least thus far.
So: What is borderline personality disorder?
BPD was not recognized until the 1930’s. At the time of its formal discovery, clinicians were looking for a term to describe patients who existed in the space between full blown psychosis (a complete and total disconnect from reality) and neurosis, a once formally recognized condition in which the patient has excessive and irrational responses to stimuli. To make a long, sometimes fun, sometimes dull story short, mental health professionals no longer believe that this concept of BPD is accurate. That is to say, BPD is not a disorder that inhabits those spaces. Someone who has BPD is not necessarily on some fast track to psychosis.
Here is what BPD is not:
BPD is not dissociative identity disorder (formerly known as multiple personality disorder). While I do experience some rather severe mood swings and dissociative states, (I get to have all the emotions all at once as I disconnect from reality! Go me!), I do not experience the kind of severe dissociation in which more than one distinct, unique personality comes out.
While I do “love” a good dissociative episode (despite the negative consequences, go me AGAIN!), I don’t have more than one personality.
At least I don’t think so. Who knows. Life sure can be an adventure!
Next: BPD is NOT untreatable. According to Robert S. Biskin at the National Institutes of Health, “Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption” (2015, para. 1). And this assumption continues to be challenged for a good reason. Although BPD currently has no FDA approved medications for it (meds for the likes of me treat the symptoms, but not the condition directly), it is generally treated by one of the most statistically useful and evidence based forms of therapy out there: dialectical behavior therapy. According to Molly Buford, “After the first year of treatment, 77% of participants no longer met the diagnostic criteria of BPD” (2021). This data is hard to reconcile was some hopeless notion that I am untreatable.
BPD is also not monolithic in its presentation. I suspect that it’s representation in cinema and fiction probably points to the more dramatic symptoms and activities, such as cutting and fits of rage. In general, mental health conditions tend to get cinematic representation that cements stereotypical thinking. Characters such as the Soprano’s Gloria Trillo (at least in my opinion) represent the more dramatic and severe presentations of BPD. The public imagination is mired in such stereotypes. As the stereotypes are rooted in some BPD realities here, they can be difficult to reshape and look at in a more balanced way.
There simply can’t be any stereotypical thinking with BPD. To meet the criteria for a ticket on this cruise, guests must meet at least 5 of 9 possible criteria. The DSM 5, which you can think of as a big, fancy book that can tell you what the hell is wrong with you, defines BPD as being characterized by:
Frantic efforts to avoid real or imagined abandonment.
Unstable, intense interpersonal relationships, characterized by alternating between idealization and devaluation of others.
Identity disturbance, such as a persistently unstable self-image or sense of self.
Impulsive and potentially self-damaging behaviors in areas such as spending, sex, substance abuse, reckless driving, binge eating, or self-harm.
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.
Emotional instability due to marked reactivity of mood, with intensive episodic dysphoria, irritability, or anxiety.
Chronic feelings of emptiness.
Inappropriate, intense anger or difficult controlling anger, often leading to frequent displays of temper, physical fights, or verbal outbursts.
Transient, stress related paranoid ideation or severe dissociative symptoms.
Wow! All of this must seem like a real treat.
As there are 9 criteria, with the demand for diagnosis being 5, there are 256 possible ways in which this condition can manifest. No wonder a diagnosis can be painfully slow. In the world of borderlines, there are really no two people who are quite alike. If you think you have an idea of what a borderline is, all you really have is one idea: your conceptions are not going to fit with everyone.
Which means we all have some work to do here.
Years ago, I read an article about BPD at work and immediately thought, “That sounds awful.” When my wife looked up the disorder and reviewed the symptoms, she suggested I read about it again. I did so, and I felt positively seen.
I would suggest that I meet at least 8 of the criteria, and if all honesty is on the table, I can probably run the table.
As all of this can be confusing and dull and tedious (how else am I supposed to attract enough readers in pursuit of extortion level advertising fees?!), I think it might be a little more helpful to think of this disorder by its alternate name: emotionally unstable personality disorder. This is really what lies at the core of someone who struggles with BPD; the inability to read and process emotions in a way that is appropriate. Here the nature of the beast is very much cyclical and dependent on surrounding events and people.
For example: In the course of a day I will likely cycle through a full range of emotions. At therapy this morning I found myself anxious, frustrated, inspired, fearful, and depressed, right before I felt a distinct sense of hope and optimism. At one point I sat at my table, looking at my DBT guidebook, trying to hold back the tears from another cycle. I was not sure why I was upset; I only knew that I was cycling again and ready for the tear factory.
And the cryings parts are always, by a mile, the longest portions of the cycle. While I do get to experience something like happiness and an elevated mood, this generally takes place in 30-60 minute chunks. I call this my “manic hour.” When I have my manic hour, my wife sometimes asks me to go outside and ride it out.
Can you blame her?
I would also, if you really get lost in all that psychobabble mumbo jumbo, suggest that you think of BPD primarily in terms of its core fear: the fear of abandonment (or what I will call FOA, which I demand to be pronounced “Foe-Ah”). This is the engine that drives the train. The FOA is the voice that tells you that nobody, absolutely nobody likes you. FOA collects in your mind like rust, until everything is affected, until you realize that some of your most innocent actions have suddenly been re-classed as defense mechanisms. You say the right thing to keep approval, and in effect, you become a chameleon, always adjusting your properties to blend into a situation. FOA makes you think about all of the sad memories, and so much so that you forget that happiness existed in the first place.
If I close my eyes and imagine real, real hard, I can convince myself that I spent all 4 years of high school, sitting at one of the lunch tables that acted as overflow for the misfit crowd. If I allow FOA to sing its song enough, I can be convinced that this was my reality the entire time.
Borderlines are, as a rule far more emotionally reactive than the rest of the population (and reactions can be vicious, but quiet, which is where the informal term “quiet BPD” comes from). When something goes wrong for a borderline, the lack of emotional control is always the parent cause, at least in some way.
For the longest time I have had difficulty defining my long-term mental health goals. I simply wanted the rain in my head to stop. I wanted the emotional rollercoasters to take a break. Now I am much more certain of how to define my goals.
My goal is to regain control. Life on maladaptive autopilot is boring.
Yours Mentally,
Nathan
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