MHAW19: Maladaptive not Manipulative - What I Wished Mental Health Professionals Understood About Borderline Personality Disorder [Guest Post]
by
Kilo Bobs
- 1:43:00 AM
As part of an attempt to bring lesser discussed mental illnesses, disorders, and diagnoses to the forefront of the conversation this Mental Health Awareness Week, I've invited people to share their experiences about under-represented diagnoses in mental health (see the series here). Today's blog about Borderline Personality Disorder was written by the wonderful Lorna who blogs over at Living Beyond the Borderline.
TW: mentions of self harm, suicidal ideation, dissociation, psychosis.
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As someone who has been diagnosed with Borderline Personality Disorder AND someone who has worked with inpatients with Borderline Personality Disorder, I have seen first-hand how misconceptions and downright misinformation about this condition impacts on those suffering.
When I worked in a psychiatric hospital, I hid my disorder as the stigma associated with this particular group of patients was so great, and I feared what would happen if I was 'found out.' I worked with nurses, psychiatrists, medics, social workers, psychologists and more, all of whom supposedly held a professional education on the realities of BPD. Yet every single day I was faced with stigmatising comments and complete misinterpretations of the disorder.
Having now left this environment, I want to share what I want professionals to know about BPD and what I wish I could have said to people back then.
Borderline Personality Disorder is a Mental illness
Please stop talking about “mental illness and Personality Disorders” as if they are separate. They are not. They may have different aetiologies, and one term is much newer than the other, but both are legitimate mental disorders. Research has repeatedly shown that those suffering BPD have significant and distinct neurological differences compared to those with other disorders, and the general population, so quite literally, it is an illness in the brain!
We're not Behaving the Way We are on Purpose
Linked to the above, we can’t always help the way we behave. When we experience an intense emotion, such as anger or fear, we react in very automatic ways. Whether this is because we learnt them to survive childhood abuse or they simply occur because our brains are wired a little differently, we struggle to contain the urge to act. Be this self-harming, hitting out or crying hysterically. At times we may even dissociate and not even realise we are behaving in such a manner until we’re re-grounded.
We’re Not Trying to Manipulate You
When we do behave in maladaptive ways, we are not doing so as a means to manipulate you or get our own way. Often it is in response to an intense emotion which is so unbearable we will do whatever we can to relieve ourselves of it.
I understand if we harm ourselves after you’ve suggested you might leave it can seem like a means to get you to stay. But it’s actually more a response to the intense emotions that stir in us at the thought of being abandoned, and a means to manage this and attempt to cope with such unpleasant emotions.
Our self-harm/suicidal behaviour should be treated with the same compassion and seriousness as someone with any other diagnosis
As I said before, maladaptive behaviours can become habitual and even automatic. Our unstable self-worth also means we may go through periods where we are more sensitive and exhibit frequent self-harm or suicidal behaviour. I get that it can seem frustrating, and even appreciate it may seem like attention seeking, but again this is far more likely to be a response to serious emotional distress which we cannot cope with. We need you to take it seriously, as if it were the first time you had ever dealt with us in such an emotional state. We need compassion, support and understanding. Even if you feel it, please don’t show us your frustration. We already feel so low and don’t need to be made to feel guilty or judged. We also don’t need you to abandon us when we feel like this, as it may escalate things for us. Please just try and ride the storm with us as best you can.
If We Get Angry, it’s Probably Not Even About You; Please Don’t Take it Personally
Anger can play a big part of BPD, and some may lash out at those around them. I know I’m guilty of this to a certain extent when I feel particularly stressed or anxious. Heightened emotions end up taking over and it’s as if the part of my brain containing manners gets shut down as the emotions need as much attention as possible.
Whilst we may appear rude or aggressive, it’s likely that inside we are dedicating so much energy to coping with an intense emotion that we snap out responses without even thinking.
There have also been times I felt significant anger at others which isn’t really about them but someone from my past. I struggle particularly with male authority figures as I experienced childhood trauma from a male and this means I can be a little guarded and abrupt with male supervisors/teachers etc. But it isn’t their fault, and I hate to think I’ve ever causes them upset from my behaviour. Because trust me, those of us with BPD always end up regretting this behaviour and use it as another means to dislike ourselves!
Oh, and if we get angry please- if you can- don’t abandon us.
I know when we are in particularly bad states, be this self-harming, lashing out or even pushing you away, we’re not fun to be around and the easiest thing to do is throw your hands up and say “I can’t do this.” But that’s probably what were expecting you to do, and possibly even testing out. Please, if you are able, stay with us and remind us you’re not going to leave. Honestly it may even help bring us out of crisis, as we’ll be so surprised you’re staying!
We Are Not Lost Causes
I appreciate that the treatment for Borderline Personality Disorder is complex. That it isn't as straightforward as medication, and often involves years of intensive group and individual psychological therapy. It can take years to reverse the maladaptive patterns learned by somebody throughout their life, and it can sometimes feel their progress is non-existent. But this isn't true. Patients with personality disorders can and do progress.
They need compassion and empathy, and viewing them as "impossible" or 'treatment-resistant' is only going to make matters worse
Sometimes, we Hear Voices Too, and They’re Just as "Real" as for Those With Psychosis
Research suggests as many as 50% of people with Borderline Personality Disorder experience auditory hallucinations. In many cases, this is indistinguishable from a person with psychosis. Even though the underlying causes differ, the experiences can be just as terrifying and disruptive for the individual. You wouldn't dare question the validity of a psychotic episode, don't question a PD patient. They are not ‘making it up’ or pretending.
So next time you come across a patient with Borderline Personality Disorder, try and be a little more understanding. They’re doing the best they can, I promise.
Lorna
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If you are struggling right now and feel like you need to talk to someone, The Samaritans can be reached at 116 123.
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