I wrote this in the last year of my undergrad as part of my literary journalism course. While it may have strayed from the original purpose, it was still a piece that I had been wanting to write for years – I just needed the opportunity. Publishing it has gone much the same way. At first I wanted a wide, nationally published release. but as it got more and more out of date, i knew that it was going to be something that I had to do myself – but I didn’t know when or where.
Seeing that today is Bell Let’s Talk day, and the existence of that day was a huge reason for my writing this in the first place, today feels like the right day. I think it’s indicative of my true feelings on “let’s talk” that it still feels like an enormous risk to post this on my own website. This could very well affect my future employment prospects.
But at the same time, posting it doesn’t change the fact that every word is true. Posting it, like everything else, doesn’t change the fact that this is who I am.
Today, let’s remember that “talking” is just the beginning.
Change requires action.
On the Borderline
I think of killing myself as I brush my teeth; wash the dishes; drive to school.
I don’t know when. It’s not that I have a specific plan. But the way I see it, it’s an inevitability.
It’s a funny thing, knowing how you’re going to die. It takes some of the pressure off, but it sure does takes away some of life’s mystery, too.
I’ve struggled with my mental health for most of my life. It’s come with a series of disjointed lowlights: Age 12, when my issues with chronic depression first came to light; Age 14, when I was put on anti-psychotic medication for the first time; Age 21, when I traded my anti-depressants for tranquilizers before trading it all for the cold sweat of withdrawal; Age 25, my shameful return to medication after accepting that my anxiety and depression could no longer be treated with the power of positive thinking.
However, the key events in my journey took place just before my 19th birthday, a couple of months before I would start University back in 2009.
I don’t remember many of the details. I had just started seeing a psychiatrist at the University of Alberta hospital. My doctor and I had decided that we should look further into my options with medications, and should address my constant problems with anger and other forms of emotional instability. I was immediately scheduled for “extensive psychological testing.”
While I don’t remember much, I know it wasn’t anything like it is in the movies. I was referred to a diagnostic psychiatrist, who conducted an interview with me and then gave me three multiple choice tests – about 500 questions – to be completed in a specific order. I remember sitting in the hospital cafeteria completing page after page of questions, more annoyed than anything.
A week later, without much drama, I was diagnosed with Borderline type emotionally unstable personality disorder (BPD) – or, simply, Borderline.
According to the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10), emotionally unstable personality disorder is characterized by a definite tendency to act impulsively and without consideration of the consequences, with unpredictable and capricious moods, outbursts of emotion, and an incapacity to control behavioural explosions.
Like the ICD-10 says, living with Borderline type emotional personality disorder means that I have a tendency to confrontational behaviour and interpersonal conflict. I have disturbances in self-image, aims, and internal preferences and chronic feelings of emptiness, along with unstable impersonal relationships and a tendency towards self-destructive behaviour, including suicide gestures and attempts.
I am aggressive. Confrontational. Explosive. Angry. My mind works in extremes. I’m unpredictable and I can’t control myself or my emotions.
I am unstable.
Also, I’ll probably kill myself.
Borderline is the only personality disorder listed in the ICD-10 that includes suicidal behaviour in its diagnostic criteria. A selection of studies shows that the suicide rate of people with Borderline is somewhere between 50 and 400 times the national average in the United States, or around 10 per cent.
One in 10 people with Borderline end their lives by suicide – and that’s without including other Borderline-related premature deaths due to things like substance abuse or disordered eating. Seven of the other nine will exhibit self-mutilating behaviour or record a suicide attempt in their lifetime.
I started cutting myself when I was just 12 years old.
Every day, I wake up older than I ever thought I’d be. Growing up, I put the cap on my life expectancy at 25. Never in my wildest dreams did I imagine my life at my current age of 26 – there was just no way I’d make it this far. Every day is one that I never planned for.
I’ve never really stopped cutting: I’ll quit for a couple years, but like any addiction, the itch is sort of always there. It’s been over two years since the most recent time, but I have too much experience to call it the last time.
It really is a compulsion: I would cut in straight lines in groups of three and then keep track in my notebook of where, when, how many, with what tools. To this day I still make a mental tally of my scars when I can’t sleep – like counting sheep.
My self-destructive behaviour started there, but that’s not where it ended. I developed an addiction to painkillers when I was about 15 – mostly as a response to the growing awareness of my cutting among my family and friends. After all, you can’t check my skin for how many pills I’ve taken.
Over-the-counter or prescription: it didn’t matter, as long as I could get it. I had a couple of near misses: a mix of codeine and every drugstore-brand painkiller in the house that knocked me out for about 16 hours before I woke up shaking, and, another time, half a bottle of Aspirin that made it so difficult to function that in my 15-year-old mind, I thought I was going to die.
Painkillers were just one of the less-visible forms of self-harm I took part in once people started to keep a lookout for those perfect red lines. For a while I would even punch myself in the face; I had to stop when someone asked how I got the bruise on my jaw.
I try to be more careful with painkillers, now. I like to say that I try not to take them at all, just in case it leads to temptation. But the truth is, I’m never without a bottle of Advil. Next to my bed; in my purse; in my backpack – the vice is never far away.
Even on my best days I think about killing myself, because of the part of me that believes it’s the only way I’ll die happy. That control is something that I don’t know if I’ll ever be able to let go of.
It’s like having the executioner following you around all day. He lets you get on with most things, but every now and then he lays a leather-clad hand over your shoulder. Just to remind you that he’s there.
I’ve lost a lot of friends because of Borderline – some because they weren’t willing to be there for me, but far more because of how I behave when I’m at a low point.
Stephanie and I have been best friends for over a decade. She’s seen it all, and can recognize the signs.
“I can always tell when you’re having a harder time,” she says. “Communication completely breaks down if you’re struggling. Conversations aren’t easy. You tend to communicate way more aggressively.”
Like Stephanie, Sarah has seen me at my worst. My manipulative behaviour and dissociative tendencies actually put our friendship on hold for months in 2014 until I climbed out of the hole I was in.
“You were a completely different person,” Sarah says about that time. “It was like I knew that no matter what, you were going to react with anger.”
Stephanie’s experience corroborates with that judgement. “You’re more sensitive. Everything intensifies,” she says. It’s true: when I’m at my worst levels of instability, even things I don’t usually care about will send me flying off the handle. “Even if something is a positive, it can be so intensified that it basically becomes a negative.
“You’re triggered by people leaving,” she adds. “That’s when I notice it the most.”
My separation anxiety and fear of abandonment are pretty infamous at this point. When Stephanie and I lived together, I’d feel a twinge of heartbreak if she’d go take a shower when we were hanging out. I’ve had full-on, can’t-breathe, hysterical-crying breakdowns triggered by people going away for just a few months.
Many specialists and definitions of Borderline personality disorder link the illness to a profound fear of abandonment. According to the Center for International Rehabilitation Research Information and Exchange (CIRRIE), people with Borderline are sensitive to any cue (real or perceived) that they are being rejected or abandoned. This can cause me to impulsively react or become enraged over even the smallest slight – like the cancelling of plans, even with a good reason. It even brings out some of my most manipulative behaviour in order to “test” my friends on their commitment to being in my life.
In September, I’ll be moving to England to get my Master’s degree. Part of me wonders if it’s just another manipulative twist to see who will miss me; another wonders if it was just an impulsive decision to see if I could actually do it.
CIRRIE also describes the intense, inappropriate anger that comes with Borderline as one of its more troubling symptoms, as its level is usually more intense than is warranted by the situation or event that triggered it.
If my separation anxiety is infamous, my anger is the stuff of legends.
I remember a time when “rage blackouts” were commonplace in my life. I would slam my fist into walls; throw chairs; scream until my throat was raw. Extreme impulses and pure rage don’t mix well: I’ve come very close to hurting people around me. In the heat of the moment, it would have been intentional.
Usually, these episodes ended with me hurting myself. A 2008 study on self-injury indicated that self-mutilating behaviour could be used as a coping mechanism to regulate negative emotions, including extreme anger; that’s always been true for me. I used it to ground myself, bring myself back to reality and channel my emotions into physical pain so they could be “released.”
I still don’t know any other way to bring myself down from that fiery rage. It’s one of the reasons why I can’t say that I’d never cut myself again.
Living with Borderline is a constant struggle between who I am and who I want to be.
There’s a clear difference in the treatment of personality disorders with the treatment of more common mental illnesses like depression and anxiety. Not to take anything away from the damaging effects of those disorders – I know first-hand how crippling they can be – but the stigma has been gradually lessening, and there is relatively easy access to medication and treatment.
Bell’s famous Let’s Talk Day, which is promoted by a host of celebrities, advocates for the mental wellness of Canadians. Of the 16 celebrity ambassadors, 12 are focused on depression or anxiety. It seems that even among mental health initiatives, depression and anxiety are still easier to talk about.
The difference is in perception. Depression and anxiety are seen as disorders that hold down or suppress your true self; a personality disorder is your true self.
Where personality disorders are often described in terms of “tendencies” and “behaviour patterns,” depression and anxiety are classified using words like “episodes” and “disturbances.”
Where depression and anxiety are changes – a noticeable and drastic departure from one’s “normal” behaviour – a personality disorder is static. Ever-present. All-encompassing.
On Jan. 25, Let’s Talk Day received huge support from around the world and subsequently contributed over $6.5 million CAD to mental health research, training, and support initiatives in Nunavut, Ontario, Quebec and the Atlantic provinces. That same weekend, M. Night Shyamalan’s latest film, Split, grossed over $25 million USD during its second weekend on top of the box office.
Split depicts a mentally ill character with something resembling dissociative identity disorder, although the magic of Hollywood allows him to present a medically impossible 20+ personalities. This character is portrayed as the antagonist who kidnaps and tortures three young girls before eventually cannibalizing them. It has grossed over $270 million USD worldwide during its run. It spent four straight weeks at No. 1 in North America, making it a massive financial success.
I’d hope that, as someone with a serious mental illness, I might be forgiven for seeing the hypocrisy in these statistics. It’s extremely difficult to see a whole country rally behind mental illness and championing the end of stigma for depression and anxiety while the most popular movie in the country portrays mental illness as a demonic quality.
I think the difficult part of accepting a personality disorder is right there in the name: personality. There’s no good explanation for it, it’s just who you are. There’s also the fact that Borderline is only diagnosed in about 2 per cent of the adult population.
Ramona Kotke Gapp is a Registered Provisional Psychologist who practices both clinical and counselling psychology. She says that finding a specialist can be hard for patients, because even therapists can share the stigmatized perception of personality disorders.
“When it presents, it can look like so many other things,” Kotke Gapp says, citing trauma, depression and anxiety as alternative diagnoses. “I think therapists don’t want to diagnose personality disorders because there’s this idea that it can’t be recovered from or dealt with.”
With a number of criteria, symptoms, and tests required for diagnosis of the disorder, time and even misdiagnosis can also be an issue.
“Someone a therapist sees one or two times with these symptoms, they might think it’s a mood disorder and send them away with anti-depressants,” she says, adding that often a full history of the patient is required, along with third-person accounts from family or friends close to the patient for a confident diagnosis.
“When a client comes in and they show these symptoms for a personality disorder, you’re looking for symptoms that have been there almost for a lifetime,” she says. “It takes longer to figure that out.” Unfortunately, many therapists – and patients – don’t have the luxury of that kind of time.
While depression and anxiety also affect my life on a daily basis, the truth of the matter is this: not all mental illnesses are treated equally.
Not only have I faced stigmatization because of my personality disorder, I’ve received it from people who also suffered from depression. The suggestion is that I should somehow be able to deal with it or fight through it, much like I’ve been able to with my situationally influenced anxiety or mood-affective depression.
Unfortunately, Borderline is different. Part of the classification of specific personality disorders in the ICD-10 is the tendency to involve several areas of the personality and to be nearly always associated with considerable social disruption.
Borderline affects everything I do, it’s who I am; it’s as much a part of me as my hair colour. I can bleach it as much as I want, but those dark, black roots will always come back.
Currently, the therapy that is most recommended for Borderline is called dialectical behavior therapy (DBT).
“It’s a mixture of cognitive behaviour therapy and current day mindfulness,” explains Kotke Gapp. “Relaxation, restructuring of thoughts, and awareness are a big part of it.”
DBT was designed specifically to treat Borderline, and teaches problem-solving skills to control emotions, reduce self-destructive behaviour, and improve relationships by focusing on the awareness and acceptance of behaviours.
Kotke Gapp also notes that psychotherapy is usually preferred to pharmaceutical methods due to the sporadic nature of the symptoms.
“There’s such ebbs and flows,” she says. “Medication might work for one phase but not for the next. The side effects of the medication are usually worse for people with BPD.”
Apparently, the best thing I can do is understand that my personality disorder doesn’t mean that I’m broken, and that it’s not because of something I did. Even though I need to recognize that my behaviours aren’t rational, I also need to recognize that it isn’t my fault. It’s just how my brain works.
“Recent studies are finding that people with BPD have a lot of activity or deficiency in the pre-frontal cortex and the amygdala,” says Kotke Gapp. “There’s problems with pain perception and behaviour. With BPD, you just don’t feel things the same way.”
She compares it to a physical disorder like diabetes. The same way people with diabetes have a problem with processing sugar, people with Borderline have a problem processing emotions. It certainly gives me some clarity as far as finally facing my disorder head-on.
I’ve been back on medication for my depression and anxiety for about a year and a half, now. I’m doing pretty well. I’m still not in therapy, but I’ve been thinking about it.
After years of denying how much Borderline affects my life, I’ve now acknowledged that it does more than just affect it; Borderline controls my life.
I’m still learning not to be ashamed of that.