A friend of my wife’s was on BBC 4 last night discussing Borderline Personality Disorder, or BPD, with Dr. Raj Persaud on his show, “All in the Mind”. Joshua Cole is the founder and primary force behind BPDWorld, a UK-based site which is “…committed to raising awareness and reducing the stigma of mental health, but focusing on Borderline Personality Disorder… providing information, advice and support.”
BPD is recognized in the DSM-IV (the standard diagnostic manual of the American Psychiatric Association) as including “…unstable impulse control, interpersonal relationships, moods and self-image. These persistent or recurrent qualities are present in a variety of situations…” A professional will make a diagnosis of BPD when a patient demostrates at least 5 of the following behaviors:
- Frantic attempts to prevent abandonment, whether real or imagined (don’t include self-injurious or suicidal behaviors, covered below)
- Unstable relationships that alternate between idealization and devaluation
- Identity disturbance (severely distorted or unstable self-image or sense of self)
- Potentially self-damaging impulsiveness in at least 2 areas such as binge eating, reckless driving, sex, spending, substance abuse (don’t include suicidal or self-mutilating behaviors)
- Self-mutilation or suicide thoughts, threats or other behavior
- Severe reactivity of mood creates marked instability (mood swings of intense anxiety, depression, irritability last a few hours to a few days)
- Chronic feelings of boredom or emptiness
- Anger that is out of control or inappropriate and intense (demonstrated by frequent temper displays, repeated physical fights or feeling constantly angry)
- Brief paranoid ideas or severe dissociative symptoms related to stress
It’s a pretty scary set of feelings, and its seriousness is not served well by the name “Borderline.” When Adolph Stern first described the symptoms of BPD in 1938 , his choice of terminology was not intended to belittle its severity, but to refer to its position on the borderline between neurosis and psychosis. In Europe, the disorder is referred to as “Emotionally Unstable Personality Disorder,” but “Borderline” seems to have stuck here in the US.
Josh was diagnosed with BPD when he was 17 and as he describes, he struggled with its effects for many years. Setting up BPDWorld was supposed to be his final act, before he committed suicde. It wouldn’t have been his first attempt; in the interview, he describes, very matter-of-factly, how, “…There was once where I went into a field and threw petrol over myself and was gonna set myself on fire, and also slit my wrists and took an overdose…”
But, he found, instead, that BPDWorld, instead of being a final act, was going to be something which involved him and gave him purpose and a sense of community. “…I’ve seen how much it helps people and how much they support each other, which I think is great. And that sort of gets me through, because I believe they’re depending on me and I’m depending on them, so it keeps us all going…”
No future is certain, and the future for people with BPD is dangerous, at best. As he states on his site, “1 in 10 Borderline Personalites commit suicide.” Let’s hope that the community he’s created helps to keep him and others strong and healthy for a long, long time.
(I’ve transcribed the portion of the show where Josh was interviewed. You’ll find the transcript by clicking the “Read More” link.)
