Borderline Personality Disorder

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.)

Programme broadcast 23 November 2004, 21:00-21:30
Interview with Joshua Cole (01:20 – 05:58)

RAJ PERSAUD: The term “Borderline Personality Disorder” was first used in 1938 and was seen by some as an umbrella term, covering a veritable collection of disorders from psychosis to schizophrenia. However, research into the clinical understanding of the disorder has advanced in recent years. Catherine Allen is a consultant clinical psychologist at St. George’s Hospital in Morpeth and the author of a paper on BPD in the Autumn edition of the Journal of Family Therapy.

Before we join her, listen to what Joshua Cole who was diagnosed with BPD when he was 17 years old had to say about it. Now in his mid-20s, he has founded BPDWorld, a website that helps and advises people who suffer from the disorder.

How would you describe what Borderline Personality Disorder is to other people?

JOSHUA COLE: It’s basically a bunch of emotions that are very mixed up and, well, very complicated. Its…there’s nothing easy. The emotions are so strong and at times so weak; there’s no sort of medium. Its always either too much or too little. You’re not feeling enough or you’re feeling so, so much.

RP: What has been the sort of time course of this problem? When did you first realize that you had a problem in this area?

JC: I’ve had problems with relationships for many years, since I was a teenager… since I was very young.

RP: When did it occur to you, though, that this was beyond the normal range of experience?

JC: It’s really hard to say. I think it all boils down to childhood, and how you were raised, and your parents and people around you… how things are at the time. And if you’re not given everything you need as a child, then it’s very hard to have them feelings and thought patterns when you’re an adult.

RP: What happened in your childhood?

JC: Well, my parents weren’t very supportive at all. There was abuse going on: there was domestic abuse, psychological abuse. Not being able to function properly, really. Every emotion that you… you sort of… you feel is always supressed by what an adult says, or by what you’ll [unintelligible].

RP: And what’s the link between that childhood experience and what you’re going through now as an adult: this rapid switch from intense affection — intense love for someone — and then intense rage?

JC: I feel it’s because you don’t know how to process them thoughts and feelings because you never had a stable time in your life to feel anything for a prolonged period of time… You’re always switching from one to the other, and then when you’re feeling one thing you’re angry about it because you should be feeling another. So every day is about relationships and controlling how you feel and… and emotions.

RP: What are the difficulties that you have with relationships?

JC: Trust is a major thing. I get very jealous very easily and… I don’t know how to see people. I cant see them as either a friend or a lover. It’s… they have to be one or the other; they can’t be in the middle. I find it very hard to make friends and just have them as friends and not as relationships.

RP: When you say “there’s no middle”, it sounds a bit as if you’re oscillating from intense love and attachment and affection to intense hatred and rage, and you’re moving from one to the other, very rapidly, without any middle ground.

JC: Exactly. It can happen within hours. One moment you can be as happy as… as happy as Larry and then the next moment you can be as down as anything.

RP: You’ve never told people that you might think of killing yourself if things didn’t work out or if someone was to leave you.

JC: Not in a relationship scenario, but I have done with my mental health teams. 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…

RP: How common is this experience with other people with Bordeline Personality Disorder? Have you talked to people who’ve had very similar experiences?

JC: I don’t think there’s anyone who has BPD that I haven’t talked to that hasn’t tried to commit suicide. some of them are less serious than others, but a lot of people are very serious in committing suicide. The statistics are 1 in 10 people do die from suicide and a lot more –

RP: –Of people suffering from Borderline Personality Disorder?

JC: – Yeah, exactly.

RP: So, it’s got a very high mortality rate?

JC: It has. Yeah.

RP: What are your feelings about the future for you?

JC: I don’t know. I always thought it was my fate to die. I thought that… Well, when I set up BPDWorld, I was gonna do the website, set up the place to support others and then it was my suicide wish to just end it. But… since then, 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, which is great. And hopefully, in the meantime, we will be getting treatment from our mental health teams that will make us progress.

RP: Thank you to Joshua Cole.