1. We are not manipulative and attention-seeking; we are desperate and we are hurting
I cannot count the number of times I have been labelled as these two things by people in my life, including by a handful of the "professionals" who have treated me. From school and treatment to friends and family, even top clinicians have described me as manipulative in my behaviours. Since entering into therapy with my 4th dialectical behavioural therapy (DBT) therapist, however, she has helped me start unravelling the belief that this adjective describes me as a person. Manipulation implies intent and has negative connotations, and calling someone manipulative suggests that they are deceitful and hence bad in some way. The truth is that my behaviour was never meant to be manipulative of anyone, nor did I do the things I did simply for attention. I have certainly cried out for help through my behaviours and I will not deny that, but I have never cried wolf; there has always been so much more than what meets the eye.
Usually when someone with BPD (also referred to as emotionally unstable personality disorder) acts in a way that may be perceived as manipulative or attention-seeking, it is because they are experiencing emotional and mental pain to such a degree that they are beyond the point of being able to reason, or lacking the skill to be effective in the moment. Most of us simply never learnt how to communicate or release our pain in any other way, and so doing so through our actions became the only way we knew how. If anything, these feel more instinctual than anything else. There is no inherent malice; we just become lost within the moment, and taken over by feelings, thoughts and urges which lead us to act in a way we otherwise would not.
2. BPD is nobody's fault
We were not simply born with BPD, but neither did we develop BPD as a direct consequence of our environment; it is a complex combination of the two. The biosocial model of BPD states that the disorder develops as a result of the interplay between nature - our genes and biology - and nurture - our early environments as children.
Specifically, a child with a sensitive predisposition who is vulnerable biologically to developing mental illness, and who grows up experiencing an early invalidating environment and perhaps various types of trauma, is more likely than a child without these characteristics and experiences to go on to develop a disorder such as BPD. However, there is no one gene or brain area responsible for the disorder, in the same way as there is no specific life event or trigger which leads to its development.
Just like any other mental health condition, BPD is not a choice and neither is anyone to blame. BPD is the unfortunate consequence of a combination of vulnerabilities.
3. We cannot simply "think" our way out of the emotional pain we experience, even if we know it does not make rational sense
There is a difference between being able to intellectualise around a situation and changing the emotional reactions we have in response to them. Most of the time when I'm in what we call 'Emotion Mind' in DBT - that is, being ruled by my emotions - I know that my reactions are not rational. However, no matter how many facts I check, how able I am to intellectualise and think rationally about a situation, or how extreme I know my emotional response is to what is happening, it doesn't take away the pain of the emotions that have been brought up.
If I am experiencing a visceral emotional response to a situation, being able to change my cognitive perception alone does not mean the emotions follow by shifting too. In fact, sometimes being self-aware enough to know my reaction is out of proportion makes the situation even worse; because I know I am over-reacting and yet, I cannot do anything to change the way I am responding on a purely emotional level.
So when people say "You are smart, just rationalise and change the way you are thinking about this one", they fail to realise that rationalising has little impact on the way someone with BPD experiences painful emotions. And it can feel pretty invalidating too when people assume it's as easy as that!
4. We are not treatment-resistant and doomed to a life of revolving hospital doors and medication cocktails; we are very much treatable, and capable of living worthwhile lives
It was thought until recent years that patients with BPD were destined to a life of suffering pierced with hospital admissions, and that the condition was chronic and untreatable. However, over the last few decades this belief has shifted dramatically and it is becoming more accepted in the field that the prognosis for the disorder is actually a hopeful one - if the right treatment is available.
Relatively new therapies such as DBT and mentalisation-based therapy (MBT) are at the forefront of treatment for BPD, and it is also recognised that some symptoms of BPD tend to reduce with age, even without intervention. After one 16-year follow-up study of patients with BPD treated at McLean Hospital in Boston, it was found that certain aspects of the illness such as self-harming behaviours had ceased in as high as 99% of patients.
At the same time, it is also important to state that BPD can be fatal. I say this because it is important not to sugar-coat the disorder, as it absolutely does take lives. Whilst it is possible to get well from the disorder or at least learn to manage it, there is no denying that the suicide completion rate of as high 5-10% does exist (Paris & Zweig-Frank, 2001). BPD is indeed a serious disorder. However, it does not have to end in fatality, and more often than not, it does not - especially when the right treatment is available.
5. We are not unable to empathise; we are highly sensitive beings, with the capacity to feel both our own and others' emotions acutely
I know a lot of people with BPD, and I can hands down say that they are some of the most empathic human beings I know. As Borderlines, we are incredibly sensitive, and this sensitivity is one which extends beyond ourselves, towards others. Yes, we may have difficulty mentalising (making sense of others' intentions, actions and thought processes) when we become triggered and emotions are high, but there is a difference between this and our capacity to love, be intuitive towards and care for fellow humans on an emotional level. In fact, our life experiences, traumas and struggles through life with BPD enable us to experience this compassion and lack of judgement towards others to an even greater degree.
6. When we stop engaging in target behaviours, it does not mean we are cured.
According to Zanarini et al (2006) there are two types of struggles Borderlines contend with: the acute behaviours and the temperamental ones. The acute behaviours, such as self-harm, suicidal activity, impulsivity in the form of abusing drugs and/or alcohol, and sexual encounters etc, all tend to decrease dramatically within the first year of recovery. The temperamental ones, however, such as feelings of chronic loneliness, dissociation, anger and fears of abandonment, take much longer to heal. Ultimately, the author draws on the distinction between symptom reduction and full recovery. What she presents is that a reduction in behaviours may look like recovery but it does not necessarily equate to freedom from the emotional pain. Just because we have stopped engaging in ineffective behaviours, does not for one minute mean we are cured.
Marsha Linehan, a recovered Borderline who founded DBT, describes our experience of these emotional pains as akin to having third-degree burns over our entire bodies. The slightest touch or trigger which may seem like nothing to most may affect someone with BPD in an overwhelming way. Using this analogy, even when most of the behavioural symptoms of BPD lessen, healing from the burns and the pain we experience requires a lot more time, patience and therapy.
It is important for people to know that even when we stop intentionally hurting ourselves, it does not mean we have stopped hurting.
Borderline Babble , is a blog dedicated to borderline personality disorder and the therapy that can help. It looks into the psychology behind BPD but also the reality of living with it. If you want to learn more about BPD then please check out the blog here .