Borderline Personality Disorder: is it the Right Diagnosis?

I didn’t get a post out last week, and that’s because I spent almost a week in the hospital. I was discharged just last Wednesday. My dad made the decision to take me and I reluctantly went along. I won’t get into the details, but ultimately I was admitted as an involuntary inpatient to the psych unit.

It was intense. I had a panic attack the first night — my worst one in a while. I struggled to catch my breath and didn’t stop crying until I finally fell asleep. Not a single nurse came to check on me while I wailed.

My first couple of days, I was angry. I didn’t want to be there, and no one would tell me how I was supposed to ‘get better.’ My psychiatrist was mean, my nurses weren’t helpful, and the groups were useless.

Even worse, my second day there, the weekend began. The ward seemed to come to a screeching halt. Some patients were let home on weekend passes, those of us left had fewer groups and activities left to participate in. Thankfully I had my ereader, but even that wasn’t always enough to occupy me. I cleaned and reorganized my room to pass the time, stared out my barely-open blinds trying to catch a glimpse of the outdoors, and I counted the minutes until my parents visited.

Eventually, I made a friend and the weekend came to an end. It was Monday, and I was finally able to see the psychiatrist again. He asked me some questions, but I didn’t think that he asked enough. I’m still not convinced that he got enough of my history, but that’s neither here nor there now.

The New Diagnosis

The psychiatrist suggested that my current diagnosis of depression/anxiety might not be accurate. He suggested that I have Borderline Personality Disorder (BPD), and I immediately told him it didn’t fit. While he disagreed, he told me that my homework would be to research the disorder and figure it out for myself.

So, that afternoon, I dutifully used my new privileges and headed over to the library connected to the hospital. I jumped on the computers and printed all of the information that I could find on BPD. I brought piles of paper back to my room and spent even more time reading, taking notes, and organizing my research. As I read more and more, I was identifying with almost all the symptoms I read:

Frantic efforts to avoid real or imagined abandonment. — Well, if avoidance counts, then absolutely…
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. — I mean this is a joke, right? Obviously, yes.
Identity disturbance: markedly and persistently unstable self image or sense of self. — Okay, slightly, but not too much.
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). — Damn, I’m back on the yes train.
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour. — Shit. Yes.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). — Okay, so this yes makes five out of six…
Chronic feelings of emptiness or boredom. — Damn it, yes.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). — I mean, so far this list is making me angry, does that count? … It’s a yes.
Transient, stress-related paranoid ideation or severe dissociative symptoms. — And here is my final and only complete no.

The diagnostic criteria is to have only five out of those nine. I hit about 7 and a half.

So, I have Borderline Personality Disorder. Now what?

What Does BPD Mean for Me?

Alright, so I finally have the ‘right’ diagnosis. In theory, this makes recovery and treatment easier. But everything is also now completely different.

My BPD won’t ever go into remission like mood disorders could. It’s not driven by my disordered automatic thoughts, it’s driven instead by my intense emotional reactions. Unlike thoughts that can be redirected over time, those emotional reactions will never go away. BPD treatment is about management, not recovery.

And though I really always had BPD, this new sudden realization is difficult. I’m reassessing my entire past and future through this new lens. It feels like all the progress I’ve made in the past suddenly no longer applies. I was working on something I didn’t even have.

My mom made an amazing analogy about it this morning. It’s like I was told I had pneumonia; I was given antibiotics, told to rest, drink fluids, and give it some time. Now, suddenly, I’ve been told it’s actually COPD (chronic obstructive pulmonary disease) and the name of the game is now pain management. It’ll never go away, never be cured, but the symptoms can be managed and treated. And now I’ll question every cough I’ve ever had or ever will have.

Did my friendships all fail because of me? Was it actually because people with BPD are ‘difficult?’

Before, I’d convinced myself that I was sick, but I don’t feel sick anymore; I feel defective. It’s a personality disorder. I’m disordered. The core of who I am and the person I love, it’s all wrong.

Now, I ‘know’ that’s not true, but it sure as hell feels like it is.

The New Treatment (Symptom Management)

I am on waitlists. I’ve taken CBT (Cognitive Behavioural Therapy). I’ve been in mood disorders programs. I know the groups, I have peer supports.

But now it’s not a mood disorder, so everything has to change.

The switch from CBT to DBT (Dialectical Behaviour Therapy) isn’t drastic, but it’s there. DBT involves a lot more of the things I didn’t like about CBT: meditation and mindfulness. And now, DBT isn’t optional — it’s one of the few effective treatments. It’s the most effective.

There are no support groups near me, no peers. There are only two specialized programs each over an hour away, both with months-long waitlists.

It feels like I’m back at the start of my recovery. All alone, fighting by myself, but screaming for help anyway. I didn’t think that I’d be right back here after almost four years of fight, but here I am nonetheless.