The following was recently posed to me on Twitter by Dr Gordon Milson (@gordonmilson):
- What do people with lived experience of ‘personality disorder’ (pd) see as the problem? Self? Dysregulation? Other?
For those of you who aren’t familiar with the diagnostic criteria for Borderline Personality Disorder, you can check them out here:
- ICD 10: http://www.who.int/classifications/icd/en/bluebook.pdf @pp159-160
- DSM-IV: http://bpdresourcecenter.org/DSM-IV.html
By the way, if you aren’t familiar with the criteria, it does make me wonder why on earth you are reading this post and I am assuming you are very odd – odd to the extent that your oddness trumps my oddness 😉
I have witnessed on Twitter and elsewhere that many people with a diagnosis of BPD find that the DSM-IV criterion of “Frantic efforts to avoid real or imagined abandonment” or equivalent ICD 10 description of “…associated with excessive efforts to avoid abandonment” is the most debilitating. It is the one that pervades all aspects of their emotion (dys)regulation and self harming and risk taking behaviours. This has always puzzled me as it isn’t something of which I have experience. Until I read the blog post of Sue Sibbald (@BPDFFS) regarding abandonment, I had no idea how scary and horrid such fears could be. You should check out the post, Twitter Just as it gave me a great insight into the pain this can cause people: http://bpdffs.wordpress.com/2012/11/16/twitter-just/
Abandonment, actual or otherwise, isn’t a struggle for me. The problems that I found most debilitating as a person with a diagnosis of BPD were those arising from emotion dysregulation (although I no longer fitting the criteria – yep, it was necessary to flag that up again :)). Any relationships I had or even still have, that others might have described as unstable were as a result of being too quick to react, feeling an intensity of emotions that the other person did not experience combined with problematic cognitive distortions. Reacting on those intense emotions and mistaken cognitive processes create instability in my relationships, not a fear of abandonment.
My impulsive behaviours – drinking, binge eating, spending etc were me engaging in mood/emotion dependent behaviour. My self harm and suicide attempts were as a result of being overwhelmed with the intensity of my emotions and knowing no other way to deal with them.
The affective instability, difficulty in controlling anger and “chronic feelings of emptiness” again, are/were primarily as a result of emotion dysregulation. You may wonder how the latter mentioned criterion of “chronic feelings of emptiness” could be emotion dysregulation as surely this is a lack of emotions? It’s because when you live with such intense feelings/emotions – be they high or low mood or anger or shame – the times when you aren’t feeling these extremes leaves you feeling empty. The emptiness is a result of not feeling dysregulated – a very strange experience for someone who is constantly swinging to emotional extremes. It’s something I now realise isn’t emptiness, just better regulated and not at an extreme with the volume turned up to max.
In fact, the constant obsession with mental health professionals to put everything down to abandonment issues when a person has a diagnosis of BPD led to me, for a very long time, with having suspicions as to the accuracy of my diagnosis of BPD – the legitimacy of a BPD diagnosis will be explored at a later date. Of course, you’re all now shouting “but there are 256 permutations of BPD” or whatever number it is but unfortunately, this doesn’t seem to filter through to the mental health professionals. The professionals that have been only briefly involved in my care and did not know me would actually end up contributing to my emotion dysregulation with such incorrect assumptions. Those incorrect assumptions and their inability to listen to me rather than jumping to their stereotype as the only possibility for my distress would leave me angry and completely at a loss as to how to ‘recover’. The issues they were assuming I had were not issues that needed to be addressed to help me out of the very deep hole in which I was stuck.
Obviously, the emotion dysregulation is not the complete picture for me, as alluded to in earlier blogs, I have experienced problems in finding my ‘self’, my ‘identity’. These issues of identity of self/identity were very much exacerbated by my involvement in services and getting sucked deeper and deeper into the system (against my will). It is an area I am exploring and plays a major part in my recovery journey. However, emotion dysregulation is my short answer to the original question posed on Twitter.
I’d be very interested in the views of any people that read this blog who themselves have/had a diagnosis of BPD. How about if you are a mental health professional, a friend, a loved one? What has been your experience of people with a diagnosis of BPD? What is it that creates the problems for those you help/support? What would your response be to the question put by Dr Gordon Milson?