Monday, May 21, 2018

Borderline Personality Disorder

Ah, the month of May.

A notable month because it contains my birthday (which I share with Tony Stark), as well as Andrew's birthday (which he shares with his twin brother), as well as National Brain Tumor Awareness Month (which it shares with Skin Cancer Awareness, Garden for Wildlife, Foster Care, and Haitian Heritage).

But I would like to talk about two things closer to home than Golf or Burgers.  (Yes, May is also Golf Month and Burger Month.)

May is Mental Health Awareness  Month and, even more obscurely, it's Borderline Awareness Month.

Most people have never heard of Borderline Personality Disorder, or if they have, they've confused its acronym, "BPD," with bipolar disorder.

 Bethlehem Police Department.

Borderline is one of those harder-to-define disorders, one of those you'll-know-it-when-you-see-it types that lacks an identifiable mechanism and therefore a clearly defined treatment.  Highly stigmatized, it's a lifelong disorder of thinking that is often stereotyped even among therapists; in fact, some therapists refuse to work with these patients, as they are high-risk and often resistant to treatment.

Let's dive in!

First of all, let's talk about what it looks like.  You might have seen Girl, Interrupted, in which the main character is diagnosed with BPD.  She famously asks, "Borderline between what and what?"


People with BPD commonly suffer from mood swings and uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. Combined with very black-and-white thinking, I think the "borderline" moniker comes from the tendency to polarize emotions, thoughts, opinions, relationships, and self.

You only need 5 out of 9 traits from the DSM to get diagnosed, but the truth is, BPD is one of those things that's remarkably easy to identify once you know what you're looking for.  Diagnosis can be tricky because many of the symptoms are themselves disorders: things like depression, anxiety, alcoholism, et cetera.  And some common traits, such as the tendency to obsess over a person (more on this later) are not in the DSM at all.

BPD has often been called "psycho bitch" or "crazy ex-girlfriend" disorder, and I'd like to take this opportunity to say that the Netflix show Crazy Ex-Girlfriend is actually the best goddamn portrayal of BPD I have ever seen in media.  The main character, Rebecca, is highly intelligent and creative, with a tendency to manipulate others and self-sabotage.  She obsesses over her ex Back in season 1, I was saying, gee, she seriously appears to have BPD.  By season 2, I felt that the writers knew what they were portraying.  And then, in season 3, the main character actually gets diagnosed.  Called it!

Hopefully in season 4 we'll see some of the treatment process.  BPD is not something that you can treat with pills (although pharmaceuticals may be used to treat symptoms such as depression).  The main treatment involves long-term therapy: CBT (cognitive behavioral therapy) or DBT (dialectical behavioral therapy, which for a long time I thought was some sort of Scientology thing).

Do yourself a favor and don't Google image search "CBT."

One of the reasons I like the show Crazy Ex-Girlfriend is that it does a good job highlighting the non-clinical signs of BPD.  People with BPD tend to be intelligent, and creative.  The lack of "self" lends itself well to a rich inner fantasy life, portrayed in the show as colorful, incredible musical numbers within Rebecca's mind.

Rebecca's ability to manipulate others lends itself well to the phenomenon of making instant close connections with people that are later fraught with conflict.  Her highs are high and her lows are lows.  She suffers from depression yet also from a deterministic streak, often going to insane (ha!) lengths to get what she wants (for better or for worse).

And, of course, the central theme of the show is Rebecca's obsession with her ex, Josh.  Josh is her Favorite Person, a term widely used in BPD communities to refer to the object of one's obsession.  The tendency to obsess over a person or idea is a HUGE player in the life of someone with BPD, which is where the "crazy ex" stereotype comes from.  (Fun BPD activity: push people's limits so you know at what point they'll leave you!  ...oh crap, you just pushed them away!  Respond by having a big freak-out to win them back!)

Like just about any other personality trait (or set of traits), BPD can be harnessed and used for good, when people who have it get the right help and have a strong, steady support network.

For example, although 1 out of 10 eventually commit suicide, 
the other 9 out of 10 have a crazy strong meme game.

I think that, although it's a personality disorder that is heavily stigmatized and difficult to treat, the advent of the internet has lent itself well to various support communities and a better ability to share and understand the triggers and personality traits associated with BPD.

Including, but not limited to:
BPD is, like any other disorder, not fun, not easy, and not to be taken lightly.  However, it is treatable, and although people who suffer from it can be difficult at times, I'm inclined to believe that the world is slowly finding better ways to help people manage their demons.  Personality disorders are rarely as strong as the people they inhabit, and with growing awareness of the symptoms and treatment options, I have a lot of hope for the future of those who suffer.

 Always relevant.

No comments:

Post a Comment