Note: Please be aware, this article contains discussions of self-harm and suicide that some readers may find triggering.
I was just 12 years old when I first self-harmed, a terrifying thought for any parent and a crippling memory as I’ve grown older. It wasn’t until my first suicide attempt at the age of 19 that I was diagnosed with Borderline Personality Disorder (BPD). Five years later I’m still struggling to come to terms with it.
While I’ve learned to control my emotions now holding strong communicative relationships with my friends, family, and partner, I still struggle with symptoms such as fear of abandonment, self-harm, shifting self-image, spins of emptiness, long-lasting feelings of guilt after doing nothing wrong and worrying that those around me think negatively of me. The stigma surrounding BPD almost stopped me from seeking the help I desperately needed.
Borderline Personality Disorder is a mental health condition commonly misconstrued with words such as “crazy”, “selfish”, “dangerous”, “psychopath” and “incapable of love”. Studies have shown that BPD affects around 1 in 100 people. To put this in perspective, at the time of writing this, 1% of the UK population is 681,054 thousand. While most cases will go untreated, the chances of knowing someone struggling with BPD are likely.
I reached out to TikToker Damon Rackam, who openly speaks about BPD, for advice she would give to someone struggling.
“Our disorders do not define us. People with BPD love passionately, are very perceptive and have a never-ending well of compassion when it comes to the people we care about. We are not the manipulative monsters that society makes us out to be.”
Here, I break down exactly what BPD is, what the symptoms are, and how you can seek help if you – or someone you know – is struggling.
What is BPD?
“People with BPD may feel like they are on an emotional roller coaster and tend to be extremely sensitive. Clients have described this as being overwhelmed by intense feelings, a sense they have been taken over by something or someone else and like it is happening to someone else, which we would call a dissociated state," explains Katriona O’Connor, a BACP registered qualified Integrative Therapist at We Listen Therapy.
"An analogy I find helpful is to imagine your system being highly activated – this is an alert response. With fight or flight kicking in, the rational side of the brain gets shut down and the primitive survival brain takes over and when this happens, it can be very difficult to calm it down.
"This can be scary and stressful and shake one’s sense of self. The combination of the two can be problematic as you navigate through life and interact with others, have relationships and careers and so on.”
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Common BPD symptoms can include:
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What BPD treatment is there?
As Katriona O’Connor explains: “The good news is that the brain is clever and with help, can learn to respond differently when your system is activated. Moving from being out of control to being in control is within your power. Every time you practice a new way of coping, your brain will form a neural pathway and in time this will override your original responses.
"A key to this is learning to tolerate the feelings of distress, to be “in it”, not to fight it. Working with a therapist on this, to calm the feelings, work with them and develop new coping strategies to self-soothe can be helpful here. They can also help you to stimulate your senses to self-soothe using healthier tactics. engaging touch, taste, smell, sight, and sound – powerful ways to bring you back into your body.
"It is also very important to look after yourself as feeling run down or stressed will emphasise those intense feelings and responses. Eating a balanced diet, getting exercise, and prioritising sleep are essential as are avoiding mood-altering stimulants. Practicing meditation and mindfulness are recommended.
"Please be kind to yourself, this is not easy for you but it can improve. I wish you well and hope this has helped in some way to shine a light on your situation in a more positive way.”
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BPD Suicidal behaviour
Opening up about my mental health when I feel suicidal has always been a struggle for the fear of being a burden or upsetting those around me. The truth is I still have severe post-traumatic stress from my first attempt. For many years I’ve turned away therapy and medication. I find it tough to believe at times I’m not in control of my emotions or thoughts. The stigma behind BPD makes me scared of what people will think of me if I open up. I'm not evil, I like everyone, but this shouldn't be labeled as who I am. I believe this is partly why the suicide rate is so high among those suffering.
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"People with BPD are sometimes compared to burn victims as you are so vulnerable and take things straight to the heart. They find it hard to have their own identity and take on a lot of other people's traits because they're struggling to find their own,” Pip Rudge discusses on Behind The Masc podcast.
Rackam shares her thoughts on the high suicide rate, “Borderline Personality Disorder, especially when untreated, can cause extreme emotional agony and distress. Sometimes it feels like we're climbing a never-ending mountain, one where rocks and boulders plummet from its peak to try and make us fall. Due to the intense chronic emptiness and the constant mood swings, sometimes people with the disorder may decide to give up on climbing that mountain and succumb to those rocks and boulders. But the mountain does have a summit, and people with BPD are able to reach it. We can still live happy, fulfilling lives with the disorder, and it's an unfortunate reality that so many with BPD give up before seeing the beautiful views that the mountain peak provides.”
BPD and Self-Mutilation
Those with BPD are more likely to turn to self-harm when emotional pain becomes too much. One may experience withdrawal symptoms and cravings to self inflict pain. Agonisingly, the form of relief can quickly become an addiction that is very hard to break.
"The only relief I knew before I had therapy was to self-harm. It was really important for me to feel something other than the emotional pain I was going through, so the physical pain would help in that minute. But afterward, I'd feel worse than I did to start with," mentioned Pip.
I reached out to Dr. Lafina Diamandis, a London GP and Lifestyle Doctor interested in the emotional and mental health issues affecting millennials, explained: "In my experience, the reason that suicide rates and self-harm are so high in people with BPD is down to 2 main factors: firstly, people with BPD have a real difficulty in processing challenging emotions which means that they are more likely to experience intense emotional pain than others. This can become intolerable over long time periods and without a strategy in place for dealing with difficult emotions, or a strong social support network to lean on, people look for a way to escape the emotional pain they are experiencing. This escape is often through the use of drugs and alcohol but also through self-harm or suicide attempts which is devastating.
"Some of my patients with BPD tell me that they have self-harmed to 'release pressure' which says a lot about the degree of stress they live with on a daily basis. Secondly, people with BPD can be quite impulsive due to the nature of the condition. This means that they are more likely to make reactive decisions based on the intense emotions they experiencing at the time, which they often later regret."
A large misconception is that people who self-harm are attention seekers, when in fact many who self-harm frantically hide their scars. While nowadays I openly speak about my history with self-harm, it's still something I don't truly understand, making it a sensitive subject. Self-harm addiction is something that I’ll always deal with. I still notice the stares I receive when someone notices or the awkwardness when someone asks what happened. Saying that I don’t think I would change my past, it’s made me the person I am today, it’s allowed me to gain a deeper emotional intelligence through research and it’s given me the ability to help others get through it, which to me, is the most valuable gift.
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Rackam feels a similar way telling me: “I've grown through my BPD due to an extreme amount of self-reflection. Whenever I experience a mood swing, afterward I will try to pinpoint what triggered it and get to the root cause of the issue. I'm constantly observing other people and how they navigate the world, as well as the different relationship dynamics that people have with each other. Because of this, I'm very self-aware of my own behaviours and am able to view most situations from many different perspectives and viewpoints.”
Other forms of self-harm can include but are not limited to:
Reckless behaviour such as unprotected sex with strangers or overspending
Over or under eating
Misusing drugs or alcohol, overdosing on medication or toxic chemicals
Cutting out the world
How can this affect close friends and family, how can they help?
"It can be very distressing for friends and family to see how BPD affects someone they love and care about. Because of the nature of the problem, BPD can seriously affect social relationships – in the most severe cases, there is a history of frequent fall-outs with friends, family members, and employers. This can result in people with BPD becoming socially isolated, unemployed, and even homeless in the worst of cases. I think the best thing friends and family can do is to learn a bit about BPD themselves, ask the person how they are affected by it, what tends to trigger them, and think about what kind of strategies they can work on together to manage difficult emotions. Talking about our difficulties reduces the power they have over us. There are also forms of talking therapy where friends and family are invited, so it can help the patient as well as their family to have everyone on board' in tackling it. Friends, families, and carers may also experience high levels of stress so it's important that they also find ways to manage stress and look after their health so that they are in a better position to support others," shared Dr. Lafina Diamandis.
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Is BPD Different to Bipolar?
"Yes! Unfortunately, people with BPD are often misdiagnosed with bipolar affective disorder due to some similarities in the symptoms occurring in both conditions," says Dr. Diamandis. "The difference is in the pattern of symptoms seen in each condition. For example, BPD is a condition characterised by a distortion of thought, feelings, and behaviours. The condition usually becomes apparent in the teenage years (once personality begins to mature) and there is a classic pattern of repeated abrupt and major mood swings (for example, between feeling very low in mood, to very elevated or energetic) alongside impulsive behaviour and problems with personal relationships. Contributing factors are thought to include genes, brain chemistry, brain structure, and environmental factors such as childhood relationships with caregivers. BPD is usually diagnosed in early adult life as more responsibilities are taken on and problems that may have been masked by being a minor rise to the surface.
"In contrast, bipolar is a mood disorder where there are distinct and prolonged episodes of shifts in mood between depression and mania with periods of stable mood in between (as opposed to the abrupt mood swings seen in BPD). It can occur at any age but is more common between 15 – 40 years of age. Causes are complex but we think the contributing factors include genes, brain chemistry, social triggers such as life-changing events (relationship breakdown, abuse, etc), and lifestyle factors (lack of sleep, stress, drugs, and alcohol) which can trigger an episode of mania or depression."
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A counselor at the treatment center where I got clean, herself a woman in recovery, surprised me when she said, ‘How clever of you to find drugs. Well done, you found a way to keep yourself alive.’ This made me feel quite tearful. I suppose because this woman, Jackie, didn’t judge me or tell me I was stupid or tubthumpingly declare that ‘drugs kill’. No, she told me that I had done well by finding something that made being me bearable… To be acknowledged as a person who was in pain and fighting to survive in my own muddled-up and misguided way made me feel optimistic and understood. It is an example of the compassion addicts need from one another in order to change.
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I love this quote, while I don't believe that drug abuse or bad behaviour is okay (it's very important to take ownership), I feel the quote gives hope to those fighting to stay alive through the act of wanting to feel something.
Rackam says: “To anyone struggling with self-harm or other destructive coping mechanisms, there IS hope for people with BPD. With the help of a psychologist, Dialectical Behavioral Therapy, and a lot of personal self-reflection and awareness of our actions, we can learn how to choose healthier coping mechanisms to better combat our rollercoaster of emotions.”
“Please be kind to yourself, this is not easy for you but it can improve. I wish you well and hope this has helped in some way to shine a light on your situation in a more positive way,” Katriona told me.
I’d like to finish by saying regardless of what mental illness you have, the stigma will always unfortunately be there. You can’t please everyone. Your emotions are not who you are, they are the reaction of your current state of mind.
If you are struggling with any of the above topics you can call 116 123 (www.samaritans.org) or Mind on 0300 123 3393 (www.mind.org.uk) go to your nearest A&E for support. Cares can find support via ReThink.
Readers in the US are encouraged to visit the American Foundation for Suicide Prevention or mentalhealth.gov.