Warning: This article includes vivid descriptions of suicidality, as well as brief mentions of drug misuse and self-harm.
I wake up happy. I jump out of bed. Today is going to be excellent, I think excitedly as I put on my favourite underwear (just in case). I pop to the shop and miss an important delivery. I hate myself. I consider self-immolating outside the Royal Mail headquarters.
I’m chopping onions. The knife glints and shakes in my trembling hands. Just stab yourself, the voices in my head chant, drowning out my thoughts. My eyes start to moisten; I have no idea if it’s the onions or my psychic pain — blistering, sweating, making it impossible to see straight.
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That evening I lean out of my bedroom window, stare up at the night and consider jumping. I get scared, close the window, then stub a cigarette out on my wrist as punishment for being a coward. I scratch at my face until blood pools under my fingernails.
I call my dealer because it’s 3am and no one else will answer the phone. He says he’s worried about me but he still delivers. I promise I’ll pay him next week.
The following day I use a credit card to book a cheap, non-refundable one-way ticket to Bangkok. I will fly away from this, I think, I will fly away from this madness.
You can’t fly away from yourself. I learned that the hard way. It wasn’t supposed to be like this. I did well at school, got straight As in college, worked hard at my dream job – but then, slowly, my mental health started to deteriorate. What started as anxiety became psychosis. Reality concertinaed around me. Depression came that was so bleak, I thought about dying constantly. Voices in my head told me I was worthless.
I bought a bottle opener from the supermarket, only to realise when I came to use it that it was broken. My reaction was to try and kill myself. I died, briefly. People always think I’m being dramatic when I say that but my heart stopped beating and my lungs stopped breathing and my brain stopped thinking and it was so, so dark. My housemate found me and gave me CPR until the ambulance arrived. I was defibrillated back to life and woke up days later with a neck brace on and an intubation tube down my throat and a catheter in my urethra and cannulas in my arms.
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You can't fly away from yourself. I learned that the hard way. It wasn't supposed to be like this. I did well at school, got straight As in college, worked hard at my dream job – but then, slowly, my mental health started to deteriorate.
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"You’re so lucky," a doctor in intensive care told me when the MRI scan showed no permanent brain damage. I was angry. I wanted to die. When they threatened to detain me under section 2 of the Mental Health Act, I thought they were bluffing. They gave me diazepam and covered me in musty grey blankets and wheeled me to the psychiatric ward.
I wish I could say that was the only time I’ve tried to die, or that it was the only time I’ve been sectioned. The truth is, I’m a bit of a broken record. My life is chaos: I have borderline personality disorder.
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a serious mental health condition that prevents someone from being able to control their emotions and impulses. It affects about 2% of the population and yet is one of the least researched and most underfunded disorders in psychiatric medicine.
If you have BPD, everything feels unstable: your relationships, your moods, your thinking, your behaviour, even your identity. Many people with BPD experience intense self-hate, shame and feelings of inadequacy and failure. This can be fatal: up to 10% of sufferers die by suicide and the condition shortens life expectancy by approximately 20 years.
To confuse things further, people with BPD usually have additional illnesses. Eighty percent of people with BPD meet the criteria for major depressive disorder, 90% suffer from anxiety and two thirds misuse drugs and alcohol.
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People with BPD are impulsive and find it impossible to consider consequences. I’ve enrolled at university on four separate occasions and failed to graduate every time. I’ve sold all my belongings. I’ve moved to Venezuela. I’ve been aggressively thrown out of countless drinking establishments. I’ve posted inappropriate photographs of myself on the internet. I’ve shaved my head. I’ve got stupid tattoos. I’ve been fired. I’ve been arrested. I’ve taken accidental and intentional overdoses. I’ve accrued tens of thousands of pounds worth of unsecured debt. I’ve adopted a puppy (don’t worry, she is now well looked after by my grandparents). I’ve broken hearts and fractured bones and dislocated limbs and smashed heirlooms. I’ve woken up covered in bruises, in strange people’s beds, miles from home.
We yearn for connection. "Drinks on me!" I holler into the crowd as I pluck another credit card out of my purse and stumble towards the bar.
We’ll do just about anything to avoid abandonment. We are often magnetic but our erratic behaviour and volatile demeanour pushes people away. Friends ghost us, lovers dump us. Everyone leaves eventually.
It’s impossible to make healthy choices and stick to them because we’re different people from one day to the next. Tomorrow doesn’t exist because tomorrow we’ll be someone else. The only constant is the disorder.
Trauma begets trauma. Folks with BPD live intensely and precariously. We put ourselves in situations that aren’t safe, get hurt, then soothe ourselves in ways that are damaging, which traumatises us further.
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Borderline is most common in those who have experienced adversity: people with BPD are 13 times more likely to report major childhood trauma than those without mental health problems.
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Borderline personality disorder is most common in those who have experienced adversity: people with BPD are 13 times more likely to report major childhood trauma than those without mental health problems. When you’re subjected to chronic, overwhelming stress during your formative years, you lose the ability to respond to normal stressors as an adult.
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There’s no singular moment in my past when the BPD switch flicked on. My childhood was oppressive in a mundane, commonplace way. You’ve heard it all before. Therapists nod sympathetically and scribble down comments as I pour my messy heart out. "When does the actual therapy begin?" I ask, confused. "This is the therapy," they say. I remain dubious. As if anyone ever got better by tearing open the fissures of their soul.
Of course, talking therapy is the only clinically proven way to recover. So we persevere, me 'splitting' on my therapist. Splitting is a symptom of borderline personality disorder where a person is unable to hold opposing thoughts and sees everything as black or white. One week I adore them, the next I resent them. I wonder what they think of me; I hope I’m their favourite.
When I mention splitting to Dr Kevin Dutton, a psychologist whose new book Black and White Thinking: The Burden of a Binary Brain in a Complex World explores how humans experience the world in binary terms, he explains that the phenomenon is not just prevalent in borderline personality disorder.
"I see splitting in patients with depression too, who have catastrophic thinking," he says. "This is the propensity to think that when something small has gone wrong, it’s the end of the world, and everything is shit. You also get it in autistic spectrum disorders."
"Many of us have difficulty dealing with uncertainty but it’s especially visible in borderline. Yes or no. All or nothing. Bad or good."
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"The reason, I think, is there’s so much emotional turmoil going on, splitting makes sense – you’re limiting the amount of information you have to process," he adds. "But when you start doing that, you get extreme emotional reactions. There’s no nuance."
Borderline patients feel everything deeply and are often described as having no emotional skin. Marsha Linehan, the psychologist responsible for the development of dialectical behaviour therapy, noted that we are the "psychological equivalent of burn victims" – the slightest touch or movement creates immense suffering.
A common misconception is that borderlines lack empathy when in fact studies show that we’re actually better at reading others' emotions than people who are mentally well. I guess if you grow up around abuse, it’s useful to be able to read people quickly, if only to know when to duck.
"BPD patients are better at recognising how someone else is feeling but another important component of empathy is emotional regulation. Although an individual might be better at reading emotions, they might not be good at regulating themselves. It depends what you mean by empathy," explains Dutton.
Dr Alexander L. Chapman, author of the excellent book The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD, agrees that the question of empathy is complex. "There has been a fair amount of research on social cognition in BPD, with some studies showing heightened empathy and others showing lower empathy. The findings really depend on the type of experiment being conducted, the samples, and the comparison groups," he tells me. "People with BPD have enhanced attention to social cues but have problems with the processing of social information."
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What’s going on? I ask, desperately searching the fringes of my chaotic mind for an explanation. My psychiatrist sketches a diagram of my brain. It shows a cluster of cells called the amygdala (responsible for fear, anxiety and aggression) overriding the prefrontal cortex (the part of the brain that is responsible for decision-making and moderating behaviour). In healthy people, the amygdala only takes over when there is a threat; it’s responsible for fight or flight. My psychiatrist scribbles all over the page, showing how my amygdala has overtaken my propensity for rational thought, even when no threat is present.
The amygdala also has no sense of time passing. Pain feels permanent. When we are in crisis, there is no light at the end of the tunnel.
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Some people with BPD have histories of being invalidated for how they think or feel, and they might have difficulty understanding and managing their own emotions. It is important to try to understand where they are coming from and acknowledge their experiences.
Dr Alexander L. Chapman
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But not everyone with an overactive amygdala necessarily has BPD. "The brain is very complicated," Dr Dutton tells me, "the amygdala could show irregular activity in any number of psychological disorders. The problem with defining disorders is that we tend to come up with arbitrary categorisations, when in fact they overlap."
Historically, borderline has been diagnosed more frequently in women than in men yet recent studies suggest that it is equally prevalent in all genders. There are many factors contributing to the disproportionately high rates of diagnosis among women, including sexism among clinicians. For example, promiscuity can suggest a disordered personality but as women are held to higher standards of sexual purity, many will consider a woman more promiscuous than a man with the same number of sexual partners. Sampling bias may also be responsible for the gender discrepancy. Most studies of BPD are carried out on patients accessing mental health services, including inpatient care. Studies conducted in these settings show female overrepresentation as women are more likely to seek medical help early. Men suffer in silence.
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The myth of the hysterical bunny boiler endures thanks to Hollywood depictions. Women with borderline personality disorder are considered bad news, often portrayed as "crazy, manipulative, difficult to work with, aggressive" (these are Dr Chapman’s words, not mine). Online support groups such as r/BPDlovedones on Reddit host thousands of posts from people condemning borderline behaviour and reinforcing the harsh stigma surrounding the condition. Of course, hardly any of the commenters take into account that BPD sufferers experience insurmountable mental agony. The focus is on the damage we cause, not the hurt we feel.
How might one cope with a borderline loved one? I ask Dr Chapman, secretly hoping he provides me with a relationship elixir. I don’t want to lose anyone else.
"Support, validation and understanding can go a long way in close relationships. Some people with BPD have histories of being invalidated for how they think or feel, and they might have difficulty understanding and managing their own emotions," he says, making it sound simple. "It is important to try to understand where they are coming from and acknowledge their experiences."
"Also, I would suggest that an attitude of acceptance and non-judging is critical. People with BPD sometimes have difficulty with impulse control, they might have challenges in relationships, and it is important to accept these problems and not to judge the person for having them," he adds.
In my early 20s I was misdiagnosed with bipolar disorder, another serious mental illness characterised by intense mood swings. I told my employer, I told my entire family. Everyone was supportive and sympathetic. Recently, celebrities such as Kanye West and Demi Lovato have 'come out' as having bipolar. Awareness is growing and it’s becoming increasingly accepted.
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When I was diagnosed with BPD, I hardly told anyone. I was so ashamed. When I did mention it to people, they often balked. The stigma and deep-seated ignorance around personality disorders are pervasive. A disordered personality isn’t something that afflicts an individual, it’s a component of their being. You can’t separate the illness from the person in the same way you can with other conditions.
Many mental health professionals refuse to work with BPD sufferers and consider the disorder untreatable. According to Dr Chapman, this is likely due to the fact that "people with BPD have historically been viewed as being on the border between being psychotic and neurotic, making them hard to understand and categorise. They also have high rates of self-injury and suicidal behaviour."
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Many of us have difficulty dealing with uncertainty but it's especially visible in borderline. Yes or no. All or nothing. Bad or good.
Dr Kevin Dutton
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Chapman doesn’t avoid borderline patients however and has devoted his life to treating us.
"People with BPD are suffering but they are often very caring, empathetic and sensitive. I have found people with BPD to be very rewarding to work with," he tells me.
While there is no cure, there are options; half of patients receiving treatment for BPD show signs of recovery within 10 years.
I ask Dr Chapman if he has any advice. "As hard as things are, you can build a life worth living," he says.
As well as partaking in weekly therapy, I take mood-stabilising, antipsychotic and antidepressant medication daily and see a psychiatrist every few months. Or at least, I’m supposed to do these things. It’s hard sometimes.
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"I will never give up on you," my psychiatrist assures me. I think about this a lot. Even when it feels completely hopeless, when the pain is almost too much to bear and the sadness feels like it will last forever, there are people who want me to survive. I’m here today because of them. The universe is not done with me yet. I am not done yet.
If you are thinking about suicide, please contact Samaritans on 116 123. All calls are free and will be answered in confidence.
If you or someone you know is considering self-harm, please get help. Call Mind on 0300 123 3393 or text 86463.
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