BPD and me

Marion Janner

My preference is to be in the centre of things, preferably with my dog, but I've recently discovered that I'm a borderline borderline. Sadly not as in Hampstead borders; I'm straddling the threshold of the mental health world's Grimethorpe as someone with definite 'borderline personality disorder' (BPD) tendencies. Borderline is a mysterious moniker — is the threshold between sanity and insanity? Criminality and law-lovingness? Being endowed with a personality or having an amoeba-esque character? It turns out that those of us with BPD are tottering on the brink of psychosis.

For months I've been treated in not any old personality disorder service but a Beacon (i.e. officially top-notch) one, and by Prof Anthony Bateman, a psychiatrist who is one of the superstars of the personality disorders' field. But through a combination of my misunderstanding the diagnosis and heroic non-labelling by Prof Bateman, it is only recently that I've twigged that I meet the criteria for BPD. That I potentially have a BPD diagnosis. That, deep breath, I could be said to have BPD. The professionals working with me have been amazingly consistent in treating me for the symptoms but not employing the label of BPD. There's not even a hint of it in my medical records.

Which is, of course, a good thing given how stigmatised the condition is. I find it very difficult to identify with having BPD. Mental illness — unquestionably. Self-harming — equally clear. Added to these, I wrestle with short-lived bursts of extreme anger, of intense depression and have also had one episode of 'severe dissociation' — feeling there were external forces compelling me to kill myself. This package places me on the threshold of the condition, and as I have splashes of most of the other qualifying factors, I'm nudged over the edge. I am, however, very lucky to be wonderfully supported with all this difficult stuff by a strong circle of friends and family. These long-standing, stable relationships are the opposite of one of the qualifying BPD conditions — mercurial and generally short-lived relationships.

As with many other ugly or scary diagnoses, it in some ways helps to at least have a name and shape to what one is dealing with. I can read up on the condition and understand the rationale behind my treatment. But I was pretty nervous while investigating my relationship to BPD. Going through the qualifying conditions is rather like the opposite of watching your numbers come up in the lottery. One BPD condition match — "Hmm. Fair enough." Two — "That's strange." The third match and things are looking decidedly unfavourable, as I'm already more than half-way to meeting the necessary score of at least 5 out of the 9 conditions. At four it's "shit shit shit" but it's the 5th one that's the real downer. The anti-thunderball. And a trigger for reviewing the first 4: I haven't really got/done/been that, or at least not very often, not noticeably.....

To confuse the issue, the above entrance quiz is only the American one, enshrined in their Diagnostic and Statistical Manual of Mental Disorders — DSM IV. The European version is enough to drive the most zealous Europhile into the arms of some zany, short-lived counter-Brussels political party. It must have been devised by someone inspired by proportional representation's tortuous process of single transferable votes, overhang seats (sic) and decoy lists.

With the European Game of Guess Your BPD Status, you have to have at least three of the first five 'impulsive' tendencies, of which one must be their number two. (Yes. They eschew the more obvious choice of number 1 as the key factor.) Appropriately, number 2 is a 'marked tendency to quarrelsome behaviour bla bla', which is clearly the state we'll have reached even before getting to the second half of the equation. Part two is to have at least a couple of the next five rather sad 'borderline' criteria. You then take away the symptom you first thought of, run the results through your BPD detection software and voila.

Having recognised that I've sort of got BPD, I've become interested in contributing to the efforts of my doctors by doing some doctoring of my own. Spin-doctoring. Starting with the bloody name. And yes, while we Brits use the American name, there is a different European one. It's not any more flattering but it is a bit more explicit: Emotionally Unstable Personality Disorder (Borderline Type). There are gentle efforts in America to have it renamed 'Emotion-Impulse Regulation Disorder' which constructively removes the 'personality' element and adds the issue of mood regulation difficulties. The risk with this name is that women with the condition will be abbreviated to WEIRD.

A PR make-over for the 9 qualifying (American) conditions would have the following conversions:

1. 'frantic efforts to avoid abandonment' becomes 'enthusiastic about other people remaining in their lives', while the then paradoxical
2. 'pattern of unstable and intense interpersonal relationships' becomes 'not clinging excessively to people we're close to'.
3. We're no longer hopelessly 'impulsive' but impressively 'spontaneous' and similarly rather than
4. 'identity disturbance' we are 'flexible' in how we see ourselves. All this is likely to lead to
5. 'affective instability' i.e. mood swings which are better seen as 'short-lived differences in mood'. A way of coping with these 5 is:
6. 'severe dissociation' which could be rebranded as a spiritual state of spacing out

The make-over would admittedly then run aground against the rocks of
7. intense anger
8. chronic emptiness and
9. suicidal or self-mutilating behaviour.

Not even Trinny and Susanna could soften the blow of these last three. And talking of girlyness, BPD is a diagnosis used disproportionately with women, while men get the parallel, but even more stigmatising, anti-social personality disorder. Now that's really having the odds stacked against you.

As long as we're stuck with the label, the bewildering choice of qualifying conditions — oh, and managing the actual BPD symptoms, we can at least be thankful about the following. There are some highly committed, powerfully effective specialists; the Government issued constructive guidelines about personality disorders (No Longer a Diagnosis of Exclusion); and there is an excellent national membership organisation for people with BPD — Borderline UK. And since the condition is regarded as treatable, I'm hoping that it won't be too long til I'm a different sort of BPDnik — simply a Boringly Public Doglover.

12 reasons why it's great to have a diagnosis of borderline personality disorder

  • None of your friends have a clue what it is
  • No-one thinks you've really got a personality disorder, just something a bit close to one
  • You can put the initials after your name and sound very distinguished
  • It's not your fault you spend more on ebay in an evening than acute wards in the UK spend on psychotherapy in a year
  • When you explain that you've got to cancel your membership because your BPD has flared up, you'll get an enthusiastic refund from the never visited gym/synagogue/in-laws
  • Informing your taxi driver that your BPD creates sudden violent tendencies secures instant co-operation with switching off the gangsta rap/Val Doonican/Wombles
  • Confessing hypersensitivity and suicidal urges tends to avoid any awkward criticism of your Arabic homework
  • If you don't like your DSM IV score, you can have a shot at the European one.
  • If you can understand the European BPD scoring system you get instant eligibility as Voting Design Manager for a small former Soviet Bloc emerging democracy
  • Each day you thank God (or the APA) you haven't got something called schizoid personality disorder
  • You'd always wondered why you cling to the milkman's ankle, begging him not to leave you and now you know
  • You could be offered the only psychiatric treatment which sounds like it was designed by Marx and Engels.