At the peak of the absolute worst manic episode of my life, my doctor gently brought up the possibility that I might have been suffering from Borderline Personality Disorder as opposed (or in addition) to my diagnosis of Bipolar Disorder. At the time, I remember recognizing deep down where the signs and symptoms were lining up, but I was quick to shut the conversation down.
At the time, I told myself that I wasn’t ready to discuss a re-diagnosis because I had only just begun to really understand my bipolar disorder at the time. I was beginning to advocate for myself and speak out more on what I was affected by. I was really beginning to identify with the term bipolar. In retrospect, I do recognize these factors as totally valid for the time being, but it took me up until quite recently to really dissect and come to terms with why I was four square against the prospect of being diagnosed with a personality disorder. In 2019 I was diagnosed with comorbid Adult ADHD, and took the news in stride. If anything, I was relieved that the diagnosis granted me access to medication and treatment I might not otherwise have been able to obtain, and it has helped me in my recovery tremendously.
So why, I had to ask myself, was I so persistent to ignore the suggestion that perhaps I was struggling with Borderline Personality Disorder? Truthfully, I only came to contemplate the subject again very recently, when I was visited by a friend that had BPD. This was a friend I met online a few years ago, and we had maintained a close friendship. I had always wondered where the symptoms of her BPD were, as she always seemed to come off fairly well rounded.
Over the weekend we spent together, not only did we talk a lot about our mental health, but I was able to experience time shared with someone that had BPD that was entirely enjoyable. I was even able to pinpoint the positive side effects of her diagnosis, like her immense trust in people, and how excited she got over things she was truly passionate about. I found myself reconsidering my diagnosis a lot this past week, and I’ve had to finally admit that I was harboring stigma against people with Borderline Personality Disorder.
When I worked as a case manager at an inpatient facility, we (the staff) collectively rolled our eyes anytime we received documentation on an incoming patient if they were labeled as BPD. More often than not, these were young women in their 20s or 30s. As we were a dual diagnosis facility, they typically came in substance abuse induced mania. These were, by far, the most difficult patients to deal with. The only word that often times came to mind when I was struggling to help one of these girls was “BRAT.”
They were demanding, needy, emotional, rude, hard headed, and wildly dramatic. The way my superiors (such as the clinical psychologists and psychiatrists) discussed BPD left a lasting impression that I’ve since come to find was incredibly wrong. Up until very recently, I had considered personality disorders to be somewhat controllable in comparison to Bipolar Disorder, which I regarded as being uncontrollable. I considered Bipolar Disorder to be a chemical issue that couldn’t be helped from time to time, and Borderline Personality Disorder to be something that was, to a degree, a choice. Yes, I acknowledged that it was typically born out of massive or repetitive trauma, I just felt like these folks had developed their signs and symptoms as a defense mechanism, and decided along the way that acting outrageous got them what they wanted.
I am speaking very candidly about this, because I feel that all mental health advocates stand to learn something about the members of our culture and themselves. I also fully admit that I specifically stayed away from the topic of Borderline Personality Disorder BECAUSE of my prejudice. Only now do I realize my developed stigma against the disorder was personal, because I can see my own behaviors are just as aligned with BPD as they are with my mood disorder.
The line between Bipolar Disorder and Borderline Personality Disorder is incredibly thin already. After picking my friend’s brain over the course of our vacation together, I began to acknowledge the specifics of BPD that I have struggled with that weren’t already associated with Bipolar Disorder. Namely, my interpersonal relationships are a struggle far beyond what I believe my Bipolar Disorder can cause. Hearing terms like “FP” (Favorite Person) from my friend, and the occurrence of “splitting” shook me to my core. These were the very same factors I was dealing with when my doctor politely suggested that perhaps I was misdiagnosed.
In the past, I had doctors look at me funny when I explained that I live in a constant state of mania. Even at my best in recovery, I’m always at least a little manic. Although I do experience what I consider depression, it’s so mild and quick moving, it even feels a bit like a micro manic episode. This constant state of mania (and bad decisions, impulsivity, and obsessiveness that it comes with) is more aligned with the everyday struggle that is associated with BPD.
When I expressed my concern to my friend, she suggested that perhaps I shouldn’t look at my mental health as a diagnosis of this, or a diagnosis of that. Instead, she suggested that I take a good look at each specific symptom of my mental illness (whatever it’s name might be) that affects my daily life, and treat that. This was, by far, some of the best advice I’d ever received… and it was free!
My friend, by the way, was re-diagnosed with BPD in remission upon returning home from our trip. Having spent time with someone that was thriving with a personality disorder greatly impacted the way I feel about the disorder over all, and helped me come to terms with the fact that not only had I been softly stereotyping a disorder that made me uncomfortable, but the fact that I was specifically hiding from the disorder because I was afraid of a re-diagnosis.
I plan on discussing this revelation with my doctor again, and perhaps taking my therapeutic approach in a new direction. In the meantime, I feel that this experience has served as a reminder that we are so much more complex than a book can address. A potential re-diagnosis would simply grant me the tools I would need specifically to address and remedy my negative behaviors.