Walking the Borderline

I was 20 years old when I found out my brain, the most complex organ in my body, is broken. Like a sewing machine gone off the rails, my brain spins lies due to patterns of malfunctioning etched into my cerebral cortex from a young age. These patterns can only be explained by one condition — borderline personality disorder.

Borderline personality disorder is a mental illness characterized by patterns of behavioral and emotional instability. An estimated 1.6% of the adult U.S. population suffer from BPD, but that number can be upward of 5.6% due to misdiagnoses as depression or post-traumatic stress disorder.

Symptoms of BPD include fear of abandonment, unstable relationships, unclear or unstable self-image, impulsive and self-destructive behavior, self-harm, extreme emotional swings, chronic feelings of emptiness, explosive anger and feeling suspicious or being out of touch with reality (disassociation). Someone must show at least five symptoms to be diagnosed with borderline personality disorder.

I was diagnosed with bipolar disorder my freshman year of college, but bipolar failed to explain the symptoms of self harm and emotional reactivity I’ve displayed since middle school. My body lit on fire during break-ups. I impulsively self-harmed without a second thought. I exploded with rage at the drop of a hat. I never fully had any form of identity until receiving my borderline diagnosis at the start of my junior year of college.

Psychologist Frank Yeomans is a director of training at the internationally recognized New York-Presbyterian Borderline Personality Disorder Resource Center and a clinical associate professor of psychiatry at Cornell.

Yeomans characterized the disorder as having difficulty in four areas of life — emotional intensity, interpersonal relationships, behavioral manifestations and, at its core, one’s sense of self.

Moods can shift rapidly, and people with borderline personality disorder can quickly idealize, then devalue romantic partners. Behavioral dysregulation can manifest itself in the form of self harm, such as cutting, substance abuse and eating disorders, Yeomans said. Borderline personality disorder is the only psychiatric disorder that classifies self-harm as a symptom.

“If you don’t have a stable sense of self, it’s like a ship at sea without a rudder,” Yeomans said. “You’re just bouncing all over the place, so you have to work both at the level of behaviors and at the level of building a strong and solid sense of self.”.

Binge-drinking, which is common in college, can also exacerbate symptoms, resulting in dangerous, harmful or often times regrettable actions. In my own experience, heavy alcohol use led to unstable nights and even worse depressive spells from hangovers.

“It is tough for the college-age BPD person (because) sometimes they have to limit what seems normal college-age behaviors since they don’t have the solid core strength to do that without getting dysregulated,” Yeomans said.

College also sends a person with BPD into a far less structured lifestyle, which can intensify interpersonal relationships.

“Up until college, you’re in high school living with your family,” Yeomans said. “If you have borderline personality disorder, you kind of begin to unravel.”

Unraveling is right. According to the Substance Abuse and Mental Health Services Administration, up to 80% of people with this disorder attempt suicide at least once throughout their life.

One out of 10 people living with borderline personality disorder will die by suicide. Combine that statistic with the suicide rate of bipolar disorder  — 15 to 20% — and I’m at high risk of dying by suicide.

This comes as no surprise. I’ve had four suicide attempts and one hospitalization during my college career.

But I knew there was hope. Studies show most patients with BPD improve over time, displaying significantly less symptoms in as little as two years.

Dialectical behavior therapy, or DBT, was created specifically for the purpose of treating borderline personality disorder, Counseling and Mental Health Center psychologist Joey Hannah said. DBT integrates different aspects of therapy such as cognitive behavioral therapy and mindfulness to give patients mental tools to manage intense emotions and interpersonal relationships.

“Struggling with borderline, there’s lots of ups and downs and back and forth and fears and hopes,” Hannah said. “All these things live in extreme different directions. DBT is about how to reconcile with those opposites in a way and to allow both to exist.

Medication can be helpful in managing certain symptoms, but is usually not the most effective form of treatment in lieu of DBT, Hannah said. The patterns of behavioral and emotional dysregulation characteristic of BPD are believed to have originated through experiences of trauma in childhood or young adulthood, but genetic and environmental factors may also play a role.

Navigating BPD as a UT student was not easy. My sophomore year, I sought CMHC psychiatric services for bipolar treatment. Later, I used UT’s dialectical behavior therapy group in May 2017 and started receiving Services for Students with Disabilities accommodations that fall.

I still have rapid mood swings, episodes, disassociations, intense feelings from interpersonal relationships and days where I miss class or have thoughts of suicide. I am now on medication, receive weekly therapy, am in a stable, healthy relationship and have self-harmed twice, and minimally, in six months. I graduate this May.

I could slip again. I could get bad again. I could attempt suicide again. But I can’t — I won’t — let myself live like that. I’ve hit a point now in my life where I have to tell the voice in my head that says I’m not worthy to simply fuck off.

I’m writing this article now, partially as an ode to my final year in college as a mental health reporter, but also as a reminder to anyone out there living with BPD that you are not alone, you are loved and you can do it.

How do I know? Because I am here, alive, breathing, with the scars to tell you I’ve made it.

And you can too.