Borderline Personality Disorder

*Please excuse the formatting in this post. WordPress is being less than co-operative.

I was first “diagnosed” with borderline personality disorder when I was about twenty years old. I use inverted commas for diagnosed because I don’t believe there was any real assessment done and I was just given a label because it was convenient for the psychiatrist at the time.

I had spent ten minutes in this man’s office and this is what he came up with. I don’t know how he came to this conclusion so quick with limited information. I can only assume he saw my self-harm and picked the diagnosis because it is a common feature of patients with borderline personality disorder.

When I went to see the psychologist who had access to my medical file I asked him more about it. He looked in my file to see the first thing written was “borderline personality disorder”. There was no evidence of diagnosis. No reasons written about how he came to this conclusion. No nothing. Just borderline personality disorder.

Now let’s give this guy the benefit of the doubt. He was an older gentleman so I’m sure he’s made this diagnosis many times before. Let’s have a look at what it take to qualify as a borderline.

In order for a diagnosis of Borderline Personality Disorder to be given, at least five of the following nine traits must be present

  1. Fear of abandonment
  2. Difficult interpersonal relationships
  3. Uncertainty about self-image or identity
  4. Impulsive behaviour
  5. Self-injurious behaviour
  6. Emotional changeability or hyperactivity
  7. Feelings of emptiness
  8. Difficulty controlling intense anger
  9. Transient suspiciousness or “disconnectedness”

Let’s go through this one point at a time.

  1. Fear of abandonment

This is defined as “frantic efforts to avoid being abandoned by friends and family.” An “intense fear of being left alone, which causes you to act in ways that, on reflection, seem out of the ordinary or extreme, such as constantly phoning somebody.”

While I didn’t always like being alone (who does?) I wouldn’t define it as an intense fear. I did not constantly phone people or act in any other strange ways. I do not believe this point counts.

  1. Difficult interpersonal relationships

This is defined as “intense and unstable relationships with other people that switch between thinking you love that person and they are wonderful to hating that person and thinking they are terrible.”

While I did have my moments with co-workers, disagreements and such. I don’t believe my feelings about these people switched as extremely as this. They were regular arguments that anyone could have. I still liked the person despite our disagreements and things usually sorted themselves out. I do not believe this point counts either.

  1. Uncertainty about self-image or identity

    This is defined as “distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.”This point is possibly valid, but let’s face it, I was a young adult still trying to work out what I wanted from life. I’m in two minds about this one but I’ll let the psychiatrist have it. One point to him.
  2. Impulsive behaviour

    For this point to be valid, you have to “engage in at least TWO activities that are impulsive and potentially damaging. Examples include excessive spending, unsafe sex, substance abuse or reckless driving.”Now let’s define impulsive. According to the dictionary impulsive means “acting or done without forethought.”

    impulsive
    The only (ONE) activity I participated in according the examples given was substance abuse. I use to smoke marijuana. However, according to the definition, I would not say it was impulsive.

    Every time I smoked it was thought out. I treated getting high the same as I would if I was drinking alcohol. I never drove under the influence. I never went to work under the influence. I only smoked when I didn’t have to go anywhere, or was at a friend’s house when I knew I would be there long enough for the effects to wear off before I drove home, or had alternative transport.

    To me this is not impulsive. Plus it was only ONE activity I was engaging in. Not TWO. I did not, and still don’t drive recklessly. I actually believe I am a very safe driver. I was not having unsafe sex. I was not spending excessively. In fact at the time I had quite a good amount of savings in the bank. So does this point even count?

  3. Self-injurious behaviour

    I’ll give him this one. At the time I saw him I had made a single (and my only) suicide attempt and was self-harming fairly regularly.
  4. Emotional changeability or hyperactivity

    This is defined as “periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.”Another point to the good doctor. I definitely had periods of depressed mood, irritability and anxiety that lasted from a few hours to a few days. Sometimes longer. In between that I could be in a regular mood like everyone else or be a little hyperactive.
  5. Feelings of emptiness

    This is defined as having “long-term feelings of emptiness and loneliness.”This could go either way for me. I did feel like this sometimes, but not all the time. Can we give half points? Half a point to the psychiatrist.
  6. Difficulty controlling intense anger

    This is defined as “inappropriate, intense or uncontrollable anger—often followed by shame and guilt.”First of all, does this not happen to everyone from time to time, especially when they are under stress? I had moments of anger the same as anyone but I don’t think it was anything that was out of control. Yes, sometimes I felt guilty after if I had taken it out on the wrong person but again, I’m sure this happens to most people from time to time. It’s not like it’s something that happened regularly and I believe the moments I was angry there was a valid reason to be feeling that way. I’m not counting this point.
  7. Transient suspiciousness or “disconnectedness”

    This one is defined as “dissociative feelings—disconnecting from your thoughts or sense of identity, or “out of body” type of feelings—and stress-related paranoid thoughts.”I did have moments of ‘zoning out’, I still do. The feeling like you’re there but you’re not there. Kind of like your floating over yourself. I believe this is more anxiety related though.

    I had the odd paranoid thought but that only happened when I had been smoking marijuana and it mostly revolved around me thinking I was being too loud and the neighbours were going to complain. I use to have the volume on the television set so quiet I basically had to sit on top of it in order to hear it myself. Does that type of paranoia count?

    I’ll be generous and give this one to the psychiatrist even though I don’t recall him ever asking me any questions about this type of thing.

 

Now let’s tally it all up

Point 1 – No
Point 2 – No
Point 3 – Yes
Point 4 – Maybe
Point 5 – Yes
Point 6 – Yes
Point 7 – Half point
Point 8 – No
Point 9 – Yes

So that’s four and a half yes’s and one maybe. Based on all this I’d say it’s fairly borderline (pardon the pun) whether I was borderline or not. It’s all very subjective really, it depends on the individuals interpretation of the criteria’s meaning.

Whether or not I actually did have Borderline Personality back then not doesn’t really matter now anyway. The last psychiatrist I saw (who actually did take the time to read my file and ask appropriate questions) has said that this diagnosis does not apply to me now.

References:

  1. http://www.borderlinepersonalitydisorder.com/wp-content/uploads/2012/12/2012_December_16_v2.pdf
  2. http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder.aspx
  3. http://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Diagnosis.aspx
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