The Face of Bordeline Personality Disorder (Part 3)

Borderline Personality Disorder is a brutal roller coaster ride, taking a heavy toll on those living with the illness as well as those who live with them. DSM-IV diagnostic criteria 5 and 6 address the self-destructive nature of people living with BPD and their violent mood swings.

5. Recurring suicidal behavior, gestures, threats, or self-mutilating behavior

From Helen's BPD Resources we learn that no all persons who pragice self-harming behaviors suffer from Borderline Personality Disorder (BPD); however, many people suffering from BPD commit some sort of self-injury.

For me, self-injury has been a fact of life since the age of twelve, when I began piercing my ar,ms with safety pins. As I grew older, I turned from piercing to scratching, and from there to cutting. My weapon of choice was a utility knife, and I cut on my arms and legs in places that could be easily covered by clothing. Sometimes I used broken bottles and razor blades.

It goes without saying that these behaviors are very dangerous and can even result in death; according to the Fact Sheet on Borderline Personality Disorder (NARSAD Research), BPD is only slightly less deadly than schizophrenia and severe depression.

Why do borderline patients cut or practice other self-harming behaviors? Most will say that it is a sort of release, a coping mechanism. The physical pain distracts from the emotional pain. To the BPD patient, the act of bleeding releases pent up tension, anger, and frustration.

I think it is a bit more complicated than that. Yes, the element of release was there. The physical pain was a whole lot more bearable than the emotional pain I often felt. I felt rejected and lonely most of the time. Borderline brains are hardwired to interpret just about all social interactions as rejecting or disapproving. To the borderliner, the world is hostile and overpowering, and any notion of the self is one of weakness and insignificance.

Harming myself confirmed in my mind three additional ideas, all in contradiction with one another. It affirmed my place in the universe as an object worthy of contempt, as something that deserved to be hurt. The cutter scars were a badge of character, proof that I willingly bore the hurt I was meant to endure. Cutting also gave me a sense of control. I didn't have control over my relationships, for example, but I could inflict pain on my body, even make it bleed. What is interesting is that borderline patients are incredibly controlling and manipulative, and the reason is that they feel out of control and must therefore grasp and maintain it at any cost. Finally, hurting myself asserted my own existence. Bordeline patients do not have a real sense of who they are. This lack of self-sense can go as far as a feeling of actual hollowness or emptiness. To me, the physical pain I inflicted on myself was also a way to prove to myself that I was there, that I existed.

In the end, cutting became an addiction of sorts. There may actually be biochemical reasons for self-harming behaviors. In my cutting days, I would cut about once a week, often not even waiting for old wounds to heal.

6. Affectibe instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

Borderline patients experience rapid and intense mood swings. Their intensity is very similar to that seen in bipolar disorder. There is an intense discussion in the therapeutic community whether BPD is actually a subset of bipolar disorder, we learn from Helen's BPD Resources. But even rapid cycling bipolar disorder, also known as bipolar II, cycles much more slowly than BPD mood swings.

It has happened to me more than once that I felt miserable to the point of being suicidal one moment and then perfectly happy an hour or so later. Prior to my most recent hospitalization, I was literally one cigarette away from slitting my wrists; I had already written the suicide letter. The "suicide kit" was ready to deploy, and I was sitting on a gorgeous hilltop, enjoying what I believed to be my last smoke.

I believe that these factors saved my life that day:

Manic and depressive cycles are very rapid. While they can last for days, they can also be over in a matter of minutes. Waiting a few minutes before executing a suicide plan can be a lifesaving proposition for a borderline patient. It is no guarantee, but it's definitely worth the try.

I also have learned a lot about my illness, and knowledge and understanding are important weapons in the arsenal against borderline personality disorder. If one knows that the depressive cycle is part of the illness, then one can learn to distinguish between the cycle's triggering event and the illness itself. The event, in other words, has nothing to do with the illness itself, while the illness illness determines how we perceive and process the event. No, the triggering event is not evidence for the idea that our life is unhappy or that the world is against us. Our illness causes us to perceive it that way. Knowing that our mood cycles are brief, we can allow ourselves to wait and see if we still interpret the event as hostile five minutes later.

Waiting the cycle out, rather than reacting to it immediately, can help a borderliner to evaluate it more rationally. It is normal to feel upset after an argument with a loved one. But it is pathological to be driven to the brink of suicide by it. An argument with a roommate over household chores is not likely to result in being thrown out of the apartment. And being thrown out of the apartment is not likely to result in homelessness. The exact opposite is more likely.