The Basics: What Is BPD?

Blue and purple text box which reads "The Basics: What is BPD?"

Content note: Unfortunately, (and as no surprise to people with BPD and their loved ones), this post discusses suicide, abuse and ableism. If any of those are hard for you, I promise that your mental wellbeing is more important than my website stats. Go and find some cat videos 💙


Welcome to The Basics, a series in which I outline a concept that comes up a lot in my work! This time, we’re looking at Borderline Personality Disorder (also known as Emotionally Unstable Personality Disorder) – what it is, how it affects a person’s life, and what might help them. This article refers to “people with BPD” rather than “BPD sufferers” or similar, because I think the emphasis on suffering is unhelpful and because we are people. My personal opinions on whether it’s truly a personality disorder, versus a subtype of PTSD or a neurotype all of its own, are less than relevant here, but if significant new information comes to light along those lines you can expect an update to this post.

I was almost angry when I first learned about BPD, in that indignant way that you’re angry when you discover a resource that you had previously never heard of, sitting right in front of you. A while before I was formally diagnosed, I was already using BPD in my vocabulary and exploring how it might explain particular events scattered throughout my childhood. It explained so much, in fact, that I was formally diagnosed, and started writing a little more about having BPD.

BPD affects your mood, the way that you process and tolerate emotional distress, the way that you conduct your relationships and your self-perception. That’s a lot of things, so let’s start with the emotional bit. Sometimes I call my BPD “Big Emotions Disorder”, or “Tinkerbell Syndrome” in reference to the fairy in Peter Pan who can only feel one, extremely intense emotion at the time. These big emotions can cloud my judgement, especially when it comes to interpersonal interaction, and can escalate into an acute crisis very quickly. One problem with BPD is that our distress is so intense and specific that it can look very different to neurotypical distress, sometimes looking performative and thus not being believed – but we often are in that much distress, at least, and assuming otherwise is one of the reasons that people with BPD die by suicide at a rate of around 10%; for comparison, the Samaritans put the suicide rate of the general UK population at 10.0 per 100,000, or 0.01%

The relationship side of BPD is obviously impacted by the emotional side of it. BPD usually features an intense fear of abandonment and feelings of dependence on our loved ones, and our attachment styles can lead to clinginess and avoidance, sometimes both within the same person, same relationship and same hour. Relationships with a person who has BPD can often feature a lot of reassurance that you aren’t going to leave, as well as supporting the person when they have their characteristic Big Emotions. This can be taxing, especially when communication isn’t great, the person with BPD doesn’t know how to ask for reassurance (or even that that’s what they need), the person with BPD doesn’t take responsibility for their behaviour during times of Big Emotion, etc. Much like with the rest of the disorder, any stumbling block in the department of relationships is magnified so as to be almost insurmountable, so people with BPD report losing treasured relationships as well as ending up in terrible ones.

There is an argument to be made that entering terrible relationships, much like impulsive risky sex, drug use and dyeing one’s hair bright colours, is a self-sabotaging behaviour that we engage in because of our poor and typically unstable self-image. I personally think there is also an element of talented abusers finding and grooming people with BPD because we are likely to be grateful for the attention, eager to change and to please, and less supported by friends, family and professionals. Regardless, I’ve found in research and in my personal life that people with BPD are more likely to be abused in our interpersonal relationships than the general population, which is also more likely to do significant harm since we’re so sensitive to begin with.

(I also have to wonder whether dyeing one’s hair is definitely a response to unstable self-image, or whether it is sometimes done all or in part because of a desire to feel in control of one’s body and/or to make a statement. This is especially possible because there is an overlap between marginalised groups who dye their hair to be subversive, such as us gays, and people who are traumatised, what with trauma having known links to the development of BPD and all.)

Risk-taking behaviours are a real problem for people with BPD, and it can sometimes be hard to find the distinctions between deliberate risk-taking, altered perception of risk, and risks taken due to a feeling of passive suicidality. Personally, I’ve tried to obstruct a number of the risks I take, accidentally or on purpose, with things like a Blue Badge that stops me from wandering across car parks, and the deletion of Tinder from my phone. My experience with kink has given me, I think, a pretty good understanding of my ever-changing risk appetite and which risks I can take safely if I so need. I have to urge patience if there’s someone with BPD in your life taking risks that alarm you, especially because I know that sometimes I’m more likely to take risks if I have been specifically warned against them (there’s that avoidance coming through again). I also want you to trust that the adults in your life with BPD definitely are adults who can make adult decisions, and who will probably ask you if they need your help in managing their risk-taking. 

Personality disorders in general are heavily stigmatised, and this is especially true of what are sometimes called Cluster B personality disorders, like Antisocial Personality Disorder, Narcissistic Personality Disorder and Borderline Personality Disorder. I like to refer to Cluster A as “Cluster Your Problem” and Cluster B “Cluster Other People’s Problem”, because that does seem to be where the demarcation lies. BPD is among the disorders most vilified and misunderstood by the public, but I am here to tell you that there’s no personality disorder that makes you an inherently bad (or good) person – it’s your behaviour that dictates that. 

By the way, I’m going to insist on calling it BPD, instead of EUPD, or Emotionally Unstable Personality Disorder. There are a lot of reasons for this (including my inability to resist jokes about my European Union Personality Disorder), but my main one is that I think EUPD is misleading in two senses. The first is that it conveys that this is a primarily emotional disorder, which in turn conveys that it is perhaps less serious than other disorders, when in fact those emotions are a result of brain chemical activity just as in other mental health problems, and can be so intense as to lead to psychosis (delusions and hallucinations). The second is that it suggests a person with BPD is doomed to a life of emotional instability, which I don’t believe, having felt and witnessed the improvements that appropriate interventions can make. This doesn’t just mislead people who have BPD, rendering them desperately hopeless, but it also seems to mislead the public and professionals into thinking that severe emotional instability, and particularly distress, is so inevitable in people with BPD that it isn’t worth addressing in the way it would be addressed in anyone else.

This is not just a paranoid hunch I have; multiple articles point to a need for more research into BPD and how to treat its symptoms. Disorders aren’t chronically under-researched for no reason; funding goes to certain causes over others, which sucks because those other causes are usually also deserving of the funds. However, BPD isn’t as appealing or relatable to the public as disorders like depression, partly because of the very visible and vocal ways it presents. I also have to wonder whether it would get more research funding if it weren’t for the fact that “women present to services more often than men” (their cissexist language, not mine) and the related fact that we live in a patriarchal hellscape. Nonetheless, we don’t need research to approach people with BPD with the empathy and dignity that we deserve. It’s beyond time to stop treating BPD as Tantrum Disorder and start treating it like the complex constellation of traits and symptoms that it is – a disorder that can and does kill people. This dismissive attitude kills people.

In summary:

  • BPD is a disorder which acutely affects your relationships, your emotional state, your risk-taking behaviours and various aspects of your functioning
  • We are at high risk of harming ourselves but we are not fundamentally evil people bent on harming others
  • BPD is dismissed by professionals at an alarming rate, but the distress we’re communicating is legitimate
  • Helping people with BPD is the same as helping any other individual, but it will sincerely help us to elevate our voices and educate the public and professionals about the reality, and seriousness, of the condition
  • We need a lot more research on BPD, which you can also help to campaign for
  • If you have BPD and this post exhausted you emotionally, you’re not on your own. And if it helps at all, here is a photo of my cat:

My black-and-white cat on a blue-and-purple background, lying on his back with his legs spread wide. He learned this from me.

 

Love Letters From Lucid Morgan: Paranoia and Delusions

Stock image of two fluffy dogs lying in bed together, apparently sleeping, because they're calming to me and hopefully to others who struggle with paranoia and delusions, too

Note: This was originally a therapeutic exercise suggested to me by my counsellor after I mentioned that sometimes “Sober Morgan” leaves notes for “Inebriated Morgan”, reminding them of the things they need to do before bed and the like. She put forth that “Lucid Morgan” could write to “Paranoid Morgan” or “Depressed Morgan”, reminding myself of coping strategies and facts of reality as well as providing myself with a much-needed dose of compassion. I figured these letters could also be useful to people who suffer symptoms similar to mine, so I’m posting them here. Also, this letter will refer to the paranoia and delusions I sometimes suffer, as well as self-harm. If that’s hard for you, give this one a miss – this is supposed to be a helpful tool, not another trigger!


Dear Paranoid Morgan,

Hi, it’s me. Well, it’s you. It’s us. I’m writing to you now, while I feel relatively sturdy and in touch with reality, to talk to you during what I know to be a deeply scary moment for us. I want you to know that everything I’m about to say, I truly believe in this moment, and that I’ve felt exactly the way you’re feeling before – but I’m stable enough now to realise that it will pass. It always passes.

I imagine you’ll remember what we’re meant to do in these situations, when you’re struggling with paranoia and/or delusions, but a refresher can’t hurt. Take deep breaths, in through your nose and out through your mouth, for a count of at least four seconds apiece. Try to ground yourself in reality with the 5, 4, 3, 2, 1 approach (that’s five things you can see, four you can hear, three you can touch, two you can smell and one you can taste), or recite your address, your address from childhood, your mum’s phone number and/or the names of all the Organization XIII members from Kingdom Hearts. You know the drill.

Now, I’m gonna make a gentle suggestion: take your damn sedatives. They are not poison. We know this because we have taken them numerous times and suffered no ill effects. The sleepiness you feel isn’t them poisoning you, it’s them working to soothe your sympathetic nervous system, so that the panic you’re currently feeling wears off. And no, the panic isn’t a good thing. It isn’t keeping you safe, because the thing you’re panicking about isn’t a real danger. And I know you know that, because you identified you were experiencing paranoia or delusions or what-have-you with at least enough clarity to pick up this letter, but I also know that knowing and believing are two separate things.

Here are some more reminders:

  • This feels like shit, and that’s very real. You don’t deserve to feel like shit. This feeling might take hours or even days to wear off, but it does end eventually.
  • I repeat, it does end eventually. We’ve been here hundreds of times and survived it, and it goes away. Even if you wholly believe that the paranoid thing you think right now is the permanent, immutable truth of the universe and you will never change your mind, remember that the panic goes away. Sometimes it does that without us doing anything. Sometimes, you need to take your sedatives and perform some sensory-seeking behaviours until you feel more grounded. But the panic goes away, as do the paranoia and delusions.
  • Bad things that have happened to you were not your fault, and they weren’t caused by that weird evil you think lives under your skin. We know that when bad things happen to other people, it’s not as a result of nameless evil residing in their bodies, and we can’t talk the talk about victim-blaming but then do it to ourselves. The bad things that happen to the people around you aren’t your fault either. I promise.
  • I know I can’t convince you that life isn’t some elaborate simulation or illusion if that’s where you’re at, but remember: other people worry about this too, and they talk about it. If it were a simulation, it’d be stupid of its designers to alert you to that possibility by having other people consider it out loud. And, like we said in AS Philosophy (much to the chagrin of our long-suffering teacher), why does it matter if it’s a simulation? If it’s so detailed and consistent and believable that it seems like real life, then, for all intents and purposes, it is real life. Plus, if it’s a simulation, there’s nothing we can do about that anyway – you might as well eat some simulated Ben & Jerry’s and relax about it.
  • You won’t die in your sleep. We have slept thousands of times in the past 21 years and lived. There is no medical reason to suspect you could die in your sleep and people don’t die in their sleep very often at all. That means that none of your partners will die in their sleep either, and nor will your mum, the dog, your friends or anybody else you’re connected to.
  • You’ve got this. You have. The panic will pass but you don’t need to hurry it along necessarily. You know what steps you can take to help it ease off in its own time, and you know that it’s your body’s outdated way of trying to keep you safe, and you know that we’ve felt like this before, recovered and felt great the next day. You will be calm again. You will be happy again.
  • You are one of the most resilient and tenacious people in the world. We can no longer count on our digits all of the things we’ve survived; nor can we count our triumphs. If today’s triumph is not cutting your face open to extract the supernatural evil that supposedly caused your partner’s recent car accident (or whatever else you think it caused), that’s huge. You should celebrate.
  • I love you. As Lucid Morgan, I can look back on Paranoid Morgan and see a scared, confused human who is trying their absolute best. I can see how hard you’re battling. I am in awe of you and I love you. Give yourself a hug from me.

Thank you for finding it within yourself to read my letter. Thank you for keeping us as safe as you can. Thank you for working so, so hard to examine and recognise the things that you’re feeling and thank you for never, ever giving up.

All my love,

Lucid Morgan 💖