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.

 

March Onwards

A scarred arm with two plasters on it, one normal shaped and one shaped like a heart

CN: This post refers in detail to suicidal ideation and planning, eating disorders (no numbers, detail about purging), self-harm, psychosis, anxiety and depression. In short, this is a tough one – please give it a miss if you need to 💖


I remember the past six months in fragments. An assortment of fragments, big and small, painful and beautiful, some much sharper than others.

The fragment in which we suddenly realised that I wasn’t safe, and started making plans and group chats to get me to somewhere I could be supervised. It was white-hot with guilt and grief and I couldn’t always block out the pain.

Several fragments of sobbing. Of clawing at my face. Of feeling, knowing that my veins ran with molasses-y evil, of being unable to escape the tangibility of it beneath my skin. Of dizzyingly overwhelming shopping trips. Of semi-coherent phone calls to my mother.

I remember a sliver of my mother helping. I hold onto slivers like these, or like of singing, of passing joints around a fire, of face masks and desserts. I hold onto them so tightly that some of them cut my palm.

The bigger fragments are often worse. In one, I went to the hospital, because I was going to kill myself if I didn’t. They wouldn’t let my girlfriend into the waiting room with me, and I had to walk an endless corridor to find it. There were sharps bins I could have stolen. There were cleaning chemicals on a trolley I could have drunk. I could have simply turned and run.

I forced myself through that corridor like I used to force myself through mealtimes. I remember the feeling of clenching my fists and chipping away at a goal I desperately wanted not to reach: one more mouthful. One more mouthful. One more footstep. One more.

I waited. Nobody came to help. I was there for twenty minutes, I’m told, and I know that I was at war with myself for every moment, punching and scratching and picking and crying and still all too aware that I could just run. I could just run.

They sent me down the hill to the psychiatric hospital. That one let my girlfriend wait with me. This is the smooth edge of the fragment, where we played Hangman and gossiped and loved each other for hours. 

Then they took me into a little room and told me they couldn’t help me.

Here is the sharp edge. I couldn’t hear anything after that. I asked for my girlfriend. She asked if there was anything they could do for me to make the past five hours worth the wait.

They could not.

I don’t remember leaving that room, but I remember leaving the building. I remember my vision fading at the edges, and all I could see was the brick wall up ahead. I recruited the wall in the fight against me, ramming my fists and forehead into it. I drew the attention of some nurses, who came out to check I was alright – but they couldn’t help me either.

Then there are the fragments in bathrooms. Running a razorblade across my cheek, but without enough courage to draw the evil out. Crying in front of a toilet, unable to cope with an ordinary stomach bug, my trousers on the floor beside me. Squishing myself in front of the mirror in quiet, poisonous horror. Stroking the back of my throat with my fingers and regurgitating McDonald’s. That last fragment should be put away safely, somewhere I can’t find it, because all I felt afterwards was a bliss that I still mourn.

Another trip to the hospital – this one fuzzier. My boyfriend at the time watching with wide, terrified eyes as I screamed down the phone to a crisis worker, trying to make her understand why I needed to die. The mounting, sickening dread in the taxi to the hospital. The glimmer of hope when they started to talk about an admission. Explaining my plan to find somewhere wooded and pretty, get very drunk and start slicing myself until I die and my body nourishes the ground. 

Being told, again, that they couldn’t help me.

The trick to living through that twice is lost to my foggy memory. I know we went home and I smoked a lot of weed. I know that I lived. I know that the people around me kept me safe both by loving me fiercely and by hiding all their medications, house keys and sharp objects.

I know that I kept trying to put one foot in front of the other. One more footstep. One more.

There are so many other fragments that I struggle to fit together in my mess of a mind. That one antipsychotic that made me lactate for two weeks. Completing and handing in some coursework, somehow. A lot of Animal Crossing. A lot of naps.

A lot of footsteps. One more footstep, and then another.

One more.

Safe, Sane and Consensual (SSC) vs. Risk Aware Consensual Kink (RACK)

Stock photo of a white tin case with red text which reads "First Aid case"

If you’re new to the world of BDSM, you may have heard the terms “SSC” and “RACK”, and you may be confused as to what exactly they mean, whether they differ from each other and which is better to use. So let me start at the beginning: they’re names for schools of thought within BDSM regarding, essentially, safety and best practice.

SSC = Safe, Sane and Consensual.

RACK = Risk-Aware, Consensual Kink.

There are other versions of these (such as PRICK, which stands for “Personal Responsibility, Informed Consensual Kink”, and CRASH, which stands for “Consensual, Risk-Aware, Shit Happens”), but they’re not as commonly used as SSC or RACK. You’re more than welcome to generate your own code of ethics and best practice within BDSM, and it doesn’t even need a cool acronym, but the benefit of terms like SSC and RACK is that lots of other kinksters are aware of their meanings, which makes communication with those kinksters that little bit more streamlined.

I have to confess, I am firmly a RACK person. I understand the appeal of SSC, especially to newcomers. We all want to believe that the things we do, in kink and in life, are safe and sane. The first problem, though, lies in the subjectivity of both of those words. Imagine you’re talking to someone from, say, 1600. You explain to them that we have huge metal carriages, called “cars”, that can travel at up to 270 miles an hour, and that even in everyday use they can exceed 70. You acknowledge that sometimes, the drivers of these “cars” can lack skill or focus, and sometimes they lose control of their vehicles. Then you reassure your new friend that we have crossings in place, where cars are legally mandated to stop, so that pedestrians can move from one side of the road to the other. They’re only slightly relieved by this, and they are aghast when you follow it up with, “But some people just nip across the road where there isn’t a crossing at all.”

To someone from 1600, that seems both unsafe and fucking insane, but to us, it’s Tuesday. Our understanding of safety changes from decade to decade and person to person. Some people won’t eat raw cookie dough because they deem it unsafe. Some people will do several recreational substances in a field with their friends, with no phone signal nor sober people onsite. (Not me, of course; I would never). People do things that they think are safe but that others do not, and some people do things that they know to be unsafe, because we’re all blessed with bodily autonomy, no matter how recklessly we use it.

There’s also the issue that some kink acts just cannot be made safe. YouTuber Evie Lupine did a wonderful video on this topic, citing breath play and the use of restraints as being among the things that beginners dip their toes into without a full awareness of the risks involved. SSC suggests that kinksters should only engage in play that is safe, but that takes a lot of activities off the table, or else minimises the risks those activities pose. Implying that things like choking are safe, rather than fraught with risks that can be mitigated, is dangerous, especially for beginners. It’s for this reason I prefer the “Risk-Aware” label.

Then there’s the “sane” issue. First, as outlined above, our understanding of what is and isn’t sane to do varies wildly. I don’t think that skiing is a sane thing to do (just chuck yourself down a snowy mountain! With some sticks! It’s fine!), but other people either disagree, or do it anyway. The implication that some types of play can be insane is troublesome, because the distinction between sane and not-sane is different for everybody and because if there are not-sane ways to play, what does that mean for the people who practice them?

The thing is, I know I am not a sane person by most definitions. I experience mild hallucinations, some delusions, huge emotional responses and more, and the idea that sanity is a requirement for kink is… troubling. By focusing instead on risk awareness, I can participate in kink so long as I comprehend the risks and can give informed and unimpeded consent (unimpeded meaning not affected by, nor primarily motivated by weird brain things). I’m sure people who prefer SSC don’t have any ableist intentions, but in suggesting that kink has to be sane, SSC runs the risk of alienating people who aren’t, strictly speaking, sane themselves.

I don’t judge people who use SSC rather than RACK – I’m sure they have their reasons for doing so, and everyone is entitled to set their own rules regarding how they approach BDSM. But I’m always going to err on the side of risk-awareness over insisting on safety and I’m always going to shy away from insistence upon sanity, and I hope y’all can understand why.