With
every fall, I learn to stand, In the face of fear, I take command
Through
the storms that try to break, I'll rise again, for my own sake
With
fire in my soul, I'll light the way, In this journey of life, I'm here to stay
Feel
the power, it's building inside, With every heartbeat, I won't hide
No
more chains, I'll break them free, In this moment, I am me
I'll
rise up stronger, no holding back, With my head held high, I'm on the right
track 
Rise
Up Stronger: Beat-Creative
After around fifteen years of having a diagnosis of Borderline Personality Disorder (BPD) stuck to my records, I began questioning its validity a year or so ago and began seeing a Psychiatrist from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW). After around one year of appointments, on April 1st 2025, the Psychiatrist told me he had finally concluded that I was right; I no longer meet the diagnostic criteria for BPD and that it would now be listed as ‘historic’ in all of my records! In ascertaining that I didn’t meet the criteria (which is to have at least 5 of 9 possible symptoms) we established I had just one and when I was diagnosed, it was with the determination that I had all 9! So, considering this meant I’ve recovered from 8 symptoms of BPD, I thought I would do this blog post to chat through how I managed it in the hope that it provides advice for others and also hope for those to know you can overcome BPD…
In
2009, I made my first suicide attempt and began my three-year journey of being
in and out of both psychiatric and medical hospitals. Not longer after things
started, I remember just so happening to look at my discharge summary from the
psychiatric hospital and saw that in the ‘diagnosis’ box it read: ‘BPD?’ Even
at that point, no one had ever mentioned Borderline Personality Disorder to me,
nor within my hearing distance. So, when I saw the summary, I had to do my own
research into it.
A
little while into these three years, when I’d runaway to a nearby town, the
Police there took me to the Station for a Mental Health Act assessment, and I
remember one of the Psychiatrists (you need two to section someone) firing off
a ton of questions, one after the other. Afterwards, he told me each of the
questions had been regarding a different symptom of BPD and that you needed to
have at least five to meet the diagnostic criteria and I had shown to have all
nine. Back home, I asked my Community Psychiatric Nurse (CPN) if this meant I
had the diagnosis now and was told: “I don’t want to stick
you with that label yet. Once you have that, no services will touch you because
people don’t get better from that.”
So,
when I was finally diagnosed with BPD, I struggled with massively mixed
thoughts and feelings with some of them being influenced by the CPN’s comment
and making me feel hopeless and as though I no longer had a chance of ever
feeling any better. Of ever being any better. However, contradictory to
that, I was also relieved to have a diagnosis because, to me, if one existed
for the things I was experiencing, that meant other people must have had the
same or very similar experiences too and this meant I wasn’t alone. And that I
wasn’t broken or weak in some way because that would mean a ton of other people
are too… It’s actually one of the most helpful skills I’ve learnt is
considering what you’d say to another person in your situation; would you be as
harsh and critical on them as you typically are with yourself?
That
CPN was right in a way though because once I had the diagnosis stamped across
my records, professionals and my local services (mental health, medical, and
the Police, in particular) became incredibly rude, discriminatory,
stigmatising, unprofessional, and unhelpful an enormous amount of the time. I
was often labelled an ‘attention-seeker’ and a ‘drama queen.’ Their poor
treatment made me angry, disappointed, left me feeling failed, and massively
destroyed my mood and my mental health in general. I felt incredibly
unsupported and when I was struggling and suicidal, I felt I had absolutely no
one I could call for help and support and, in all honesty, I’d rather have
actually been completely alone than have people there who mistreat me as much
as those professionals and services did back then. It gave me reason to use the
bridge analogy where I explained that if someone called the Police or an
Ambulance or the Crisis Team when they were standing on a ledge, those
professionals had the very real chance of providing that person with either
more reason to jump or a reason to take a step back, a step towards safety.
They can literally be life-saving or life-threatening.
The
largest way I benefited from the diagnosis was the one way in which I learned
that all that mistreatment was actually not a result of stigma or
discriminatory thoughts and opinions, but instead a huge lack of knowledge and
understanding. And the way I established this more productive and kind insight,
was in 2012… On discussing my discharge from my local psychiatric hospital, the
Consultant told my CPN (not the one I spoke about earlier; this was a nice,
empathetic one!) that he thought it might be a good idea for me to be admitted
to a hospital which specialised in Personality Disorders. He explained that he
thought it was necessary because he felt that the ways in which my diagnosis
was presenting itself were too difficult to be ‘managed’ by local services who
had no specific training around helping and supporting someone with this
Disorder. So, whilst still in the hospital, I had an assessment with a
specialist psychiatric hospital just over 100 miles away from home. I actually
liked the sound of it, the way it ran, and the therapy available in it, but
they ended up concluding that they couldn’t accept my flight risk because they
were a low secure hospital (there are three levels of security in psychiatric
hospitals, low, medium, and high) and I had been running away and regularly
managed to escape from hospitals – psychiatric and medical – on numerous
occasions.
So, I
was discharged from the local psychiatric hospital and in the community, a
little while later, I was assessed by a specialist hospital just over 120 miles
away and boy did I hate the sound of it?! They explained that it was a medium
secure hospital, that you had to undergo both group and 1:1 Dialectical
Behaviour Therapy (DBT) sessions, there was a wake-up and bedtime, a
therapeutic timetable which meant groups between the DBT sessions, it was
defined as being a ‘long term ward,’ we could only have phones/laptops during a
certain timeframe, and communal morning meeting and Reflection meetings in the
evening. It sounded incredibly intense and structured, which I found to be
really off-putting because it would mean a huge lack of freedom and control over
my days, and I found my laptop and phone really good for distraction when I was
struggling with my mental health. And so, despite them offering me a bed, I
declined it and because I was no longer sectioned, I couldn’t really be forced
there.
A few
months later, in Summer 2012, I made another suicide attempt, and the hospital
Doctors used the 2005 Mental Capacity Act to declare me to be lacking capacity
and they put me on life support to enable them to administer the lifesaving
medical treatment against my will. When I woke up, my Mum said I had to go to
the specialist hospital, and I agreed to go voluntarily. I acted like being on
life support had been a shock to the system and a kick up the bum to recognise
how bad things really were and that I’d realised I don’t actually want to die.
But actually, I had the thought in my head that one hundred and twenty
something miles was far enough to be able to run away and make another attempt
and succeed this time!
Later
the following week, two of the hospital staff came to pick me up in a huge van
but that was helpful because the average length of admission to the hospital
was stated as being ‘12 – 18 months,’ so I actually had two suitcases – which
were packed to the brim! – to take with me! Within hours of getting there, I
tried to leave! But the whole ‘medium secure’ thing was right and so there was
an airlock to the ward and both doors to it were permanently locked, and then
the main entrance doors – which were next to the ward – were locked too. But I
remained determined and so they sectioned me under section 2 of the 1983 Mental
Health Act, but that’s only valid for 28 days so within a couple of weeks, it
was changed to a section 3 (which is six-months and if it’s kept in place at
that point, it is reviewed yearly).
After
two and a half years of DBT, medication, and so many other beneficial
contributions to my mental health from the staff and the hospital/service
generally – and, actually, from the other inpatients and my Mum and my other
loved ones! Everything just built up to help me to find the determination,
dedication, passion, and strength to finally cooperate with the staff and
really engage in DBT and the other therapeutic groups. And obviously I got
better! But I recognise that I wouldn’t have had access to these specialist
services and the knowledge, understanding, and empathetic staff, if it weren’t
for my diagnosis of BPD.
With me
summing up all the general contributions to me getting better, in establishing
I now only have one BPD symptom, I realised that I’ve actually never thought
about each of those I’ve overcome and how they have been helped in different
ways and by different things and different people. So, from the moment I first
had the idea for this post, I have been really looking forward to looking at
everything in much more detail because I feel like I’ll actually learn a lot
from this. And in doing so, I think this will better my ability to help others
because I’ll have an increased insight into what is beneficial specifically for
each symptom and helping others is massively helpful for my own mental health
because it helps to give me a purpose and a responsibility. Actually, it is in
a very similar way to that which I experience from my blogging career.
So,
below are each of the eight symptoms a Psychiatrist has deemed me to have
overcome, and for reference; the wording of each is from: DSM-5 Criteria for Borderline
Personality Disorder.
I think that in talking about overcoming each of these eight symptoms, it will
likely be necessary to include bits and pieces about my actual experience and
the way they manifested for me. I’m a huge advocate for everyone’s mental
health being different and that different experiences can initiate different
mental health experiences or symptoms. With this in mind, I also think it’s
really important and connected to recognising that even if you have ten people
with the exact same diagnosis, that doesn’t mean they experience the symptoms
of that in the exact same way.
PTSD
(Post-Traumatic Stress Disorder) is probably a really good example of this
because some sort of understanding or knowledge of it is fairly widely known
and understood. And so, the example is that, with PTSD, it means you can get
ten people with that diagnosis, but each person will very likely have a
completely different trauma (or traumas – multiple) which have caused or
influenced the development of the PTSD symptoms. I mean you hear of Soldiers
who have seen war being diagnosed with it and also someone who has been in a
car crash or a person who is a survivor of domestic violence. Trauma manifests
itself in different ways, at different points in life, and with people – both
the person who has experienced it and others on the outside looking in –
deeming them as actually also having different levels of severity.
Here goes…
The most
significant and fundamental cause for this symptom manifesting in me and my
mental health, was the abuse I experienced when I was 15. In November 2006, I
was attacked on my way to school and after it, I began experiencing panic
attacks. My abuser offered to give me a pass so that if I started to struggle
in a class in school I could leave, but I had to go and sit with him. That’s
how he worked his way into my life. Into my trust. Into my respect and
appreciation. Because he was so helpful and supportive for a few weeks… But it
was also a hugely contributing fact to how he managed to get away with the
abuse because when he started calling me into his office, his colleagues
assumed it was because I was struggling and that he just wanted to offer his
support.
When he
went from being supportive to hurting me in ways I didn’t know existed, I felt
abandoned then. I felt letdown and betrayed because I had trusted him, and I’d
confided so many thoughts and feelings in him. It felt like a complete waste of
emotions, and I felt embarrassed too – embarrassed that I’d gotten him so
wrong. That I hadn’t seen this coming. As though I should have known better. As
though I should’ve been more cautious and had higher standards for who I
trusted in life. But my childhood was incredibly innocent and naïve and so I
didn’t know people like him even existed in the world, and my sex education was
limited to putting a condom on a banana, so I didn’t even know the name of what
was happening to me. Nor did I really know what I was supposed to do about it.
Not
long after the abuse started, so did the threats and the manipulation –
although I didn’t recognise any of it as being those things. He would regularly
tell me that I wouldn’t be believed if I spoke up and I believed this because I
saw how respected and admired, he was by his colleagues. And, in a desperate
attempt for someone to sit up and wonder why I was doing it, I kept being rude
and talking back to those people, so they had a hugely negative opinion of me.
And so of course, they would believe him. This recognition also then proved to
be a bit of a catalyst for me to end up realising that it wasn’t just his
colleagues who would do that. As soon as my Mum knew she would have to choose a
side. And yes, a small part of me worried she would choose his, but a larger
part of me was more concerned that it would be really horrible even just to put
her in a position where she would have to face that pressured and stressful
conundrum.
Finally,
in addition to those recognitions of not being supported by others due to his
threats and manipulation, just the pure fact that the abuse and one instance of
rape had happened, was a large reason for me to feel abandoned. Back then,
there was nothing in the media about rape or abuse and like I said, it was
never even talked about in sex education, so I felt completely and utterly
alone in experiencing it. I felt like I was the only person in the world to go
through this and that led to thoughts and questions around how deserving I was
and all the things I’d done wrong that had led to me being treated so
differently to others. It left me feeling not only abandoned, but also isolated
and that made me scared because how on earth could I get through all of this by
myself? How would I survive it? And so, in a bid to get through things by myself,
I avoided further feelings or notions or abandonment by minimising the number
of relationships in my life and – most importantly – minimised the number of
relationships which I regarded as special or key to my life, my happiness, and to
the general state of my mental health.
In
being hospitalised in 2012 and undergoing DBT, I thought I would talk about how
I overcame this symptom by sharing the modules, skills, and exercises I felt were
most helpful in both minimising these thoughts and feelings around abandonment
as well as providing me with better coping mechanisms for the parts of this
symptom which didn’t just vanish…
The
most helpful module of the four that make up DBT, was ‘Interpersonal Effectiveness’ because it largely focuses on
bettering your communication skills with others, setting boundaries, and being
assertive but with the ability to still resolve conflict.
The
first skill within this module which was helpful for my abandonment
difficulties, was Trust in Relationships which recommends three methods
of building trust within a relationship:
1.
Being
honest
2.
Being
understanding and respectful
3.
Being
consistent
I feel
that I used this skill in rebuilding my relationship with my wonderful Mum
because as supportive as she always was, I think there was a huge lack of trust
which likely, largely stemmed from the fact that I regularly lied to her in
order to be able to self-harm or runaway. I think that this is also an
illustration of the fact that I showed very little respect for her because if I
had, I’d have felt she wasn’t deserving of my deceit. With another symptom of
BPD being around having an unstable mood, this meant that all these components
e.g. the lack or respect and the issues around honesty, were never consistent. And
I think that perhaps if they had been, it would have made them more manageable
because there’d be an aspect of adjustment and familiarity.
In DBT,
a huge method of learning and of ensuring what you’ve learnt becomes something
you actually use in your life, there are a lot of worksheets (my DBT
Facilitator actually said that when you reach a point where you can’t fill in a
diary sheet of which skills you’ve used and when, that’s when DBT has worked
because it’s coming naturally to you)! Here’s a useful one for this skill: DBT-IE-7-Trust-in-Relationships-compressed.pdf
The
second skill from the Interpersonal Effectiveness module which helped with this
symptom was Resistance and Conflict which, again, provides three
tips for resolving or working your way through a disagreement:
1.
Validate
the other person
2.
Repeat
your own view
3.
Establish
specifics e.g. “what exactly did I do to upset you?”
Learning
to validate someone and seeing the reassurance and generally positive and
productive thoughts and feelings it instils in them, really contributed to me
discovering how incredibly beneficial validation is for my own mental health
too. And, in learning – through this skill – about repeating my view, I was
taught to use short sentences which are effective and straight to the point
because anything vague or which could cause additional questions and discussion
topics, could lead to a whole other conflict!
A
useful worksheet for this skill: DBT-IE-10-Resistance-and-Conflict-compressed.pdf
This
symptom can very realistically and reasonably be massively affected and similar
to the previous one around abandonment because thoughts and feelings of being
alone, can impact both the intensity and the stability of a relationship. So,
since I talked a little about my relationship with my Mum (who I would say I
also had an unstable and intense relationship with – but only throughout the
height of my mental illness), I thought I’d focus this part on the romantic
relationship which this symptom really affected.
On
January 17th, 2009, I met my ex and by February 1st we
were a couple, and he was giving me a lovely necklace at my party for my 18th
Birthday. It was definitely one of those corny, textbook relationships – which
you don’t believe actually exists unless you experience it – where a person
says they knew from the moment they met someone that they were going to fall in
love.
In
keeping with this symptom, one really good quality in our unstable relationship
which led to the idealisation thoughts and feelings, was that he was literally
there from Day One because I made my first suicide attempt when I started
experiencing auditory hallucinations just a few months after we first met. I
think that having met prior to my mental illness, was quite a good quality for
our relationship because it meant I had the knowledge that he loved the real me
and not any version (a symptom that actually comes up next!) of the person I only
became as a result of my mental illness. It was reassuring for when I would
struggle with my confidence levels and consider myself to be a bad person; to really
counteract and defy it, I could remember that he had fallen in love with me when
I was purely myself and he seemed to generally have a pretty good judge of
character so…
A
difficulty – and therefore devaluating quality – however, from the fact he’d
been there from so early on in my journey – well, from before it even began,
really(!) – was a level of guilt. Mostly because I developed the worries that
he had seen the good times, and I had robbed him of those. But there was also
the fact that because I had been struggling in silence for the two years
between the abuse and my first suicide attempt, I felt that I should have known
it would get to the point that it did. And so, I experienced some guilt with
the feeling that I should have warned him what he was getting himself into by
starting a relationship with me.
Another
quality to our relationship which really played a role in it being unstable
because it came to light every now and then, was that even through my mental
illness, we had some very lovely moments and memories together and that gave me
some sense of reliance. Like, I gave myself no credit for those good times, I
didn’t consider that they were happening because I was being strong and staying
safe, I deemed him to be responsible for the positives. As though they were
only happening because he was fighting back against my negativity. So, it meant
that I thought I needed him in order to have some sense of fun and happiness in
my life.
Now, I
thought I’d explain how I feel I’ve managed to overcome this illustration of
the symptom because I got through it in a different way to how I coped with my
unstable relationships with professionals.
So, for
this part, DBT actually helped again! Particularly the Modulating Intensity skill, again from the Interpersonal Effectiveness module. The skill is all about
the level of strength you use in in requesting something from someone else. Before
making a request, this skill recommends you consider two things:
1.
The
level of urgency for your need
2.
The
level of vulnerability for both the other person and your relationship with
them
As with
the previous skill, there’s a useful worksheet on the website which prompts you
to do some self-reflection on recent, relevant experiences in order to learn
from them: DBT-IE-9-Modulating-Intensity-compressed.pdf. From this DBT skill, I learnt
the power of equality because I felt that it really helped me to be less
selfish and instead, act with more consideration for others.
Then,
the other example of how this symptom manifested for me and my mental health,
and which was helped in a different way, was in my relationships with
professionals – particularly those within mental health services, but also
A&E staff and the Police. I think that relationships with those people were
incredibly up and down – sometimes on an hourly basis! – and a huge reason for
that was that I didn’t ever take responsibility for my actions and – more
importantly – for the consequences they were having on others. If I
self-harmed, I would say “I only did it because such-and-such said that!” or “I
only did it because you did that!” I never sat back and thought about the fact
that the wrongdoing of others was their responsibility, but my reaction to it
and I coped with it, was on me.
I think
a reason why this was sometimes hard was because I didn’t want to think of it
as that I was responsible for choosing to cope in the ways I did. I
didn’t like the thought that I could have other options and yet I was opting to
self-harm or to do something unsafe or unhealthy. I believed that if I honestly
felt there was an alternative coping mechanism/method, then I would have used
it. And this was actually a thought or belief which really affected my
cooperation and engagement with DBT when I first started undergoing it. I was
reluctant to learn of all these alternatives that I felt I should have thought
of myself. I also didn’t want to discover that there was actually something
simple and far less dangerous that would’ve been helpful for me this entire
time.
The way
in which failing to take accept responsibility influenced or caused unstable
relationships with professionals was mostly through the blame-game. It made me
furious (another upcoming symptom!) to think that I would self-harm and then
have a ton of consequences for it e.g. having to have big talks with people,
being repeatedly asked why I hadn’t tried to get help before doing it, and then
obviously also any physical consequences e.g. stitches and surgery etc, and the
whole time, I felt it was someone else’s fault why I’d done it. So, it felt
unfair that I was dealing with the difficult side of the aftermath. It led me
to hold a lot of resentment towards people and that built a lot of mistrust and
lack of willing to engage or cooperate with services or the advice and
treatment they were providing.
I think
that the most helpful quality to me overcoming this element of the symptom, was
purely time and the consistency of numerous people pointing this failure of
mine out to me. In addition though, DBT was also helpful; particularly the Cost Benefit Analysis from the Distress Tolerance module. In this skill, you’re
taught to really give proper, thoughtful consideration to both the benefits and
cost of doing a behaviour and the cost and benefits of doing an alternative
behaviour. There’s actually a worksheet to do that, here.
The
largest challenge in overcoming my part in ignoring responsibility, was
actually being faced with professionals not always taking responsibility for
their mistakes or failures either. Often, I would think; ‘why am I going out of
my way to do better?’ and ‘how do they get to lecture me about it?!’ I’d say
that ‘hypocrites’ was my most-used word for some time! Eventually, though, I’ve
come to recognise that the very least I can do is look after myself and try
hard to regulate and manage my own attitude and behaviours. I can’t control
those of anyone else! Their failures reflect on them and not me.
I think
that one of the two most fundamental influences on this symptom for me was my
change in mood (another symptom which will come up soon in this post!) because
the changes would feel so dramatic and overwhelming that I felt like I had to
become a different person to accompany how I felt. Like, when I would get
really angry (another symptom!), I felt like it was beyond anything ‘Aimee’
could hold or beyond anything she could ever show. If I was in a really
terrible mood and having equally terrible thoughts and feelings, it was almost
as though I didn’t want to admit that was ‘me’ who was experiencing those
things. And, in a bid to differentiate myself from someone who would have these
things go on in their life, I just became a different person and tried to sort
of, de-personalise things. It was like I was someone when I was angry. Someone
else when I was suicidal. And only really ‘me’ when I was happy and energetic!
The
other fundamental influence on this symptom – the one which a huge amount of
people would probably be surprised that it wasn’t mentioned first(!) – was the
rape and abuse. I think the largest impact the trauma had on my identity was that
I felt like I had to make a conscious effort to separate myself from who I was
before it and who I was after it. For the first couple of years after the
abuse, a lot of my memories of the instances actually came to me as though I
was up in a corner of the ceiling in the room, and I was just watching all
these horrible things happening to a poor girl who I felt I couldn’t help.
Over
the years, I’ve had to tell this to multiple professionals, who have varied
from Police to Psychiatrists to A&E Nurses, and despite their differences
in qualifications, knowledge, and roles, literally all of them have concluded
that the fact my memories are from that perspective is actually a survival
tactic. That my mind has done that and turned my view into being at that safe
and protected distance, as a means of coping with the memories and the simple
fact that it most definitely was me that it happened to. It’s like that fight
or flight concept (which you can read about here if you don’t know what I mean)
and my mind chose to fly – to the ceiling, so not exactly far, but somewhat of
a distance nonetheless!
I think
that detaching in that way and escaping from the entire thing, really stayed
with my head as a good method of coping with a difficult or challenging
situation. As though it had ‘worked’ fabulously! When, actually, I did have
moments where I wish I’d just been able to face some of the abusive situations
because I always wondered whether, had I done so, maybe I would have
successfully fought him off on more occasions. If I’d been present in my mind
and in my body, maybe I would have defended it more? And had I done that,
perhaps my mental health wouldn’t have gone to pot, and it wouldn’t have almost
instinctively gone to a coping method that has ‘desperation’ stamped all over
it. Because I had the abuse memories already up there, I think it reduced my levels
of tolerance and therefore any – even slightly – difficult moment to come up
through my mental illness, seemed to automatically warrant the flight response.
Using
this coping method more and more, meant that – because it can take considerable
time to come out of it – my body was in it for longer and longer periods of
time, and eventually, my mind was mostly ‘away’ from my body even when very
rare, but good, positive, happy things were happening. So, I found myself
missing out on those too and that massively contributed to any sort of suicidal
thoughts and feelings – like, what was the point of being ‘here,’ if I wasn’t
experiencing any of it? If I wasn’t feeling the highs and lows of life’s
rollercoaster and getting to smile and cry within a few hours of each other. It
meant that I was starting to recognise that varied moments of happiness were actually
a thing for most people in life, and that facing them, can be what makes you
stronger and more robust and versatile. But, seemingly, regardless of that
hugely important recognition, my mind kept escaping; and that led to my
thoughts that I literally had no control over my life anymore and so, why
should I sit there and have to live it?!
My
natural escapism didn’t only have a bad impact on my suicidal thoughts and my
passion for life, but also upon some of the most important relationships in my
life e.g. my Mum and my partner at that time – but mostly my Mum. There was one
time when she asked me, if I had planned in my head to self-harm or to make a
suicide attempt, and she collapsed on my way out the door, what would I do? I
don’t even remember her asking me this, and I certainly don’t remember that
apparently my answer was “I’d ring 999, then I’d keep going.” And I feel that
this is the perfect example of how deep I was in it all. How far out I was from
shore. I was unreachable. By anyone.
A more
general way I have overcome this symptom, has been through just learning – or
gaining the ability – to recognise my safety levels. It’s like developing a
proper sense of evaluation and analysis skills which can help me to ascertain
what skills I need to be calling upon to get through that situation. Being able
to look around and think of everything that’s happening in a situation and
consider; “do these things mean I’m safe, or unsafe?” If I’m safe, then that’s
good; let’s enjoy things and continue. There is actually a DBT skill from the Emotion Regulation module which, I think, has
helped me to develop the motivation to do this evaluation of my situation, Emotions and Physical
Vulnerability. Just
because it teaches you the connection between the emotions that can affect your
physical vulnerability.
If I
think I’m unsafe in my little self-evaluation of the situation, then the
following DBT skill has helped me to avoid ‘flying…’: Recognising Emotional Crisis which is from the Distress Tolerance module, but you actually needed
a lot of the various skills from the Mindfulness module to really be able to do
it efficiently and effectively. I think that this skill really emulates the
importance of trying to recognise or label a situation as difficult or
challenging as early as possible because, DBT recognises that in doing so, you
are giving yourself ample preparation time to consider ways you’ll cope and the
resources of help and support you could utilise. In putting this skill into
practice, you can complete their worksheet (which you can download the PDF here) where you list various
qualities of an emotional crisis for you e.g. key triggers, thoughts you have
during them, any sensations you experience when you’re in one… This is so that
you can better recognise and prepare for an emotional crisis in the future.
Learning
these skills and managing to avoid the flight response happening whenever it
pleases, has meant that I have a more solid and comfortable sense of identity.
But actually, losing this BPD diagnosis triggered thoughts around that… I found
it difficult to admit but I also recognised the benefits to talk about it… I
named my blog I’m NOT Disordered because I wanted it to be a message that a
person with a mental health diagnosis or Disorder – that isn’t all that they
are. They’re still a person. With a story. They aren’t a case number or a
statistic to be put in a box and discussed through a study!
Yet,
one of my first thoughts on losing the BPD diagnosis was “who am I now?” And
the irony of the entire thing is that BPD had obviously become somewhat of my
identity and the way I think it did? Through my blog! Because my blog is
massively about me having BPD. And my blog is an enormous part of my life – not
just my personal life, but my professional life now too! I’ve literally made a
career of this! A life. I mean, I would more than happily take ‘Blogger’ to be
a defining quality of mine! But would I even have my blog if I hadn’t had BPD? And,
in all honesty, finding myself questioning things in those ways, left me
wondering whether maybe this was still a symptom I struggled with… But I
reasoned that these considerations are normal as I have had both my blog and my
diagnosis in my life for over one decade! So of course, there’s going to be a
level of questioning and a stage of adjustment to a life without one of them! I
also recognised that in asking myself these questions, I’m not unsafe, or struggling
in any way. I feel secure in the thought that I don’t have BPD anymore and so I
use that as motivation to just work on adapting to life without the official
label. Life where I have the agreement of professionals.
We’re
halfway through! So, let’s push on to this one around impulsivity, now, the two
areas which made this symptom applicable to me, were spending and eating –
though more restricting my eating and bingeing.
The
eating element came before the spending, so it makes sense to start there. It
actually started during the abuse in 2006, and I originally had a very innocent
excuse for not eating; in the mornings, I couldn’t eat breakfast because I’d
feel sick at the thought of what might happen to me that day. At lunch, if
something had happened in the morning then I would still feel sick from it, and
if it hadn’t happened yet, then I’d still feel sick at the thought of it
occurring. Then, teatime, I’d be feeling sick at the thought of going through
the entire thing all over again the next day. After around two or three months
of the abuse and the one horrific instance of rape, I developed the wonder
whether losing weight would contribute to my body being displeasing and
unattractive to a point where my abuser would actually lose a reason to keep
hurting me. As though that’s why he was doing it! As though it had anything to
do with appearance! And the fact that it didn’t, meant that losing weight – to the
point of being bullied and called a ‘bag of bones’ – did nothing to stop him or
even dissuade him in the remotest of ways.
After the
abuse, the stress of all the memories and how much I was struggling to cope with
them, meant that my appetite didn’t get much better and my weight continued to fall.
After the first suicide attempt, I ended up being referred for an assessment with
an eating disorder charity/service and the conclusion was that despite my BMI etc
meeting the criteria for a diagnosis of Anorexia, I was still having periods,
and they have to be no longer present to get that diagnosis. Whilst it’s obviously
good to have not been given the diagnosis, I do wonder whether if I had been, I
might have gotten the specialist support and help that could have sped up my
recovery from it.
The
other way this symptom manifested for me, was in spending and impulse buying. Now,
this bit will be a little shorter because I obviously don’t want to go into too
much detail about my past or current financial situation – especially considering
the size of I’m NOT Disordered’s audience!
Some
people have always been fairly bad with money, but when I was younger, my Mum
said that if my Nana had taken me shopping, she would always tell Mum that she
was impressed with the bargains I’d found and how much I’d got for my money.
So, a year or so after my first suicide attempt, when I started struggling with
impulsive spending, it was hugely obvious that my ill mental health was the
cause of it. A specific reason why I lost a lot of control and regulation over
my money, was actually massively linked to another symptom (chronic feelings of
emptiness) I’ll be discussing soon. I felt that my head was so full of the
memories of the abuse and the rape, but that my heart was empty – not that I
felt unloved or was still experiencing any sort of abuse or poor treatment… It was
more about the bit I discussed in the previous symptoms (identity disturbance
and unstable relationships) around my difficulty in really showing good,
compassionate emotions towards a loved one, such as my Mum.
And so,
I felt somewhat desperate to have something in my life which inspired or
influenced good feelings and emotions within me – something which I really
cared about. I didn’t realise or consider at that time though, that if I could
have very little feelings towards my own Mum, why on earth would a
materialistic item gain any? Why would it change anything? But, when your
mental health is poor and when you’re desperate to experience something, you don’t
always think reasonably or sensibly. In fact, you don’t always even think! And
that obviously brings the impulsive side to this symptom into play; the fact
that I wasn’t thinking things through. I was spending zero time trying to
process or analyse anything and I also wasn’t talking to others who perhaps
could have helped me to put more consideration in prior to taking an action.
So, a
helpful DBT skill for this symptom was Balancing
Emotional Urges from the Emotional
Regulation module because it really focuses on the fact that sometimes your
emotions can ‘naturally pair with certain behaviours.’ The worksheet for this
skill (which you can download here)
instructs you to consider a situation, think of the emotions is causes, and look
at the effectiveness of negatively acting upon that emotion. You then have to make
the effort to act in an opposite way to your emotional urge. The skill advises
that you utilise this opposite behaviour until the emotion ‘changes its quality
or gets diminished’ and it also talks about being persistent in repeating this
opposite action over and over for you to recognise that it is justified and ‘suitable.’
I think
it would be fair to say that for a lay man hearing of a ‘Personality Disorder’
for the first time, a symptom they will likely assume to be part of that
diagnosis, would be something around a person’s mood. And I’d say this is probably
because often, a person’s mood can be seen as a quality to them fundamentally
as a person – to their personality. Like, if there’s someone in your life who’s
just always happy, positive, and productive; that could be one of the first
things you say about them when talking about, mentioning them, or introducing them
to someone else. Like it’s a defining characteristic. And so, of course it’s a
symptom of BPD.
For me,
it was probably one of the most influential upon my safety levels because
sometimes, if there was something wrong in a relationship or something around abandonment
came up, I wasn’t necessarily sad or upset. And so, if I wasn’t, then those
things wouldn’t inspire or cause thoughts and feelings around suicide or
self-harm. Those things were completely reliant upon my mood – which didn’t
seem to be reliant upon anything! That’s how unstable it was. Like, often with
different elements in mental health – and physical health actually! – a professional
will recommend you keeping some sort of diary or a record of a symptom so as to
see if there’s any pattern in it which could help you to be better-prepared and
therefore more able to cope. There was no pattern or routine to my mood fluctuations.
I did
also initially think that there were no warning signs for a big change in my
mood, and I felt that way because I didn’t think I could pinpoint an exact,
influential element to it. And so, if I didn’t know what caused it to change,
how could I possibly foresee it changing?! But, through time and DBT, I learnt that
there was a difference between pinpointing a trigger for a change in mood and
being able to determine signs that it’s going to change. For me, my mood-changing
warning signs were typically around changes in behaviours, with the largest
being if I started to withdraw from people and social situations. Like, if I
noticed that I was beginning to isolate myself and really create distance between
me and those who were supposed to be my support system e.g. my Mum, my friends,
and the staff who I saw most often from the Community Mental Health Team (CMHT).
This typically meant my mood was going downhill.
On the flipside
though, a confusing aspect for me was that if I began making plans to self-harm
or those that I put together for the suicide attempts I’ve made, my mood would
actually pick up and I’d have a lot of energy and be really talkative. I think
that this was partly to do with me having the knowledge that things were going
to be over soon, but that they were also because I didn’t want anyone picking
up on what I was going to do. I didn’t want people to realise because if they
did, there was the chance they would step in or do something to prevent it from
happening/working.
Living
with me through those years though, my Mum was actually the one person who
fully wised up to this warning sign and often, she would say “I knew something
was going to happen because…” When she would say that, before I had learnt the
warning sign, it was actually really frustrating because I hated that she could
spot it before I could. That she had more awareness and – arguably – a better
understanding about me and my mental health than I did myself! This left me
feeling powerless and useless; like how much was wrong with me if I couldn’t even
get a handle on my own mood?! A huge frustration came when more people developed
the same insight and observations as my Mum. And it was a bit more of a difficult
one because it wasn’t too positive or even really fair… It was that they
managed to see through my ‘act’ when I was planning to hurt myself, but no one
had managed to see through my abuser/rapist’s act when he was hurting me. This thought
led me to experience huge issues and difficulty around an upcoming symptom regarding
inappropriate and intense anger/difficulty controlling anger.
One of
the first, most useful resources in overcoming this symptom, was my medication and
the drugs out there that are known as ‘mood-stabilisers’ (Mind actually has a
really useful page about these, which you can take a look at if you’d like to
understand this more: What
are mood stabilisers? - Mind). This type of medication is typically administered
to someone with bi-polar, but they can be utilised for people with other
disorders that affect the stability of their mood.
The
useful DBT skill which also helped me with this symptom were very obviously
most of those from the Emotion
Regulation module, but particularly:
1.
Being
Effective: Which is purely about getting things done to ensure your needs
are met because DBT recognises that when this happens, you experience positive
emotions.
2.
Self-Validation:
Which is a focus on accepting the emotions you’re experiencing with the hope
that you will better cope with an overwhelming emotional process.
So
this, I feel, is one of the symptoms that has actually come up quite a lot through
talking about the previous ones and I think that’s because it’s a pretty
fundamental feeling or notion that can really, truly be the groundwork for all
the other bits developing and starting to begin their destruction on your
mental health and, ultimately, your life.
My
first recognition of feeling empty, came – probably at the most predictable and
understandable point – it was after the very first instance of abuse when I was
15 and had spent almost one month – though the feelings of betrayal from the
start of the abuse, made it seem like I’d confided in him and relied on him for
forever – really trusting someone who, absolutely everyone I knew genuinely trusted,
seriously admired, and fully respected. And I think that, in this instance at
least, the ‘emptiness’ was actually more about the fact there’d been some sort
of act of loss to have had something emptied. And my loss had been that trust,
confidence, respect, appreciation… All those positive, productive, and helpful
thoughts and feelings I’d had toward my abuser – all the things he’d been – all
the qualities he’d had until he absolutely didn’t anymore. Until he lost them.
Until I lost having someone in my life who held these qualities. Who had honestly
seemed utterly committed to playing this very important and integral role in my
life.
I
guess this meant that the first real thought of emptiness was in the form of a
shape. The shape from a person who had been a massively positive figure in my
life. Who was playing a massively helpful role in my life. So, I felt this
constant sense of their being a real hole in my life – a vacant area which I experienced
immediate desperate thoughts to fill it in some other way and to gain some sort
of a replacement. Then the abuse continued… For six months. And every instant
that went by, I felt another piece of me disappear too. It was almost like my body
had the attitude: ‘if he’s ‘gone’, why am I still hanging around?’ And I felt that
the abuse was just sapping all the strength out of me to be able to hold onto
all these pieces that were either melting away or running for the hills – as
though some bits could see all the way to the future of my life and literally
just wanted to play no role in it and hit the escape button!
Obviously,
the fact this symptom is detailed as being ‘chronic’ means that even when the
abuse ‘ended’ (in a physical sense) those feelings of emptiness continued to
stay with me, and to have a huge influence on many of aspects of my life… Mainly,
though, I’d say, that the largest influence it had was upon my mood (something which
I think is quite understandable and perhaps even an obvious element to be
affected).
The
most common emotions I’d say I experienced as a result of the feelings of
emptiness, were those which played a huge role in me being suicidal and making the
attempts that I have to end my life. I think a reason for this is because the
emptiness I was experiencing, left me utterly desperate. Desperate for filling.
And when – after a short time – I learnt that nothing could really fill this
void, I grew desperate for relief. Relief from the emptiness. Relief from the
feeling that I would never be whole again. I would never be the same. I had
changed and I hadn’t even had the opportunity to make the decision to change. I
hadn’t wanted to!
The
first most helpful DBT skill for this symptom came from the Emotion Regulation
module and it was the Emotions
and Cognitive Vulnerability skill. In this skill, you’re taught about three
cognitive distortions:
1. All-or-Nothing Thinking – which is
when you think about an event in a biased way.
2. Maximisation or Minimisation –
which is blowing a negative aspect of a situation out of proportion.
3. Overgeneralisation – which is the
assumption that when something bad has happened once, it will keep happening.
I
think that at one time or another, all three distortions became applicable to
my chronic feelings of emptiness and so the exercise for this skill was
helpful. It meant writing down your distorted thought, recognising which
distortion was applied to it, and creating an objective response instead –
there’s actually a PDF worksheet to guide you with this exercise, you can
download it here.
The
second helpful DBT skill was from the Distress
Tolerance module, and it was the Radical
Acceptance skill which really promotes the idea of fully acknowledging and
embracing the present moment – including any difficult bits – and not trying to
change or control it. There’s two exercises to this skill; the first is a
couple of steps to help you to accept an event, and the second is to help you to
create Coping Statements, you can download the PDF for both of these, here.
Another,
more general way that I overcame this symptom has been with the help of all of
you; I’m NOT Disordered’s incredible audience! For what felt like the longest
time (though it was probably around three or four years) I wholeheartedly
believed that my purpose in life was to commit suicide at a young age, and in a
way which would highlight the colossal, life-threatening failings that mental
health services are making every single day – and, very obviously, not just in
my care! I don’t think I really recognised the debilitating impact this lack of
positive purpose was having on my mental health and my life generally, until it
was being challenged by a Psychologist in a psychiatric hospital!
That
instance of challenge, was actually whilst I was in the psychiatric hospital
where I created I’m NOT Disordered, so I ended up blogging about it (here).
Whilst we eventually agreed on the belief that destiny isn’t set in stone, it
was a belief I still occasionally struggled with until I found an actual, easy,
straight, replacement for the purpose! And that came from my blogging career!
From developing the recognition that I’m NOT Disordered wasn’t just helping me
and my mental health, but also that of its readers and learning that, actually also
ended up benefiting me too! So, I found myself really nurturing this new
confidence that I’d been put on this Earth and given the journey I had up until
that point; in order to blog and to be granted all the incredible opportunities
I have from my blogging career. It’s a reassuring notion that comforts me with
the thought that all the hardships have been completely worthwhile because they
led me to be able to create the content I do. The helpful content!
And being filled with this really positive and productive belief, actually really
helped to counteract some of the emptiness.
This
feels like the easiest – and will therefore likely/hopefully(!) be one of the
quickest – symptoms to talk about because it was so strong, overpowering, and
life-changing! It was something I was so caught up in and surrounded by for
years and years, and I feel that if it was difficult to put into words, it might
actually take away from the fact that it truly became a part of me. I mean, something
that familiar, shouldn’t be too hard to write about, should it?
Growing
up, since my childhood was so innocent and naïve, there was no real need or
necessity for any anger or even frustration. So, I don’t think I even really
experienced the feeling – and the thoughts that came with it – until the abuse started
when I was 15! It honestly felt like the abuse and the anger literally came
hand-in-hand! As though you couldn’t have one without the other. Like, I wouldn’t
have been at all angry if that hadn’t been happening to me. But also, as though
that wouldn’t be happening if I hadn’t been so angry! It was like a ‘fuel to
the fire,’ kind of scenario, I guess in trying to determine what one would be
without the other. What was my anger if I wasn’t being abused? But what would
the abuse leave behind, if not the anger?
Now,
the thing here is that becoming angry at your rapist/abuser, wouldn’t – in my
opinion, at least – be considered ‘inappropriate’ at all. If anything, I think
it should be regarded as actually being very predictable and completely understandable.
But I think that it was most certainly intense and difficult to control. I
mean, over the years, I found that the most effective and powerful example I
could give in terms of just how important and dangerous my intense anger was,
was through self-harm – and so it gets a little graphic here (trigger warning!).
So, if I were to self-harm with no thoughts in my head, I would maybe draw blood.
If I self-harmed with the anger at the forefront of my mind and putting a ton
of focus on its intensity and severity, though, then I needed plastic surgery. Like,
literally. That’s how ‘day-and-night’ it – both the anger, and the self-harm – could
be.
I think
that the fact that I didn’t speak about my anger for years and years, was what
actually led to it becoming inappropriate because it meant it sort of… Hung around
on my shoulders. Over my head. Like a veil. Shielding my gaze and getting in
the middle of my vision and other people because it always really clouded my judgment.
It was like the opposite to rose-tinted sunglasses which is a saying that’s used
for when a person has some sort of ideal, positive belief, and they just really
end up ignoring or dismissing any signs that contradict the belief in some way.
But, with my anger, it was obviously a much more negative, pre-judged notion
that really got in the way of me having any kind of peaceful, happy, and
productive life. It just seemed to permeate everything. Like smoke, it just
clung to everything in my life – even the new things/new people! It was like I just
couldn’t break free of it.
As
destabilising and unsafe as my anger was the majority of the time, I have come
to actually really consider it to have been lifesaving too. I think that the fury
and the hatred I held toward my abuser, sometimes provided me with a level of
motivation or some sort of energy to keep going. It was almost as though I couldn’t
ever be 100% suicidal or empty if I had all this anger inside of me just
waiting to explode. And I think that having some sort of a positive or
productive mindset or thought process around it, was a huge sticking-factor in
so far as to why it took so long for me to finally realise that it was
actually, slowly eating me alive. And eventually, gaining the insight that it
took to be able to recognise this, was actually massively supported and
promoted by the DBT skill Willingness
Vs Wilfulness from the Distress Tolerance
module.
This skill
labels ‘willingness’ to be about being ‘engaged in the present moment’ and being
‘open’ to new experiences and different perspectives. Whereas ‘wilfulness’ is deemed
as a ‘resistance to change’ and it is stated that this can ‘stem from’ someone’s
fear of change or their need to stay in or maintain control. In relevance to my
anger symptom, I was completely wilful of seeing anyone else’s thoughts or
opinions on it. I mean, I was especially reluctant to take on any feedback,
advice, or tips around it because I felt quite defensive and protective of it. I
felt like it was my anger, I was entitled to it and entitled to be in complete
control of it. It wasn’t up for public opinion or discussion.
Overcoming
this almost natural act of self-defence, meant I was finally able to see my
anger as the toxic force it had become and also gained insight into just how devastating
it was on the verge of becoming if I hadn’t begun confronting it and challenging
it then and there.
We made
it! The final symptom I’ve overcome!
The way
this symptom manifested for me, was mostly in relation to the ‘severe
dissociative’ part of it and that was formed as a result of the parts in the ‘identity
disturbance’ symptom I spoke about earlier and how I remembered the abuse as
being on the ceiling of the room and watching it happening to someone I couldn’t
help or defend. With my head doing that, and my body thinking that was a successful
coping skill because – ultimately – I survived the abuse, it meant that my mind
continued to really disassociate and distance itself in other, difficult
situations or in instances when I was experiencing really challenging or
upsetting thoughts and emotions.
I think
that a huge reason why my brain distanced during the abuse was because I had
started to become suicidal… I remember being hurt in his first-floor office and
feeling absolutely filled and consumed – so that it felt like this was the only
thing in my head/entire body! – with the question: “what would happen if I just
jumped from his window?” And I think that the fact I debated this, led me to
recognise that there was no escape route. No way out of the abuse. No alternate
path. Literally the only way out was through it! Or, through the glass window…
And if I recognised that death was my only real escape option from a situation,
why would my mind let itself go through the situation time and time again? Why
would it let me experience all of that? Why wouldn’t it protect me and help me
distance myself in a way that didn’t include death. It was like, the next best
thing… And it’s like this thing that people always say about how the human body
does whatever it can to survive. Like survival is a fundamental, natural instinct
for the human body. It’s all that it wants to do. So, it can really get super creative
in order to do it!
The
most helpful DBT skill for this final symptom was Grounding
from the Distress
Tolerance module, because it teaches you techniques (and there’s a PDF to
help with it, you can download it here)
that are goaled at shifting your focus from an upsetting thought, emotion, or
event. Using this skill, helped me to stay present and in the moment because I
learnt that doing so, was the only way I was going to recover. If I kept
avoiding reality and distancing myself from hardships, it was just going to
prevent or – at the very least – delay my recovery because I wouldn’t be confronting
the problems and tackling my difficult experiences head-on! In using this skill
however, it was really important to ensure that the reality I was grounding
myself back to, was safe and that there was help and support was readily available
to me, in case I should struggle being in the present.
So,
with that in mind, the greatest resources for someone with a Personality
Disorder?
And,
the greatest resource to help someone you know who has a Personality Disorder?
Helping
someone diagnosed with personality disorder - Mind