When I first started writing for International Bipolar Foundation, it was a coming out of sorts about my mental illness. I was open about it with the people in my life, on social media and on my own blog, but it wasn’t until I started writing for IBPF that, if you Google searched my name, you would find information about my bipolar disorder. Potential employers who did would see the articles I had written and know about my mental illness. They might choose not to hire me because of it. I decided I wanted to write anyway because I enjoy it, because it makes me feel emotionally brave (something I place a high value on and really strive to be) and because I want to help fight the stigma. I love the community here and reading the comments people leave on my articles. This article is kind of my second coming out. I want to tell you about being diagnosed with borderline personality disorder in addition to bipolar disorder.
It’s not uncommon to have both. They are frequently comorbid disorders. But, as much stigma as there is attached to having bipolar, there is even more stigma attached to having borderline. Some doctors and therapists won’t work with people who have borderline because even they buy into all of the stigma. I was diagnosed with bipolar in January of 2014. I took the diagnosis well. I was relieved there was a name for what I had been suffering through on my own for years, medication to treat it and communities of people who understood. I melded it into my identity. I read, watched and listened to everything I could find about bipolar disorder. I almost turned learning about my new diagnosis into a hobby of sorts.
I did not take the borderline diagnosis nearly as well. This is how it happened:
I arrived at my therapist’s office with some things I wanted to talk with her about. She asked me if I had ever heard of borderline personality disorder and pulled out a mini-copy of the DSM. I had heard of it. I thought it was a terrible, condemning thing to be diagnosed with. I had bought into the stigma, too, in my ignorance. We never got to talk about the things I had come to talk about. She told me that she and my psychiatrist (they’re married and work in the same office) thought I had borderline personality disorder in addition to the bipolar disorder. She ran through a list of things I had told her — experiences and emotions I’d had, things I had done — that she said led her to believe I had this disorder.
I did not take it well. If I could do it over again, I would be a lot more chill about it, but I left her office feeling defensive, ambushed and confused. It was a Friday and I called both her and my psychiatrist on their after hours phone lines several times over the weekend, trying to figure out how to cope with this new information about myself. They didn’t call me back and I felt even more abandoned, something that, if you know anything about borderline, is a quintessential trigger for people with the disorder. I cried a lot. I felt so angry with my therapist for putting me in this situation (I know) that I spent almost all of Monday calling around, looking for a new therapist. I thought maybe I had “bipolar with some borderline tendencies,” that was the most I would admit. I was in denial.
I do not fit the criteria for borderline perfectly and it’s difficult to parse apart what’s borderline, what’s bipolar and what’s just my semi-neurotic self. Some professionals don’t even believe borderline is a real disorder and believe it’s more of a catch-all diagnosis for patients who don’t respond correctly to treatment or who have a few characteristics in common. If you do not know the DSM criteria for borderline, here are the main descriptions:
- “Frantic efforts to avoid real or imagined abandonment.
- Unstable personal relationships that alternate between idealization and devaluation.
- Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.
- Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving.
- Suicidal and self-harming behavior.
- Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
- Chronic feelings of boredom or emptiness. Inappropriate, intense or uncontrollable anger—often followed by shame and guilt.
- Dissociative feelings and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.
Borderline personality disorder is ultimately characterized by the emotional turmoil it causes. People who have it feel emotions intensely and for long periods of time, and it is harder for them to return to a stable baseline after an emotionally intense event. Suicide threats and attempts are very common for people with BPD. Self-harming acts, such as cutting and burning, are also common.”
I am very afraid of abandonment and have done things I am ashamed of in the past in an effort to avoid it. I have attempted suicide once, and it was an impulsive decision. I definitely have periods of depression that are intense but too short to be considered bipolar episodes. I am frequently and easily bored, and I often feel empty and like my life is meaningless. I get slightly paranoid when I am under severe stress.
So that’s how the borderline criteria fit in with me. As you can see, I fit some of the criteria quite well but others don’t apply to me at all. As you can also see, a lot of the criteria could be mistaken for, or overlap with, bipolar symptoms. It wasn’t until my psychiatrist and I finally (and good lord, do I mean finally) found the right medication to treat my bipolar that the borderline became visible. My mood was so all over the place and my life such a mess before my bipolar got under control that the borderline was completely invisible in the chaos. However, even though it’s been a long time since I have had a bipolar episode (manic or depressive, and lasting long enough to be considered a true bipolar episode), I still get these short half-a-day to two-day or so depressions that aren’t really helped by anything, and that’s borderline for you.
After the horrible weekend following my diagnosis, I went the same way I did with the bipolar diagnosis and made learning about borderline my new way to fight it. There was just something that felt so much more personal and insulting about the new diagnosis. With bipolar I had a disorder of my moods, but with borderline my very personality was the disorder. It was a hard pill for me to swallow.
I didn’t even feel like I had a right to go to bipolar support groups or write for IBPF anymore, like I couldn’t talk about bipolar because things had become murkier and more complicated now that I had a second diagnosis. But I had to remember that it’s not uncommon to have both, it doesn’t make my bipolar any less real and that, as traumatizing as getting the diagnosis was at the time, I’ve always had borderline, the only difference is that now I know about it.
There is, as I mentioned above, a lot of controversy about borderline in the medical community, both about the diagnosis itself and about whether it is helpful or harmful to even give the patient the diagnosis. For me, I am glad I know because now I can make sense of my miniature depressive episodes without thinking my bipolar medications just aren’t working. Borderline can be helped by some medications but it can’t be entirely treated by them in the same way bipolar can. Therapy is really the only treatment for borderline (though, if your doctor thinks you should take pills in addition to doing therapy, by all means please give them a fair shot.) There is a special kind of therapy that was designed for borderline patients called DBT (Dialectical Behavioral Therapy) that works wonders for some people but did not work for me.
I don’t really know how to conclude this piece other than to tell you that, even with bipolar and borderline disorders, my life is mostly moving forward and mostly going well; so if you are feeling hopeless or trapped, there is hope. If there is anything I didn’t cover about bipolar and borderline in this piece, and you’d be interested in hearing more, leave me a comment on this article and I’ll write a follow up piece answering people’s questions.
Read the rest of Kait’s posts here.