Thanks so much to everyone who asked me a question on Twitter last Sunday and Monday. I really enjoyed it and loved hearing your questions, as well as some of your experiences.
Here are some of the questions I was asked and some slightly fuller responses! I hope to do another question session soon, so please give me a shout if you have any questions for me!
[Text reads 'my responses to your questions'. The background shows greenery and yellow pansies.]
What was the process of getting a diagnosis of BPD and how long did it take?
It took a several years. Before I had a diagnosis of borderline personality disorder, I had a diagnosis of depression, an eating disorder (anorexia type) and generalised anxiety disorder. Depression didn't feel right for me, at least for more than a year.
It's true that I was depressed for a year, completely depressed. But in a wider sense than that, the diagnosis of depression didn't sit right with me. I felt something else was going on and for many years I thought I had bipolar actually. I've written more about my route to a diagnosis in this blog post.
Do you suffer from periods of paranoia (thinking people hate you, are talking about you etc)?
Yes- a lot. I find it very distressing actually and it causes big problems for me. I have experienced paranoia so strongly that it has led me to feel very anxious and behave in irrational ways around my friends. It links a lot to my fear of abandonment I think. I often think people don't like me or have planned to deliberately exclude me.
If friends are all busy, for example, I might falsely conclude that they are all together and have planned with one another to avoid me joining them. When I'm really stressed, I think people are talking about me even when they aren't.
What can mental health professionals do to help?
Wow what a fantastic question! First of all, I think mental health professionals need to be educated about the fact that many people with BPD have gone through trauma and difficult life experiences. Just because it's called personality disorder, it doesn't mean the distress is a result of a 'personality flaw'. Professionals are in a position of power and they have a responsibility to avoid re-traumatising their patients.
The main way professionals can help is by having a non-judgemental stance and by being validating. There are times when mental health professionals have told me to 'just be happy' because 'life is good'. It's so invalidating. These kinds of responses still very much exist within professionals, sadly. Professionals need to reflect on stereotypes also and ask themselves if they subscribe to stereotypical views of patients and if so, why. Is it that the patient is manipulative, or are they desperate for help after a lifetime of being dismissed? Is it that someone is being attention seeking, or is it that they are understandably craving comfort because they are in crisis?
I think there needs to be a higher level of specialisation from mental health professionals in caring for people with personality disorder. Lots of professionals feel out of their depth when looking after individuals with personality disorder. I can appreciate that it is at times frightening to be faced with a patient who is suicidal or self-harming. However, mental health professionals need to be trained in how to manage this, rather than projecting that back onto the patient in the form of anger or helplessness.
Systems need to be in place for mental health professionals to be supported, learn and keep emotionally healthy themselves. I think there is a huge need for a greater availability of specialist services for people with complex trauma and personality disorder. My therapist at the moment is part of a specialist team caring for people with personality disorder and as a result she has colleagues who all work together in a system to make sure each member of the team can work effectively.
Are there any great books about BPD you can recommend?
There are so many awful, stigmatising books about BPD. I've learnt to be very careful what I read and where I get my information after being hurt in the past by some very derogatory 'information' books. I recommend Mindfulness for Borderline Personality Disorder by Blaise Aguirre and Gillian Galen (New Harbinger, 2013). I also love the DBT Skills Training Handouts and Worksheets by Marsha Linehan (Guilford Press, 2nd Edition, 2014).
My review video for Mindfulness for Borderline Personality Disorder by Blaise Aguirre and Gillian Galen (New Harbinger, 2013)
Did you find it hard to apply for jobs because not being hired seemed like a rejection?
My BPD hasn't ever stopped me from applying to jobs, even though it has affected me at work. My BPD affects my relationships and how I feel about myself more than my work to be honest. In fact, I have tended to thrive in my studies and work environments for some reason.
I can completely see why someone with BPD would find applying to jobs hard though. I can see how not being employed could feel like a rejection. I think it's completely valid for that to really hurt, especially if you have been through a lot of rejection in the past.
I have used the support of my friends in the past when I've applied for jobs and have not been successful. They have reminded me that being rejected is a normal part of applying for jobs and in fact shows ambition sometimes.
How do you manage to keep stable enough to work consistently in a job?
There is way too much pressure (financial and political) for people with mental health problems to go to work even when it's actually endangering a person's mental health. I think politicians need to move away from pressurising people into jobs when it's not a healthy or viable option for them. For me, work is helpful and something that really helps me manage my mental health.
I used to be a primary school teacher. Even though I loved working with children, this job was really tricky for me with my BPD because of the stress and sleep deprivation. I had to wake up at 6am every day to get to work for a 7.20am start (huge workload to manage). It was very hard for me to have GP or therapy appointments in term time too. I changed my jobs after completing a master's degree last year.
I now work in an office, in a health/disability related charity. I work in psychosocial services and the routine of it is helpful. However, I feel that working with children suits my personality better and fulfils me more, so I will probably go back to teaching when the time feels right for me (most likely special education this time).
[Photo of a teacher helping a child, showing hands pointing to an exercise book.]
Was getting the diagnosis important to you? Did you feel it helped you or not?
Yes, it was enormously important to me. First of all, it helped me to realise that my emotions and behaviours were not because I was a 'bad' person and that there was a reason for feeling this way. BPD as a diagnosis helps me because I found out that people with this diagnosis often have been through difficult life experiences and the chronic invalidation of their emotions. Knowing this gave me a sense of understanding about why my emotions became out of control.
Secondly, the diagnosis showed me that DBT could help. I couldn't access DBT for years after my diagnosis, but I managed to find out about it online and through YouTube etc. I started blogging and tweeting about my experiences using BPD as a hashtag when I was first diagnosed. It helped me connect with others and feel less alone- and here I am still blogging today!
I've written more about my route to a diagnosis in this blog post.
At what age did you realise something was wrong in terms of your mental health?
I started self-harming when I was around eight years old, but I didn't see child mental health services or anything. It just wasn't a thing that anyone did for me in my circumstances back then (for a whole bunch of complicated reasons). I don't think adults around me were educated enough about mental health in the 1990s and early 2000s to recognise a problem and know what to do. Even though education is better now, it is still not good enough.
When I was eleven, my emotions were very unstable. Anger, shame, sadness and anxiety became huge problems for me. I was very unhappy in school. I was lonely and, like many young people, I didn't feel like I belonged. I cried probably every single day around this time and I had terrible anxiety. Insomnia was a big issue for me too.
[Photo of a young girl at the supermarket with a woman holding an orange basket.]
What other mental health diagnoses do you have or have you had in the past?
My main diagnosis right now is borderline personality disorder and this is the diagnosis that makes the most sense to me and explains my experiences most fully. I used to have an eating disorder and there are times when I still show traits of this, but very mildly. I don't have a diagnosis of OCD (obsessive compulsive disorder), but I do have traits of it and I have had some short-term treatment for this as part of my therapy.
I am pretty sure I would meet the criteria for generalised anxiety disorder, and I have had this in my medical notes in the past. However, I feel that the anxiety I have is much better explained as part of my BPD. I did have a diagnosis of depression in the past (as mentioned above), but I never felt like it was quite right, at least in the long term. I certainly had major depressive disorder in the past, for a year or two, and this was in my notes.
Looking back, I am certain that I was showing all the symptoms of BPD during these couple of years of major depression, but I never had access to a professional at that time who was qualified to diagnose me with a personality disorder.
Which therapies have helped you the most?
The therapy that has been the most helpful is DBT because it is so tailored to the difficulties I have with intense emotions, interpersonal triggers, self-harm and suicidal thoughts. In the past, I've done CBT (specifically for eating disorders), integrative counselling and psychodynamic therapy. DBT has been by far the most helpful. My DBT therapist has been really open to working with me to examine my past and it hasn't been solely present-focused which I know DBT is a lot of the time.
Thanks so much for your questions, I hope you found this post useful. If you would me to credit you for your question please let me know on Twitter @TalkingAboutBPD.