Author: Peter Miller
My path to getting diagnosed with Borderline Personality Disorder…
I come from a broken home. My parents divorced when I was about nine. The whole family endured lots of conflict and drama while my parents worked through their divorce process – it was an awful time. Mom left the country after a couple of years after leaving the house, and after that, I stayed with Dad and two older sibs. I’m sure I suffered attachment issues due to mother leaving at such an early time in my life, although I still haven’t pinpointed or fully resolved these issues. The way I remember it, I didn’t mind her leaving because religion so embarrassingly consumed her. I haven’t reconnected with her since or had any desire to do so.
I had issues throughout childhood, teens, and early adulthood in regards to anxiety, depression, emotions, and functioning in relationships. At a few points, I went to doctors and therapists to investigate things, but the investigations were always short-lived, either because doctors offered suggestions and treatments to address the apparent physical manifestations of my problems (e.g., stomach problems or food intolerance) or I couldn’t connect with whoever was attempting to counsel me.
My first experience of debilitating mental health issues as an adult was in 2009 (age 34) when I started having panic attacks. I experienced my first panic attack at work – seemingly out of the blue. It hit me fast and hard. I suddenly became frantic and started looking for somebody/anybody to support me through the panic symptoms and figure out a way to get me home.
While having panic attacks I was extremely dizzy and short of breath and full of dread and fear. I believed I must have a brain tumour or something worse was happening (misinterpreting symptoms). I had no understanding of what was going on inside of me psychologically or physically at this time, but I now realize there were lots of irrational thoughts and related emotions happening all at once, and this no doubt took a tremendous toll on my mind/body system over time until it reached a tipping point.
My wife took me to the hospital emergency after a couple of days waiting for the dizziness and other symptoms to pass, but they didn’t, and that resulted in me to thinking more that “something terrible must be happening.” At the hospital, I waited in agony for a doctor to attend to me. It was probably a relatively short wait in emergency, but it seemed like “forever” and as though no one was noticing or caring how bad I was suffering. Once admitted, the emergency doctor quickly determined I was suffering from some “anxiety issues.” He gave me an Ativan prescription and suggested I seek out counselling and consult my family doctor for follow-up.
Over the years on my path of mental illness, I sought out other brief counselling and doctor consults. I recall only going to one or two therapy sessions and not being motivated to explore meds. Therapists gave me some tips for managing anxiety and explained why taking an antidepressant might be a good idea (to adjust certain brain chemicals, etc.). I mostly decided that going back for more therapy wasn’t necessary. I honestly had no idea that I needed so much more understanding and help than a couple of short consults. I just didn’t (or couldn’t) believe my mental health issues could run so deep and that my mental health needed to take a much higher priority in my life.
Continuing to experience anxiety and depression symptoms over the years, I started looking at my issues as a real nuisance that “I shouldn’t be having,” or like “they were stifling my career progress.” I wasn’t prepared to take a much more in-depth look into things. To be honest, I suppose I had some mental health denial that I couldn’t move past.
I realized I had insecurities and intermittent anger issues in my family relationships (especially with wife and with girlfriends before marriage) and that these recurring moments were hinting that something was not right with me. Nonetheless, I never made looking more in-depth into “my stuff” a priority. Everything else – work, money, providing for the family, and finishing education – always seemed like the most important places to keep my focus. Putting mental health matters above these other “much more important things” wasn’t going to happen. I believe this may be a common type of thinking and behavioural pattern for many males coming into their adulthood, unfortunately.
I was afraid of being exposed as “a broken person” or “a piece of garbage abuser” if a therapist ever knew how abusive I had been in my relationships. I was also afraid that if my partner ever discovered I had severe mental health issues that would take extensive work to correct, then maybe she would want to give up on me. The truth was I did have serious mental health issues and I was lucky I didn’t lose all of my family relationships after all I had said and done over time in the midst of my disordered functioning.
And imagine this: I maintained all this resistance for doing self-inquiry/mental health work despite being halfway through a master’s degree in psychology and working towards becoming a psychologist! Lol!! That said, I now also realize that going to school does not necessarily provide a complete understanding of self, mental health issues, induce motivation for self-help, or fully inform the student as to how mental health issues play out in real life – not even close actually, in my experience.
My big moment of “mental health truth”…
I didn’t even consider BPD as something possibly relevant to me until an experienced colleague in mental health (someone who understood personality disorders very well) pointed out some of my traits (e.g., tendencies to misinterpret the meaning of events, having unrealistic demands and expectations, avoiding assertive communication, reacting to emotion, impulsive decision-making). Truthfully, I didn’t know very much about personality disorders at this point in my psychology career (about age 37) and was surprised my colleague would even suggest it. I was at the tail end of my psychologist registration process and arrogantly assumed I could recognize whatever she saw if anything was there. But I couldn’t!
And so I looked into BPD further… watched some videos, read some books, etc. Eventually, I recognized I couldn’t continue running away from my issues, and so I diagnosed myself with BPD. I embraced it… in large part due to this mental health colleague in my life, but also recognizing for myself that my mental, emotional, and behavioural patterns were indeed a BPD pattern. I didn’t go for any other official assessment; I knew well enough that I had this problem.
Lucky for me I was surrounded by mental health and BPD resources because of my work environment, and over time I figured out which symptoms I could manage with therapy skills and which symptoms I needed the help of medication to function. My interest level in everything about BPD skyrocketed. I remember reading a book called “Overcoming Borderline Personality Disorder: A family guide for healing and change” (Valerie Porr, M.A.) and being completely shocked by how much this information applied to me and how long it had taken to figure this out. I after that read several similar books and studied myself relentlessly to heal my mind/body system as much as possible. I started writing blog posts as my BPD learning progressed, and I developed a lengthy PowerPoint presentation for teaching others about what I had learned through my journey. I am now sharing this PowerPoint presentation at BreakAwayMHE.com (see “The 9-Steps”).
In addition to my reading and writing about BPD, my helpful colleague was willing to engage me in several private conversations (basically free consultations) about personality disorders and how it affected my life. She also allowed me to “co-facilitate,” for two years in a row, an 8-month/once-per-week therapy group that she and another therapist developed for patients suffering from BPD symptoms (inspired by Dialectical Behavior Therapy, credit Marsha Linehan). The therapy group was provided for women (only) because women, in general, seek out therapy more often than men, and the group could also help women feel safer to express their thoughts and emotions when they otherwise couldn’t feel safe in regular life. And again, lucky for me my colleague needed another therapist to run the group as her other female helper left the clinic, and so she made an exception to allow me (a male) into the group to help run things and learn at the same time.
Since I have been part of the public resources for mental health in Alberta (Canada) since 2012, I would have to recognize that services to investigate and treat disorders like BPD are potentially available. That being said, disorder identification and success in treatment could depend a great deal on who you are meeting with, how they practice, and how much they know about personality disorders. Recall I was almost all the way finished becoming a psychologist but didn’t know very much about personality disorders? Psychologists and other mental health professionals have varying skill levels due to different years of experience and various educational programs, but also quite often have different areas of interest that they focus on and therefore become more or less qualified to assess and treat.
Where I live in Canada, I would say the available public resources for mental health in general (and possibly for BPD) are the same for men as they are for women. Anyone can call in, get assessed, and receive treatment. But again, it depends on what clinic you go to and how much the available therapists know about BPD. For instance, public clinics in Canada run groups for specific conditions and sexes at certain times, while others do not. I guess that a men’s BPD group might be hard to find anywhere. Getting the right help with BPD may also very well depend on how much money you have or what your mental health benefits are… so if you have ample financial resources to work with, it could significantly expand your options for receiving timely, private, and specialized mental health treatment.
It can be very hard as a male to admit to having mental health issues because of stigma, but also very difficult or impossible to allocate time to deal with it. The most discouraging BPD resource issue for the average male, I believe, would be that BPD is a complicated disorder that takes lots of time to talk about, understand, and treat (several months to several years). However, most men are almost entirely preoccupied with training to earn a living, or already working to make a living and support a family. Effectively treating BPD may also involve informing family members how best to interact with the suffering person, therefore requiring even more time, transparency, and vulnerability.
I am very thankful I was immersed in a BPD treatment environment as part of my job – so my learning became more or less a part of my everyday life, and I could still get paid! Recognizing that my mental health progress was so intimately connected with my physical survival, I now believe that addressing mental health issues adequately also requires addressing the priorities issue of acquiring money versus taking time to learn how to become and remain healthy in your body and mind. It usually takes lots of time and energy to earn money, but it also takes lots of time and energy to get healthy. Talk about a conflict of interest!
The stark realities of late diagnosis, misdiagnosis, and delayed treatment of BPD…
I think the diagnosis and treatment of BPD often come too late in a person’s life, although there may be no way around this. I think the development of BPD could be spotted and prevented by parents if the parents were better informed about mental health issues and what types of situations and experiences were harmful to childhood brain development. However, in my experience working with patients and learning about their histories, I am not convinced at all that parents at large are sufficiently capable of noticing how their actions contribute to harming the brains of their children.
Diagnosing BPD may also be delayed as it may not be considered as a possible diagnosis until some of the more visible manifestations of the disorder become apparent (e.g., suicidal threats, self-harm, extremes in emotion). Even then, the symptoms may be explained away as “chemical imbalances” or “behavioural issues” depending on who’s making the diagnostic opinion and how old the patient is. It sometimes seems like everything but BPD is considered diagnostically first (e.g., medical conditions, depression, anxiety, bi-polar, trauma) therefore leaving a BPD condition unrecognized and untreated for long periods of time – This is what happened to me!
**My personal belief is that it may be good practice to consider BPD as a highly common “root mental health issue,” with other common conditions and symptoms being secondary. **
Bipolar and BPD diagnoses, in particular, seem to be variously applied to patients depending on who’s doing the assessing/diagnosing. But again, many different types of clinicians take different approaches to assessing, diagnosing, and treating, even though all these clinicians may share the same working titles (e.g., psychologist, psychiatrist). There may also be a medical bias in diagnostics, such that bipolar may be chosen over BPD because there are more medical (pill) options for treating bipolar than there are for BPD.
However, even if there is excellent early detection of BPD and treatment options available at the time when traits and symptoms start to become more apparent (I would say in late teens and early twenties), there still needs to be a way to get a person on board with a lengthy and learning intensive mental health/self-help project. How many young people are prepared to focus their time and energy on this sort of thing? I would suggest not many, just because people in this population are more focused on getting a career going and otherwise participating in the modern materialistic/capitalistic world. Young people are also focused on being in new relationships and starting families, even though an undiscovered and severely debilitating mental health condition (like BPD) could undermine it all. Pause here to consider the high divorce rates and how much BPD might be playing a role.
Good health in several aspects (in both body and mind), and otherwise relatively high functioning are needed to survive the demands of the modern world – mainly when the demands include all the expectations of a middle-class (or higher) lifestyle. An unfortunate but inevitable reality may be that discovering the facts about having deep-seated brain health/developmental issues such as BPD may not come until later in life if it comes at all. This “discovery time” may be one of the most challenging phases of life, since people often “hit a wall” when they realize through hard experience that their emotional and relational skill levels are not where they need them to be to keep up with all of the demands of life. Things keep breaking down emotionally and relationally, and so it isn’t possible to solve the work/life problems efficiently and continue meeting basic human needs.
As soon as functioning starts to be a problem, people will commonly be looking for quick fixes to solve complicated problems. For instance, doctors are consulted for pills. Natural health remedies might be considered. Sometimes people focus on religion and their beliefs and “getting right with God”. Sometimes other methods of coping may be attempted to deal with the suffering that can’t be alleviated skillfully, such as substance abuse and other vices. Sometimes a combination of all or some of the above is attempted before looking further. This “attempting to solve problems without the right set of tools (or a complete set of tools)” can go on indefinitely, especially if any of the approaches attempted to bring temporary relief, but in reality, dig a deeper hole.
I would suspect it is somewhat rare for people to take a more extended/closer look at themselves through mental health services, and then to also realize there are no quick fixes to their issues. In my experience, this more true type of health-seeker comes for a brief period… perhaps until benefits run out, or money runs out, or patience to continue attending appointments runs out. Sometimes these people leave services and then come back to maintain their mental health work; sometimes they don’t. Again the question is: How much continuous time and attention are people willing to invest into these matters, especially when there is no apparent short-term benefit, or when the action taken does not seem directly connected to meeting their physical survival needs? It is for reasons like those mentioned above that I have been developing a new concept and approach to mental health at BreakAwayMHE.com
Legitimate reasons alternative approaches are needed to help people work through BPD (hence BreakAwayMHE.com)…
In my psychology practice, I do see BPD more often in female patients than I do in male patients, and I do believe any available statistics would support this pattern as well. That said, and as I said before, females tend to access therapy services much more often than men do… in my experience about 8 women to every two males. Also when males do attend therapy, they tend to have only a few sessions rather than complete a full intake, diagnosis, and treatment. This time commitment dilemma makes sense to me as a fellow male who has struggled with mental health issues, the main reason being that time allocation for a significant mental health project isn’t realistic when you have so many other responsibilities and obligations pressing down on you.
If I see a male or female in therapy and BPD seems like a proper diagnosis, and if they continue attending past the number of sessions needed to complete intake assessment, I will inform them what I think. Other clinicians may take a different approach. I don’t see the point in calling BPD something that it isn’t, or focusing on a secondary or related diagnosis. I could see how a gender bias for BPD could come about if males were getting assessed less overall, and therefore being diagnosed less. Even for myself, I am reasonably sure that if I wasn’t in “psychologist training,” or if I didn’t have my helpful colleague to point me in the right direction, I would have been only partially treated and ultimately lost to myself.
In addition to the “time constraints issue,” I would say it is tough for males to break through cultural stereotypes of masculinity, to be more vulnerable, and therefore to get the mental health treatment they need. I have gotten used to openly sharing my mental health struggles (on my blog and social media). I have also gotten used to talking about my issues with wise and caring others. It has been harder to openly discuss my concerns in everyday/family life, especially when mentioning the diagnosis name out loud. I would say that if I didn’t have a way to put my mental health issues into a clinical perspective, openly admitting to having BPD (or anything like it) would be incredibly embarrassing and hard to bear.
Part of the reason for and design of BreakAwayMHE.com was to offer an alternative avenue for the information to be received by people who wouldn’t usually receive it through traditional means, such as through clinics and meetings with therapists. At BreakAwayMHE.com we recognize that the male population (and perhaps others as well) may be less likely to seek out therapy using traditional formats, but still very much require the information to get started with helping themselves and initiating a healing journey.
We hope that BreakAwayMHE.com offers a format for learning about BPD that is useful, flexible, far-reaching, and appealing to BPD sufferers who struggle to give up their time used for earning a living or struggle to move past stereotypes and stigmas about mental health. If options for treatment are easily accessible and flexible, then perhaps people in these groups might willingly take the time they need for figuring out these critical mental health issues.