The latest chapter is now live on the site, and details the key features of Borderline Personality Disorder, comorbid conditions, and the ways in which it all intersects, in a wobbly web of the mind.
Here is an excerpt from that chapter, which hopefully contains some useful information, and provides an idea of what you can find in this series.
In the early days, I could sometimes be heard bemoaning The Tight-Rope Walk – feeling that without intense concentration on my part, to maintain proper mental balance with every single step, I would be sent hurtling to the ground, only to have to clamber back up and start again. In time, I took to describing BPD as being the ball in a pinball machine – where the slightest tap could send me bouncing off the walls in a hundred different directions, with no idea where I might land, emotionally speaking.
The common denominator between these two very different characterisations of this chronic illness is a lack of control. Walking a tight-rope, I felt I could only control my own level of concentration – and willingness to get back up after falling. Whatever it was that was coming to knock me off course was out of my hands. Pinging around an emotional pinball machine suggests an even greater loss of control – because the ball is literally thrust into its chaotic movements by somebody else pulling a lever.
This is interesting, because it reflects the relationship between a person and their triggers early on in the process of treatment and recovery. In a mental illness characterised by emotional dysregulation, triggers are key, because these are the things that relate most to the central issue, and provide an opportunity to regain control of your psychological situation. To be clear, in the early days, triggers were my mysterious enemy. Today, heading into my late thirties – and being six years into meaningful recovery – triggers are the tools that help me maintain mental stability. They are no longer something of which I should be fearful, and are instead, something I can harness to improve my mental health.
This change in perspective comes with investigation and therapy. When spiralling into a pit of emotional turmoil, and when being told that there is something wrong with you, the first question we are naturally inclined to ask is, “Why?” Why me? Why now? While, at the time, they feel like futile and pointless questions, they are actually the starting point for getting better. They are the initial, instinctive inquiries of a mind that seeks to heal itself.
The tragic irony is that, in BPD crisis, we are unable to see this fact. We are unable to see anything clearly, because the conflict in our heads is so loud, it clouds everything. This conflict spawns from dichotomous thinking, in one or another – if you’ll excuse the pun – and this is a key feature of Borderline Personality Disorder. It is the thought process that leads to extreme emotional reactions, because it is essentially an inability to see compromise, or a ‘middle ground’.
Dichotomous thinking in BPD is often referred to as ‘splitting’, and sometimes as ‘black and white’ thinking. It means that there is a difficulty in merging the good and bad aspects of the thing we are thinking about – whether that is an object, a situation, an environment, an experience, or a person and their behaviour, including ourselves. This is the BPD feature that is often highlighted as being the main cause of the pattern of unstable interpersonal relationships displayed by many people with Borderline Personality Disorder, and is also an example of automatic thinking.
The thing about ‘splitting’, however, is that it is a fairly comprehensive defence mechanism for people with BPD. For us, social interaction is fraught with danger. Leading Borderline Personality Disorder researcher Dr Marsha Linehan often describes a person with BPD as being like a person with serious burns trying to function in day-to-day life. We are vulnerable in interaction, because our protective outer layer is seriously damaged. On a bad day, any interaction is painful, and has the potential to cause complications. It is hardly surprising, then, that extreme reactions occur, and that we might seek to instinctively protect ourselves by rejecting a person, situation or thing the moment we spot a potential hazard on the horizon. Conversely, if something seems to be soothing and distracting, we might well embrace it for all we are worth, just to enjoy the respite – however fleeting that may be.
This is where investigation and therapy come into play. If we woke up one morning with full-body second-degree burns, and faced a lifetime of all the associated complications that come along with that, we might wonder where those burns came from. Discovering the source of the injury would not make those burns magically disappear, but it would help us avoid being burned in the future – because further burns would be potentially catastrophic. At the same time, different burns require different dressings. We must find the cause, to treat appropriately, to help that protective outer layer heal. When burns heal, that outer layer might never be the same, but it sure does feel a lot better – and helps keep us healthy.
When you are diagnosed as having Borderline Personality Disorder, the most common treatment option discussed and recommended is Dialectical Behaviour Therapy. This is an off-shoot of Cognitive Behavioural Therapy, and was developed by Dr Marsha Linehan in the 1970s. The reason for its popularity in relation to this particular illness is its areas of emphasis. Like CBT, DBT works largely by changing automatic negative thought processes – but DBT also specifically addresses ‘splitting’. By combining the more mechanical aspects of emotional regulation found in CBT, with processes of mindfulness, awareness, acceptance and the testing of reality, DBT has proven to be among the most effective methods of managing Borderline Personality Disorder in the long term.
What is revealed, during the determined undertaking of Dialectical Behaviour Therapy, is the realisation that nothing occurs in a vacuum. Extreme emotional reactions occur as the result of triggers, these triggers have causes, and throughout it all, the mind as a whole is trying to protect itself. Our mind has the natural desire to survive and, like any other organism in nature, will seek to defend itself. Sometimes, the strategies developed by the mind become so problematic that this becomes a self-defeating process, and suicidal ideation begins to occur. Sometimes the noise of the mind being unwell, and trying to defend itself becomes so unmanageable that substance abuse develops. These are cause-and-effect situations created by the state of the mind, and so, in order to right the ship, it is necessary to understand how your specific mind is operating.
This is how I came to stop regarding my BPD as The Tight-Rope Walk, or The Pinball Machine, and in fact stop picturing it at all. Now, I picture my mind, and imagine it to resemble a giant spider web – for the purposes of management. The web of the mind has beauty and order, and is incredibly strong. Although its presence is generally discreet and subtle, it is a wonder of structural engineering, and often, literally, holds things together. Now, a web constructed in a Borderline mind has some often unusual points woven into it at critical junctures. This is where comorbidity and triggers come into play.
The nature of the web means that any vibration – at any point on the web – is felt across the whole thing. But, depending on where the vibration begins, it has a greater impact on some areas than others. There are also very effective safety mechanisms built into the web, to prevent it suffering too much damage. Too big a step on the wrong point will cause that thread to snap – sacrificed for the structural integrity of the larger part – and the web consequently changes shape, causing all those critical junctures to shift to a new position, creating new areas of intersection.
To understand how the web is best handled, we must map out its structure, and learn how each intersection relates to the whole. We must be aware of the safety threads, and accept that the web will always be susceptible to wobbling – but that proper care and attention can limit the possibility of excessive damage. Like webs spun by spiders, each mind-web is unique, and specific to the individual – and my description here is my own. As people with BPD, however, there are likely to be common features at various points. The way that they intersect is dependent upon your own triggers and experience. For the purposes of demonstration, though – and to fully inform the way that I respond to incidents in my own story – let’s take a look at my web, as I have mapped it out for Borderline Personality Disorder management…