The other day I went to the hospital for a routine endoscopy. The anaesthetist came to introduce himself to me.  He started with the usual routine questions, “Do you take any medications?’, “Do you have any allergies?”, and so on. I rattled off the answers, practiced and predictable. Then he asked, “Do you have any medical conditions?”.  I started with the physical ones: “immune deficiency, sleep apnoea, asthma”. Then I hesitated. I was reluctant to list my mental health diagnosis; I knew from experience this could affect my treatment. Even in today’s largely progressive world, mental illness is still highly stigmatised. However, in the spirit of honesty, I told him that I had anxiety and PTSD. I paused for a moment, wondering if I should tell him my other diagnosis: Borderline Personality Disorder (BPD).  I made the decision in that moment to stay silent. Mostly because I didn’t want to be judged, and if I’m being honest, I also felt ashamed.

Even now, when medical science is so advanced, people living with mental illness are still judged and widely misunderstood by so many. BPD, along with Schizophrenia, are thought to be the most stigmatised of all mental illnesses. If you search any online forum, like Reddit or Quora for the phrase ‘BPD patients’; you will find endless posts about patients with BPD, or ‘borderlines’ as some people like to call us. Perhaps if these posts were all written by laypeople, we could justify the ignorance. But what I find particularly concerning, is that many of these posts are written by medical professionals. Often these professionals are experienced in mental health settings, such as psychiatric nurses. You may wonder what these professionals say about people with BPD.  Perhaps they offer advice? Perhaps they explain how to understand and support someone with BPD? You would be wrong. Almost all these posts talk about how people with BPD are ‘the worst kind of patients’, they label us as attention seeking, annoying and manipulative. Rarely drawing attention to the fact that these people have an illness; and whilst they may elicit behaviours that could be labelled as attention seeking and manipulative, they behave that way for a reason.

Medical professionals and laypeople must move beyond their ignorance and understand that people with BPD behave as they do because they have an illness. They do not elicit these behaviours because they wish to be annoying or a ‘difficult patient’. They behave as they do because they have an illness.  If a patient with a cold constantly blows their nose, nurses wouldn’t label the behaviour as ‘difficult’, it would be understood that the action is caused by a cold. Yes, it may be annoying, but they are doing it because they are unwell. This thought process should be the same for patients with BPD. Alas, as more medical professionals label and push them into a corner, the likelihood reduces that they’ll receive the support needed for their behaviour to change.

Approximately 10% of people with BPD take their own lives. 10%!  

That is a huge mortality rate for an illness. I had a friend with BPD who took her own life. Did she die by suicide because she was intentionally manipulative and annoying? Of course not! – she was a lovely, gentle, warm-hearted lady, one of the kindest people I’ve ever met.

And the 90% of people with BPD who don’t end their lives, what about them?  If they don’t get the help and support they need, they never really get to have a life worth living. A life of hospital admissions and medication. Of not being able to work. Of repeated self-harming or substance abuse. It’s not much of a life, is it? I know for me personally; I’m almost 40 and only really begun to live my life this past year. Thanks to a team that approaches my illness with compassion instead of stigma or judgment, I am now finally living my life.

I have a family member who is a mental health nurse – we used to be quite close and get along well. Almost overnight she went from being my friend to judging me and ostracizing me. What changed? One thing – she found out I have a diagnosis of BPD. The stigma towards BPD from mental health professionals is scary. The reluctance of doctors to diagnose and treat patients with BPD is concerning. This stigma prevents individuals with BPD from seeking the help and support they need to change certain behaviours and flourish into their best possible selves. Without this, they don’t really have a life worth living.

So how then, can we help people with BPD? Number one of course is to take away the stigma. The next is understanding, compassion and empathy. Empathy, not sympathy – this is important. Whilst dishing endless sympathy to a person with BPD may seem kind in the short term, its long-term impacts are questionable. This can be comparable to making excuses for a BPD patients’ negative behaviour.  Now, please don’t think that I’m saying those with BPD don’t deserve sympathy, that isn’t what I mean. Let me be clear. Most people with BPD have been through significant trauma, so of course they deserve sympathy.

But by solely sympathising with a person with BPD while failing to hold them accountable for their behaviour – you are doing them a disservice in the long run. 

To highlight this, I have an example from my own life: my experience with chronic pain and addiction. Some years ago, I began to have significant back pain. At first, my GP and I assumed I had sustained an acute injury, but unfortunately the pain didn’t go away with time. I was eventually diagnosed with chronic pain and referred to a pain specialist. This specialist started me on medications for my pain. One of these being Endone (oxycontin). This pain specialist explained that it was important not to take this medication every day, only when I really needed it. Requiring me to record in a diary every time I took it.  If you give a patient with chronic pain and mental health issues Endone, chances are they will love it. For me, as well as reducing my pain, it made me feel happy and light, like I was floating on a cloud. For a few hours that tablet took away all my pain – physical and emotional.  But of course, I started to need more and more to get that happy feeling. Every time I saw the specialist I asked for more tablets. For a higher dose.  But my doctor set limits – he wouldn’t increase the dose, or the number of tablets dispensed. I concluded that he was mean and uncaring, and I found a new pain specialist.

When I first met my new pain specialist, I felt like I had won lotto.  He was happy to increase my Endone dose – and he also started me on some fentanyl patches. The next month when I saw him, I told him my pain was really bad, so he increased the dose again.  Every month the dose went up. One month he increased the dose simply because it was easier to write one script for 20mg tablets, than two scripts for 5mg and 10 mg tablets. Man, I loved that doctor, I thought he was the bees’ knees!  Unsurprisingly I developed a substance misuse problem.  A few months into DBT, I plucked up the courage to admit I had a problem to my therapist, and I found a clinic that could prescribe me methadone. I’m eternally grateful those Endone tablets no longer control my life. Now, when I swallow my methadone, I can be content with the prospect of taking it every day for the rest of my life. I can now see that that my second pain specialist wasn’t so great after all!  There is a quote from Harry Potter, where Dumbledore discusses the difference between what is right and what is easy. It was easy for that pain doctor to give in to my requests and keep increasing the dose, but I can see now that it wasn’t right.

I digress. I chose that analogy to emphasize the fact that by offering endless sympathy to BPD patients, without holding them accountable, we are not doing the best thing for them in the long term. If medical professionals fail to hold BPD patients accountable for their behaviour, the patient will be supported to follow a self-destructive route. Do patients with chronic pain deserve pain relief? Yes of course – no one should have to be in pain. Are high doses of opioids going to be the best thing for people with chronic pain in the long term? Perhaps not.  Likewise, patients with BPD – do they deserve sympathy? Yes – remember most have been through significant trauma. But is endless sympathy going to help them get better? Probably not. I know for a fact that sympathy didn’t help me get better.

You may think that I am contradicting myself; In one paragraph I’m urging people not to stigmatise BPD.  Then the following paragraph, I express that people with BPD need to be held accountable for their behaviour.  However, I am not contradicting myself. I know for a fact, from my own experience with BPD and DBT treatment, that it is possible to show compassion and empathy, whilst holding them accountable for their behaviour. If this wasn’t possible, I wouldn’t be where I am today.

So how then, can we help people with BPD?  What helped me get better was receiving empathy and being taught the skills I needed to learn to be able to change. I have been doing a DBT course now for nearly two years. It’s hard to express in words how grateful I am for what DBT has given me. DBT has taught me the skills to cope with life’s ups and downs in a healthy way. And by doing so, it has given me back my life.

I am so incredibly grateful to my treatment team. These clinicians showed me compassion and empathy, and they held me accountable for my behaviour.

After two years of DBT, I’ve stopped my self-destructive behaviours.  

I went through some horrible times during my childhood. No child should ever have to go through what I did. But I allowed this trauma to take more from me than just my childhood. Even once I became an adult, and the threat was gone – I continued to let the trauma affect my life.  If I was to meet my younger self now; if I saw that girl who was in so much pain, I would probably simultaneously give her a hug and a kick up the arse. A hug because she was clearly hurting, and a kick up the arse because choosing to be miserable and wallow in self-pity was letting those bastards win!

If you have BPD, please get help. Learn the skills you need to change, because if you don’t, you will never really get to live. Whoever hurt you in your childhood has already taken so much from you, please don’t let them take anything else. If you know someone with BPD, the best gift you can give them, is to encourage them to access DBT treatment, and learn the skills they need to change. If you are a medical professional, please let go of the stigma. Remember patients with BPD are not behaving as they are because they want to be annoying or manipulative; they are ill. Just like someone with a obvious physical illness, they are hurting. In my own experience emotional pain is far worse than physical pain, and yet physical pain is usually what elicits the most sympathy from professionals.

Finally, if, like my treatment team, you choose to work with people with BPD, I don’t need to ask you to take away any stigma.  In all likelihood you chose to work with such clients because you know how lifechanging DBT treatment can be.  All I can say is thank you for not judging; for showing compassion and for teaching us the skills we need so we can change our life. Thank you for your empathy and thank you for having the courage to hold us accountable for our behaviour; because only then can we really live our life.

And me? Well, for the first time in my life I am happy.  I am finally living my life. I am happier and healthier than I have ever been. I have a full, productive life and am contributing to society.

DBT has given me the most precious gift that can be given:

hope, and a life worth living.

Thank you for reading.