It was a late spring evening on the Upper West Side, New York, or was it late Summer, I wondered? Time had assumed an amorphous, ambiguous quality. I sat in my new therapist’s cramped office, less than one year after my mother’s death. It was unusual that my older sister sat with me. My therapist, Michael, had asked to meet with family members in an attempt to effectively assess my stories of horrendous childhood emotional abuse.

“People with Borderline Personality Disorder, like you,” Michael started but his words trailed into terrifying darkness as I cast my eyes about the narrow room. Whom, I thought, is he addressing? Certainly, I don’t have Borderline. I went home and took every online self-assessment test for Borderline that I could locate. The diagnosis remained the same… severe Borderline Personality Disorder profile. Following is a link to one test, here. The test briefly explores feelings of “emptiness”, a paranoid fear of abandonment, and rapidly shifting moods about oneself and attitudes towards others.

Ultimately, I was relieved to have a diagnosis. I could then move forward with treatment options.  I had slogged through several years of well-intentioned, but ineffective therapy because, the Psychoanalysis, Talk Therapy, CBT, did not address my feelings of dark engulfing emptiness, boredom, self-loathing and an increasing desire to mitigate these emotions through harmful behaviors such as bulimia, sporadic excessive spending, and even though I had been sober since 1996, a deep desire for alcohol.

I was determined that my diagnosis, like the one that I had received for Epstein-Barr, years earlier, would not define me. I was comforted by the thought that I would beat the odds much like Elyn R. Saks was when she wrote about her schizophrenia diagnosis.

 “There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life,” said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with schizophrenia in “The Center Cannot Hold: My Journey Through Madness.”

I moved towards the most highly recommended and only treatment modality specific to Borderline Personality Disorder - Dialectical Behavioral Therapy – which enables students to cultivate skills to increase distress tolerance, reduce rage, anger, while offering cultivation skills to successfully manage interpersonal relationships. The episode that led me to seek a diagnosis occurred when I awakened December 26, 2011 and felt a quiver of warning. It was the day after Christmas, and I had decided to enjoy time alone over the following two weeks and had taken vacation time – dangerous territory. That morning, I assessed that I was tired and felt that it wouldn’t be emotionally destructive to remain in bed. My desire to hide that drizzly, gray morning, preceded 8 months of anguished fear, anxiety, emptiness, and an inability to eat or to leave my apartment, though leave I did, when necessary. I felt alone and abandoned as I shivered on Manhattan streets because I perceived each individual as a threat. I had been suffering through the repercussions of the 2008 economic crash and had lost 3 consulting jobs due to the economic downturn.  I was left with one consulting gig which did not even approach paying my bills. I would sit, in agony, for hours, ruminating over injustices while chain smoking. It was hell.

Oddly, my ability to focus on work as a sales professional never diminished. But I approached work with gnawing anxiety as only the proliferation of commissions would pay my bills. My $1,500 monthly retainer barely covered my maintenance. My bills were $6,000 monthly.

It is my opinion that years of emotional abuse led to my diagnosis. My mother though never treated or diagnosed was at best, a hysteric. There were no solutions in my fragmented and terrifying childhood, merely hysteria and blame. My therapist explains that there are families that blame and shame, and those that solve problems. My earliest memories were qualified by endless amounts of unstructured time alone, as my mother claimed each day unique in her inability to cope. She would thrash and throw herself on the floor, beating her head, biting her arms and wrists. She often experienced real or fake fainting spells and severe migraines. She simply could not cope. I was privy to her most intimate fears and insecurities from an early age. Instead of guidance or “nurturing” I was weaned on her neurosis, peppered with questions such as, “Am I pretty?” “Do you love me more than your father?” I was constantly told that I was not safe and that her mother’s milk had run dry. My father had congenital heart disease. He did not share this information with my mother until he went into congestive heart failure during her early pregnancy with me. My mother’s life was simply too difficult for her to navigate.

My therapist heartens me when he repeats, “It’s not your mess, but you still have to clean it up.”  My earliest memories were of a joyous, expansive, curious child with a tremendous capacity to love. My older sisters, respectively 9 and 6 years older had little to do with me. My mother was in labor for three days during my birth. I was six weeks premature and the doctors did not think that I could survive a C-section. She returned home to a sick husband, who, was then a Christian Scientist. He did not believe in medical intervention. He kept my mother locked in their bedroom after she returned home with me, her infant, and did not allow my sister’s access to our mother.

Hypnotherapy led me to believe that my mother who had gained only 6 pounds during the pregnancy, had done her best to abort me through starvation and regular bouts of hysteria and self-imposed bodily abuse. When I was taken home after my birth, my sisters’ finally did gain access to my parents’ bedroom. They were scared when they confronted a room splattered with my mother’s blood. Simply, my mother was hemorrhaging and had 30 minutes of life left. My older sister called our Aunt who arrived with an ambulance. My mother was hospitalized and returned to her mother’s home for several weeks to recuperate. I questioned my mother many years later when early dementia had asserted itself. She told me that she did not want to return home and that she did not want to care for her child, me. Hence, the images that I saw during hypnosis were verified. My sisters and I later confirmed that mommy did not regularly change us and we remembered terrifying hours, shrieking in our crib with no comfort. My mother often said that she wanted to die. When I developed suicidal ideation, I didn’t know if this was from a damned background, or if I was really in crisis. It was “normal” to eschew life in my home.

Marsha Linehan writes about parasuicidal tendencies and how her DBT therapy addresses this in her article: Dialectical Behavioral Therapy: A Cognitive Behavioral Approach to Parasuicide

DBT is based on a biosocial theory that views parasuicide as problem-solving behavior emitted to cope with or ameliorate psychic distress brought on by negative environmental events, self-generated dysfunctional behaviors, and individual temperamental characteristics. Three factors keep parasuicide high in the individual's hierarchy of problem-solving responses: (1) low distress tolerance, (2) inadequate functional coping resources, and (3) parasuicidogenic expectancies. Low distress tolerance provides a powerful motivation for the individual to do something about the problem. Poor coping responses include deficiencies in emotion regulation, interpersonal problem solving, and self-management skills. Parasuicidogenic expectancies include beliefs about the value and probability of consequences of suicidal behavior. Parasuicidal behavior occurs when the individual believes that an intolerable, inescapable life problem exists and that parasuicide is the only or the best possible solution; that is, the parasuicidal act is regarded as a potentially effective problem-solving behavior. 

I often quip that I was raised by wilder beasts. But this humorous diagnosis did not save my life. The skill and care of a gifted psychiatrist and therapist who insisted that I enroll in DBT Skills training, saved me. DBT is based on a quadrant of key skill training principles: Mindfulness; Interpersonal Effectiveness; Distress Tolerance and Emotional Regulation. 

I would liken my emotional dysregulation to a tsunami that crashed over me. A white-hot rage impulse that was characterized by a sudden and violent onset and an out-of-body experience where I lost vision and reason would overwhelm me. It took months to understand that beneath the rage and feeling that I had been invalidated or insulted, was sadness, frustration, grief, anger, loss, and disappointment. DBT asked me to slow my responses and to analyze the emotions. When I no longer had someone to “rage against”, as I was divorced and ignored by my family, I embraced tools that led to balance and regulation. The following overview of DBT is helpful - link here.

Finally, depression is often diagnosed first with people who have borderline. I have noted a feeling of painful, expansive emptiness and agitated boredom that characterizes depressive episodes. It is difficult for me to engage in positive activities or to feel a connection or an association. I do have to clarify that I always functioned at a high level in my career as an advertising sales professional and that I retain an interest in physical activity that raises my endorphins. I also trained as an opera singer and that passion fueled me for many years. Though when I left the pursuit of the art as a career after my x-husband abandoned me, I engaged in self harming behavior through smoking. I reasoned that I did not deserve to experience the joy in singing since I failed at the career. I have a prescription for Chantix and am determined to quit and to vocalize each day. I do deserve that joy. The following article discusses the relationship between borderline and depression - link here.

Armed with a diagnosis I moved forward on a path towards recovery. I interviewed therapists who had been trained in DBT. I chose the therapist who resonated with me and who had the skills to work with my diagnosis. I joined a DBT skills group and remained in the group for over 3 years. I purchased Marsha Linehan’s DBT Skills training manual, here.

It is imperative that you do the exercises as well.  So I recommend that you purchase this book as well, here.

It is highly recommended that you buy the second editions as they are easier to follow. I also urge you to join a DBT skills group. The support, encouragement and a knowledgeable moderator who can review the information and exercises is crucial. 

Medication may be necessary. I work with a psychiatrist and a therapist. A skilled psychiatrist can recommend a treatment protocol for the depression, anxiety, and strong emotional responses. Medication is NOT a cure, but it can provide a higher bottom so that you do not fall so far when triggered. My psychiatrist would not give me prescriptions without the certainty that I was in therapy.  She and my therapist consult a few times each year, as needed.

Ultimately for me, borderline is a diagnosis, not a qualifying label. I determine who I am in the world. I have the skills and ability to pursue and succeed in achieving goals. I have had the wits and ability to support myself throughout my life and have maintained an apartment in Manhattan for the past 30 years. I have traveled extensively, as that is a passion. I have close and often enriching friendships. I have survived and often thrived by the grace of God.  Spiritual cultivation is important and has enabled me to invoke acceptance when my efforts have failed to achieve the desired results. I recently remarried and share a rich and intimate relationship with my husband that would not have been possible without DBT and the help of gifted and invested mental health professionals. I share my life with five Persian cats who are unrivaled in their intuition, unconditional love and beauty.

Don’t allow a diagnosis to hamper you. Go forward with grace and courage to embrace the remarkable individual that you are. Through resilience, courage and fortitude, anything can be accomplished.  If not now, when? You will learn to dance in the rain.

For more information on Borderline Personality Disorder, please visit BorderlinePersonalityDisorder.org

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Cover Image: Daria Hlazatova

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