BPD Diagnosis and Confusion

About six or so years ago now, I was diagnosed with borderline personality disorder. This diagnosis came after numerous other diagnoses were given to me including major depression, Impulsive Control Disorder and bipolar II disorder. Somewhere along the way, I think it became evident that actually all of those other diagnoses were true to some extent or another and that they all fit nicely together like a puzzle into a diagnosis of borderline personality disorder.

Since the point of diagnosis, I have been hospitalized a number of times, each with varying degrees of benefit, been seen by a number of psychiatrists and a couple of therapists—two of which “fired” me as a client because of my BPD behavior.

My BPD diagnosis came during one of my many hospital stays. When I found out that I had been christened with the borderline diagnosis and had it become part of my permanent mental health record, there was a sense of confusion, dread and relief. The confusion came from trying to figure out how someone who had only known me during a seven-day psych hospital stay had determined in that small amount of time had settled on a diagnosis as complex as BPD.

The dread came from knowing just a small bit about borderline personality disorder, mainly from what I had read in passing while researching my other diagnoses. I read that BPD was a mess to treat, that most professionals didn’t want to have to see people with BPD and that people with BPD were usually seen as treatment-resistant, difficult, overtly hostile and manipulative. Was that really me? Relief came from finally having an answer. For so long, I had struggled, along with those who loved me, to figure out why it was that I kept falling into the same pattern of what most labeled an “oversensitivity” to little hiccups in my life, which led to me to “making mountains out of molehills,” pushing and shoving people out of my life abruptly, cutting myself, becoming suicidal and then frantically trying to repair the damage I had done to my relationships with others by apologizing profusely, saying I would never do it again and making the other person promise not to leave me.

At the point of my diagnosis with BPD, in hindsight, I can see how the diagnosis was developed. I met the required five (or more) of nine diagnostic criteria needed for the borderline diagnosis. Extreme reactions – check. Pattern of intense and stormy relationships– check. Distorted and unstable self-image – check. Intense and highly changeable moods – check. Chronic feelings of emptiness and/or boredom – check. Inappropriate, intense anger or problems controlling anger – check. Recurring suicidal behaviors – super double check. Throw in all the self-harm I was doing and it was a diagnosis that fit.

For as relieved as I was to be able to be able to look on paper at the checklist of my symptoms and finally be able to say, “Yes, that is me,” it certainly didn’t open the doors to any sort of magical cure or pill or treatment I was hoping so desperately would come with the diagnosis. What it was met with though was a very honest explanation to me by a doctor (who I now know was completely out of line) that *if* treatment could work for me, I probably would never be “fixed” because of how extensive my symptoms were (in particular, the self-harm and suicidality) and any recovery that was possible would take years. In my mind, I didn’t have years. I was too suicidal to place bets on having years to work with. And I had a psychiatrist who was pretty pessimistic that I could be helped anyways, so really, what was the point of trying to stay alive, right?

I was fortunate that after many years spent circling around the mental health care system, I found a therapist who believed I could get help and knew how to point me in the direction of DBT. I started an intensive Dialectical Behavioral Program, participated in that for just over 12 months, got set up with a new psychiatrist and was put on medications that helped with the depression, anxiety and other symptoms. The belief my therapist had in me, the tenacity that those at the DBT showed even in those times I was the most difficult to work with, the unwavering love from family and friends and my own hard work has gotten me to where I am at now. I have the skills from DBT needed to manage my emotions more effectively, better awareness of when I am slipping into relapse with my self-harm issues and I have a support system around me that now knows how to help me better when I am at my worst times and at my best.

But now, if you look at the list of diagnostic criteria to have the diagnosis of borderline personality disorder, I don’t quite fit into them anymore. Do I have periods of anger, yes, but not to the extent as I used to. Feelings of emptiness? Again yes, but that comes from the continued bouts of depression. I have not self-harmed in over six months with barely any urges to do so. The fears of abandonment are still an issue for me and now I have the ability to speak openly to people about them instead of the frantic grasping for reassurance that they wouldn’t leave me, like I used to do before. I no longer have the five of nine benchmarks needed for the diagnosis of having borderline personality disorder.

What happens now? Am I now cured? Is this like substance abuse where I am in “recovery” from BPD or like cancer where I am in “remission” or a “survivor” of BPD? What happens when you lose the cornerstone diagnosis that has consumed so much of one’s life for so many years?

I have yet to figure this out. The last six years have been an emotional rollercoaster, not only for me, but also for my family, close friends and those mental health professionals who have stood steadfastly beside me through all of this. And while I wouldn’t want to go back to the chaos that was the last six years, I also feel a sincere sense of loss over having “lost” my diagnosis of BPD.

The BPD diagnosis had a huge impact on my life. For many years, my life revolved around treating my mental health condition. While relapse is always on the radar as something to be cautious of and attentive to, living and fighting with the constant barrage of BPD symptoms is now something that has taken a back seat to all of the hopes, dreams and goals I now have.

By getting better and controlling my BPD symptoms, I have now lost the criteria that gave me the borderline diagnosis in the first place. I somehow feel like I have lost a piece of the puzzle that made me…well, me. There is a grieving that I wasn’t prepared for and still unsure how to process. Don’t get me wrong, I am glad I am no longer in the place that I was emotionally for the last six years and some may find my sense of loss as odd, but it is certainly there and I have yet to figure out what to do with the conflicting thoughts and feelings it has brought up. I am stuck in this place between a sense of pride in all the hard work I put in to making me better and feeling like I lost something really important in my life. A blessing wrapped around the grief of letting go of the diagnosis I grew to embrace is the best way I can describe it I guess.