May is Borderline Personality Disorder (BPD) Awareness Month! We want to highlight the experiences of several graduate students who have this disorder, as well as provide some basic information. BPD is often poorly understood (this list of myths about BPD is a helpful resource), so taking a few minutes to learn more about this disorder is a good way to improve your ability to be a mental health ally.
BPD is marked by instability – in mood, emotion, self-image, and behaviour. For most people, the predominant symptom is difficulty regulating emotions, which leads to intense and often overwhelming emotional experiences. Dr. Marsha Linehan, a leading researcher in the field, has described this aspect of BPD using a metaphor:
“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
Research on the etiology of BPD is still in its infancy (see this article for a brief discussion of some of the proposed causes), but we do know that it is diagnosed much more frequently in women and often occurs in cases where there has been past abuse or trauma. As with most mental illnesses, the actual experience of the disorder can vary widely from person to person. In fact, a diagnosis can be made when a person displays any 5 of the following symptoms:
- Strong fear of abandonment
- Unstable interpersonal relationships
- Unstable sense of self
- Impulsive behaviour with the potential to bring harm to the self
- Suicidal or self-harming behaviour
- Emotional instability (e.g., intense irritability or anxiety)
- Feelings of emptiness
- Difficulty controlling anger
- Stress-related paranoia
The label borderline stems from the outdated view that individuals with BPD are at a “border” between two diagnoses: that of psychosis (being out of touch with reality) and that of neurosis (involving maladaptive responses to stress and anxiety). Today, many people argue that it is an inappropriate label for the disorder, especially given that our understanding of the etiology and symptoms of BPD has evolved over time. The label conjures up stigmatizing stereotypes and research has shown that even mental health professionals are influenced by these negative perceptions. In addition, the label does not clearly communicate the key features of the disorder. Both clinicians and clients with BPD have suggested that an alternative label (e.g., “Emotion Regulation Disorder”) would be more descriptive and would do more to promote empathy for the very real struggles of individuals who have BPD.
To get a first-hand perspective on what it is like to be a graduate student with BPD, we talked to Chantelle*, a PhD student in social sciences at a Canadian university.
Thanks for chatting with us Chantelle. Can you tell us a little bit about your mental health history?
Chantelle: I have struggled with mental health issues (now diagnosed as Borderline Personality Disorder) since I was 16 years old. I was not diagnosed with BPD until the very end of my 20s and already in my PhD. I would say that BPD is one of the major forces that shapes who I am as a person, both positively and negatively.
The positive side is that it helps me build resilience, and if not for BPD-related mental health concerns, I very likely would not have sought out the emotion-focused counselling (psychoanalytic approach, DBT, etc.,) that I did. Through this counselling and support, I am much better able to understand myself and those around me, and can work to have positive relationships in many cases. You could say that without the BPD I may not need this counselling, but I think everyone can benefit from a little extra support and guidance with being introspective and empathetic to ourselves and others.
The negative end of this is, of course, the extreme ups and downs, especially when the downs head deep “down the rabbit hole” as I like to call it, engulfing your entire being in a seemingly inescapable spiral of depression, loneliness, mania and general lifelessness. The frequency, duration, and severity of these symptoms varies, and are highly connected to external pressures and levels of stress and anxiety. For me these last anywhere from about 3 intense days or weeks, followed by recovery time to “normalize” because it is so taxing on your mind and body.
But it is not just the major downs that are hard to deal with. The little ups and downs on a day to day basis can be difficult to handle, especially when you are engaging with people who do not know your condition and don’t fully understand you as a person (i.e., my PhD advisor, amongst others). To them I may come off as a bit of a raging lunatic. People with BPD are emotionally stable and rational much of the time, so I feel like people see the times I am down and my resulting reactivity as conscious choices, or as part of my personality. I also thought that’s what it was until I was diagnosed, and learned that I am ultimately “in control” of myself and my behaviour – but because of my disorder, I have additional hurdles to overcome in order to maintain that control over myself and my actions.
And honestly, sometimes these hurdles feel as if they are the size of mountain ranges.
Being diagnosed with BPD was a bit of a relief in some sense – all of this instability isn’t just me and my personality. I am now on a fairly effective course of treatment, or rather “management plan”, so even though BPD has no cure, and no specific treatment for the condition as a whole, I can take solace in the fact that I am not a horrible person because of my ups and downs.
In my earlier years, BPD had more of an impact on my personal life, and less so on my professional and academic life. But as I have gotten older (I am now in my early 30s), it has crept its way into my academic and professional life as well. Handling all of this is still a work in progress, and, as with any other mental illness, some times are better than others. And some aspects of academia make it both better and worse, because pursuing academics is full of ups and downs.
Did your experience with BPD affect your decision to go to graduate school?
C: Not really. I had decided many years ago when I first started my masters degree that I would someday soon go on to do a PhD, and so I set this as my life goal. However, during and following my masters work, my BPD and mental health issues got worse. I believed that finally going back for my PhD might just solve all of my problems. But surprise! It did not. What it did relieve in one sense (giving me purpose), it exacerbated in another (stress, depression, feeling inadequate).
If you could speak to a senior undergraduate student who has BPD and is considering graduate school, what advice would you give them?
C: Don’t rush into it. Grad school is fantastic. It may well be the biggest challenge you have ever faced, but it is worth it. Definitely take some time to get to know yourself as a person, what you want in your life and how this connects to your graduate school experience. Travelling and working for a few years before attending grad school is a very good idea.
Be ready to deal with things you cannot control, ranging from excessive bureaucracy and a lack of transparency with decision making to demands from your advisor and beyond. If you really want to be in grad school, it is a lot easier, but if you are on the fence it makes it substantially more difficult to deal with. Make sure you are making informed decisions (i.e., when and where to go to grad school) and doing what is best for you.
Do not go to grad school because you think you need more letters behind your name for a job.
I would also suggest that if you go into a research-based masters, or any PhD program, that you join a program under an advisor where you can be part of a research group or lab, rather than being an individual student working under an advisor who is not affiliated with a larger research program.
Being part of a group significantly reduces your isolation and provides you with a support network, that you may not find otherwise.
Can you describe some ways that a diagnosis of BPD makes being a graduate student different or more challenging for you, compared to the experience of a “typical” student?
C: As a result of my BPD (and, well, other things in life), I suffer from issues of abandonment. These issues are significantly aggravated by rejection, and grad school is full of rejection – specifically in relation to scholarships, fellowships, and publishing. And you normally don’t get much – if any – explanation for this, which I find to be a huge trigger for feelings of abandonment. Because of my predisposition for this, I find it all that much more difficult to deal with.
Another big issue that I have dealt with would be time lost to the “downs” which can be significant. When you’re in a downward spiral due to BPD, time goes on, and work remains and sometimes even increases, but you can’t necessarily get any work done, so it creates big challenges on that end. I have lost nearly entire semesters multiple times due to situations where I couldn’t get anything more than minimal amounts of work done because of my BPD, particularly in research stages where work and deadlines are much more flexible than when you are doing course work.
Has BPD affected your relationships in graduate school (e.g., professional, supervisory, or with your peers)?
C: Well, I haven’t told my advisors that I have BPD. I haven’t been able to bring myself to do it because I just can’t get comfortable enough to tell them, and I fear they would stigmatize me and have the old “she just needs to pick herself up and get over it” attitude. This is a major issue. When I go into slumps I can’t get any work done, but I don’t have any other explanation for it, so I wind up just avoiding my advisors and acting unprofessionally, which negatively impacts their perception of me and my work. Let me tell you, this really, really sucks.
If you could provide one piece of advice to other graduate students who might want to support their colleagues with BPD, what would it be?
C: Read up on BPD, understand what it is all about and how it can be addressed. Be open and supportive, and ask your colleagues what you can do to support them. I wish I had more advice on this end, but I am at a loss because everyone’s BPD is different, and how it manifests is different each time.
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Chantelle’s responses clearly highlight how having BPD can exacerbate the typical stresses associated with graduate school (e.g., dealing with rejection and navigating supervisory relationships). The experience of having graduate school drag on longer than average because of frequent downtime which interferes with productivity is also a frustrating aspect of dealing with BPD.
Do you have BPD or are you close to someone who does? What would you add? What advice would you give to graduate students who want to support their colleagues with BPD?
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