Preksha Dutt (name changed), had no idea that she had borderline personality disorder (BPD) until a time came when she was sitting at a railway station, contemplating suicide.
Dutt’s life had come crashing down that morning. The boy she loved claimed that she was “too possessive, too impulsive and nagging,” and was now refusing to answer her calls or even respond to her messages.
He even told people at her workplace that she was “dreamy, lied multiple times, made false claims” and was to be “kept at a distance”.
Her colleagues now behaved differently, and her friends were few and far in between.
Her parents were unable to understand her — she was “too moody to be around” and “absent-minded”. Dutt wasn’t able to understand herself either.
“I looked at people on the station and wondered why I cannot be like them! Why can I not be normal?”Preksha Dutt (name changed)
It was only after three years of therapy that Dutt was able to build a decent support system where she had a few friends she could lean on. But relationships always remained a tricky area for her.
Dutt’s story is not the only one where someone with BPD has trouble forming stable relationships.
People suffering from BPD tend to have extremely intense feelings, impulsivity and mood swings.
As a result, social and personal relationships also tend to be short-term and impulsive, with a marked inability to have a meaningful sustainable relationship in the long term.
Sunil Raj (name changed) shares his story where he ended up “smothering his wife to a point where she got overwhelmed” and started cheating on him with a friend of his.
“It broke my heart to a point where I felt like I didn’t want to live,” he recalls.
“But then again, I wanted to make it work, I am still trying to figure it out,” he adds.
Raj and his wife have been seeing a couple’s counsellor, who made Raj realise how he has been having unrealistic expectations from his wife.
“I can now see where I have been going wrong. I haven’t trusted her fully and I have been too paranoid which has driven her away from me."Sunil Raj (name changed)
We take a closer look at how people with BPD have trouble forming relationships and how it can be worked upon.
The Stigma Attached to BPD
Divya Srivastava, Counselling Psychologist, Founder - Silver Lining Wellness Centre reveals that Borderline personality disorder is associated with immense stigma not just within the general population, but also by healthcare professionals.
“It breaks my heart when I often hear fellow colleagues in private practice stating that they don't like working with clients having that diagnosis simply because they can be "difficult".Divya Srivastava, Counselling Psychologist, Founder - Silver Lining Wellness Centre
One needs to understand that more than 80 percent of people with borderline personality disorder have a history of abuse.
Some block out the trauma they experienced in their childhood, but the impact of their emotional, physical or sexual abuse as a young person is profound and present for many years afterwards.”
Srivastava feels that Amber Heard's diagnosis of borderline personality disorder will only add to the stigma people with these mental health conditions already face.
She adds, “For a long time, mental health advocacy has been trying to delink perceptions of bad or dangerous behaviour being related with mental illness - this diagnosis during a trial will only end up fortifying the stigma we've been struggling to break for decades. Most importantly, this case displays how barriers to justice get erected for those with personality disorders - how can you testify against an abuser if your mental health paints you as inherently unreliable?”
Her view is supported by that of Kanika Soni, Clinical Psychologist, Karma Centre For Counselling and Wellbeing who concurs with Srivastava as she says that BPD is characterised by emotional dysregulation along with other symptoms and is often one of the most misdiagnosed personality disorders.
“The grounds over which the diagnosis has been given in this case is somewhat questionable and seems more like an opportunity to use it against Amber Heard."Kanika Soni, Clinical Psychologist, Karma Centre For Counselling and Wellbeing
"This diagnosis in no way should directly impact the case, because it has nothing to do with it. Honestly the only thing it is doing is stigmatising a diagnosis of BPD even more. This is a clear example of how people use mental health diagnosis in a manipulative manner,” she asserts.
A Difficult Diagnosis
Srivastava believes that BPD is difficult to diagnose because it is not a condition that has been properly understood.
She explains, “BPD is often a debilitating mental illness that makes it hard for someone to control their emotions and impulses.
We use the label to diagnose someone who displays frequent and intense mood swings, fear of real or imagined abandonment, difficulty maintaining healthy personal relationships, impulsive behavior – like reckless driving, unsafe sexual activity or gambling and paranoia – where people worry that others don’t like them or don’t want to spend time with them.”
She shares that 42 international studies of over 5,000 people conducted in 2019, showed that 71.1 percent of people who were diagnosed with the serious health condition reported at least one traumatic childhood experience.
The most common form of adverse experience reported by people with BPD was physical neglect at 48.9 percent, followed by emotional abuse at 42.5 percent, physical abuse at 36.4 percent, sexual abuse at 32.1 percent and emotional neglect at 25.3 percent.
Srivastava believes that As a diagnostic term, borderline personality disorder not only fails to capture any of the underlying issues and mechanisms involved in producing its symptoms, it also paints an unfair picture.
She emphasises, “The term "borderline" was used to describe patients with symptoms that did not fall into the psychosis spectrum nor anxiety or depressive disorder, but somewhere in the middle.
Most people interpret the term, however, to mean that this condition "borders" on being a real illness thereby invalidating the experience of the person who is suffering from this condition.”
In her view, “ the next words that follow – "personality disorder" only amplify the disregarding of the condition as it suggests that there’s something about someone’s personality that’s disordered – especially as personality is, collectively, the intimate and unique qualities that describe a person – and therefore, cuts further into the already diminished self-esteem that people with this condition have.”
Dr Kedar Tilwe, Consultant-Psychiatrist, Fortis Hospital Mulund & Fortis Hiranandani Hospital explains that BPD is also associated with a marked fear of abandonment and insecurity in almost all their relationships which make it a serious challenge to sustain long-term commitments.
He adds that a fear of abandonment with an inability to maintain long-term relationships, a high degree of impulsiveness, sometimes even self-harm behaviour, and poor self-esteem are some of the signs and symptoms of the illness.
Soni remarks, “Relationships for someone diagnosed with BPD may seem like a rollercoaster ride."
"They may view things in extremes and their opinion of people may shift resulting in sudden valuing and devaluing. This results in intense and unstable relationships," she adds.
They may also have attachment related anxiety and abandonment concerns which can make them sensitive and hyper vigilant toward their partners in relationships.
"Being impulsive, easily upset and reactive are few common characteristics which may result in social interaction becoming a challenge for them. according to Dr Soni.
Srivastava provides more insight into the difficulties by bringing in the angle of stigma, “One of the biggest hurdles someone diagnosed with BPD faces is that instead of being looked at as "a person with a problem",
they are viewed as "the problem person". We need to understand that people with BPD have insecure attachment patterns which developed as adaptive responses to the trauma they experienced when they were younger.”
She provides an alternate perspective by sharing that people with BPD can be compassionate, very caring, and very devoted to their partners.
“They are eager to please their partners and spend time with them. However, they are sensitive to rejection and fear abandonment. Many are hyper focused on perceived signs that a romantic partner isn’t happy or may leave them.
When a person with BPD senses a shift in their partner’s feelings, whether real or imagined, they may immediately withdraw.
These switches can be difficult to deal with, but one needs to understand that this may be a common experience for people even with partners who don't necessarily have BPD,” she reveals.
Soni believes that any relationship is challenging and that it's just that different types of relationships need different types of effort.
She shares some aspects one can be mindful of if they are in a relationship with someone who has BPD :
The first step is to learn as much as possible about Borderline Personality Disorder.
Asking about how your partner is experiencing feelings. Take the effort to understand your partner’s feelings and not judge.
Keeping the environment calm, relaxed, predictable and distress free.
When in a distress mode try to remain calm. Do not rush into discussing issues and do it only when you feel the person with BPD is settled and relaxed.
Keep conversations simple and clear.
Create, uphold and assert boundaries to make the relationship healthier.
Incase of self harm tendencies, do take your partner seriously and help them by seeking professional help.
Therapy is a great way to manage symptoms of BPD. So encourage them to seek therapeutic help.
(Divya Naik is a Mumbai based psychotherapist, writer and media professional. She is passionate about women's mental health, especially perinatal and post-natal mental health and works closely with the community of therapists in the network to build on the same.)
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