BORDERLINE PERSONALITY DISORDER (BPD) is one of the most misunderstood mental illnesses in existence.
Marked by emotional instability, impulsive behaviour and intense and unstable relationships with others, people with BPD are among some of the most likely to self-harm and to attempt suicide.
According to the HSE, the best understanding of BPD is as a disorder of mood and of a person’s ability to interact with others.
Roughly 2% of the Irish population suffer with BPD. The HSE estimates that 60 to 70% of people with the illness will attempt suicide at some point in their lives. And 10% of those are estimated to succeed in their suicide attempt.
Courtney Smyth is a student at IADT in psychology and was diagnosed with BPD last year after spending five weeks in St. Patrick’s Hospital.
Since her time there, she has learned how to manage her condition more effectively. But she still has good and bad days with her mental health.
On a good day, she says that she functions the same as anybody else. On bad days, she can feel so anxious that even getting out of bed is an ordeal.
“Bad days would be that I wake up and feel that I can’t get out of bed… What that actually means is that, physically, the thought of standing up, going out and leaving my house is terrifying.
“It is not that I’m tired or too lazy to do it. And I think people kind of get that confused. When someone says ‘I can’t get out of bed’, it doesn’t mean ‘I’m exhausted and getting up is hard’, it literally means that the thought of leaving the front door is petrifying.
“Since I’ve been in St. Pat’s, those days are not as common as they have been before,” Courtney continues.
But bad days are frustrating, they’re difficult. All I want is my bed and to sleep through it, and it’s a lot of effort to do anything.
Experts agree that there is not one single cause of BPD.
Genetics are likely to affect a person’s likelihood of developing it. Changes in the levels of neurotransmitters in the brain can have an impact on mood and behaviour, and this is also possibly a factor with BPD.
It has also been found that some people with BPD have abnormal structure and function in some parts of their brains. Past events and childhood events are also thought to be an important factor in developing the illness.
When Courtney went to psychiatric hospital, she learned better ways to cope with her BPD, aided by the safe environment of the hospital.
“As soon as I went in there I felt safe… It gave me the headspace I needed to be able to really think about what it was I needed to do and how I was going to go about getting better,” she says.
Like many mental illnesses, long-term treatment is best for treating symptoms.
Dr. Brendan Kelly, a consultant psychiatrist at Tallaght Hospital and Professor of Psychiatry at Trinity College Dublin, says that therapy first is usually the best course of action.
Both can be needed, but the first step needs to be psychological therapy rather than medication. For the most part, psychological therapy is better.
There are different types of therapy used in the treatment of BPD, such as Dialectical Behavioural Therapy (DBT), which was specifically designed to treat people with BPD.
Another treatment that is available is Mentalisation Based Therapy (MBT), which helps people with BPD with their capacity to ‘mentalise’, or to think about their thoughts and to analyse their usefulness and reality.
‘I wouldn’t be here right now’
Courtney got the right treatment at a time when she needed it most. “Honestly, if I hadn’t gone to St. Pat’s, I wouldn’t be here right now,” she says.
“I was at such a distress level when I went in that I needed it. It was literally that that was the only option for me. I was at the point where I couldn’t go to college, I couldn’t go to work. I couldn’t do anything fun.”
As well as high levels of distress, people with BPD often experience suicidal tendencies.
“Getting to a point where you’re suicidal, it just feels like the only way out,” Courtney explains.
“It’s different for everybody, but for me, I needed an escape. I honestly would feel like life wasn’t worth living. I didn’t need to be here, people would be better off without me.
“And I did start to get into this thing of ‘it’d be so much easier for my family if I wasn’t around’, ‘it’d be so much easier for my boyfriend to not have to worry about me’, ‘my friends don’t really care about me’ – all this stuff that wasn’t true, but that I was able to convince myself was the reality.”
For people who suspect they may have BPD, Dr. Kelly says seeking medical assistance is the first thing to do.
“The first step is probably to go to see their GP, who might be able to advise them as to whether or not further assistance is needed,” he says.
“There’s also a primary care service that can offer short term psychological input that people can find very helpful, particularly during crisis periods, and very often Borderline Personality Disorder is characterised by recurring crises.”
There are currently three main treatment centres in Ireland for BPD. St. Vincent’s Hospital in Dublin and Cluain Mhuire offer therapy based on the DBT model. The Endeavour Project in Cork’s North Lee Adult Mental Health Service offers a similar therapy system.
People can only avail of these services if they have lived in the area for at least six months, meaning that accessing BPD specific treatment is a challenge for people with the illness.
Comparing life before her time in hospital to now, things are radically different for Courtney.
“Life before was incredibly difficult and I didn’t know my limits,” she says. “If I was having a good day I’d keep pushing myself to a point where I might not be able to handle it.
So I have to be very balanced now, because I’m aware that I can tip back into having loads of bad days.
I’m having more good days than I have bad days compared to how I was before St. Pat’s. I understand myself a lot better, so if I find myself saying yes to a lot of things I’m able to step back and evaluate and say ‘maybe this isn’t a good idea’… I’m aware of what my limits are.”
For Courtney, the key has been in finding helpful treatment and developing a better understanding of her own mind. While bad days will be inevitable, what treatment has provided her with is an ability to minimise those bad days so that they are outweighed by good days.