People with borderline personality disorder (BPD) have big feelings. This isn’t a character fault, or a pathology (in fact, big feelings, when they're appropriate, can add great richness to life). But it can be hard to manage these intense emotions, and they can lead a person to think of themselves as broken or disabled.
In part, this happens because people with BPD are vulnerable to feelings of dysphoria, which is basically the opposite of euphoria. This feeling is kind of like an intense combination of depression and anxiety. It makes you feel as if everything is just really, really “wrong.”
Dysphoria is a particularly unpleasant emotional state, which crops up quite often (sometimes daily, or near daily) for people with BPD. Dysphoria also causes a lot of confusion: “if I’m feeling this badly, then something must be really wrong…” It can lead the person to believe that they have social anxiety, or that they have PTSD, or bipolar disorder or another mental health condition.
While people with BPD certainly can have other conditions as well, the reality is that many people with BPD self-diagnose, or worse, have mental health practitioners suggest another condition that is not an accurate or official diagnosis, such as “complex-PTSD”. In some cases, mental health practitioners suggest diagnoses that they’re not even qualified to make!
When the person then seeks treatment for that condition, unfortunately, their symptoms don’t improve. After all, if the person doesn’t actually have a given condition, then a treatment developed specifically for that condition probably won’t help very much. Then, when the person’s dysphoria continues, they understandably, but unfortunately, might conclude that therapy doesn’t work.
The reality, however, is that dysphoria is a frequent and intense emotion for people with BPD. In order to reduce it, the person needs to work hard on distress tolerance and emotion regulation. They also need to work hard on their cognitive distortions. You can think of cognitive distortions as untrue and unhelpful thoughts, which cause a person to feel upset. Everyone has them (regardless of what mental health diagnosis the person may or may not have), and cognitive distortions lead to distressing and unnecessary emotions…like dysphoria, depression, anxiety, and perhaps fear and anger.
Another risk for people with BPD is somatization-which is a person’s tendency to experience dysphoria and other negative emotions ‘in the body,’ in a very physical way. This might take the form of chronic pain, health-related anxiety, or heavy physical fatigue. Understandably, then, a person who experiences a lot of somatizing might conclude that their illness is physical or medical. They might even become fixated on their physical health concerns to the extent that these physical symptoms ‘take over’ their thoughts. Because these thoughts become such an obsession, the person might start to wonder if they are physically disabled…creating more anxiety and fear.
In and of itself, BPD is challenging enough, without the added worry of another mental health condition, or a physical illness or disability. It is important for people with BPD and physical symptoms to cultivate and hold “good” thoughts—thoughts that are optimistic, focused on gratitude and possibility, etc.—so that negative or despairing thoughts don’t take over. Honestly, this is an important practice for everyone!
For most people with BPD, the first step towards healing is to accept that they have borderline personality disorder, and that this is likely their primary diagnosis (a primary diagnosis is the mental health condition that impacts a person’s life and functioning the most significantly. The primary diagnosis should be considered the highest priority for treatment and therapy). When individuals stay “stuck” on the idea that they have another mental health condition, and especially if they are in ‘denial’ about the primary diagnosis of BPD…they really do stay stuck, in many, many ways. Accepting that you have BPD does not mean that your diagnosis is your identity, or that you won’t be able to improve your life or your mental health because you have a “personality disorder.” To the contrary, that’s where the most meaningful and important work of psychotherapy lies: in personality development, and deep, intentional, and courageous personal growth. That work is a lot easier when we find ways to let go of the stories of “stuckness,” the stories that we can’t change, grow, or heal, or improve.
“Disability” is a very important word, and idea, to be clear about. It is pretty common in the field of clinical psychology for people to ask if they have a disability—for example the type of disability that would qualify for a disability tax credit, or a disability financial assistance program. For people with BPD, there are a few motivations for this:
- Because people with BPD experience such big feelings, at times their emotions can feel incapacitating, and they might feel incapable of doing certain things in life (for example, they might feel incapable of handling social situations, such as a workplace).
- Anxiety and distress can feel very physical and lead the person to believe that they have a medical condition—understandably they may wonder if that medical condition would be eligible for disability status.
- People with BPD often have a lot of negative thoughts and feelings towards themselves. This tendency can make them doubt their own ability to take care of themselves, and understandably makes them wish for another person or entity to take care of things for them (such as providing money for rent, cost of living, etc.). Some individuals with BPD see disability status as a means to be taken care of, in this regard.
- There is a “victim mentality” that affects some (but not all!!) people with BPD. Often these individuals have had hurtful, negligent, or even traumatic experiences in childhood, which plant the seeds of this mode of thinking. This victim mindset can lead them to believe that some form of compensation is owed.
All of these modes of thinking are understandable, but very unhelpful. They are “stuck thoughts” that quite literally block the peron from moving forward in their life. These thoughts hinder the person from taking ownership and control of their own life, and from facing the challenges that will allow them to thrive.
At the end of the day, it is a psychologist’s responsibility to be reasonable, and maintain a reasonable sense of belief and optimism for their client. A competent psychologist will strive to understand you well, and accept you as you are. They will also understand that BPD is not a disability. In fact, there are very few mental health conditions that would be classified as disabilities and, as we’ve written about elsewhere, there’s a big difference between the word “disorder” and the word “disability.” Your psychologist will understand this difference, and work hard to help you.
It is very important that we all work together to get rid of the stigma around mental health, including borderline personality disorder. To truly support those with BPD, it is important that we declare, loudly and clearly: borderline personality disorder is not a disability!