Welcome to day five in the #AtoZChallenge. When thinking of a topic for the letter E post, I was thinking of how popular yesterday’s post on depression had been and how it had helped destigmatize mental health. I thought of doing today’s post on another mental health topic. Emotion regulation disorder is the term sometimes used here in the Netherlands to describe a condition that’s still formally called borderline personality disorder. As BPD is neither borderline (bordering on what?) nor a personality disorder (in that there is very effective treatment for it), I think this is appropriate. Besides, emotion regulation disorder is a lot less stigmatizing of a word.
My husband asked me, after hearing what my first four posts had been about, whether I’d be making my letter E post about something positive. I said “No”, as mental illness isn’t generally seen as a positive thing. Indeed, I’m still feeling pretty depressed and this may be why I chose this topic. However, the stigma associated with mental illness can still be worse than the illness itself. If I can help remove a bit of that with this post, I’m happy.
I was diagnosed with borderline personality disorder in 2013. I didn’t like it. This diagnosis replaced two other conditions I’m pretty sure I do have as well, namely dissociative identity disorder (DID) and PTSD. I was told that BPD is a trauma-based condition too and that dissociation really runs on a spectrum from BPD to DID. This is true, but I still wasn’t happy about the diagnosis. I had a lot of internalized stigma about it. This wasn’t helped by my therapist, who pretty much assumed my BPD was causing me to make up the DID. Well, I’m not making it up.
My husband didn’t believe I could possibly have BPD. After all, borderlines are known for unstable relationships and he had been my first boyfriend. Then again, there are nine different criteria to BPD and one only has to meet five of them to qualify for a diagnosis. Symptoms I most definitely do have include an unstable self-image, dissociation and stress-related paranoia, fear of abandonment and self-harming and suicidal tendencies. I can also have bad anger issues and react impulsively. In fact, the only criterion I’m pretty sure of I don’t meet, is the one about unstable relationships. People who do meet this criterion, often engage in what is called “splitting” within the BPD community. They alternate heavily between idealizing and devaluing their favorite person (who can be a partner, but can also be a family member or even a therapist).
In 2016, my diagnosis was downgraded from full-fledged BPD to just BPD traits. I’m pretty sure I’d still meet the full criteria, though not as strongly as before maybe. It is common for BPD symptoms to lessen as a sufferer gets older.
I prefer to refer to my BPD traits as emotion regulation issues, like I said. Not only does this sound less stigmatizing, but it feels more true to what I experience. I do experience, after all, very strong emotional outbursts. These can be of anger, but more recently also sadness or fear. I also find it hard to distinguish emotions and tend to express every strong emotion as anger.
Like I said, BPD, unlike other personality disorders, is treatable. The most evidence-based treatment is dialectical behavior therapy (DBT). DBT combines cognitive behavioral strategies with mindfulness. I tried it last year, but was finding it hard to pay attention in therapy and carry over what I learned from the manual into real life. I do however still try to apply the skills.
A Multitude of Musings 
BPD is so stigmatised! I prefer the term emotional disregulation too to bpd! It sounds better!
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Very informative, I didn’t know about that one at all. Have a pleasant weekend.
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Yes, Astrid, many people can identify with emotion regulation.
Wasn’t it historically the “border” between reality [neurosis] and non-reality [psychosis]? And there was a lot of transient psychosis in the criteria.
And in the last five-six years there has been talk of “types” or “patterns” when it comes to personalities.
Brian, I hope you and the cats have a pleasant weekend too.
How did sadness and fear come into your outbursts, Astrid?
And of course it was interesting when your husband effectively said, “Write a positive thing” for the Alphabet.
I would write about Euphoria or Euthymia – which is, respectively, a very happy mood and the right kind of mood [one that is appropriate to the situation].
And does it have to be a “favourite” person when it comes to idealisation and devaluation? This seems similar to Narcissistic issues.
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Yes, originally borderlines were thought to be on the border between neurosis and psychosis. This was heavily based in the psychoanalytic tradition, which is IMHO complete pseudoscience.
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I agree it should have a far better title and since we never were taught to regulate or be able to contain our own emotions in an appropriate way why be stigmatised for it? I did not know this was another name for BPD. It is a much more useful term. its so painful carrying stigma for things that are not your fault in the first place.
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Emerging from the dark into light: Exactly!
Loved your post about shame and the inner/internalised critic. [and the poem from today as well]. Didn’t realise until late the point about comedy – and then I think of Nanette and Douglas [two Hannah Gadsby shows] – and the whole comedy universe.
The emotional container concept is a good one.
And it’s harder not to stigmatise the teaching and/or lack of teaching. Though if we want society and psychiatry to act differently …
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I feel Psychiatrists need far more education. Many therapists abandon so called borderline patients as they cannot deal with the anger aspect and truly validate and help the person to down scale the anger once the deep hurt or betrayal beneath is faced.
Not all comedy is unhealthy I guess it is a kind of container in a way of poking fun at the ridiculousness of somethings. Its a fine line really. Did you see the recent interview with Hannah Gadsby about her autism diagnosis. It aired this week.
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Agree. I do think we have a responsibility to try to heal, but we cannot help being dysregulated in the first place.
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Yes exactly..
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Thank you for writing such an informative post and for your honesty. I don’t much care for the labels, they make me nervous, but your attitude is so matter of fact that I find it reassuring.
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Learning lots here.
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