The Things I Do For Sanity

Last night, I had a meeting with a therapist at the Sheldon Chumir Medical Centre downtown. It was basically a long interview to see if group therapy would be right for me. It would be a big change in the psychotherapeutic dynamic for me, because, with the exception of my going to a trans support group here in Calgary, I've always had my therapy one-on-one, with little to no structure. Group therapy would be completely different. In addition to having to drop my current therapist (who's been wonderful for me, literally bringing me out of crisis), I might not have much support should a crisis re-occur. I almost never use it, the last time being when my father passed away last year, but I still like the option. We'll see what happens.

So what's this "borderline" thing anyway? Wikipedia describes it as "described as a prolonged disturbance of personality function in a person, characterized by depth and variability of moods". The Simple English Wikipedia actually summarizes it better: "People diagnosed with BPD might have strong mood swings, see things as "all good" or "all bad" (splitting), and be confused about their identity. They might have a lot of trouble with relationships with other people". This was just like finding out I was trans; I always was, I just never knew it. The diagnosis was like finding the last piece of a puzzle I've been trying to finish for years.

What do borderlines go through then? The DSM-IV (North America's mental health diagnosis guide) lists nine symptoms of BPD, of which a minimum of five must be present for the diagnosis to be made. They are:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

Simple English Wikipedia simplifies it a bit:

1. Trying very hard to stop feeling abandoned
2. A pattern of trouble in relationships, often thinking that other people are much better or much worse than they really are
3. Being confused about personal identity
4. Being impulsive in ways that are dangerous (like casual sex, drinking too much alcohol or taking drugs, not eating or eating too much, driving dangerously)
5. Trying to commit suicide, or self injury (like cutting)
6. Mood swings - feeling very happy, sad or anxious, for hours at a time
7. Feeling empty inside
8. Feeling very angry, getting into fights
9. Having delusions or being paranoid

#1 is something I've done; I'll take public transit an hour and a half to the other side of the city to visit someone unannounced if they've suddenly gone incommunicado.
#2 shows its ugly head at work most of all, in particular with my boss. He'll do or say something I don't agree with and I'll stab him in the back to get back at him.
#3 is there; I went from changing to Canadian spelling, to wanting to immigrate to Quebec and being ashamed of being an anglophone, to wanting to keep American spelling when I write.
#4 is iffy; it's hard for a virgin to have unprotected sex, and I don't drink or do drugs.
#5 is a definite have; I have a history of self harm; not that much mind you, but it's still there.
#6 I have big time! My moods will persist for quite a while.
#7 I not only have, but it's been really dangerous for me, making me want to leave Montreal and move to New Jersey, and made me move to Calgary. Even though I have a job, I'm still looking on Monster for job openings.
#8 is triggered both at work and elsewhere. I can yell at co-workers or throw things down angrily when my boss pisses me off, and I can tell somebody off on the street.
#9 happens when I get stressed, and it usually happens at work. I start to dissociate, which is like when everything slows down and it's like watching a movie of yourself.

The one good thing in my situation is that I don't have the disorder as bad as many others do; my arms don't have scarring from cutting, nor have I tried to commit suicide. I have done self-harm though; I hit my head on walls when I was young and I scratched my arm intentionally several times this year in order to bring relief. I also get the occasional impulse to kill myself. I've also somehow managed to not be hospitalized, although I've come close.

Granted, everybody can act a little borderline every now and then, but some of us are more borderline than others.