One of the biggest misconceptions I come across relating to my diagnosis of BPD, or towards my former patients with a range of Personality Disorders, is that a Personality Disorder is not a mental illness. When I worked in a psychiatric hospital, I would hear the following sentence every single day, primarily from psychiatrists and psychologists:

“No, [s]he has a Personality Disorder, not a mental illness.”

I once asked my supervisor, a forensic psychiatrist, about this and he explained it was largely due to personality disorders being a relatively new diagnosis, and only being formally recognised in the Mental Health Act in the 2007 revision (sorry, boring I know!) It also appears to come down to a traditional view of mental illness having an identifiable starting point, such as a clearly distinctive psychotic or manic episode. Further, the responsiveness of ‘traditional’ mental illnesses to pharmacological treatment (i.e. medication) is greater, suggesting a stronger physiological element to their origin. Personality Disorders, however, are often the result of early life trauma and developmental in origin, with maladaptive behaviours being learned and reinforced over many years.

This distinction, between ‘traditional’ mental illness and Personality Disorders, is incredibly stigmatising. With ‘mental illness’ growing to be increasingly understood as on par with physical illness, Personality Disorders have no such respect. Distinguishing them as somehow separate from mental illnesses, coupled with the use of the term Personality Disorder in and of itself, suggests a level of blame to the sufferer. The implication being that instead of an illness, which develops without the individual’s choice or often knowledge, the Personality Disorder sufferer is made to feel damaged at their core, their very being, their personality.

Similarly, professionals, loved ones and friends appear to disregard the diagnosis in its entirety at the sight of challenging behaviours, viewing sufferers as ‘difficult’ or ‘dramatic’. They imply the individual is choosing to behave in such a harmful manner, in order to obtain control and attention or to manipulate.

The reality is far from this. I developed a personality disorder largely because of the behaviour of other people; my father’s violence, my teacher’s invalidation, my peer’s bullying. All of this occurred at an age when I was far too young to be seen as in any way complicit or responsible for such behaviours. These behaviours seeped into my unconscious, teaching me I wasn’t good enough, that love had to be earned, and that all people would eventually leave. I had to develop unconscious behaviours to navigate this dangerous and hurtful world. I learned to stay silent in the face of conflict, to never stand up for myself, to be suspicious of other’s intentions and to punish myself when I felt I had done wrong before other’s got the chance. I was constantly looking for someone who might harm me, be it physically or emotionally, my vigilance to threat continuously heightened. These behaviours kept me alive. As my young brain developed, these behaviours weaved their way into my very neuroanatomy. They became unconscious, beyond my control. My brain changed. It adapted. And now, these adaptations are no longer helpful and are classified as a disorder.

So having this collection of behavioural and emotional symptoms, the very same ones that equate to a diagnosis of Borderline Personality Disorder, is not my choice. I am not trying to manipulate you, I am not trying to make your life harder. In fact, more often than not when I behave in the ways you find difficult, I am scared, scared you will leave me, or hurt me (and quite often I’m unsure which would feel more painful) and I am trying to show you how much I need you.

I would love to be normal. I would love not to feel every single emotion, good or bad, like a spear through my heart. I would love not to spend every moment expecting the people I love to leave me or harm me. I would love to never again feel so unworthy as to take a blade to my own skin. I would love to not feel empty every day. I would love to have a consistent view of whether I am a good person or not. I would love to be able to maintain close friendships. I would love to be able to be around others without feeling paranoid.

I would love that choice.

But I don’t get one.

Lorna

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