The Terry Project on CiTR #25: Emilie, Living With Borderline Personality Disorder

In many ways, Emilie is your average twenty-something. But living with borderline personality disorder isn’t easy, and neither is getting the necessary medical attention. Emilie gave us an intimate look into her life on the first episode of our radio diary series.

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Produced by: Chirag Mahajan, Sam Fenn, Gordon Katic

Special Thanks: CiTR’s Duncan McHugh, CBC’s Kathryn Gretsinger, UBC’s Teaching and Learning Enhancement Fund, and the Alma Mater Society.

Background

This episode was produced from audio gathered by Emilie over a period of approximately two months. The tapes were edited for brevity and clarity, but no scenes or sounds were re-created. We did not give Emilie a script. We did very little coaching and gave Emilie full editorial control. Our goal was to let Emilie show you her world on her own terms.

Have questions for Emilie? Email her. She’d love to hear from you.

BONUS: Interview with Joe Richman.

Can the subaltern speak? If so, can we record it? Sam Fenn talks to NPR Producer Joe Richman about the politics of representation and the journalistic ethics of making radio diaries. Check out his radio diaries at radiodiaries.org or subscribe to his podcast.

What is Borderline Personality Disorder? by Sophie Comyn, Research Assistant, Terry Project on CiTR.

Borderline personality disorder (BPD) affects the way in which a person relates both to him or herself and to others and is characterized by rapidly fluctuating moods, impulsive and risky behaviours, and unstable relationships. People with BPD often have an insecure sense of self that can fluctuate rapidly leading to frequent changes in education, jobs, friendships, and life goals. First recognized as a distinct, diagnosable mental illness in the 1980’s, the term BPD remains somewhat of a misnomer as it is based on the brief psychotic episodes experienced by 40-50% of patients that were originally thought to be signs of borderline or atypical versions of other mental disorders. It is estimated that 1-2% of the population has BPD, however, despite advances in our understanding of mental illness BPD remains under or misdiagnosed perhaps, in part, because an estimated 85% of people with BPD meet the criteria for other mental disorders.

Symptoms of BPD usually begin in adolescence or early adulthood and fall into five categories: risky and impulsive behaviour, rapid and extreme mood changes, difficulty in maintaining relationships, an unstable sense of identity, and psychosis. Many patients have co-occurring disorders. Women are more likely to experience depression, anxiety, and eating disorders whereas men tend to have problems with substance abuse or antisocial personality disorder. Approximately 60-80% of people with BPD show suicidal behaviour and upwards of 10% will commit suicide in their lifetime. More than 90% of patients engage in self-harm. The difficulty in maintaining healthy relationships, a hallmark of BPD, may stem from feelings of hopelessness or a fear of being alone or neglected. Patients are often sensitive to real or perceived rejection, failure, or abandonment. Some may go to great lengths to avoid being alone whereas others may react to the fear of abandonment by becoming socially isolated. Although people with BPD can, and do, have meaningful relationships they may perceive and experience these interactions as rather binary and fluctuate between viewing the other person involved in an extremely positive or negative light. While often unable to manage their own negative emotions people with BPD also experience problems in reading the emotions of others.

The exact cause of BPD remains unknown, however, a combination of genetic and environmental factors are thought to be involved. Those who have a family member diagnosed with BPD or an impulse control disorder are at higher risk for being diagnosed themselves as are those who have experienced childhood violence or neglect. Although 75% of diagnoses are in women it is thought that this number is skewed by sampling bias and as such the true gender prevalence is unknown. Diagnosis is made using a thorough interview performed by a professional and based on reported symptoms present since adolescence or early adulthood. The Diagnostic and Statistical Manual of Mental Disorders details nine criteria of which five must be met for a diagnosis of BPD to be made. Although sometimes difficult to diagnose, there is a distinction between BPD and a number of other conditions as a number of the symptoms associated with BPD, such as psychosis and mood changes, are triggered by external events or stressors and are often shorter in duration than those experienced by those with other mental illnesses such as schizophrenia and bipolar disorder. Currently no medication has been approved by the FDA for the treatment of BPD however, many patients are given drugs in conjunction with psychotherapy to help reduce the symptoms of co-occurring disorders such as depression and anxiety. Two of the most popular and effective treatments for BPD are dialectical behaviour therapy and mentalization based therapy. Dialectical behaviour therapy was the first psychotherapy shown to be effective for the treatment of BPD. It involves a mix of individual patient-therapist sessions and group life-skills sessions that focus on: mindfulness, distress tolerance, regulation of emotions, and interpersonal effectiveness. Initial treatment focuses life threatening behaviours such as suicide and self-harm.

Further information regarding BPD is available from a number of sources not limited to those below:

Additional Resources: