The cover story of Psychology Today this month, “Diagnosed In Adulthood,” made me think back to the timing of my own diagnoses. They all came in adulthood, in my late twenties: anorexia, major depressive disorder (with the modifier of with psychotic features added later), and borderline personality disorder.
This was 1990 and we had never heard of borderline personality disorder. Depression, yes. Anorexia, yes, but BPD, no. There was no internet to turn to, no way to research this diagnosis. We had to take the doctors’ word. Even though I was 29 when I was diagnosed with BPD, the team of the psychiatrists on the acute unit to which I was admitted following my second suicide attempt spoke to my parents and not to me. My mother didn’t tell me this until many years later, but the psychiatrists had told them the prognosis was poor and not to hope for much.
An article that discusses the life span of individuals with borderline personality disorder states, “Until around 1990, therapeutic nihilism prevailed concerning the treatment options of BPD. Since then, beneficial effects have been demonstrated for four comprehensive treatments: dialectical behavior therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), and schema therapy.”
It looks as though I was right on the cusp. The psychiatrists’ prediction to my parents reflected the therapeutic nihilistic thinking that accompanied the BPD diagnosis right up until around the time of my diagnosis. However, if it weren’t for their actions, in the form of their treatment plan, my future might have looked very different. They arranged for me to be transferred to New York Presbyterian Hospital in Westchester which housed two long-term BPD units. I was admitted to the one that utilized intensive DBT (dialectical behavior therapy) as its treatment model.
The same article states: “BPD in young adulthood predicts a host of negative outcomes across the life span, including mood, anxiety, eating and substance use disorders, increased risk for physical illnesses and medical care, reduced quality of life, and reduced life expectancy. As a consequence, many BPD patients never manage to fully participate in society.”
Yes, I have dealt with many of these conditions: mood, eating, and substance use disorders, and I am still wrestling with multiple physical illnesses and the need for increased medical care. However, I work full-time and have a fairly active social life, or as much as I care to. I also enjoy spending time alone, to write, recharge, for inspiration and to spend time with my dog, Shelby.
Source: Time Magazine
The negative connotations continued, though. In January 2008, Time magazine posted this headline on its cover: “Borderline Personality: The Disorder That Doctors Fear Most.” The article within summarized individuals diagnosed with BPD as follows: “Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide — an extraordinarily high suicide rate (by comparison, the suicide rate for mood disorders is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them — yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise.”
By 2008, when the Time article was published, I was three years into transference-focused psychotherapy, or TFP. I’d just emerged from a severe depressive episode that necessitated my then psychiatrist, Dr. Lev, hospitalizing me six times in 18 months due to my detailed suicidal plans coupled with intent. TFP treatment generally lasts about two years; I worked with Dr. Lev for 11. In 2008, Dr. Lev had insisted I go back to work even if it was part-time. I recall her saying that she doesn’t treat patients who remain stagnant. I was so terrified of losing her, I would have done anything she told me to do.
In TFP, the therapist uses a combination of clarification, confrontation, and interpretation, but the focus is on the patient’s experience of the therapist. Dr. Lev was extraordinarily skilled at these techniques and although we moved the needle a millimeter at the time, and at times the needle even slid backward, I maintain it was my work with Dr. Lev and TFP that made the difference in my life.
Personality Essential Reads
Today, thinking has shifted, and BPD is more likely to be diagnosed in adolescence. One article notes: “The early detection of BPD in adolescence would permit psychological interventions to be implemented before maladaptive behavior patterns become crystallized and refractory to treatment in later life.”
It doesn’t do any good to wonder what would have happened if times had been different and I had been diagnosed with BPD when I was an adolescent. Would I have wasted three decades going in and out of psychiatric hospitals? Would I have tried to kill myself four times? Would a good part of my adult life have been lost to mental illness? Going there is not productive and I refuse to let myself get caught up in that mindset.
I do want to acknowledge an additional point this article makes:“Typically, specialized treatments are offered rather late in the course of BPD, tend to be costly and lengthy, and available only to a subgroup of BPD patients who do seek help and manage to attend to the treatment setting.” I realize that I’m extremely fortunate to have had access to the different types of intensive treatment I’ve had. When I was on the long-term unit, it was before managed care pervaded every aspect of our healthcare system. When I worked with Dr. Lev, she didn’t accept insurance. She generously lowered her fee so we could work together for as long as we needed to. I also received family support to help pay for our work together. And at times, she let me carry a balance because she knew I would pay her back when I was able. And I did.
