Borderline personality disorder (BPD) does not mean crazy. It's also not solely reserved for psychopathic serial killers in murder dramas.
It's a mental health condition which around one in every 150 in the UK people live with - whether they realise it or not.
"When people say ‘you've got a split personality’, borderline personality disorder is what they really mean, not the common misconception of being schizophrenic," says Dr Adrian Lord, psychiatrist at The Priory Chadwick Lodge.
"If there is someone with borderline in your family, office or friends circle you will know it believe you me. But you - and even they - might not realise that is what it is.
"They will be the daughter, boyfriend, or colleague who seems so moody and unpredictable, so charming, so entertaining and beguiling yet so infuriatingly difficult to know and be close to. Never short of a strong opinion themselves, they will also divide opinion and be either loved or loathed by others."
He continues: "Demanding, capricious and intense in relationships, you will be in turn exhilarated and exhausted if you have a partner with borderline. You may never be quite sure of where you stand and the constant crises will have you wondering if the upsides of the relationship are worth the pain."
Ian Kay has suffered from OCD for 10 years. He was diagnosed with the condition aged 13, and then developed depression shortly after. In 2013, doctors identified Ian as having BPD.
"I have distorted and unstable self-image," he says. "I will often tell myself I am worthless and that no-body loves me. I will constantly seek reassurance from others on how I look.
"I feel like I lose touch with reality. There are days when I feel confident about who I am but then others when I feel evil or don’t exist. Some days I don’t get out of bed because I’m unable to cope with the day ahead, I know if I do, it will just be another painful self-destructive day."
Ian made a short film about living with BPD as part of an initiative with the youth campaign charity Fixers
Dr Lord says the key difficulties those suffering from BPD have are controlling their emotions and the subsequent behaviours.
"They have the same, but much stronger emotional responses to any given situation than the rest of us. They also take much longer to return to baseline again. So they may feel, anger and rage or sadness and loss much more intensely and for longer.
"And this can overwhelm the usual behavioural controls and inhibitions. Urges and impulses can burst through their shackles and result in self-harm, or inappropriate rudeness, hostility or even aggression."
According to Dr Lord, the cost in terms of damage to interpersonal relationships is "inevitably high" - and there's an even darker side. The suicide rate can be anything between four to 10% in sufferers.
Ian says he has attempted to end his life three times, and has self-harmed on numerous occasions.
"I feel I become unpredictable because I’m not able to control my overwhelming emotions," the 23-year-old explains. "I have days where I feel suicidal with despair, and then feel reasonably positive within the new few hours."
Symptoms of BPD
"The first step is to understand what your diagnosis is," says Dr Lord. "This in itself is often great relief to sufferers, to know that what they’ve got is a recognised condition and that there is indeed help available."
- Sudden mood swings? Tick.
- Dramatic, impulsive, reckless behaviour? Tick.
- Hypersensitive? Extreme emotional reactions? Tick.
- See everybody as all good or all bad, no shades of grey? Tick.
- Intense, roller-coaster relationships; either bliss or war, no in-between? Tick.
- On a self-destruction mission, self-harming? Tick.
- Feel numb, hollow, and empty inside? No sense of who you are? Tick.
- Mr or Mrs Angry? Tick.
- Constantly in some sort of crisis or other? Tick.
- Desperate for a loving, close relationship yet always seem to screw up and get rejected and abandoned? Tick.
"I recently was working on a monologue, and a dear friend helped me prepare the piece, and it was all sorted," Ian continues. "The following day I worked on it for eight hours, I become so frustrated, tears rolled down my face but I couldn’t stop going over the monologue.
"I felt like I wasn’t good enough and nothing I did would have been enough, so I kept going over it to make it enough. In the end I physically hurt myself because I wanted to stop the emotional pain. I wanted to feel that I was a good actor, but all I kept thinking I was incompetent."
Ian's condition has also led him to be "out of control", resulting in police intervention.
"Several times I’ve had to been restrained to stop hurting myself and others. I then feel overwhelmed with incredible guilt, I start to believe I’m a bad person and shouldn’t be in this world.
"The police have been called because I’m out of control. I was handcuffed and placed in a cell. I was incredibly scared, lonely and I can remember crying while in the cell and banging my head. I tried to explain to the police I have BPD and they just said ‘it’s not an excuse’.
"I wasn’t trying to make an excuse I just wanted them to understand and help me."
But having BPD isn't just about learning to cope with the condition. Sufferers also regularly encounter stigma and prejudice.
"A lot of reports that come out about people with BPD are about murderers and rapists," says 23-year-old Rachael Johnston. "It's trying to battle what people perceive against what is actually true.
"It's important children and adults are given the chance to ask questions [about BPD] otherwise they would never learn."
Rachael speaks about her struggle with BPD
Ian agrees, adding: "BPD is incredibly stigmatised due to the lack of knowledge people have about the condition. I read in an article BPD is common within prison, again this reflects BPD as something negative, and as a result of suffering from BPD they end up in prison.
"When I’ve had conversation with my friends and mention ‘Personality Disorder’ they automatically think you have a split personality, and two different people are trapped inside of you.
"A lot of the time when I get overwhelmed with emotions, I often get called childish because you behave in a way a child would respond.
"For example, if I needed to find a letter that I’ve misplaced in the house, I would behave the same as a child would if they wasn’t allowed a sweet. It’s like expressing emotions in an exaggerated and theatrical way, which to other people can be seen as attention seeking. For a lot of people and even my friend they find this incredibly hard to deal with."
Dr Lord is keen to highlight the flip side of "borderlines", as they're known. "They are often incredibly creative, artistic, and inspiring, charismatic people to be around. They may contribute works of genius to the fields of art, music and literature. They burn brightly like shooting stars – the trick is to help them not burn out."
Ian is currently on a foundation acting course at the Academy of Live and Recorded Arts in Wigan, while Rachel has set up her own mental health charity, and visits schools to educate youths about BPD.
Three quarters of sufferers improve after only a few years after diagnosis and are able to manage and control their emotions and behaviours much more effectively, and have stable relationships and occupations.
As Dr Lord succinctly puts it: "A life worth living."
How can you help someone with BPD?
- Listen actively, validate and be sympathetic. Trying not to be judgmental even if you disagree with what they saying.
- Focus on emotions rather than the words. BPD sufferers struggle to make their feelings and needs clear verbally, communicate more by raw emotion and body language. Often what they’re saying seems incongruent and irreconcilable to the rest of their presentation. This can be infuriating and can provoke us into judgments. Try to set this aside, try to make the person with BPD feel heard, even if what they’re saying is totally irrational.
- Try and stay calm when your loved one is acting up and infuriating you. Walk away from arguments and take time space to calm down – being defensive and trying to win the argument will only escalate their anger - and yours. Recognise that this can be the hardest thing to do when confronted with seemingly irrational, unfair, and harsh criticisms or accusations.
- Try to soothe and distract them when they’re emotional and you can see it is starting to build up. Suggest a calming, soothing, diversionary activity perhaps.
- Set clear, mutual limits and boundaries within your relationship. For borderline people, having clear and fair boundaries and structure can be enormously helpful in enabling them to gain control over their emotions and behaviours, bringing some order and stability to where it was once chaos and unpredictability.
Setting limits and boundaries creates consistency of responses to given situations and behaviours. This builds a sense of containment, trust and respect within a relationship. Putting in boundaries, setting limits, and creating structure is not easy and may initially make matters worse before they get better. It’s really important to stay firm and ride out this phase - if you cave in, it reinforces problem behaviours. Stick with it, and if the boundaries are consistent, fair and appropriate, the dividends for the sufferer and indeed all those around them, are manifest and abundant.
Useful websites and helplines:
- Samaritans, open 24 hours a day, on 08457 90 90 90
- Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
- Young Minds offers information to young people about mental health and emotional wellbeing
- HopeLine runs a confidential advice helpline if you are a young person at risk of suicide or are worried about a young person at risk of suicide. Mon-Fri 10-5pmand 7pm-10pm. Weekends 2pm-5pm on 0800 068 41 41
- HeadMeds - a straight-talking website on mental health medication