The Analogy That Helped Me Understand My Borderline Personality Disorder

I’d been in the emergency room for nearly 12 hours. I’d behaved recklessly and impulsively the night before, set off by a series of the tiniest offenses, and a concerned friend had brought me to the ER. The psychiatrist came in and pulled up a chair. He told me warmly that he’d read my file, he knew my history, my diagnoses, my trauma, my struggles to find the right combination of medications to treat my borderline personality disorder (BPD) and major depressive disorder (MDD) with mixed features.

He asked me how much I knew about these illnesses. I told him I’ve read lots, done research. And then he gave me the analogy that made my whole life make sense.

In people with BPD, he started, the amygdala — the part of the brain responsible for our emotional responses — is very active. And the prefrontal cortex — the part that tempers emotions, controls urges and makes decisions consistent with our goals — is underactive. The psychiatrist shifted in his seat to lean forward and look me in the eye. “It’s like you’re driving a car with a very sensitive accelerator; the slightest touch makes the car race forward, but the car’s brakes are unreliable.” As he described this, I pictured my whole life as racing along a rocky ledge, pumping anxiously on failed brakes, like a scene from an action film.

This analogy resonated with me. In my dozens of visits to emergency rooms and dozens of conversations with psychiatrists eager to move on to the next patient, nobody had ever made my diagnosis make this much sense to me. I could see how it had played out in my life story. I felt affirmed and known just by hearing the doctor explain it. My whole life, I have been a recipe for disaster, always about to careen out of control, uncertain I’ll be able to apply the brakes in time. A thousand times a day, I use the skills I’ve learned in therapy and carefully steer myself away from the cliff, but when I don’t, the crash is big and catastrophic.

It’s affirming to know I don’t experience emotion the same way other people do. My whole life, I’ve been told I am too much; too dramatic, too sensitive, too emotional. But I have not been over-reacting my whole life to an ordinary amount pain; I’ve been reacting as anyone would to extraordinary amounts of pain.

It’s affirming to hear my “brakes,” so to speak, are unreliable. It’s what I’ve known my whole life, that sometimes my feet take me places I don’t want to go, that I find myself catapulting in a direction I cannot seem to stop, has been put into words I can grasp.

And it gives me hope, as I continue to learn new skills and techniques, that those brakes can become more reliable. But in the meantime, it reminds me to be patient with myself. The occasional crash is not a grave personal failure; it’s the natural outcome of a too sensitive accelerator and brakes that don’t work. For the first time in a long time, I left the emergency room feeling known, understood, and hopeful.

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Thinkstock photo via pecaphoto77

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