Why Self-Harm and Outbursts in Borderline Personality Disorder Aren't About Manipulation
One of the most frustrating things about having a diagnosis of borderline personality disorder (BPD) is the stigma that surrounds it, including amongst health professionals. They believe everything I do is in order to get my “needs met” — in other words, every action is to elicit a reaction from another person. This, in particular, includes all self-harming behavior as a form of cries for help or to communicate pain with others, rather than what can be a self-punitive measure or a way to express deep emotional pain with myself.
It became particularly clear to me when receiving dialectical behavior therapy (DBT) that this was the perceived case with myself: psychologists believed I would manipulate others through self-mutilation or extreme emotional responses in order to gain desired responses such as sympathy or feeling cared for. Subsequently, to target such behaviors, the 24-hour rule is implemented in this therapy, which means that if someone with a diagnosis of BPD engages in self-harming or suicidal behavior, they would have no contact with services for 24 hours. What I alternatively found with myself and others is that, instead, people would internalize their pain more, often hiding high-risk behaviors. If it were the case that those with BPD truly self-harmed in the name of “attention-seeking,” then why harm themselves without the knowledge of anyone at all? I came to realize the perception of those with BPD was wrong. That’s not to say engaging in high-risk behaviors in order to gain a reaction from others does not happen, but the disorder is so complex and does not revolve completely around interpersonal relationships.
What I have found is that I am profoundly impacted by emotional dysregulation, in which I feel emotions at their full intensities and that these emotions can change extremely rapidly. It can also exacerbate other comorbid disorders such as anxiety and bipolar disorder. It’s the inability to regulate such powerful and rapidly changing emotions in a healthy way that can cause the greatest strain on my relationships. Given that I am hyperaware of the negative impact that outwardly expressing symptoms can have on my loved ones, it further can trigger that fear of abandonment in the sense of “people will leave me because my mental health is too difficult to manage.” I then must juggle implementing boundaries in order to ensure myself and others are OK, which makes living with my disorder(s) exhausting. Unfortunately, I experience more negative emotions than positive ones, meaning my life feels as if I am physically weighed down by this overwhelming sadness. I live life experiencing this endless and fathomless misery that I never get any respite from. It’s an overpowering sadness that I feel every day, and have felt for a really long time, that there are regularly times that I question why I continue with life. The intensity of what I experience explains why I exhibit so many outbursts so publicly because when things feel too overwhelming, I am already at my maximum capacity for managing.
Therefore, exhibiting symptoms so outwardly does not equate to wanting my loved ones to meet my needs. The hyperawareness I have — of the impact of constantly managing someone always at risk — is so high, that I probably resent myself for being so expressive. I have no desire to manipulate more than the average person because I do not want to strain my relationships with loved ones, and most importantly, my behaviors are a sign of feeling too much emotional distress. My behaviors are a response to extreme emotional pain, not to gain a response. Having BPD, to me, is more about emotional dysregulation rather than the misconstrued theories professionals have that contribute to a damaging stigma.