The Key to My Recovery From Borderline Personality Disorder
What does full recovery from borderline personality disorder (BPD) look like?
No more self-harm, no more suicidal ideation and suicide attempts. A stable sense of self and not feeling as though I am mired in chaos. The words abandonment and rejection have absconded from my vocabulary. Attached to anger is the modifier of appropriate. Black and white have melded into grey, and impulsivity has tempered toward thoughtful.
I’ve achieved that and more.
In Mary Zanari’s 10-year longitudinal study of patients with BPD, she found that overall, 93% of participants attained a remission of symptoms lasting at least two years, and 86% attained a sustained remission lasting at least four years. However, that number dropped to 50% when she added good social and vocational functioning to remission of symptoms.
I’m not married, nor do I have children. My brother is my best friend (both of our parents are gone) and I have close friends from various activities in which I’m involved. Friends from different writing groups I’ve been a part of, friends from an entrepreneurial venture which I launched last year, friends from my previous job, from my current job and other friends I’ve picked up here and there.
The thing is, I’m an introvert by nature, a definite eight out of 10, where 10 is staying hidden from society. I’ve always lived alone and I need massive amounts of solitary time to recharge after spending time with people. I always thought I was some kind of “freak,” until I read the groundbreaking book by Susan Cain, “Quiet: The Power of Introverts in a World That Can’t Stop Talking,” which made it acceptable, even desirable, to be introverted.
I graduated with my master’s degree in social work in 2000. Except for a period from 2006 to 2008, when I was dealing with a severe depressive episode during which I endured multiple psychiatric hospitalizations and a course of electroconvulsive therapy (ECT), I’ve been working full-time as a licensed clinical social worker since graduation.
I entered therapy for the first time several years after I graduated college, in the mid-1980s, for “relationship issues” like half of New York City. I soon discovered I didn’t even know what a feeling was. My therapist’s office was on the Upper West Side of Manhattan and she took the entire month of August off and headed for the Hamptons. Two years after I started with her, I fell into a deep depression and two years after that, I was hospitalized for anorexia. I wasn’t diagnosed with BPD until 1990, after my second suicide attempt. I’ve made four suicide attempts in all and I’ve been psychiatrically hospitalized between 20 and 25 times. I stopped counting at 20.
I remain on medication and will for the rest of my life. Depression is hard-wired into my DNA. My father was depressed and an alcoholic, medicating his depression with Johnnie Walker Red while I was growing up. Once he stopped drinking, he retreated from the world. He also likely struggled with undiagnosed schizoid personality disorder. Per the DSM-5 criteria for schizoid personality disorder, the individual must have a persistent pattern of detachment from and general disinterest in social relationships, and limited expression of emotions in interpersonal interactions. Additionally, other criteria can include strong preference for solitary activities, no desire for or enjoyment of close relationships, including those with family members, and enjoyment of few, if any, activities.
I was in individual therapy for a long time, 33 years. Much of that time was spent chatting during ineffective therapy. I didn’t know the difference. I was also very ill, more ill than I think a few of my therapists realized. My last therapist was also a psychiatrist and specialized in transference-focused psychotherapy (TFP). She said although I didn’t meet the criteria for full-blown schizoid personality disorder like my father likely did, I did for a good part of my life, display some schizoid traits.
How did I overcome all this to fully recover? By layering two types of evidence-based treatments for BPD. Following my diagnosis in 1990 and during the pre-managed care era, I was admitted to a long-term unit in a psychiatric hospital in Westchester, NY that treated only patients diagnosed with BPD. The unit focused on utilizing what was then a relatively new treatment called dialectical behavior therapy (DBT). It was a totally immersive environment and for the 10 months I was there, I ate, breathed and slept DBT.
We had multiple skills group every week, coaching sessions, individual psychotherapy sessions and every night we had to fill out a DBT diary card for homework and review it in our first group of the day the next morning. There were also informal skills support from the community and the staff.
When I was discharged from that unit, I went to a DBT day program for six hours a day which was run by the same hospital. Many of the staff from the inpatient unit had moved over to run the day program so I felt comfortable there. I stayed at the day program for 18 months. Having built a solid foundation, I continue to use my DBT skills to this day. There are some I find myself using more often than others, and they generally fall into either the mindfulness module (breathing, wise mind, non-judgmentally) or the distress tolerance module (self-soothe, radical acceptance, pros and cons). I find each time I use one of the skills, I learn something new. I sense a shift in the way I view my challenges and my perception of them.
The key to recovery for me, though I didn’t know it at the time, was starting TFP with my doctor in 2005. I met her through a chance referral by a group therapist for a medication consultation, not necessarily for therapy. After that first meeting, the doctor asked me if I wanted to enter therapy with her. She was an imposing figure, sitting tall in a black leather chair with her feet up on a matching ottoman. She spoke with an Eastern European accent. Part of me was intimidated by her and I wondered how therapy would work if I felt that way. I also realized she was whip-smart and I knew at a deeper level this was an opportunity I couldn’t pass up.
TFP is based on the relationship — or the transference — that develops between the client and the therapist. The premise is the therapeutic relationship holds up a mirror to every other relationship in your life. As you and the therapist work on the issues that arise over the course of the transference, breaking down defenses and integrating the self, those insights carry over to the other relationships, and they improve as well. I was even able to resolve relationships with my parents — my mother who had passed away before I started with this doctor and my father who died while I was in therapy with her.
I was in TFP for 11 years (twice a week for at least nine years). TFP is a psychodynamic treatment as opposed to DBT, which is more of a here-and-now treatment in which learning coping skills is the focus. In TFP, I explored events, feelings and thoughts from my childhood and delved into my unconscious, retrieving painful memories that had been buried for a reason.
Though TFP is psychodynamic in nature, don’t confuse it with psychoanalysis. The therapist is active in the process, asking questions, making interpretations, commenting, responding and confronting, if necessary. I never worked so hard in therapy as I did working with that doctor. Over the 11 years, the intensity of our work was shaped like an arc, rising slowly for the first seven or eight years, then peaking during years nine to 10, then plummeting almost straight down during year 11 as I prepared for termination. For most of the 30-plus years I’d been in therapy, I thought I would never be able to function without having that once-a-week appointment, but at the end of 2015, I was the one who said to my doctor I was ready. We spent the entire year of 2016 terminating.
When I talk about layering treatments, I say that because the entire course of TFP was so intense I could not have tolerated the powerful breadth of emotions evoked in treatment if I did not have my DBT skills to fall back on. The verbal exchanges and the agonizing feelings they awakened would have certainly resulted in self-harming behaviors, restricting and suicidal ideation in the past, but because I had the foundation of DBT skills, I was able to use those instead.
Although I credit TFP and the work my doctor and I did together with saving my life and giving me a life worth living, it was ultimately the layering of TFP and DBT that gave me the ability to achieve full and sustained recovery from BPD.
You can follow my journey on BWellBStrong.
Original photo by author