Looking Back on 31 Years After My Borderline Diagnosis
Thirty-one years ago, in 1990, there was no Internet and there were no cell phones. It’s hard to remember what that time was like. No social media, no Uber, no Netflix.
Thirty-one years ago, in 1990, I was diagnosed with borderline personality disorder (BPD). I was 29 years old. The diagnosis followed my second suicide attempt. I’d already had a six month and a four month inpatient admission for anorexia at 27 and 28 and the psychiatrists had thrown in major depressive disorder for good measure.
BPD Criteria per DSM-III-R. BPD Criteria per DSM-5
Unstable relationships. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of
idealization and devaluation.
Impulsivity. Impulsivity in at least two areas that are potentially self-damaging.
Affective instability. Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Inappropriate anger. Inappropriate, intense anger or difficulty controlling anger.
Suicidal/self-mutilative behavior. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Identity disturbance. Markedly and persistently unstable self-image or sense of self.
Chronic emptiness. Chronic feelings of emptiness.
Efforts to avoid abandonment. Frantic efforts to avoid real or imagined abandonment.
(added to criteria in DSM-V in 1994) Transient, stress-related paranoid ideation or severe dissociative symptoms.
Neither my parents nor I had ever heard of BPD. The psychiatrists at the hospital to which I was admitted following my overdose told my parents my prognosis was poor and not to hope for much. My parents were devastated. They had to take the doctors’ word as absolute. They saw no reason not to.
From that hospital in Manhattan, I was transferred to a private psychiatric hospital in a suburb north of New York City. That renowned teaching hospital housed a long-term unit specifically for patients with BPD. The staff was trained in a then-new therapy known as DBT or dialectical behavior therapy. I stayed on that unit for 10 months. Managed care had still not infiltrated the country’s healthcare system. Regardless, 10 months was all my insurance would cover.
The opportunity to be a patient on that unit was just one of the few pieces of an arduous and prolonged treatment journey that fell into place 31 years ago. A journey that led to full and sustained recovery from BPD. Yes, recovery from BPD is possible.
When I was discharged from the hospital I simultaneously attended a BPD/DBT day program for 18 months and lived in a 24/7 supervised residence. The staff at the day program consisted of many of the staff from the inpatient unit who had transferred over. These were truly dedicated and compassionate professionals who wanted to work with patients with BPD.
At the residence, the counselor to who I was assigned had also spent time in one of the long-term BPD units. Now she was working and attending nursing school. She was an early role model for me for BPD recovery. I lived there for three years, becoming so dependent on my counselor, they had to formally ask me to leave.
What does recovery look like and how did I get there?
I’ve been working as a licensed clinical social worker since graduating with my master’s in 2000. I took about three years off from work, from 2005 through 2008, when I experienced a severe depressive episode and needed six inpatient admissions and a course of electro-convulsive therapy (ECT). Those three years were a bad stretch.
In addition to the DBT, I’ve also had intensive TFP (transference-focused psychotherapy), a psychodynamic treatment for BPD (as opposed to DBT which is focused in the here and now). I worked for 11 years (2005-2016) with Dr. Lev, a psychiatrist who is specially trained in TFP. I don’t believe any of my previous therapists realized just how ill I was until I walked into Dr. Lev’s office. I credit the work we did together with saving my life and giving me a life worth living.
During the aforementioned depressive episode, as I started to climb out of the abyss, I signed up for a writing class at a local center. I wrote about what I knew. My first essay, about anorexia, was accepted for publication in an anthology about illness and healing. Seeing my name in print was a sustainable high, unlike seeing the numbers drop on the scale.
Writing was instrumental in helping me shed my patient identity, giving me a reason to focus each day. Repeated rejections from literary journals and anthologies forced me to build a thick skin whereas before my skin was paper thin.
Writing became a passion, one that I continue today. Writing keeps me sane.
I never married. My father, who was supposed to be the first man in my life and the role model for all relationships with men going forward, was an alcoholic and incapable of performing that critical task. I remained terrified of making myself vulnerable in a relationship and the possibility of being hurt loomed forever. I told Dr. Lev once that I’m fearful of being consumed and consuming. She responded that my comment sounded a lot like food. I came to accept I was incapable of engaging in an emotional and physically intimate relationship with a man or a woman.
I’ve made a conscious choice to be childfree. I made this choice in my early twenties, even before I was diagnosed with a mental illness. I lacked any maternal instinct or desire. My mother interrupted a brilliant career as a female computer programmer in the early 1960’s to raise my brother and me. I know my mother loved us, but I also believe if she had the choices women have today, she would have also chosen to remain childfree and continue with her career. After she divorced our father during my senior year of college, in 1982, she updated her programming skills and started her own custom software development firm, which was extremely successful.
During the last four years we worked together, Dr. Lev and I spent a lot of time exploring my sexuality. In high school and college, I played sports and because many of my teammates and some of my friends were gay, I wondered if I was also. In my 20s, while working in advertising, I played on three teams in Central Park and I questioned my sexuality again. I had no one to talk to. I first entered therapy at this time due to “relationship” issues, but didn’t feel I could bring this issue up with my therapist. Throughout this time, I didn’t date and I remained a virgin, which was a source of great shame.
With Dr. Lev’s help, I finally came to the conclusion I’m asexual. The decision felt right and asexuality fit. It explained a great deal and to realize I was not alone was an incredible relief. We have our own community, AVEN.
I have solid relationships with family and friends. Our parents are gone, but my brother, Daniel, and I are best friends and he’s my staunchest supporter. At his wedding in 2018, Daniel asked me to walk him down the aisle. I have friends from various communities in which I’m involved—the writing community, the entrepreneurial community, friends from my two previous jobs with whom I keep in touch and get together periodically. I just started a new job about four months ago. I have friends from nowhere, in particular, friends whom I’ve known for over 20 years and those who I’ve met recently.
In March 2020 I launched a mental health advocacy and awareness organization. My mother was a brilliant woman and an entrepreneur, and I never thought I had entrepreneurship in my blood. I thought I was more of a cog-in-a corporate-wheel type. It turns out I needed to find my passion.
I have, 31 years after I first was diagnosed with BPD.
Getty image by Yelyzaveta Hryhorieva