Another diagnosis that would come up often would be Borderline Personality Disorder. Mostly women, these clients were some of the hardest to work with at times, primarily due to the lack of consistency in their patterns of behavior. Caring and kind one visit, completely out of control the next. Sometimes you knew what set them off, other times it was pretty well under wraps.
I had also heard about Borderline Personality Disorder in a different context prior to and since the start of my social work career. "Borderline Bitch" was one of those derogatory terms used, typically by men, to describe women that they had come across. It seemed like this was the de facto term to replace "moody" or to absolve men of hurtful or inconsiderate behavior.
Borderline Personality Disorder, according to DSM-IV (Diagnostic & Statistical Manual of Mental Disorders)*, is as follows:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
Now, some people that know me professionally and have fallen victim to one of my rants about the DSM know that I hate this book. Written by what one can assume was primarily wealthy, white, male doctors, this book has been used as the primary diagnostic tool since the 1950's. There have been updates but it does not negate the fact that homosexuality was once listed as a mental illness, nor does it negate the lack of compassion throughout the book. On a good day, I call DSM the "billing book", used merely to select the juiciest disorder within reason to ensure that clinicians gets paid for their services. On a not-so-friendly day, I call it the "stigma book" or "oppression manual".
I have been informally diagnosed as Borderline in my own life. According to the criteria above, technically I guess that could be true. It was especially true in my 20's. I have always been hesitant to accept this diagnosis fully, in part due to the stigma around it ("Borderline Bitch") and partly due to the bleak "treatment options" and expected "recovery" from this condition. As with most mental disorders, a combination of therapy and medication is recommended but when it comes to Borderline, most researchers and healthcare professionals have decided that it is unlikely that one can recover from Borderline. A death sentence by way of DSM.
This is where I call bullshit. Re-read the diagnostic criteria with an open heart instead of a clinical mind and one will find that whoever has been diagnosed with this disorder has been hurt by others. Badly. And most likely often. This diagnosis screams abandonment, trauma, violation, violence and most of all, betrayal of trust. Over and over and over again. No surprise that mostly women are diagnosed with this.
Why do we, as a society, find it necessary to pathologize hurt? To pathologize pain and mistrust? Why have we accepted that a death sentence according to DSM is good enough in relation to trauma and betrayal of trust? Why do we, as a society, make each other sick and then blame each other for getting sick? Get me off of this ride.
I will be the first to admit that I am not always easy to get along with. I am not always easy to get to know. It takes a long time for me to let someone in and oftentimes, even when someone thinks I've let them in all the way, it's so far from the truth it's almost heartbreaking. Im getting better as I get older and further removed from my childhood and adult trauma experiences but I can still be difficult to navigate. I live with myself every day and sometimes I find myself difficult to navigate.
So what has worked for me? Medication? Talk therapy? Hardly. Both have been expensive and stressful wastes of time.
What has worked for me is a small but powerful circle of support consisting of friends I've known for a year to over fifteen years, a man who patiently loves me and sees me through the noise, a spiritual advisor who challenges me to heal myself through loving myself and a couple of fuzzy kids of the cat and rabbit variety who are the only beings on this planet to have "seen it all" when it comes to me, and love me unconditionally anyway.
So how do you treat Borderline Personality Disorder?
Love.
Fierce, patient, real love.
Because that's all a Borderline Bitch wants and that's all that this Borderline Bitch wants to give.
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