Attention-seeking, manipulation. Many borderline personality disorder patients are accused of these, and I struggle as I come to terms with the fact that, indeed, a lot of my behavior at least comes across like this. For example, a few weeks ago, my crisis prevention plan was changed to the effect that staff no longer need to make me come back if I run off. It’s up to me to decide whether to run off and, if I do, what to do about it. After trying to communicate my discomfort with this change and being told off with references to choices and responsibility a few times, I ran off and wandered for about an hour until the staff eventually decided to find me.
I can see in a way how this can be interpreted as manipulative. The staff also said I have tremendous power when deciding to run off, because there is no way the staff can responsibly not take care of me eventually.
To my defense, I find myself in situations many times where I communicate in a normal way that I need support and am not being heard because other patiets, with different diagnoses, are acting out more. For example, today I asked the staff to take me on a walk because I was feeling irritable. They couldn’t, because there are several patients in a psychotic break right now. I rationally understand that my needs need to go on the back burner when people are in more severe conditions, but at the same time, this feels like a double bind. If I act out, I’m attention-seeking, manipulating and it’s my responsibility, but if I ask for support in a normal way, I’m obviously not sick enough to need it. In this situation, how am I supposed to show that I’m genuinely not coping?
Today, my husband and I attended an evvent for sufferers of and family of people with borderline personality disorder. First, a psychiatrist spoke about what BPD is. He was interrupted mid-sentence by three women who had BPD themselves and felt they were in a better position to tell what it is. This looked a bit foolish as it was obviously planned. After the women were finished, the psychiatrist took over and explained about causes and treatment. One important point is that there is no one cause of BPD. In fact, BPD is caused by many factors interacting, such as environment, traumatic experiences, genetics, neurobiology, etc. Another interesting point was that there are four different therapies for BPD which are on average each equally effective. Also, the therapeutic alliance is more importan than what type of therapy you’re following. He said that therapeutic skills are important in all psychotherapy practice, but to an exaggerated extent so in BPD treatment.
Then we went to meet some peer supporters who told their stories and had us ask questions. I had expected to sit and listen but ultiately was the most talkative on my table. One of the peer supporters said she suspected she was born borderline. I have discussed this topic before. Some personality traits, such as aggressivness or risk-taking, make someone more prone to end up in traumatizing situations. Also, people with certain traits experience more seemingly minor evetns as traumatic. For example, my husband later told me he had experienced the same event that one of the peer supporters said was traumatic to her, and he was unaffected. This is one reason I don’t like the narrow DSM-5 definition of trauma in PTSD. PTSD too is as much a brain-based and genetic condition as it is trauma-based. So are the dissociative disorders by the way. I hope eventually the DSM developing people will realize this and remove the mandatory connection of PTSD to specific traumas. Science is already there on the dissociative disorders, but sufferers need to follow. Note please that I am not saying that abuse or trauma has no role in these conditions, or that it isn’t horrible when it occurs. All I’m saying is that it’s not like you’ll only and always develop PTSD or a dissociative disorder if you’ve experienced a certain trauma.