Therapy

A Self-Described “Strange Girl” Talks About Borderline Disorder and Dialectical Therapy

By Randi Kreger
Created Apr 1 2011 – 10:48am

By guest blogger Stacy Pershall:

It’s a little embarrassing when you realize you perfectly fit the stereotype of a person with borderline personality disorder. As I wrote in my book Loud in the House of Myself: Memoir of a Strange Girl: “Borderline means you’re one of those girls who walk around wearing long sleeves in the summer because you’ve carved up your forearms over your boyfriend.”

By Randi Kreger
Created Apr 1 2011 – 10:48am

By guest blogger Stacy Pershall:

It’s a little embarrassing when you realize you perfectly fit the stereotype of a person with borderline personality disorder. As I wrote in my book Loud in the House of Myself: Memoir of a Strange Girl: “Borderline means you’re one of those girls who walk around wearing long sleeves in the summer because you’ve carved up your forearms over your boyfriend.”

You make pathetic suicidal gestures and write bad poetry about them, listen to Ani DiFranco albums on endless repeat, end up in the emergency room for overdoses, scare off boyfriends by insisting they tell you that they love you five hundred times a day and hacking into their email to make sure they’re not lying, have a police record for shoplifting, and your tooth enamel is eroded from purging.

You’ve had five addresses and eight jobs in three years, your friends are avoiding your phone calls, you’re questioning your sexuality, and the credit card companies are after you. It took a lot of years to admit that I was exactly that girl, and that the diagnostic criteria for the disorder were essentially an outline of my life.”

I am fortunate enough to live in New York City and have access to New York Presbyterian Hospital, where I entered dialectical behavioral therapy in the summer of 2005. I was so afraid of myself and the world, so unable to trust that I could get through a day without a rage outburst or suicide attempt, that I could barely bring myself to get on the bus and go to my first appointment. Fresh from my latest emergency room visit, I was determined that either DBT was going to work or I was going to make a concrete plan to kill myself. It was this sense of finality that kept me committed to the program for a year and a half.

Today my life is radically different. Dramatic screaming matches with friends and family are (mostly) a thing of the past, I (usually) weather everyday storms successfully, and I no longer catch myself on pro-anorexia websites looking at “thinspiration” pictures. But finishing DBT doesn’t mean you’re cured – it just means you’ve had time to build up a protective layer of skin. What you do with what they gave you determines the course of your life.

DBT discourages friendships between clients, and I think this is a disservice. In most ways, I am an unabashed poster child for the therapy, but on this rule I differ. When you graduate from DBT, it is your job to cast off into the world and navigate a terrain in which your skills do not work on everybody, because not everybody is interested in negotiating with you.

My response to this unwillingness is often anger, and this is my major road block to a live fully worth living. I frequently wish for a DBT refresher course, a place where you could stop in for a tune-up, a tamping-down of disruptive emotions that threaten to derail your progress. I believe this is a crucial missing component of the treatment.

The memories of the times my anger boiled over and I hurt other people still haunt me. They whisper to me all day that I am not worth getting better, that I deserve to still suffer for what I’ve done. Self-punishment and suicidality in response to guilt of this magnitude still seem, on some level, rational. I revert to a cause and effect I’ve known all my life, like breathing through your mouth when your nose is stuffed.

Not long after I finished DBT, I got into a new relationship. I had refrained from dating while in therapy, but a friendship grew into romance, and I DBT-ed the hell out of it. I was meticulous in my interpersonal skills. I thought the universe was rewarding me for being successful in therapy, and I was startled to find that I could in fact be someone’s girlfriend without becoming psycho. Things went along beautifully for a year, right up to the morning when he broke up with me over breakfast, gathered his things, and walked out the door, never to be seen again.

It was my worst fear, the worst fear of many borderlines: unforeseen abandonment by a trusted partner for no apparent reason. If you have BPD, that scenario is like being doused with gasoline and set on fire. And, like breathing through my mouth, my instantaneous impulse was to beg my lover to stay and try to kill myself if he refused.

But my DBT skills kicked in like superheroes, my therapist’s voice screaming, “ACT OPPOSITE” in my head, and I shocked myself by letting him go. I cried in a ball on the floor for days, but that’s not out of the realm of normal human behavior after a breakup. What would have helped, however – what I ached for in those first barely-functional days (okay, weeks. Okay, months) – was contact with someone who could remind me of the skills and encourage me to practice them. I needed coaching sessions, the kind another DBT client and I could have given each other in the absence of a therapist.

I clung to borderline message boards and fantasized often about a DBT hotline, where we could hear each other’s voices, take comfort in the audible breath of another human being, and practice distress tolerance together.

Marsha Linehan states that the first order of business in DBT is to reduce self-harm and therapy-interfering behaviors. Obviously this is essential; you can’t treat a client who’s always in the emergency room getting stitches or her stomach pumped. But not enough attention is given to what comes after, when that client leaves treatment still carrying the shame of those ER visits and the guilt over the pain her suicide attempts caused her loved ones.

Ally, a borderline woman I met online, participated in a DBT day program for six months. Five years later, she credits the program with saving her life, but says the black-and-white thinking of BPD still haunts her. When she makes a mistake or believes someone is angry at her, she says, “first I think about how I am hated or how horrible of a person I am and then the urge to purge or cut wells up.”

She uses her DBT skills to ride out the urges, but says, “If I had to rate my recovery on a scale of 1 to 10, 10 being ‘normal’ or totally recovered, I think I am about at 5 or 6 on bad days and 7 or so on good days…my biggest problem is the negative self talk I do and the fact I am not in therapy right now.” Ally speaks longingly of a DBT refresher course.

Adding to the sense of isolation amongst DBT graduates is the continued stigma of admitting to a borderline diagnosis. An e-book available on Amazon, written by a private investigator, purports to teach people how to spot us, with the implied message being that they can then avoid us.

The book’s cover features a closeup of a woman’s eyes, partially obscured by her hair. She looks wild, like a demented wolverine. A woman diagnosed with BPD, if she cops to it, faces a lifetime of convincing others she’s not a bunny-boiler.

Given this constant uphill battle, it would be nice to check in with a post-graduate DBT group a few times a year just to reassure myself that I and my kind are not disheveled wolf creatures. We are valid human beings struggling to forgive ourselves, and anything that relieves even a little shame and guilt is like water in the desert to us.

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