Content Warning: Hospitals, Self-harm, risk-taking behaviour, and suicidal thoughts/actions.
“I know that I do have quite a few traits of it, but I still don’t feel as though this diagnosis fits me fully. It’s just that, each time that I’ve been admitted onto one of the psychiatric wards, I’ve met several other people with this diagnosis – and whilst they’ve all been very similar to each other, in their personality traits, I felt as though none of them were similar to me.”
Being diagnosed with Emotionally Unstable Personality Disorder (EUPD – also known as Borderline Personality Disorder, BPD) felt like a huge kick in the face at first, but that’s because it wasn’t handled appropriately – or at all sensitively – by the clinician.
I had been admitted onto a psychiatric ward for the first time in my life, this was in December 2016. For the first 36 hours, I hid in my hospital bedroom wardrobe, too anxious to come out. I only spoke to say “thank you” four times per day, when a nurse would bring me my medication in a little paper cup, or to say “no, thank you” when someone would come in to tell me that dinner was ready and ask me if I wanted anything. The only person I could talk to was my partner if he came to visit. And yet, despite the complete lack of interaction between myself and anybody working on the ward – the consultant psychiatrist on the ward insisted that, from the staffs observations of me (sitting in my room doing nothing) over those 36 hours, he had enough evidence to draw the conclusion that I had ‘Borderline Personality Disorder.’ Not only that, but he also tried to deny the existence of my anxiety issues, uttering nonsense such as: “You are not anxious.” I remember thinking that was a ridiculously odd thing to say to someone; after all, no one can truly know exactly how another person is feeling. Besides – I was shaking with fright, fidgeting, tapping my foot, not making eye contact – I was anxious, just like I always am, just like I had been for 7 years. Every doctor I’d seen throughout those years had recognised and attempted to treat my severe anxiety and panic attacks. So who the hell does this man, this ‘expert’, think he is – denying a significant part of my mental health difficulties, having only spoken to me for less than 3 minutes?
The EUPD diagnosis stuck to me like a stubborn plaster; I desperately wanted to get rid of it, for two reasons:
1.) Because it didn’t seem to fit me accurately. A few years previously I believed I may have EUPD, but the more I researched it, the less I agreed that the symptoms matched my experiences. Plus, it didn’t explain my anxiety, my main symptom – the psychiatrist just dismissed it.
2.) Because there is such a terrible stigma associated with personality disorders, specifically EUPD. People with EUPD are often regarded by others as being impulsive, unpredictable, self-destructive; inconsiderate, angry, attention-seeking.
I was completely aware of the fact that, by rejecting the diagnosis based on the attached stigma, I was inadvertently contributing to that stigma – and as a person who campaigns against mental health stigma, I hated myself for this – but for some reason I just couldn’t seem to let myself accept it. I felt less desperate to escape from the diagnosis as soon as I had a consultation with a different psychiatrist (on a second admission to a psychiatric ward the following month), who spent 90 minutes with me, going thoroughly through my life history. He acknowledged my co-existing difficulties, diagnosing Generalised Anxiety Disorder as well as EUPD, so I felt as though I had at least been listened to. But something still didn’t seem quite right. Every person I had met in the hospital who had told me they had EUPD seemed to be a relatively loud person, who enjoyed being at the centre of attention. They had visible mood swings and outbursts of anger, which involved shouting at other patients and being rude to the nursing staff. There were some displays of violence, too; as though there was a constant conflict, a fight that needed to be won. It’s very important to me that I make clear here that I did not see anything inherently wrong with these behaviours – they are all just symptoms of illness, something that everyone in the hospital displayed in their own way. But these EUPD-symptoms that I’d noticed were symptoms that I did not share.
Fast-foward 8 months.
This week I had an appointment with my community psychiatric nurse (CPN) and we were discussing whereabouts I’m at, mentally, right now. It’s been a rocky year, and I’ve had several hospital admissions to both the general hospital and the psychiatric hospital; with the most recent psychiatric admission being for two weeks at the beginning of last month. I’m up-and-down, but I am definitely making some progress. I said to my CPN: “It’s been 9 months since they said the dreaded diagnosis. I’ve sort-of accepted it now, but I still don’t feel as though it fits me fully.” When she asked what I meant, I described the EUPD patients that I’d seen during my hospital admissions, and the behaviours that they seems to have that I didn’t have. “The shouting, the rudeness, the violence, the disruptive behaviour. They’ve all been very similar to each other, with their personality traits, but I felt as though none of them were similar to me.”
We discussed my personal symptoms; the numbness, the depressive mood, that never-ending sense of hopelessness. The fluidity in my identity. The self-harming behaviour, about a dozen overdoses. The low self esteem, the low sense of self-worth, the self-loathing… And then we discussed the traits I do not display; instead of having unstable relationships, my relationships with others – particularly with my partner – are rock solid. Instead of fighting to be the centre of attention I hide away from it unless I am very comfortable with the people I’m spending time with. I don’t take recreational drugs, I’d never do dangerous or drink-driving. I barely touch alcohol at all, really. I wouldn’t hurt a fly, let alone another person – and I don’t feel as though I’m in conflict with society (apart from hating the current government – but who doesn’t hate the tories?!) I don’t have any issues with authority. I don’t believe that I act to manipulate others. I’m not often very passive-aggressive. I just don’t display the stereotypical behaviours that people with EUPD are assumed to display.
But now, after my CPN explained something to me, I understand why I felt so confused about the diagnosis; why I felt as though it didn’t fit me properly. She said that there are four sub-types of EUPD – Impulsive, Petulant, Discouraged, and Self-Destructive. The four different types are not concrete; a person diagnosed with EUPD probably has some traits from all or most of the types, and some people might not really fit into any of the types solidly. But for most people with EUPD, their main symptoms and behaviours will usually fit into one or two of the types more than the others.
Here’s a brief description of the typical symptoms arising within each type.
The Impulsive Borderline type:
This is probably the most stereotypical view of someone suffering with EUPD. The impulsive borderline may act without thinking, often endangering themselves and/or others, due to having a lack of control on their impulses. They may over-spend, take drugs, drive recklessly, self-harm, or regularly engage in sexual activity without using protection. Strong feelings of anger, severe mood swings, or episodes of violence and conflict with others are not uncommon. The Impulsive type may find that they switch between feeling very energetic and happy, to very angry and cold. They may feel resentful of other people and think that others are to blame for the pain they are experiencing. These feelings and beliefs can often disturb relationships or prevent them from forming at all. On the other hand, the impulsive borderline may instead seek approval in any way possible in an effort to avoid abandonment or disapproval.
The Petulant Borderline type:
The petulant type may feel irritable, and pessimistic, and the fear of disappointing others or being abandoned by others could be very strong. They are often a more passive-aggressive character, and may feel that they need to self-harm or engage in dangerous behaviour in order to be noticed by others. This is often because they struggle with assertiveness; they have difficulty vocalising their feelings and needs in a clear way that makes sense to others. They may also have a very unstable sense of who they are, what their values are and what they believe in; this could change depending on who the person is with, in order to seek the approval of others. The Petulant type may find that they have a tough time soothing themselves, and as such may develop substance abuse problems or eating disorders due to failed attempts at consoling themselves whilst upset.
The Discouraged Borderline type:
The Discouraged type may feel empty or numb for long periods of time, and may choose to deprive themselves of things they enjoy instead of indulging themselves. They may present at first as suffering from severe depression. It’s likely that they have feelings of anger that manifest as self-loathing, often resulting in tearful episodes (rather than the typical anger presentation of shouting / arguing). Feelings of anger, or the perpetual empty feeling, may also result in self-destructive action or suicide attempts. Short periods of psychosis may occur at times of high distress. They will typically have very low self esteem, resulting either in avoidance of others due to believing that they are not worthy of any attention, or being highly dependent on others – sometimes trying to seek a sense of self-worth from those who they are dependent upon. The Discouraged borderline might also struggle with securing their sense of self / their identity. It is not uncommon for the Discouraged Borderline to struggle with chronic or repetitive physical complaints alongside their mental health problems.
The Self-Destructive Borderline type:
The Self-Distructive type perpetually struggles with feelings of self-loathing, and as the name implies, they engage in a lot of self-destructive action such as self-harming, overdosing, reckless driving, unsafe sex, and suicide attempts. They may also experience mood swings; this is all as a result of emotions being so unstable. Often a Self-Destructive borderline believes that no-one cares about them or that they are not worthy of other people’s love, and therefore they react by not caring about themselves – and being self-destructive as a way of showing that they don’t care about themselves. Their identity is blurred and uncertain and as such it is not uncommon for the Self-Destructive type to not have a sense of who they are. Depression often co-exists in this type. They may find that because they have a lack of feelings and a lack of identity, taking harmful action against themselves is a seemingly effective way of making themselves feel something (instead of feeling empty or numb).
Across all of the types, there seems to be a notable lack of regard for our own wellbeing (hence the self-harm or destructive behaviours), as well as a fear of being abandoned or hated by those around us. I think low self-esteem probably fits in with every type as well, though the way in which this presents can be very different across the types.
Thinking about it now, it seems that I am mostly the Discouraged Borderline type at present. I only struggling with the Self-Destructive type characteristics when I’m in a state of crisis, but I feel like the Discouraged type most of the time. I am most dissimilar to the Impulsive type, which explains why at first I felt as though the diagnosis of EUPD did not make sense for me (as the Impulsive Borderline is the ‘stereotypical’ view of what EUPD patients are like). The characteristics the Discouraged Borderline typically displays are not exactly unique to EUPD, or in fact personality disorders in general – which also probably contributed to my initial rejection of my EUPD diagnosis. Many of the symptoms of the discouraged borderline type could be caused by depression alone. However, I believe the combination of those symptoms with the easily-identifiable root cause (which, in the case of many EUPD patients, is trauma), is the reason that the discouraged-type symptoms result in the diagnosis of EUPD rather than a depressive disorder.
From my personal experience, I think it must be possible to shift between types over long periods of time. I think in the fairly-distant past I displayed many characteristics of the Petulant Borderline type, because I really didn’t know how to assert myself or express my feelings and needs in a valid way. As such I’d self harm, and without me having to work out what my needs even were, I would be noticed – and then helped – by others, which resulted in me feeling better. I also used to struggle very much with eating disorder symptoms: I would binge, then purge, and repeat, particularly if I felt low at the time though I would never tell anyone about it. I still relapse very occasionally with this disordered eating but it’s nowhere near as much of a problem as it used to be. I feel that I’ve managed to develop myself in such a way that I no longer act in the way the Petulant borderline typically does, because I’ve managed to unintentionally learn to trust people again – meaning that I can communicate better with people about what my needs are. I suppose this gives me hope that I can also lift myself away from the traits I do still display, and heal from EUPD almost completely. I know I’ll need to tackle the root cause (through EMDR therapy, which I am currently waiting for) and change my behaviours (via DBT – which I’ve been going through a workbook to learn!) in order to heal properly, though.
I’ve found it interesting to learn about the 4 different types of EUPD. It has helped me to accept my diagnosis, and I finally feel as though everything makes sense. My CPN actually said that the way in which my illness presents also makes her question the presence of complex-PTSD; the root cause of PTSD and EUPD can be fairly similar, and when someone is presenting as the Discouraged type there are questions to be asked about a crossover between the two diagnoses.
I hope this brings a little bit of new info for some of my fellow EUPD-sufferers!
- Do you have a diagnosis of BPD / EUPD? Did you accept the diagnosis straight away?
- Do you feel that the diagnosis fits you well? If not, did you know about the 4 different types, and do you feel now as though maybe you do fit into one of these 4 types?
- Like myself, have you noticed a change in the ‘type’ that you are, over a long period of time?
- Do any of my readers struggle with their mental health and think that maybe the characteristics of this personality disorder are in line with their symptoms?
- If you are a health professional, did you know about the 4 different types of BPD/EUPD? Many of the health professionals I’ve spoken to don’t seem to be aware of these subtypes, so I’m intrigued!
I’m very interested to know about others’ experiences of receiving their diagnosis and, if necessary, the process of acceptance that they had to go through. I’m also eager to talk about the 4 different types of EUPD / BPD and whether or not other people believe they fit into one, all, or none of the sub-categories. Please do feel free to message me using the contact form, or just comment on this post below 🙂
Lots of love,
R / DisabledCatMom