By Chloe Lim
CN: self-harm, suicide, eating issues,
depression, anxiety, personality disorders
On the 25th of October, the Guardian published an article titled ‘Personality disorders at work: how to spot them and what you can do’ as part of its ‘lunchtime read’ section. This was one lunchtime read that left me, and many others, feeling sick instead. Given the Guardian’s usually inclusive politics, I was shocked to read horrifyingly outdated, stigmatising remarks written by clinical psychologist Dr Mary Lamia. Choice quotes include that it’s “not good news if you work with one of them, since they [persons with Borderline Personality Disorder or BPD] are divisive, use power tactics, show intense or inappropriate anger, and regard others as either all good or all bad”. These remarks were also coupled with damning indictments of sufferers of other personality disorders including Narcissistic Personality Disorder. Unfortunately, Dr Lamia’s comments reflect a critical, isolating and exclusionary attitude adopted by the general public and healthcare professionals toward sufferers of personality disorders. For people like me with a personality disorder, this is the hatred and fear that we face everyday, and that prevent us from disclosing our conditions.
In the standard classification of mental disorders used by professionals, the Diagnostic and Statistical Manual of Mental Disorders, personality disorders are grouped into three clusters as follows.
- Cluster A: Paranoid, Schizoid and Schizotypal Personality Disorders. Characterised by social awkwardness, withdrawal and distorted thinking.
- Cluster B: Borderline, Narcissistic, Histrionic, Antisocial Personality Disorders. Characterised by problems with impulse control and emotional regulation.
- Cluster C: Avoidant, Dependent, Obsessive-Compulsive Personality Disorders. Characterised by high levels of anxiety and fear.
“Personality disorders are incredibly debilitating, and the effects are beyond the control of sufferers”
While personality disorders are relatively rare, Cluster B disorders in particular have time and again been presented in the media and in medical discourse as ‘difficult’ and ‘dramatic’, people to be avoided rather than supported. From my contact with the BPD community, I understand that psychologists continue to refuse to take on more than one patient with BPD at a time, claiming that Borderlines are draining, manipulative and treatment-resistant. This is despite the fact that BPD is a serious, life-threatening condition, with 60-70% of sufferers attempting suicide and a fatality rate of 10%.
What medical professionals and the media continue to fail to fully recognise, is that personality disorders are incredibly debilitating, and the effects are beyond the control of sufferers. Recent studies show that anything between 1-5% of the population suffers from the most common personality disorder, BPD. A good metaphor that I have used to explain what having BPD feels like is ‘having no emotional skin’. While someone forgetting to invite you to a party might make you feel slighted and unhappy for example, I feel the same emotion far more intensely and might become distraught and convinced that everyone at the party does not want me there.
On the flip side, if doing well in a sport makes you feel accomplished and satisfied, I might feel incredibly euphoric. This high emotional sensitivity is coupled for Borderlines with an instability in moods and sense of self, which means that these emotions can fluctuate quickly, over hours, flipping from one end to another in a single day. Because of these intense emotions, Borderlines might also resort to reckless behaviour including binge-eating, over-spending, impulsive sexual behaviour, self-harm or alcoholism in order to cope. What I find the most difficult however, is other aspects of the condition, including black-and-white thinking and a fear of abandonment. Being left alone leaves me sometimes gripped with terror, and I cling on to my closest friends, ironically overwhelming them sometimes, in order to make sure I am not left behind. Far from being intentionally ‘dramatic’ or ‘manipulative’, how I act as a result of my personality disorder stems from genuine fears and large, powerful emotions that overpower and scare me.
“With most personality disorders, patients often also have a family history of mental health conditions, or a personal history of abuse and trauma.”
What sufferers of personality disorders, like me, need more than anything is compassion and the patience of carers and mental health professionals to work with us through very trying and complex conditions. This is especially since personality disorders are often misdiagnosed, or not identified, while often being co-morbid (existing at the same time) with other conditions like depression, anxiety and bipolar disorder. With most personality disorders, patients often also have a family history of mental health conditions, or a personal history of abuse and trauma. Sufferers of personality disorders often live with the guilt of hurting others unintentionally, and the fear that they might do that again. Combined with what might be a constant struggle to negotiate a complex personal history or difficulties with identity, it is a wonder that so many continue to contribute to the workforce, several in a highly-empathetic capacity. Instead of prejudice and rejection, patients need to be met with compassion, love and sympathy both in treatment, at home and in the workplace. It should become normal to disclose personality disorders, to not have to worry about being avoided, or being immediately labeled a monster and a bad person.
We need to redirect the discourse around personality disorders, away from carers and those who must ‘deal’ with Borderlines or Narcissists, to sufferers of personality disorders themselves. This is not to say that support for carers is not important, but I feel strongly that it should not be the first thing that we think of. One of the best selling books on Borderline Personality Disorder for example is Stop Walking on Eggshells: taking your life back when someone you care about has borderline personality disorder. This instinctive leap to defend those around people with personality disorders, instead of engaging with the difficulties of having a personality disorder, is something I would like to see change. From an academic perspective, discourse around mental health needs to be interrogated as part of larger societal issues. Gender bias also continues to prevent men from receiving accurate diagnoses when it comes to personality disorders, while women with personality disorders attract intense misogyny, treated like hysterical Victorian women. Disability support is also crucial in ensuring long-term treatment for personality disorders and more research is needed to improve our knowledge of these conditions.
Ultimately, Dr Lamia’s article in the Guardian simply reminds us that we have so much more work to do as a community invested in the treatment and support of patients with personality disorders. Even as awareness around mental health conditions continues to improve, let’s not forget to also turn the spotlight on to relatively stigmatised conditions while rejecting attitudes that only are regressive and incompatible with an inclusive future.
Chloe Lim was the President of Oxford Student Minds from 2016 to 2017 while finishing her BA at Oxford. She continues to be involved in mental health campaigning alongside reading for the MSt Literature in English at Wadham College. She is particularly thrilled with having a name for her emotional self with the diagnosis of BPD, served with a side of high-functioning anxiety.