Borderline personality disorder, and why young people are falling through the cracks
Natasha Swingler has lived with complex mental illness from a young age. “I didn’t want to be seen, to be heard. I didn’t really want to exist, I didn’t feel that I was deserving of any form of care,” she says. It would take some time until she would learn of her diagnosis — borderline personality disorder, or BPD.
Even though BPD affects a significant number of people in the community, a large proportion of them having suffered trauma early in life, it remains one of the most misunderstood and stigmatised mental health conditions.
And that stigma extends to the healthcare system, where the enduring myth that it is untreatable prevails and sees many people like Natasha fall through the cracks.
“For me, it saw me believe that this was all my life would ever amount to.
At the age of 10, she started to self-harm.
“At that age, you know that it’s not right, and you know enough to hide it,” she says.
“I started a pattern of utilising self-harm as a way of managing pretty difficult emotions and hiding everything that was going on for me on a really personal level.”
“It was incredibly busy, it was incredibly loud,” she says.
“And I would be discharged that evening with no support for myself, no support for my family, which started pretty much a 24/7 vigil, my family checking that I was still breathing overnight.”
People living with BPD can experience intense and painful emotions, which can make it hard for them to maintain relationships, says Dr Martha Kent, a psychiatrist and advocate for healthcare reform.
They may also be living with, or be at risk of, developing other mental health conditions such as anxiety, depression and psychosis.
“They can shift from intense anger, to sadness, to despair, to mania sometimes, and often there is an underlying sense of emotional pain, which is very difficult to live with,” Dr Kent says.
“They have difficulty containing their impulses, they have a tendency to be attracted to addictive behaviours.
“But I think what BPD is particularly associated with are efforts or the impulse, if you like, to self-harm, and often that is accompanied by suicidal thoughts.”
The enduring stigma surrounding BPD
The complexity of BPD, as well as the stigma surrounding it, means it can often be missed. But even the right diagnosis does not guarantee adequate help and support.
“It’s very confusing for the patient, because the patient usually knows that something is seriously amiss in their lives,” Dr Kent says.
“And I think there is every indication from my experience, and from the literature, that people with BPD are not treated as seriously as people with other mental illnesses.
“There are many examples of people with BPD who are refused admission or treatment because the treating clinician considers that BPD is not a genuine mental illness.”