Over the Borderline
Treatments for borderline personality disorder and alcoholism are similar. But dealing with one doesn't fix the other.
If borderline personality disorder sounds familiar, that may because it was made famous by the movie Girl, Interrupted featuring Winona Ryder and Angelina Jolie back when Winona Ryder was the big star between the two. It was based on a memoir by Susanna Kaysen about her experiences being diagnosed with BPD and then ending up in a psychiatric hospital in the 1960’s. I liked both the book and the movie when I was exposed to them but I didn't think much about them. I hadn’t been in a psych hospital then. I didn’t keep roasted chickens under my bed. Case closed.
I first found out I suffered from BPD in 2004 when I received a bill from my psychiatrist and noticed a code at the bottom of the page. Out of curiosity, I punched them into Google. Up came depression (no shocker there), substance abuse (ditto—I was a full-fledged cocaine addict at that point) and then...Borderline Personality Disorder. Whaa? At first, I was speechless. Then I Googled BPD, and was even more speechless when I read the description and symptoms. It was as if I was reading a report that had been specifically written about me.
What immediately struck me the most about this type of therapy is how similar it was to AA.
Borderline personality disorder—or BPD—is a condition, I read, marked by emotional instability and turbulence, impulsivity with money, substance abuse, sexual acting out, binge eating, shoplifting, repeated acts of self-injury or suicide attempts, fear of abandonment and a fear of being alone. People with BPD, it said, idealize and then devalue or demonize people and have a tendency toward “splitting” or black-and-white thinking. They are extremely moody and have a very unstable sense of self. Perceived rejection or failure can trigger long-lasting states of depression, anger or anxiety. And while they know that BPD is much more common among young women, they don't entirely know what causes it, though it's thought to be a combination of genetic predisposition and early trauma.
Way before I had picked up booze, I had an eating disorder. I’d always struggled with depression, starting back when I was 13. I had just recently tried to kill myself. I had very volatile relationships with other people: friends, boyfriends, coworkers and bosses. I had no sense of self and couldn’t remain committed to what I thought I wanted to do with my life. One minute I wanted to be an actress, the next minute I hated acting and wanted to write. Then I wanted to be in fashion. I moved constantly, trying to get away from—well, myself. The list of medications and rehabs grew longer with every year.
My horror at being diagnosed with BPD turned to relief. Finally I knew what was wrong with me. All those times I had been berated by my family for being self-destructive or flaky or dramatic were all explained by this one disorder. The apologies came flooding in. I forwarded the BPD links to my father, mother, and multiple step mothers and they all apologized for judging me, for misunderstanding, for making light of what turned out to be a serious condition. But that didn’t really solve the problem of having yet another condition that needed to be dealt with.
The best treatment for BPD, I came to learn, is a type of cognitive behavioral therapy called DBT—which stands for dialectical behavior therapy. It is a series of tools that the patient uses to quell impulsivity and calm turbulent emotions. You’re given a “diary card” so that you can check the tools you used and rate your “urges” and whether or not the urges led to an action or you were able to use the tools to avert the action in question each day. You meet with a DBT therapist once a week and go to a “group skills” group once a week as well.
My therapist was a tiny old hippie. She looked a little like Linda Hunt. She was soft spoken and never judged. She was so encouraging that, even when I engaged in self-destructive behavior, she found a positive spin. “Well, you made it through the week,” she’d say. “You’re here.” Or: “You haven’t dropped out of therapy.” Her catch phrase was “Just breathe”—which, I have to admit, I always found annoying and trite. If I was successful and used the skills when triggered to stay balanced, she put stickers on my diary card. Cats or frogs or gold stars always felt like a pretty infantile reward for not fucking up your life.
It was the group skills groups where all the action happened. That’s where I studied the different skill sets with a bunch of other borderline women. My role in the group was to be the comedic relief—when I wasn’t crying, that is. Group skills met on Monday nights for an hour. It was a motley crew of girls. But in that group, I didn’t feel “crazy” like I often did in the real world. These girls got me. They also had multiple suicide attempts, psych ward visits, trips to rehab. To each other, we were “normal.” What a relief it was to feel normal, if only for an hour a week. There were certain rules we had to follow for everyone to feel comfortable, like we weren’t allowed to talk about any self-harm or drug abuse, lest it trigger the others. One girl referred to her drinking and drugging as “festivities,” which I always found highly amusing. It was obvious to me, a member of AA, that she was a fledgling alkie and drug addict but I kept quiet about that.
Come Monday nights, we’d all sit in chairs in a circle in a tiny office on the West side. There was a 30-ish plump executive who was struggling with anxiety and cocaine abuse and a very young student who had a terrible cutting problem. Her arms were scarred from wrist to shoulder and she was constantly in and out of the ER getting stitches for her self-imposed injuries. I called her “chopping block”—my attempt to make light of a horrifying situation—which always made her laugh. There was an old Persian woman who never knew what skill we were studying and constantly complained about her stomach. There was a “dancer” who wore very short shorts and whose aspirations included marrying rich and being a Playboy centerfold. There was an angry, arrogant bisexual with a pierced septum who always showed up loaded and bragged about her bondage fetish. There was a rich aspiring stylist who constantly commented on everybody’s footwear and eventually landed in Debtors Anonymous after buying $600 sheets. And then there was me: a young-looking 40-something rocker chick with a foul mouth and a botched suicide attempt.
What immediately struck me the most about this type of therapy is how similar it was to AA. One of the central beliefs of DBT is “radical acceptance,” whether it was the situation you were in or a strong painful feeling. Acceptance, they teach, does not mean that you like what is happening or how you are feeling—just that you are willing to stop fighting it. Pain plus non-acceptance, they said, equals suffering, while acceptance decreases suffering. Also, the thinking went, in accepting the negative emotion, you can stop trying to run from it through self-harm, drug abuse, acting out sexually, or whatever else you might have done in the past. Sounds a little like the Serenity Prayer, right?
In DBT, there is a heavy emphasis on “observing your breath” to get centered and on “mindfulness”—which means staying in the moment rather than dwelling on the future or past. When you’re washing dishes, just wash the dishes. It’s all very one day at a time.
There is also something called “Wise mind,” which, they say, is a cross between your rational mind and your emotional mind. It’s your intuition—your God consciousness, as they’d say in the program. There is a tool called “Turning the Mind,” where you return to accepting something over and over even if you have an aversion to it. To me, this is like turning your will over—and over and over again. And, just like with alcoholism, there is no cure for BPD—only active treatment. And when you stop using the tools that treat your BPD, you lapse back into old behavior—just like with alcoholism. And, just like with meetings, skills group is a place where borderlines can hear other borderlines voice their life struggles and talk about how they are trying to use the steps to keep from acting out and creating more wreckage.
Plus, once you go through all the modules of the skills, you go back through them again. You never stop. Just like the steps. It’s a continual process of relearning, remembering, mastering. And among the many “self-soothing” skills are prayer and meditation. Can anybody say 11th step?
At first, I thought that I could just go to skills group or just go to AA. They overlapped so much that attending both felt repetitive. But I soon realized that too much is never enough when it comes to BPD and alcoholism. How many signs did I need that these were the tools I needed to master to keep from destroying my life and myself? These days I go to AA meetings every day and DBT group once a week. They reinforce each other and I’ve found that when I remove or back away from one, the whole structure of my life comes tumbling down.
I’m certainly not proud of or happy about the fact that I’m borderline. It comes with a ton of baggage and stigma—just like alcoholism. I’ve never understood people who said they were grateful to be alcoholic. What I would give to be normal. But I accept that these are the cards I’ve been dealt and that I must play the hand to the best of my ability. And just as with alcoholism, I wear my BPD with irreverent rebellious shamelessness, hoping to diminish my shame through humor and acceptance.
Amy Dresner is sober comedian who liberally pulls material from her depressive illness and drug addiction. She performs all over Los Angeles and is also on a national recovery tour called "We Are Not Saints." She also wrote about sex and dating and managing chronic pain in sobriety, among other topics, for The Fix.