Walking the Border: The Delicate Dance of OCD and Borderline
I walk the border
between chaos and sanity,
crisis and functioning,
fear and courage,
questioning and certainty,
despair and hope.
When I went to my therapy appointment early Thursday morning several months ago, I knew I would end up in the hospital. The psych ward, to be exact. I had even packed a bag of string-less clothes, and left it in the trunk of my car for someone to bring to me hours later. So, I went to my appointment, talked through Dialectical Behavioral Therapy (DBT) skills I could use in the upcoming week and then, in the last few minutes of the session, completely broke down. I had been upset and out-of-it the whole session, complying with discussing skills, but not really focusing, so I had expected her to ask about suicidality. It’s a common question in DBT.
I was about to leave but, to my surprise, she hadn’t asked. So now I had to be assertive and bring it up myself. When someone asks, I answer honestly, but it is so much harder to bring up myself. This is partially because there’s a history of me going to the ER, but not being admitted because, outwardly, I am ridiculously high-functioning and I look completely fine. I think being sleep-deprived helped me have the courage to fight through the fear and say something to my therapist. I mustered, “Even if you don’t believe me. You didn’t even ask. Everyone else is believed and admitted,” with a hint of anger, even though I knew she would always take me seriously. My therapist replied, “Ask about what?” but I couldn’t answer. I looked at the floor, biting my lip and hoping she would figure it out. “Being suicidal?” she asked. I nodded slowly, tears forming and my throat closing, making it even more impossible to answer. “Morgan, you have to tell me if you’re hurting like that.” I would if I could; I really think I would.
Thus, commencing the process of being hospitalized, which involved a lot of waiting. My therapist said, “I think you need to go to PES (Psychiatric Emergency Services),” and called a campus police escort to take me there. It took twenty minutes for them to arrive and I almost passed out while waiting from becoming so anxious and overwhelmed. My therapist gave me some water and sat with me, talking soothingly; she wasn’t allowed to leave me alone. When the officer finally got there, I rode in the cop car to PES. Once there, I spent ten hours telling my story to different professionals and then waiting for an available hospital bed. Now, I had a week-long stint in the psych ward ahead of myself
In the afternoons, I go to ballet class. I get dressed in an elegant leotard with pink tights, pin my hair back in a neat bun, and lace up satin pointe shoes. The essence of ballet is making strategic lines and placements with your body to create a beautiful, as precise as possible image. You are supposed to make something extraordinarily painful look like a piece of cake. To do this, you lift your chin and lightly smile, showing the world this precise, pulled together façade.
This version of me is in stark contrast to the chaos I feel inside; my emotions rage like a tornado, constantly cycling between sadness, fear, elation, despair, excitement, hope, and hopelessness. It can shift in an instant, as a reaction to the smallest thing someone has said. Even when I feel stable, I am just waiting for the floor to be pulled out from under me once more. I rarely feel in control of my emotions. Instead, they control me as if I were a limp puppet. If I’m not careful, they can dictate my every thought and move.
Yet, despite this internal tsunami, my image in a ballet class is a perfect representation of my typical, outward presentation. I am nothing like the “classic,” stereotypical image of someone with borderline personality disorder (BPD). I dress modestly, am the opposite of impulsive (thank you, OCD), and have never even had a drink. Someone recently said to me, “You have your life so together.” I laughed. It surprised me, because I forget that my internal world is invisible. Unless I tell someone, no one can see, or would expect, the whirlwind of emotions I constantly experience.
I go to university class every day, get near-perfect grades, am involved in clubs, TA a science class, work in a research lab; the list is endless. That’s what everyone sees. And, some of the time, that is truly who I am. If I’ve had a good week, I feel happy and productive. I’m able to function at an exceptionally high level, and not just externally. But, most of the time, it feels like I am just switching between crises. On the rare occasion when I’m not in a crisis, I wait nervously for the next one. When will the next ER visit or hospitalization be? The next existential crisis? The next two a.m. emails to my professor needing to delay an exam? The next panic attack? I am constantly walking this border between matching how the outward world sees me, and being completely consumed by emotional downpour. I can switch sides so fast.
A few weeks before being hospitalized, I had asked my DBT therapist if she thought I had BPD. Borderline is, after all, what DBT was designed for. I was referred from my previous therapist to a DBT therapist specifically; I’m not ignorant. But no one had ever outright said that was my diagnosis. So, one day I plucked up the courage to just ask. Actually, I didn’t ask out loud. I scribbled on the bottom of the diary card I turn in to her every week “diagnosis?,” but that still took courage.
My therapist looked at me with hesitation on her face, almost like she didn’t want to answer. “Well, diagnoses aren’t really important to the work we do. It’s still about learning to manage emotions and be skillful,” she said. I continued to stare her down, not taking that as her answer. I’ve always liked having official diagnoses; they make it so I can attribute symptoms to the diagnoses, not myself, and meet others with similar experiences. She continued, “But, as a patient you do have the right to know.” She mentioned the OCD and depression, which I already knew. Then she paused again before asking, “Have you heard of borderline personality disorder?” I replied honestly, “Yes, that’s why I’m asking.” My suspicions since starting DBT were about to be either confirmed or denied. She then pulled a piece of paper from her drawer and handed it to me. It was a list of symptoms I had already seen when I took abnormal psychology. “These are some characteristics we use to define the disorder. Do any resonate with you?” I read the list. “Some do, some don’t,” I told her.
“For right now you are a borderline rule-out,” my therapist said. I looked at her suddenly confused. I thought I was going to get a definitive “yes” or “no.” I didn’t expect “borderline rule-out.” I didn’t even know what that was. She explained that she wasn’t sure yet if I had the personality disorder. We would continue to explore it in our work together. I would have to wait for my answer, which made me feel uneasy. I didn’t care if the answer was “yes” or “no.” I just wanted a straight answer.
While in the hospital, I met with so many different professionals it was hard to keep track of them all. There were medical students, residents, social workers, social work students, and the head psychiatrist. There was one medical student, “Molly,” with whom I met quite frequently. She always wore lovely A-line dresses, and I came to feel quite comfortable talking to her.
We talked about a lot of different things over the course of my week in the hospital: how I got there, what I planned to do after discharge, school, and my general plans for the future. One day, she coaxed me out of my room to have a chat. She had a piece of paper in her hand she was playing with. As she asked how I was, she began to fold the top of the piece of paper back and forth, as if she was going to rip it off. Now, as someone who reads a great deal, it is not particularly difficult for me to read upside-down. So, from my chair across from Molly, I read the top of the paper: “Borderline Personality Disorder test.” I smirked. This didn’t surprise me. Frequent ER visits (I had five before this last one) and being hospitalized are often a classic sign of BPD. I had almost expected it, especially after discussing my suspicions with my therapist a few weeks prior.
Since I had already read what the paper was, I went ahead and stopped Molly. “I already read the top of the paper. I know what this is,” I said, with a hint of laughter. She looked taken aback, almost embarrassed that she hadn’t ripped off the top before getting me. “How do you feel about it?” she asked. I confidently explained to her that I had already asked my therapist if I had BPD, and she had said she wasn’t sure yet. “I would have known what this paper was, even if you had ripped off the top. I would have recognized the symptoms from psychology classes,” I assuredly explained. She smiled. I smiled. “You can’t fool me that easily,” I joked.
In the end, I took the test and met with Molly the next day to talk about it. There were some questions I felt unsure about, in between a “yes” and “no.” I wrote explanations on the side, but I knew they had to just count the “yesses,” and this might affect my score. Molly explained, “You definitely have traits of borderline personality disorder, even if you don’t meet the full diagnosis.” She never explicitly said if I had it or not. For some reason, no one would. A few days later when I was discharged I saw on the diagnosis, “Cluster B Personality Disorder.” This is code for BPD, but not quite. A more definitive answer would have to wait, which frustrated me. I just wanted a definitive answer
A few weeks after being discharged from the hospital, I decided to bring it up with my DBT therapist again. Once again too shy to ask out loud, I wrote it on the bottom of my diary card: “Do I have BPD?” This time, she was less hesitant to answer. “Oh, I thought we had discussed that I thought that was something we were dealing with.” This time I was the one at a loss for an answer. She had before only said I was a “borderline rule-out,” not that it was a definitive diagnosis. Still, I was grateful for her honesty and direct answer. She asked how I felt about it, and I replied, “I don’t mind having the diagnosis. It helps me separate the symptoms from myself because they are BPD, not me.” Still, I knew the stigma that can come with a BPD diagnosis.
I work hard not to self-stigmatize in regard to having a mental illness, but it still hurts to know some professionals might hear “BPD” and feel fear. It still hurts to know some clinicians might refuse to treat me because I have this diagnosis and am higher risk. It still hurts to know my therapist almost didn’t want to give me this diagnosis because she worried the mark it would leave on my records. But it was a definitive answer, and that is what I had wanted.
Over these past few months since being hospitalized, discharged, and then finally diagnosed with borderline personality disorder, I’ve had plenty of time to think about what a BPD diagnosis means. I know it means there have since been many more crises and a second hospitalization, which is classic of the disorder. I know it means there will likely be more crises, though I’m hopeful I can be skillful enough to prevent anymore hospitalizations. I’ve been working harder in DBT, spending more time on my homework and practicing skills every day. I call for phone coaching when needed and really try to apply the DBT skills to nearly every situation.
A borderline personality disorder diagnosis is so complicated. I know I can check of several of the symptoms boxes, enough to have it written on my insurance claims. I know the stereotypes associated with the diagnosis, even if the stereotypes don’t usually seem like me.
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This internal conflict about revealing the diagnosis came up when I was meeting with a new doctor a few weeks ago and she asked me all of my diagnoses. I said OCD and depression, but hesitated before adding BPD. I was ashamed to have this label permanently on my charts. I don’t want anyone to think something bad about me because of it. Yet I was honest, and I included it in my list. This doctor had excellent bedside manner and was very warm to talk to, so I felt comfortable revealing it to her. I even told her why I had hesitated. Then I added, with a laugh, “Maybe I can help change the stereotypes by having it on my file. A doctor might see it, but then meet me, and find out I’m a totally normal person.” The doctor smiled at me understandingly. She replied, “Honey, even if it doesn’t change their mind, you don’t need to care about what others think.” It’s taken some time to get there, but I can see the truth in her statement.
Yes, I have been diagnosed with borderline personality disorder. Yes, I have been through emotional chaos, crises, and even hospitalizations because of it. Yes, I am sometimes difficult to have a relationship with because of these things. Yet, I am still a good person. I am still kind, empathetic, smart, nurturing, hardworking, and hopeful. I’m still the poised, functioning ballerina everyone sees. Borderline personality disorder isn’t a scarlet letter on my records. At least, it isn’t to me.