BPD comes with a lot of baggage. Most people have at least one other psychiatric disorder and some have several. Maybe, depression, anxiety or struggle with alcohol or drug use. It is very challenging to deal with all the symptoms together, making it more difficult to recover so it is worth knowing the most common co-occurring disorders often associated with BPD…
Substance abuse
2/3rds of BPD sufferers have substance abuse problems and it is thought that as many as 1/5 of substance abusers meet the criteria for BPD. They may use substances as a way to escape emotional pain. No-one says ‘I want a day of upset’ so it is understandable. It is avoidance. This causes problems as avoiding your feelings doesn’t help you with the problems that led to these feelings in the first place – you don’t face them and can make them much worse. The problems hang around and you get more upset
Substances turn you into an altered state – a mental state where you don’t feel like yourself, and this seems good for emotional people who are at a loss for how to deal with their distressing feelings. But these are temporary fixes – escapism. Escapism/avoidance is fine in small doses, as it can give a sufferer breathing space to just be indulged in the present moment (films, travel, socialising) but using substances to achieve the same feeling of avoidance is not healthy and can be the start of a debilitating habit, leading sometimes to addiction. And you can feel worse afterwards, when suffering a hangover and go back for some more substances to feel better again….
Then you might build up a tolerance, and may suffer from withdrawal symptoms (sweating, agitation, anxiousness and nausea). This can then lead to using more. Then the substance is in control of your life. Relationships may suffer, responsibilities at work may not be met and health problems may develop. BPD and substance use go hand in hand so often, many popular treatments make a point of dealing with it. DBT involves teaching people with BPD other ways to cope with and tolerate unpleasant feelings.
Eating disorders
Eating disorders such as bulimia nervosa and anorexia nervosa can occur too and 50% of BPD sufferers have an eating disorder. (I did when I was 15 to 18 years old – 3 days not eating, binge eating, bulimia, anorexia, purging, over-exercising and laxatives). Eating and purging can be a release from stress or problems and food is used for comfort too. Bread, cakes, chips and candy help to release dopamine in the brain, so are a temporary comfort too. Purging is dangerous and vomiting only gets rid of around a third of the calories consumed. The processes take over your life and can damage your relationships, health and life.
It also incorporates body dissatisfaction but not solely Maybe a negative past has made them this way, and they can self-hate by acting out this self-harm process.
When you feel that your life, emotions, relationships and behaviours are out of control, you may seek to find control in your eating disorder – you CAN control what you eat or don’t eat and therefore gain control of a part of your life that you can cling to, even though it actually controls you in the end and becomes obsessive.
Depression
• Intense sadness and hopelessness
• Loss of pleasure in formerly enjoyable activities
• Suicidal thoughts
• Low self-esteem
• Appetite and sleep changes (too much or too little)
• Concentration difficulties
• Low motivation and energy
This is the most common disorders among people with BPD. People with BPD have difficult relationships (arguments, break ups and abuse). Also intense fears they will be abandoned. They may find themselves full of negative emotions and helpless to cope with the intensity and frequency of them. They may not have much sense of who they are and worry that others are talking about them behind their back or are not supportive of them. Treatment can be difficult and a painful process.
This can all lead to depression and not surprising is it. You may feel that it is longstanding that there is no helping you and that there is no purpose in wasting time or energy on trying to get better. Stormy relationships and constant fighting with the people around you might be another negative symptom. You might start to feel really isolated and lonely. So these are perfect ingredients for the start of depression.
However, once the BPD symptoms subside with help, the depression will subside as the problems will not be so depressing.
Bipolar
10% of BPD sufferers have bipolar too leading to extreme fluctuations in their moods (although mood swings are prevalent in BPD as well, bipolar mood swings last longer). Depression may last for a couple of weeks, then swing up to mania (top of the world, powerful and able to undertake huge projects, lots of energy or irritable – impulsive and little sleep) – extreme mood swings.
Often misdiagnosed, BPD is different to bipolar, as the mood swings change much more rapidly and last minutes or hours, whereas bipolar mood swings change more slowly and last days.
Social Anxiety Disorder
One in four BPD sufferers also have social anxiety disorder (fear of being negatively valued in social situations, parties, meeting new people, eating in front of people) – for me, dancing in a club, sometimes meeting people, sometimes eating at restaurants and sometimes parties and not being left alone could spark an anxiety attack.
Panic Disorder
One in three people with BPD also have panic disorder. The ‘fight or flight’ reflex when we are threatened or scared is where our body prepares us to flee a dangerous situation – rapid heartbeat, sweating, tunnel vision, muscle tension and rapid breathing. When we are stressed out or not taking care of ourselves and are scared of being anxious, our fight or flight system may fire without a threat being present. This is a panic attack. It comes out of the blue and is frightening. You may think that you are having a heart attack, going crazy or about to pass out. It is a chain reaction that can be set of easily. It is easy to start avoiding situations that you feel may lead to a panic attack or places that they cannot easily escape from. Some people don’t go out at all and become agoraphobic. Because BPD makes you stressed, this is why it is easy to have this disorder too.
PTSD
Half of BPD sufferers also have PTSD – as it manifests itself from a traumatic event that may have occurred as a child or adult. This can lead to dissociation and avoidance. As BPD affects how people feel, think, behave and interact with others, it probably isn’t too surprising that BPD rarely occurs on its own.
OCD (obsessive-compulsive disorder)
Obsessive Compulsive Disorder (OCD) is essentially the way our mind forms a pattern of thoughts (obsessions) which then lead to a pattern of behaviours (compulsions)
This pattern is formed as such:
•Obsession – this is a constant fear or worry about something in the mind which can become overwhelming. This might be a fear that our actions may lead to harming another person
•Anxiety – thinking about this obsession over and over can bring anxiety and panic
•Compulsion – to reduce the anxiety and panic, one might stop going out to avoid causing any harm. This is a compulsive action carried out to try to relieve ones worries.
•Temporary relief – This compulsive behaviour may help at the time to relieve the anxiety and panic, but the obsession will come back and one has to continue the compulsive behaviour in order to relieve oneself again. It is a vicious circle which cannot seem to be broken.
Self harm and suicidal behaviour
This can often be mistaken as attention seeking, such as suicidal behaviours and self harm. It simply is not true. Ambivalent suicide attempts are when you are half sure you want to die and half sure you don’t want to die. Suicidal ideation is where you are thinking about ending your life. It is not a suicidal gesture (it is not a gesture let’s face it, it is real), it is not a cry for help as the only reason they do it is not to gain attention – calling these behaviours a cry for help undermines their seriousness and invalidates the needs they meet. People hurt themselves to escape emotional pain and to feel better, and to say it is manipulative is to dismiss the real reasons they are drawn to doing such a bad thing to themselves.
20% of people in psychiatric hospitals are BPD.
75% of BPD sufferers attempt suicide
5-10 % actually do kill themselves
69-80% have self-harmed
BPD is the only disorder in the DSM-IV-TR that has self-harm and suicidal behaviour as one of its criteria
Why self-harm – attempt suicide?
People may have no idea how to make themselves feel better when they are really upset. They may be so overwhelmed by their intense emotions that they think of any way to get relief. People who have self-harmed regularly actually show lower emotional arousal when they imagine harming themselves.
When you cannot see a way to make things better, you may think that suicide is the answer to feel better, but you don’t, as you are not around to feel anything and who knows what happens at that point? Punishing is a better action than attempting suicide, as they need to be alive to punish themselves more so don’t want to die, but it is detrimental and makes you feel worse about yourself anyway. Growing up in an invalidating environment, people might have punished, dismissed or criticized you when you struggled with your emotions… Like me.
Having BPD can make you feel like you are a burden to others and they would be better off without you, but people would be much worse off. Also, we may be trying to communicate something to other people, as they are not skilful enough to ask for what we want or assertive enough. So self harm and suicide attempts serve many purposes and there are many reasons why people resort to them.
While many of these co-occurring disorders often seem like they are part of BPD they are separate in their own right and should be treated as such. If you have experienced any of these other disorders and would like to talk to someone about them do get in touch with us via the Contact Us page.
