It came to me that every time i lose a dog

She presses the next electrode to her own forehead, attaches a wire to it, and shrugs.

- Now he reminds me of the fear I overcame.

She gets up from behind. I grip the arms of my chair so tightly that my knuckles turn white. Tory pulls on the wires, attaches them to herself, to me, to the car behind her. Then he hands me a test tube with a clear liquid.

“Drink,” she says.

- What is it?

My throat felt swollen. I swallow hard.

- What will happen?

- I can't tell you. Just trust me.

I exhale noisily and tip the test tube into my mouth. My eyes are closing.

They open in just a moment, but I find myself in a different place. I'm standing in the school cafeteria again, but all the long tables are empty and it's snowing behind the glass walls. There are two baskets on the table in front of me. One holds a piece of cheese, the other holds a knife as long as my forearm.

A woman's voice behind her says:

- Choose.

- Why? I ask.

“Choose,” the woman repeats.

I turn around, but there is no one behind me. I return to the baskets.

- What should I do with them?

- Choose! she screams.

When she yells at me, fear disappears, replaced by stubbornness. I frown and cross my arms over my chest.

“As you know,” she says.

Baskets disappear. I turn at the creak of the door and see a sharp-nosed dog a few yards away. He crouches down and stalks towards me, baring his white teeth. A growl rumbles deep in his throat, and I understand why cheese would be useful. Or a knife. But it's too late.

Run away? But the dog is faster than me. I can't pin him to the ground. Blood is pulsing in my head. I have to make a decision. If you jump over some table and block it ... no, I'm too small to jump over tables, and too weak to knock over one of them.

The dog growls and I can almost feel the sound vibrate in my skull.

It says in a biology textbook that dogs smell fear because of a chemical that human glands release when threatened with violence. The same substance is secreted by animals that dogs hunt. The smell of fear prompts them to attack. The dog approaches me, claws scratching the floor.

I can't escape. I can't fight. Instead, I hear the dog's bad breath and try not to think about what he just ate. There are no whites in his eyes, only a black flicker.

What else do I know about dogs? I shouldn't look into his eyes. This is a sign of aggression. As a child, I asked my father for a puppy, and now, standing in front of the dog's clawed paws, I can't remember why. The dog comes closer, still growling. If eye contact is a sign of aggression, what is the sign of submission?

I breathe loudly but evenly. I get down on my knees. The last thing I want to do is lie on the floor in front of the dog - face level with his teeth - but this is the best thing I can think of. I stretch my legs and lean on my elbows. The dog creeps closer and closer until it burns my face with its hot breath. My hands are trembling.

He barks in my ear and I clench my teeth to keep from screaming.

Something rough and wet touches my cheek. The dog stops growling, and when I look up at him again, he breathes noisily. He licks my face. I frown and sit on my heels. The dog puts his paws on my knees and licks my chin. I recoil, wiping drool off my skin, and laugh.

- You're not a scary monster at all, are you?

I get up slowly so as not to startle the dog, but he does not look at all like the wild animal that stood in front of me a few seconds ago. I hold out my hand, cautious, ready to pull it back if need be. The dog pokes his head into my hand. I'm suddenly glad I didn't choose the knife.

I blink, and when I open my eyes, there is a girl in a white dress on the other side of the room. She stretches out her hands and squeals:

- Puppy!

She runs towards the dog next to me and I open my mouth to warn her, but it's too late. The dog turns around. He does not growl, but barks, snarls and snaps his mouth, and the muscles bulge under his skin, like coils of wire. He's about to jump. Without thinking, I throw myself at the dog; I lean on him with my whole body, wrapping my arms around his thick neck.

I hit my head on the floor. The dog disappeared, as did the little girl. I was left alone - in the testing room, this time empty. I slowly turn around and don't see myself in any mirror. I push the door and go out into the corridor, but this is not a corridor; it's a bus and all the seats are occupied.

I stand in the aisle and hold on to the handrail. A man is sitting next to me with a newspaper. His face is obscured by the newspaper, but I can see his hands. They are scarred, as if he had been burned, and clutch the paper as if they want to crumple it.

- Do you know this guy? he asks, tapping the photo on the front page of the paper.

The headline reads: "Brutal killer finally apprehended!" I look at the word killer. A lot of water has flowed under the bridge since I last read that word, but its shape still fills me with dread.

In the photograph under the heading, a young boy with a plain face and beard. I think I saw it somewhere, but I don't remember where. And at the same time, it seems to me that you should not tell a man about it.

- So what? – Anger is ringing in his voice. - Do you know him?

Don't… no, by no means! My heart is pounding, and I grip the handrail to keep my hands from trembling, so they don't give me away. If I tell him I know the guy in the article, something terrible will happen to me. But I can convince him that I don't know anything. I can clear my throat and shrug...but that would be a lie.

I clear my throat.

- Do you know? he repeats.

I shrug.

- Well?

I shudder. My fear is irrational; this is just a test, not reality.

“Nope,” I casually reply. - I have no idea who it is.

He gets up and I finally see his face. He wears dark sunglasses and his mouth is twisted with malice. His cheeks are scarred, as are his arms. He leans towards my face. His breath smells like cigarettes. Not reality, I remind myself. “Not reality.”

“You are lying,” he says. - You are lying!

- I'm not lying.

- I can see it in your eyes.

I straighten my back.

- You don't see anything.

“If you know him,” he says quietly, “then you can save me. Can you save me!

I squint.

“Alas,” I say, and protrude my jaw, “I don’t know him.

On the Edge: Living with Borderline Personality Disorder

Medical Issues

Text: Masha Pushkina,

Ekaterina Tarasova

Illustrations: Alena Belyakova

October 31, 2017

Borderline personality disorder affects 3% of people on Earth. It would seem that 3% is not much at all, but we are talking about several hundred million people, and this is twice as much as the entire population of Russia. What is BPD and where does it come from, how can a “border guard” live with himself and what should his relatives do, can he be cured and how can he help himself on his own - all this is in our new large material on disorders. Anna Ushkalova, a psychiatrist at the International Medical Center, assisted us in researching the issue. Special thanks to Katya Novikova for collecting comments from people with BPD.

Borderline personality disorder ( BPD, Borderline personality disorder ) is a psychiatric disease characteristic of people who are characterized by instability in interpersonal relationships, self-image, emotional instability, impulsivity. These symptoms occur at a young age, appear regularly in many life situations and lead to maladjustment in society.

Unfortunately, in our country little attention is paid to the problems of people with BPD. Incorrect diagnosis often complicates the treatment process itself.

“People with BPD are often treated incorrectly with medications that only make them worse. But in most cases, “border guards” are unaware of their diagnosis and, accordingly, do not know that their condition can be corrected.

In Russia, acquaintance with the methods of psychotherapy of borderline disorder common in the West is just beginning, there are only a few experienced specialists. But the first psychotherapeutic communities are already opening up where people with BPD can get help, ”says the Resource Center, an information portal for people suffering from borderline disorder.

Psychiatry classifies BPD as a personality disorder, a group of diseases that includes various character pathologies, from dissociative disorders to narcissistic disorders.

Despite the similarity of the name, "borderline personality disorder" has nothing to do with "borderline". Psychologists call the borderline state the degree of severity of character traits on the verge of norm and pathology.

Diagnosis

In order to make a diagnosis of BPD, in addition to general symptoms, at least five other signs from the following list must be present:

1. Strong fear of being alone. The tendency to make excessive efforts to avoid the real or imagined fate of being abandoned.

2. A tendency to intense, tense and unstable relationships, in which extremes alternate - idealization and devaluation of the partner.

3. Identity disorder: instability of the image or feeling of the self. Ups and downs of self-esteem. Fuzzy ideas about myself (who am I? what do I like? what do I want?).

4. Impulsivity, which manifests itself in at least two areas of dangerous behavior, such as spending money, sexual behavior, substance abuse, risky driving, overeating.

5. Recurrent suicidal behavior, suicide threats, repeated acts of self-harm. Masochistic tendencies in behavior and relationships with people.

6. Affective instability, extremely changeable mood. In this case, periods of intense dysphoria, irritability or anxiety are usually short and last from a few minutes to several days.

7. Constant feeling of emptiness, senselessness, boredom.

8. Inappropriate displays of intense anger or difficulty in controlling anger (eg frequent irritability, repeated fights).

9. In conditions of severe stress, paranoid ideas and suspicion, dissociative symptoms, derealization, depersonalization may occur.

10. Violations of mentalization, that is, understanding the motives of one's own and other people's actions, difficulty in understanding the emotions and reactions of other people.

11. Chaotic interpersonal relationships.

To understand what the world of the "border guard" looks like from the inside, I interviewed more than ten people with a diagnosis of "borderline personality disorder. " They talked about the main symptoms of BPD through the prism of personal and very painful experience.

Features of "border guards"

Psychiatrists call it identity disorder, psychopathy, sluggish schizophrenia - because BPD only exists in the DSM-4 foreign classification of diseases. "Border guards" are so dependent on the attitude of other people towards them and their own emotional outbursts that they hardly understand what they really are and what they want from life. These are solipsists in reverse: they consider the world around them to be a figment of their imagination, while people with BPD often doubt their own reality.

Who am I?

Anya: “The hardest thing is the complete fragmentation of the world and oneself. Every day or several times a day you are a completely different person, and you are strongly influenced by the people around you and events. Either you are tough and distant, then you are deeply dependent and extremely emotional, then you are straight, then you are lesbian, then you are generally asexual. You can react radically differently to the same thing, depending on which part of your personality you find yourself in at that moment. And each of the states seems to be absolute, you are not able to remember yourself at this moment.

It's almost a split personality, and your parts are barely connected. The hardest part is the feeling that you don't really exist. It's like you only exist while someone is looking at you and talking to you, while someone else is reflecting you. Sometimes these fluctuations leave you so isolated that you want to go outside and pester passers-by, asking if they see me at all.”

Anastasia, 18 years old, actress in the experimental theater and physics student: “I still do not clearly understand who I am. A feeling of inner emptiness that has been progressing since childhood, an extremely unstable self-esteem. But it's not that disturbing yet. But after I was visited by depersonalization and dissociation, it became not fun at all. And when there was a constant desire to harm myself, I was not the only one who got scared. Poisoning, cuts, blows, blackouts, bulimia - an incomplete list of my adventures.

Existence with such a fragmented self-perception is very painful. The life of a "border guard" during periods of deterioration is a constant fear of being rejected and mental pain; what Freud called the word "Angst".

Lois , aged 23: “My brain hurts. Every time I experience hell like the first time. During the next episode, it always seems that it has never been worse, now it’s definitely an apocalypse. The memory of what was bad before and then disappeared disappears.

Even answering the question “How are you?” is problematic. Immediately a swarm of questions arises: how are you when? now or today? Or maybe you're hinting with your question that you don't like me? what answer do you want to get?

Fear sends me into a vicious circle, when all options for action are bad: not talking about what I feel, keeping everything in myself is bad for me. I speak out - people take it personally, even if I clarify that these are just my feelings. Friends get angry and upset, which makes me even worse. And I can talk in a bad state endlessly. The more I talk, the more I regret what I said."

But several people noted positive aspects in their condition. For example, the ability to empathize (although other people have said the opposite: that obsession with their feelings prevents them from taking the place of another).

Ksenia, 25 years old, social media manager: “I think I feel everything much brighter and deeper than others. It is very difficult for me to be alone on the streets and especially in the metro, where there are a lot of people. Grandmothers begging, a sad girl, a stray dog, a tired driver - they all give me an uncontrollable pity and a feeling of empathy that is almost impossible to cope with. Crying three times on the way from home to work is a common thing.

The disease has expanded the boundaries of my perception, growing such a huge range of feelings that it allows me to easily enter into the position of others. My young man says that sometimes he himself does not have time to understand himself and understand some of his inner experiences, as I already feel the slightest changes in him and anticipate events.

It is important to understand that the condition of a border guard is not a continuous series of suffering. There are periods of improvement, and quite long ones. At this time, they can experience "brighter, richer and more interesting feelings, sharpening in perception, the ability to notice and enjoy such things in the world around them that ordinary people simply pass by."

Max: “During episodes of good mood, you want to communicate with everyone, you become very friendly and there is a lot of energy that is easy to direct to any business, just give it a push. But everything is fine only until something hits the switch. Even one ridiculous thing - say, the death of a dove - can cause the world to abruptly change its tone to black.

Don't leave me - leave immediately!

The void must be filled with something, and the fragmented consciousness must be glued together. Most often - strong feelings and emotions of other people, which the "border guard" needs like air.

A feature that distinguishes all people with BPD is the difficulty in building stable relationships. On the one hand, they strive for dependence and complete merging, but at the same time they are afraid of intimacy, feeling danger in it. After all, if a loved one rejects you, it will be tantamount to losing yourself. Therefore, such people try to leave first, often suddenly and for no apparent reason.

Xenia: “People with BPD have such a thing as Favorite Person (FP). This is the one who replaces you all and everything. To some extent, this is reminiscent of the relationship between the dog and the owner, when the dog was left at home alone, and he trashed the whole apartment and whined at the door for several hours, waiting for the owner. Most of the time I cannot be alone with myself, I am corroded by emptiness and at the same time a storm of emotions.

Rina, 25 years old, philologist: “I am constantly waiting for rejection. You may not be aware of this, live in peace, and then one of your friends will express himself incorrectly, say, for example, “Let's say goodbye” - and your world will immediately collapse. You start to think that the person doesn't want to see you again. You delve into yourself, trying to figure out what you did wrong, until you plunge into the abyss of sadness and thoughts about death. And a friend just wanted to say that he needs to go home now, we'll meet tomorrow. Always like this".

Being close to a "border guard" is risky. In his love, idealization is always replaced by depreciation, and the one who yesterday was a “handsome prince”, after a couple of unsuccessful phrases, can turn into a “terrible tyrant”.

N: “Because I am afraid of being left and abandoned, I have always destroyed all relationships. I started seeing a therapist because I was unable to trust the girls I dated. If we didn’t see each other for a day, and sometimes for several hours, I was absolutely sure that she had cheated on me, that everyone around me was deceiving.

Pain and razor

Many do not believe in the depth and severity of the experiences of BPD sufferers. Their loud suffering from the outside may seem like just a way to attract attention and manipulate. But all these feelings, even if they are objectively inadequate, are completely real in the mind of the patient. Their ignoring and depreciation can end in a real disaster.

Up to 10% of "border guards" die by suicide. These are extreme cases. What happens much more often, at some point in life - with almost everyone, is self-harm, that is, self-harm. Chaos inside and mental pain become so strong that physical pain seems more acceptable.

My interlocutors named various motives for inflicting physical harm on themselves: it could be “punishment” for bad behavior, a way to drown out guilt and shame for their “abnormality”, and even an attempt to destroy the “monster” inside, which destroys everything around and poisons the lives of loved ones . It can also be a cry for help, a desperate attempt to get support, most often from indifferent parents.

To suppress pain, both alcohol and psychotropic substances are used, so borderline disorder gives rise to addictions and codependencies.

Xenia: “Many harm themselves spontaneously, thoughtlessly. But there are also those who specially, in a special way, prepare for this: they sharpen a knife, sterilize the skin, prepare bandages. Sometimes it is not enough for such people to inflict a wound on themselves, because it will heal anyway. They pour lemon juice over the cuts and cover them with salt.”

D., 20 years old, student: “At five in the morning, I was standing in the dormitory toilet with a knife in my hand. Blood was splattering down my leg. Back then, self-harm was the only reliable way to deal with emotions without losing performance. Then I carried the knife in my bag, kept it on the table next to the laptop at home and even sometimes slept with it, hiding it under the pillow or under the bed. Only then did I realize that it was a disease.”

The greatest risk of suicide in BPD is at a young age (13-15 years)

© Berman A.L., 1985; Friedman R.C., 1987

Aggression can be directed not only at oneself, but also at another. Not so long ago, the Internet was bypassed by a video of schoolgirls who beat each other in a wasteland while friends were filming it. The audience was shocked by girlish aggression: they tried to blame her on television, computer games. It seems that no one then thought that this could be a way to overcome mental pain: “Anya (author's note: the heroine's best friend) backhanded me in the face. We fought: we thrashed with our fists and legs, pulled each other by the hair, scratched, tried to knock each other to the ground and beat each other harder. We smashed our noses and cut our lips, ripped our clothes and tried to release our heartache, like in Fight Club.

Some are able to channel this need for physical pain into more acceptable channels. Among the border guards there are many fans of piercings, tattoos, BDSM.

Not all people with BPD cut themselves and abuse alcohol or other substances: borderline disorder can present with relatively "mild" disorders. In borderline disorder, either impulsivity, suicidal attempts, or violations of direct interpersonal relationships may predominate, when, due to emotional instability, relationships with others become negative. There are more severe violations, as in the case of suicide attempts, when psychiatric consultations are necessary. There are such disorders in which you can improve your life with the help of regular psychotherapy and work on yourself. That is, the gradations of symptoms in the manifestation of BPD are very different! Sometimes people seem to be adapted at first glance, everything “seems to be all right” with them: they work, they live well, but in stressful situations they can show impulsive destructive behavior. One hundred and fifty-one different combinations of symptoms are possible in the clinical picture of patients diagnosed with BPD (and some authors give two hundred and fifty-six as a possible number of combinations of symptoms)!

Self-help

Borderline disorder is by no means a sentence. Almost all of my interlocutors were able to recognize their problem and find constructive ways to deal with emotional extremes. In order to perceive the world as it is, and not as dictated by a sick imagination, the "border guard" needs to make great efforts.

D: “I have a whole list of self-help methods: meditation, mindfulness exercises, detachment from the situation (I physically interrupt the conversation, leave the apartment, and so on). And, of course, in my head there is always a background process of tracking my thoughts and correcting errors of perception. Regularly do “reality checks”:

1.

in my mind I build a “line of defense” in favor of the person whom I suspect of bad things;

2.

asking a stranger how he would react to the situation;

3.

step back, wait until emotions subside, and only then make a decision;

4.

I try to keep a schedule of work and rest: I am especially unstable during sessions and deadlines, so I try to prepare in advance and always get enough sleep. ”.

Daria, 34 years old, psychotherapist: “Psychotherapy helped me understand myself. With the help of a therapist, I learned to understand what my boundaries are. Then I figured out exactly what I feel, what I want at that moment and what to do with it. I learned to console myself. A person with BPD mourns the lost love of his parents, and this grief is hidden under a huge layer of rage, because the family was not allowed to grieve. Then I had to learn to take responsibility for my own needs and not take revenge on my relatives for the sins of my parents.

N: “The therapist gave me an exercise based on meditation: in an inner voice that expresses self-care, acknowledge my feelings, acknowledge that right now it hurts and is unpleasant, and then imagine a gesture that would express self-care ( like a big hug). It helps a lot. It became incredibly easier for me to live when I realized what was happening, that all these things (a change in the meaning of life every ten minutes, breakdowns and tantrums) are not really me, but my disease.

Lois: “Adequate view from the outside is extremely important to us. A friend recently told me what my “borderline” part looks like. And that was the most helpful information I've received in months. She helped me finish a difficult episode. Without a friend, I would never have guessed what it looks like.

She (my border side):

1.

requires constant attention;

2.

she needs to explain everything;

3.

her thoughts must be guessed;

4.

she acts like a child.

I am learning to catch and unravel "boundary" thoughts, make them absurd, I try to share them with my loved ones in order to jointly refute them. It's a very useful practice."

Polina: “I am a perfectionist and have always strived to be the best. But if I've learned anything during my illness, it's that the world and the people around you are already demanding enough, so it's important to be kind and gentle with yourself. Now I just allow myself to be weak. I allow myself to listen to sad music, cry and whine. I allow myself to take breaks from work. Because I know that if you do not allow yourself weakness, it will be even worse.

Alexander , poet, journalist: “I am always looking for new, constructive ways. For example, the People Skills To Go app for people with BPD. In times of crisis, without psychotherapists and psychiatrists, I would not have coped. Sometimes people get tired of me and stop talking, but many people stay in relationships for many years, and I think that love overcomes pain.

Many BPD sufferers have a desire for creativity, self-expression through it. And this is also a form of therapy.

Anastasia: “The theater saves me. If there are no rehearsals, I dance, merge with the music. If there is no physical strength, then I lie on the floor and listen to cello and piano recordings.

Xenia: “The Telegram channel saved me, I wrote everything I felt there, trying to spit out all the lines in a beam between my eyes. The letters floated in front of me, blocking out the pain for a while. A round dance of unspoken words that flew like canvases to the Internet to thousands of people.

Relationships

Many people with BPD are quite happy with their social and personal lives, but this is exactly the case when you cannot rely on feelings and the will of fate alone. A lot of work is needed on oneself and relationships, and on both sides. The “border guard” needs to be aware and pronounce every conflict moment, and, most importantly, learn to express their feelings without aggression. Partner, respectively - to support him and calmly answer even the strangest questions.

The popular advice for dealing with "tantrums" - to go away and wait until she calms down - is not applicable in any case, because everything can end very badly.

Daria: “I used to have more friends, but it was codependency based on the 'eat my mental waste and I'll eat yours' co-dependence. Now I redefine the concept of friendship for myself.

It was hard for my second husband, whom we met at the height of my treatment. He says that he had to calm me down two or three times a day. I was stormy at the sudden appearance of a valuable person whom I tried to simultaneously idealize and completely appropriate, and completely devalue - that is, forever banish from the horror of intimacy. Now, three years later, when I sometimes start to stagger from fatigue and overstrain, I “hang” on my husband - I describe my feelings to him, he gently tells that in reality everything is not so, but much better, and it becomes easier for me.

Rina: “My friends know my diagnosis. Friends and colleagues consider me an interesting and very eccentric person. I studied so much literature about PHR that I learned how to lecture my friends about what was happening to me. Now they almost see me better when I am carried, and can insure in time.

Polina: “I do not hide my condition from anyone: not so long ago I published a long post on Facebook explaining my diagnosis in detail, and received a lot of support. Many relatives are also aware, but not everyone understands how to behave correctly. Even my father, when I told him about BPD, joked: “Go to the village to milk the cows at five in the morning.” Not a very good joke, I think.

I think it's pointless to hide, because sooner or later my condition will become public - I'm not made of iron. So I try to avoid rumors, discussions behind my back and accusations of a bad temper. I'm really lucky that they accept me, because, perhaps, I myself would not want to be my own friend.

Lois: “Before, I couldn't tell when something was going on, now I can say to a new acquaintance, 'Sometimes I react illogically to what's going on around me. If I ask: Are you sure you don't hate me now? “It means that I’m really afraid to hear: yes, I hate you and don’t want to see you ever.”

Diagnostics in Russia

The cases described above are the exception rather than the rule. Most people with borderline disorder do not know their diagnosis and do not receive any treatment.

Since BPD has almost no obvious psychiatric manifestations such as hallucinations and psychosis, it does not occur to the patient or his relatives to see a doctor. Self-harm - the most obvious manifestation of BPD - patients carefully hide.

Acquaintances consider such a person to be hysterical, self-centered, capricious, with a bad temper and do not believe that he can be changed. He himself, due to the specifics of the disease, is not able to analyze and evaluate his condition, and in his problems he sincerely considers others or external circumstances to be guilty.

Anna Ushkalova, psychiatrist: “Difficulties in diagnosing BPD – like other personality disorders – lie in the fact that historically the mental health care system in Russia has been oriented towards inpatient treatment with an emphasis on acute and emergency conditions. Russian psychiatry paid insufficient attention to personality disorders in general. In addition, psychotherapeutic education in our country is not included in the basic course of psychiatry. Nevertheless, interest in this problem is growing, as is the number of specialists with skills and experience in working with such disorders.

The situation is complicated by the fact that in the International Classification of Diseases (ICD-10) adopted in Russia, the diagnosis of "borderline personality disorder" does not exist at all. There is a concept close, but not identical to it - "emotionally unstable personality disorder" (disease code - F60.3).

Daria: “I realized what was happening to me when I was about twenty-five years old, when they started writing about BPD on the Internet. I realized that I am not a lazy, inconsistent, irresponsible hysteric, but that what is happening in my body and head has objective reasons.

Up to a third of all completed suicides are committed by people with BPD

© Kullgren G. et al., 1986; Runesson B. et al., 1991; Links, 2003

Unfortunately, often those with BPD do not see a doctor for the first time until after a suicide attempt. If it does not reach such an extreme, the diagnosis can turn into a whole investigation.

Polina: “The prerequisites were still in early childhood, and alarm bells began to be heard in high school, when, unexpectedly for myself, I started cutting myself, then starving myself and depriving myself of sleep. It took me a long time to figure out what was wrong with me. At first she turned to a private psychotherapist, but she suspected a charlatan in her. Long trips to the doctors began. They didn’t tell me anything worthwhile, they advised me to drink glycine. In the meantime, I suspected that I had bipolar disorder, it seemed to me that I was wasting time with doctors - in general, it was so. The mother of a friend once told me that she was successfully treated in the Clinic of Neurosis. Already at home, in St. Petersburg, a neurologist in the district clinic wrote me a referral. At the clinic, I was first diagnosed with “bipolar disorder”, but it was not confirmed. The psychiatrist started calling me ‘border guard’.”

Some of the symptoms of borderline disorder are indeed similar to those of bipolar disorder (mood swings, alternations of agitation and depression, depression), and misdiagnosis is not uncommon.

It is important to remember the differences: in BPD, unlike bipolar affective disorder, mood swings are instantaneous and can occur dozens of times a day, and are most often caused by external events rather than internal processes.

But there are also patients in whom these two diseases are combined: according to a number of studies, such cases are more than 10%.

Anna Ushkalova, psychiatrist: “In the new, eleventh edition of the International Classification of Diseases, a transition to completely different criteria for all personality disorders, including BPD, is planned. First of all, the degree of maladjustment of a person will be taken into account. If a doctor in the public care system can even determine the very presence of the disorder and send the patient to a psychotherapist, this will be a breakthrough in treatment.”

Making a diagnosis, no matter how hard it may sound, changes the lives of patients for the better. Understanding what exactly is happening to you, and that you can influence it, gives a sense of control that people with borderline disorder lack so much.

Xenia: “Before, I constantly thought that other people just didn’t want to understand me, that I didn’t try hard enough, that I should become like everyone else, or vice versa, everyone should become like me. Until the age of twenty-four, I had full confidence that I was special, that I had a completely unique set of qualities, that I did things that were peculiar to me. And then I read an article about BPD and realized that I had lived my whole life as if by a textbook. ”

Causes of borderline disorder

There is no clear understanding of the causes of borderline disorder.

As with most mental illnesses, both innate predisposition and early trauma seem to play a role. In almost every case history there is an emotional shock: the loss of a very close person, physical or sexual abuse, generally inappropriate behavior of parents.

If in due time the child is not taught to value himself as a person and to understand where the boundary lies between his interests and the interests of others, he will not be able to trust either others or himself in the future.

Anna Ushkalova, psychiatrist: “Currently, the biosocial model has gained the most recognition. The pathogenesis of BPD can be represented as follows: against the background of a genetic predisposition, there is a “vulnerability” of individual biological structures (hyperactivity of the limbic system, a decrease in the regulatory function of the prefrontal cortex). This leads to increased excitation and slower inhibition in response to stress. The combination of these factors with adverse conditions, especially in childhood (such as sexual or physical abuse, neglect) leads to the fact that the patient develops a dysfunctional pattern of emotional response and behavior.

Psychological reasons

The most common cause of borderline disorder is considered direct child abuse in the family and chronic childhood trauma.

Xenia: “When I was four years old, I was sexually abused by an elderly man. This situation haunts me to this day and clearly had a great influence on the formation of my personality. Specifically, it blew the roof off me at thirteen or fifteen: alcohol, drugs, the wrong company, fights, hooliganism, running away from home, uncontrolled sexual behavior.

Lois: “When I was twelve, my stepfather confessed his 'love' to me. The first "kiss" was with him. At that time, I did not understand so much what was happening that I froze physically, disconnected from all emotions and did not talk to anyone for another two days. Then there was a series of cases of psychological and physical violence, and he constantly said that he loved me and suffered because of such a difficult situation. In addition, he followed all my actions, read correspondence with my friends, communicated with them if he did not like something. I didn’t understand what was going on at all, but he threatened me and I haven’t told my parents anything until now.”

However, more often than not, an unfavorable emotional situation is enough: often "borderliness" is brought up by parents with their own mental disorders.

Anya: “Mom has a mental disorder, although she has never seen a psychiatrist. Her contact with reality was clearly broken, she always lived in imaginary worlds, and from my early childhood I was left to myself, there was practically no communication within the family.

Daria: “The family was middle-income, no one beat or raped me, and for a long time I could not understand what had destroyed me so much. My brother and I had cold, anxious, aggressive, demanding parents, a depressed mother, and a combination of borderline and narcissistic father. It looked like this: something rolled over one of the parents, and they began to bombard my brother and me with demands, accusations, claims against each other - “your neglected mother” and “your crazy father”. It was quite difficult to predict when and whom it would close, so we grew up in an atmosphere of complete chaos, which we attributed not to our parents, but to ourselves. As a result of such an upbringing, I considered myself practically crazy and honestly thought that I would end my life in the garbage, where I belong.

Some people described their families as outwardly quite normal and, in the opinion of others, prosperous. Often the violence is purely emotional and goes unnoticed by outsiders.

Rina: “All through my childhood, I diligently fulfilled the function entrusted to me — reconciling my parents when they made scandals.”

V., IT specialist: “There was a conflict in the family. I was a very late child and... I don't know how to explain it - this is a huge gap between the parents' view of life, the way it should be, and the views of other people. I was “that weird kid” who was dressed the wrong way and treated the wrong way. As a result, at the age of eighteen, he ended up in a therapeutic department of psychiatry with hysteria.

Polina: “My earliest childhood was almost perfect. But in elementary school, my father lost his business and fell into a deep depression. So that I would not see this, I was sent to live with my grandmother. Grandmother is a church-going person, which she instilled in me as well. This had a rather strong influence: I treat each of my mistakes as a terrible sin, I feel guilty about everything. At confession, you pronounce your sins to the priest, and he lets them go for you. My “sins” never let me go, I didn’t feel forgiven by anyone.”

Biological causes

Physicians have discovered abnormalities in the functioning of the brain of people with borderline disorder.

Tendency to depression, anxiety and fear of being abandoned were explained by disturbances in the functioning of serotonin receptors. Due to childhood stress, these receptors become less sensitive to stimuli. That is, impulsiveness, weak will and self-control are not the result of promiscuity: it has specific biological causes.

Using brain mapping techniques, researchers have identified key reasons for the inability of BPD patients to regulate their aggression. BPD sufferers have a strong activation of the amygdala, which is responsible for emotions, which can cause errors in perceiving other people's neutral facial expressions when they appear unfriendly. Moreover, doctors note that distortions in the mental world can be not only a consequence, but also the cause of impaired activity in the amygdala. In addition, patients with BPD produce more of the stress hormone cortisol, so they are in a constant state of hyper-alertness. The prefrontal cortex, which is responsible for self-control, on the contrary, is too weakly activated in such patients: this prevents them from evaluating their actions from the outside. Also, many “border guards” found a decrease in the volume of the hippocampus, which is responsible for memory: it is suggested that this makes it difficult to comprehend the history of relationships with other people. The hormone dopamine, which causes us to enjoy pleasant things and encourages us to seek these pleasures, is often produced in BPD sufferers from relationships that bring negative emotions - hence the desire to repeat unpleasant relationship patterns.

Useful resources about BPD

In 2017, the first Russian Resource Center was opened - an information portal for people suffering from borderline personality disorder, created on the basis of the experience of colleagues from the USA and Australia.

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