Interview with Courtney Cook, Author of The Way She Feels: My Life on the Borderline in Pictures and Pieces

Courtney Cook, author of The Way She Feels: My Life on the Borderline in Pictures and Pieces (Tin House, 2021).

Courtney Cook, author of The Way She Feels: My Life on the Borderline in Pictures and Pieces (Tin House, 2021).


Disclaimer: This interview contains a first-person account of experience with mental illness and other topics relating to mental health that may be sensitive to some audiences. It is presented for informational purposes only. Please take care when reading, and engage with this interview only if you feel you’re in a place that will allow you to do so safely.  If you feel you’re in need of support at any time, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or consult SIoutreach.org. In the event of a medical emergency, please seek emergency care immediately through a doctor, hospital, or by calling 911 in the United States. The views expressed herein belong to the interviewee and do not necessarily represent the views or opinions of Emotions Matter, Inc.


 Bea Tusiani of Emotions Matter interviewed Courtney Cook, author of the recently published book, The Way She Feels: My Life on the Borderline in Pictures and Pieces (Tin House, 2021) to learn more about her memoir and recovery journey.

Q: You describe BPD as a ghost that follows you around, haunting you. How have you managed to live with this and confront it?

Though I was first speculated to have BPD when I was thirteen, I didn’t receive a formal diagnosis until I was twenty-three. I felt that BPD was more of a ghost during the ten years where I wasn’t yet diagnosed, as I didn’t understand why I reacted so strongly to situations that others weren’t fazed by, why it took so long for my emotions to reach baseline even after the trigger was resolved, why I couldn’t seem to maintain friendships or relationships and constantly feared I was going to be abandoned, why I felt empty all the time. Just as ghosts are (theoretically) invisible but leave evidence of their presence—a curtain swaying without a breeze to cause that movement, a floorboard creaking as if someone were walking on it without anyone doing so—my BPD was invisible, but I could see the destruction and disruption it was causing in my life. I just couldn’t identify the root of that destruction or figure out how to stop it, because you can’t change something you don’t know exists in the first place.

I know that some people feel that receiving a formal diagnosis is limiting or harmful, but I personally found it freeing. Receiving my BPD diagnosis showed me that I wasn’t alone in the world, and gave me hope that I could get better, and that I wasn’t doomed. It allowed me to recognize the detrimental patterns I’d been unaware I’d been engaging in, which gave me the ability to work to stop myself from engaging in those patterns in the future. Rather than addressing the peripheral symptoms I was experiencing as a result of my BPD, I was finally able to address the root of those symptoms, and this allowed me to grow and heal in a way I was never able to previously.

Even though I am in a much better place than I was ten, five, even just one year ago, my BPD still sneaks up on me and certain symptoms or thoughts will rear their heads when I least expect it. I still consider my BPD a ghost that haunts me in some ways, but because I have been able to work through my patterns in therapy and learn coping skills to help mitigate my symptoms, but I’d say BPD is now more of a Scooby-Doo-style ghost—like my BPD is poorly disguised in a bed sheet with cut out eye holes.

 

Q: You have an essay in your book titled, “I Googled “Borderline Personality Disorder” and Wanted to Run for the Hills.” Can you elaborate on why that was?

 When I was first diagnosed with BPD, I noticed a humongous gap between my experiences as someone with BPD and the way BPD is portrayed in books, films, and the media as a whole. Simply Googling “borderline personality disorder” and being met with suggested searches such as “Can people with BPD really love?” “Are borderlines abusive?” and “Are people with BPD dangerous?” was startling. It put into perspective not only how misunderstood BPD is as a whole, but the ways people might view me or the assumptions they might make about me once they discover my diagnosis. This is what ignited my desire to “run for the hills.”

 I was especially hurt when I clicked the suggested search “What celebrity has BPD?” expecting it to come up with Pete Davidson, and it taking me to an article about Jeffrey Dahmer, the infamous murderer and cannibal. As I desperately searched for more representation, I was mostly met with articles about celebrities who are (or were) merely speculated to have BPD, such as Amy Winehouse, Kurt Cobain, and Princess Diana, and I became overwhelmingly discouraged knowing that Amy and Kurt both died at age 27, and Princess Diana at 36. It made me question where I had any hope of living into my thirties or beyond. I looked for more hopeful depictions in books and films, but the media representations of BPD weren’t any better—aside from shows like Crazy Ex-Girlfriend and books like Girl, Interrupted, I was met with media that portrayed a demonized version of BPD that I didn’t recognize and couldn’t relate to.

 Though one could argue that fictional media isn’t necessarily meant to be a truthful or accurate representation of reality, the harm caused by these stigmatized, problematic depictions floods from the fictional realm into the real world. I’ve heard people throw around “borderline” as an insult. I’ve seen the fear the mere mention of BPD can bring forth in someone whose only concept of BPD comes from the media. After receiving my BPD diagnosis, I was even turned down by eight therapists prior to finding one who would work with me, and all eight of those therapists cited BPD as their reasoning for not taking me on as a client. They heard that I had BPD and they decided they knew all about me they needed to know, as if my diagnosis could somehow speak to my entire demeanor and character.

 Though I found that Google search disturbing for a million reasons, and absolutely felt hurt by learning how the world perceives BPD, it’s ultimately what spurred my desire to publish a book on my experiences with BPD. I wanted to write the book that I wished I’d had when I was diagnosed; one that let readers take a look into what it’s like to be someone who lives with BPD without all the fear-mongering, misportrayals, and stigma. While I am obviously only able to speak to my individual experience and am in no way claiming or trying to represent the BPD community as a whole, it’s my hope that allowing readers a glimpse into what it’s like to live with BPD through my memoir will help to break down some of the stigma that surrounds BPD, and help to humanize BPD for those who might be wary or fearful of it, as I strongly believe that their fear is directly correlated to a lack of understanding and information.

 

Q: When you were in middle school you were sent to La Europa Academy, a residential treatment center in Utah, where you stayed for 10 months. What was that experience like?

If you’d asked me what I thought about La Europa Academy when I was actually a student there, there’s a good chance I would’ve told you I hated it. And I did hate aspects of it—I hated being away from my family, dog, and friends back home in Chicago; I hated having no access to my cell phone or iPod and only being able to use the internet for homework purposes while supervised; I hated having to talk about all the feelings I’d been trying to bury in endless group and individual therapy sessions—but the ten months I spent at La Europa were among the best months of my life.

 As much as I dreaded talking about all the feelings and experiences I’d been trying to avoid addressing, working through them in therapy helped them carry less weight and made being alive feel less and less heavy, until one day it didn’t feel like a curse anymore. Though I hated not having access to my phone/iPod/the internet, their absence allowed me to return to a simpler time where I didn’t have anything to focus on but what or who was in front of me, or anywhere to be but the present, and I found myself excited by the smallest things, like roasting pink Starburst over fires in our backyard, or visiting the animals at the farm down the road on fieldtrips. Before going to treatment I had a really strained relationship with my parents, and almost no relationship with my sister (who was only ten at the time), but missing them made me realize I wanted a relationship with them, and I became willing to put in the work to foster it. I wrote snail mail to my friends back home and realized who was willing to stick around when things got tough, and who wasn’t willing and therefor wasn’t worth my time, all the while living with 32 other girls, some of whom would become my best friends.

There are certainly aspects of my time in treatment that I don’t feel any fondness toward, rules I didn’t and don’t agree with, and experiences I would rather forget, but when I think back to my time at La Europa, I feel immeasurable gratitude. I am so, so lucky to have had the privilege to receive the care and support I so desperately needed, care that I know so many other deserving individuals do not have access to. I feel unbelievably thankful for those ten months, and absolutely credit La Europa for saving my life by giving me the opportunity to work my hardest to save myself.

I have an essay in TWSF titled Ten Months in Europe that explores my time at La Europa in more depth, which was recently excerpted and published by The Guardian, which you can read here.  

Q: You dedicated THE WAY SHE FEELS to your thirteen-year-old self. What would you tell your thirteen-year-old self now, over ten years later, if given the opportunity?

“Hey, this will come as a huge surprise, but we’re alive. How cool is that?”

For more information: https://tinhouse.com/book/the-way-she-feels/

 

Interview with Anna Steinberg of the Borderline Bakery, Buffalo, New York

Anna Steinberg Photo.jpg

Bea Tusiani of Emotions Matter interviewed BPDFest21 featured speaker Anna Steinberg to learn more about her BPD recovery journey and Buffalo, NY based Bakery.


Disclaimer: This publication contains content about self-harm behaviors that could trigger a medical condition or be found offensive.  If at any time you feel offended, you should cease viewing this publication.  In the event of a medical emergency, please seek emergency care through a doctor, hospital, or emergency call number immediately such as 911 in the United States, the National Suicide Prevention Lifeline at 1-800-273-8255 or consult sioutreach.org. Emotions Matter Inc. expressly disclaims responsibility and shall have no liability for any damages, loss, injury, or liability whatsoever suffering as a result of reliance on the information in this publication.  Reliance on this is solely at your own risk. 

Q: WHILE MANY OTHER SMALL BUSINESSES CLOSED DOWN DURING THE RECENT COVID 19 PANDEMIC, HOW DID YOU MANAGE TO OPEN AND RUN YOUR OWN HOME-BASED BAKERY?

I think the biggest reasons why I was able to begin Borderline Bakery during the pandemic was because people wanted comfort in a difficult time (and let’s face it, carbs are comfort!) and I offered non-contact delivery. When people couldn't get to their favorite stores due to quarantining, I was able to provide that comfort food for them!

Q: WHEN CUSTOMERS ASK HOW BORDERLINE BAKERY GOT ITS NAME, WHAT DO YOU TELL THEM?

The name "Borderline Bakery" came to me when I had approximately 5 minutes to fill out the cottage-law registration form and stick it in an envelope before the mailman came! I honestly hadn't thought of a name prior to that moment. Before that point, I didn't even really know that I wanted the bakery to have a mental health focus, but when the name popped into my head, everything just clicked all at once.

Q: HOW DO THEY RESPOND?

Some people are initially confused when I let them know the name of the bakery but if there’s anything I’ve learned after being open about mental health, it’s everybody knows somebody with mental health issues, or they have them themselves. The response has been 99.9% fantastic! It's truly more common than people tend to think. Unfortunately, the stigma keeps so many people quiet.

Q: YOU WERE TREATED AT AGE 21 FOR MENTAL HEALTH ISSUES, BUT IT WASN’T UNTIL 8 YEARS LATER THAT YOU LEARNED YOU SUFFERED FROM BPD.  HOW DID YOU REACT TO THAT DIAGNOSIS?

When I found out about my having BPD, I was initially scared, much more so than with my other diagnoses. But then I decided to do research into what BPD actually is. I was able to check off every single symptom as something I had or was experiencing. Once I read about the reality of BPD, I decided to embrace it as something that was part of me! Research was key. I realized why my bi-polar treatment wasn't "working" for me, and that was because BPD isn't managed or cured by medication like bi-polar is. Once I embraced CBT and DBT therapies, I noticed how much better my life, and once-strained relationships, had become.

Q: WHAT KIND OF SYMPTOMS DID YOU STRUGGLE WITH THE MOST?

The BPD symptom I struggle with the most would be fear of abandonment, with a second being impulsive behaviors. I have never planned a tattoo or piercing more than a couple of hours in advance, and definitely have trouble controlling my money.

Q: YOU HAVE SAID THAT BAKING IS SOOTHING AND RELIEVES STRESS. WHAT IS THAT EXPERIENCE LIKE?

For me, baking is soothing mostly because it's something I know how to do and I know that there is a right way to do it. It's almost mindless in a way. When I'm baking... kneading dough, forming bagels or twisting dozens of pretzels, my mind doesn't really have to be there, but my hands have something to do. On my long baking days a few times per week, I like to turn on a TV show to binge watch Schitts Creek or The Office and it's like my hands just know what they are doing.

Q: BESIDES BAKING, WHAT OTHER FORMS OF TRADITIONAL THERAPY HELPED YOU?

The therapy that has helped me the most has been dialectical behavior therapy, or DBT. Before Covid, I actually loved going to my group DBT sessions. I was so into it that I even bought the Marsha M Linehan DBT skills book to work on at home! I think the skill I've used most this past year has been Radical Acceptance. It was initially a hard concept for me to grasp, but over this past year I've used it to "radically accept" all that came along with the pandemic.

Q: IT APPEARS YOU HAVE ALSO EMBRACED THE ROLE OF MENTAL HEALTH ADVOCATE AS A FORM OF SELF THERAPY. HOW DOES THAT MAKE A DIFFERENCE?

I have always loved speaking up on the behalf of others. My whole goal is to create an environment where nobody is silenced by the stigma of mental health. I know that when I was initially diagnosed with all my mental health issues at age 21, it was not something I was encouraged to discuss. It wasn't until much later that even my own parents were okay with me talking about my mental health, although now they are my biggest cheerleaders in the fight to end the stigma. It helps me to know that there are so many others who have the same diagnoses as I do, but if I had been silent, I would never have known that. When I learned about my BPD diagnosis, I didn't know that I knew anyone with BPD, my only references were people in books and movies. And really, the media never really portrays BPD as a good thing at all! I want everyone to realize that although I have BPD, I'm not a "psychopath" or a murderer, I'm not out to hurt anyone. I'm just... me.

Q: THE ONE THING I COULDN’T FIND DURING THE RECENT SHORTAGE OF SUPERMARKET PRODUCTS WAS YEAST. ANY INSIGHT AS TO WHY THERE WAS AN EXPLOSION OF BREAD BAKING DURING THE LOCKDOWN?

Ohhhhhh the yeast shortage... I had been so lucky to find some right before the mad rush, and then I just bought in bulk online! But anyway... I definitely think it started out as being stress relief and something to do inside while people were quarantining, and then with the popularity of social media, it was turned into a fad! Everyone wanted to show pictures of their bread!

Q: RIGHT NOW, YOUR CLIENTELE IS LOCALLY BASED IN THE BUFFALO AREA. ARE THERE ANY FUTURE PLANS TO GROW THE BUSINESS?

Right now, I'll be staying in Buffalo. Due to Borderline Bakery being a home-based bakery (apartment-based, actually!) I have to follow strict New York State "Cottage Food Laws", which prohibit selling any of my products out of state! EVENTUALLY I would love to have a commercial kitchen, so I wouldn't have that issue. I could do so much more with a bigger oven and more room but for now, unless the law changes, I'm staying here :-)

Q: WHAT ADVICE TO YOU HAVE FOR BPD SUFFERERS WHO LACK CONFIDENCE IN THEIR ABILITIES?

I often lack confidence in my own abilities. Thankfully, I have an amazing support system, but I know not everyone is as lucky as I am to be surrounded with such amazing, supportive people. My advice would be to not overthink the negatives of what could happen, but instead overthink the positives of any situation. I'm definitely not always a positive person, and it's so easy to wallow in the negatives. But then I try to force myself to see the positive outcomes of something instead, and that can make a huge difference. 

BPD does not have to be a bad thing. My diagnosis has helped me flourish in my relationships with friends and family, in my business, and in my life. I honestly think that my life got 100 times better after I accepted it, because I learned so many of my negative behaviors throughout my life were a result of BPD. And once I learned, through DBT therapy, how to cope with those symptoms, life just became easier. We can be more creative with our BPD brain! We have more empathy than the average person. We know how to love deeply. We need to take that negative stigma and turn it right around. We are wonderful people, and we can't let that stigma define us.

To hear Anna speak at BPDFest, https://www.accelevents.com/e/EmotionsMatterBPDFest2021

To hear Anna speak at BPDFest, https://www.accelevents.com/e/EmotionsMatterBPDFest2021

This is a © 2021 publication of Emotions Matter Inc., and may not be reproduced, excerpted, or distributed without express written consent of Emotions Matter Inc.  All rights reserved. 

 

 

An Interview with Erin Cookman – aka Erin Incoherent – Indie Punk Rock Singer, Guitarist and Songwriter from Fort Collins, Colorado

Erin ‘Incoherent’ Cookman.  Photo Credit: Photographer: Habiyb @beloved1___

Erin ‘Incoherent’ Cookman. Photo Credit: Photographer: Habiyb @beloved1___

Disclaimer: This publication contains graphic content about non-suicidal self-injury, self-harm and suicidality, including mention of some methods that could trigger a medical condition or be found offensive.  If at any time you feel offended, you should cease viewing this publication.  In the event of a medical emergency, please seek emergency care through a doctor, hospital, or emergency call number immediately such as 911 in the United States, the National Suicide Prevention Lifeline at 1-800-273-8255 or consult sioutreach.org. Emotions Matter Inc. expressly disclaims responsibility and shall have no liability for any damages, loss, injury, or liability whatsoever suffering as a result of reliance on the information in this publication.  Reliance on this is solely at your own risk. 


Bea Tusiani of Emotions Matter interviewed BPDFest21 featured speaker Erin “Incoherent” Cookman to learn more about her BPD recovery journey.

Q: If you look up the word “incoherent” it’s defined as confused, mixed-up or all over the place.  What made you identify yourself in this way? 

My whole life, I’ve confused people. I’m not punk enough. Not girly enough. Not quiet enough. Not queer enough. I’m too intimidating. I wrote about it in ‘25’: ‘I’ve never really felt like I belonged; I don’t feel like people listen, or ever really wanna talk...’ 

Being born a woman put me on a billboard instead of a body. I sometimes wonder if people are listening to me or just consuming my image. Patriarchal societal structures and the ethos of the punk community have tried to tell me what I cannot do. I have always pushed back against my limiters. I create space for inclusion and change. I champion for justice locally and globally. To me, this is the work we came here to do. Really change things. That’s the only work that makes sense. The world doesn’t function harmoniously. In today’s world, our morals are wound up in money and status.  

 I chose the name Erin Incoherent to portray the juxtaposition of making sense in a world that’s ‘confused, mixed up and all over the place’. When insanity is the norm, what do the sane sound like?   

Q: Many of your song's lyrics (such as The Fog, The Storm, Of Roaches and Roommates) are filled with pain and throbbing beats revealing stinging truths that reflect your lived experiences. How did that come about?  

My music isn’t a band aid- it’s a therapy session. It’s a place where people who feel fucked up can be seen and expressed. I’ve always written songs from an autobiographical standpoint. Music helps me interpret my life. I can process the cutthroat truth of the matter, as demonstrated in the above-mentioned songs. The Fog/The Storm (which follow one another on the album ‘Deja Vu’) are the story of the drug binge/breakup of my last relationship.

Of Roaches and Roommates (also ‘Deja Vu’) is the story of my roommate overdosing in Philadelphia. I did a music video for ‘Of Roaches & Roommates’ (https://www.youtube.com/watch?v=4Iz9Kum7GPM) with the ambition to include as many people as possible in the conversation of harm reduction.

I asked family, friends, and fans to send me pictures of loved ones they had lost to overdose. I interviewed people who’d done heroin, people who work in harm reduction, and people who’d lost someone to overdose.

The result is one of the most powerful and emotionally moving projects I’ve ever been a part of. A soul-felt ‘thank you’ to all who collaborated in the making of Of Roaches & Roommates.

 To me, those songs are beautiful BECAUSE they are so intensely personal. You can’t get away from the pain, you can only resonate with it. And that resonance is a powerful tool for communal healing.  

We came together in this music.  

Music is healing.  

Healing is growth.  

Q: What exactly were the kinds of symptoms and behaviors you were struggling with and at what point in your life did they occur? 

I’m not joking when I tell you that I have been managing my symptoms my entire life. Meaning, there was never a period of ‘before I had B.P.D’, there was only ‘before I got a legitimate diagnosis.’ Before the diagnosis, I knew there was something dysfunctional about how I interacted in interpersonal relationships. About how ‘big’ my feelings were/are.  

Growing up, I would have severe bouts of rage, depression, frustration, and suicidality. Innocuous things would trigger emotional spells that would last for days. I would take out my frustrations on whoever was close to me. I would ignore a random friend for days. I would accuse people of hating me. I would completely detach and sever ties with people I loved. I would leave social gatherings without warning. I had no idea this was ‘splitting’ until much later on. I had no stress management skills and the turbulence of my home life further contributed to my emotional intolerance.  

The first time I tried self-mutilation was in elementary school. In 4th grade, I pulled out all of my eyelashes. By 6th grade, I was cutting myself. In junior high, my arms and ankles were covered in cuts. I was cutting and also beginning to heat objects and burn them into my skin. I would wear fishnet sleeves and pants every day. At a certain point, my parents did discover my self-harm and I went to therapy for 6 weeks. I was only ever diagnosed with depression. I was prescribed medication but after a disassociation spell and a slew of other side effects, I flushed them after less than two weeks. 

After high school, I began drinking, which made my impulsivity with self-harm more reckless. I began using bigger and sharper knives. It was around this time I was reading an article online and saw the person in the article had been diagnosed with Borderline Personality Disorder. I clicked on the highlighted text and began reading about my diagnosis for the very first time. I made an appointment to get evaluated by a physician later that same week. 

Q: What was your reaction when you learned you were actually suffering from a diagnosable mental illness called Borderline Personality Disorder? 

I cried and cried and cried. I remember saying ‘I just wish my brain could be normal.’ when I got the news. There was a deepness of feeling sorry for myself. There was anger and shame and resentment. There was some relief but it was definitely not sitting at a big place at the table. I just felt a lot of shame for being who I was. 

Q: Did you undergo treatment right away? If so, what did that entail? 

When I got diagnosed, I was in an unsafe living situation in an abusive relationship. I was an alcoholic. My boyfriend and his band mates (our other 2 roommates) were leaving for 40 days to go on tour and I got the diagnosis right before they left. The doctor prescribed Zoloft for me and I began medication in an empty house. The medication was frightening. My side effects were extreme and unbearable. 24-hour panic attacks, diarrhea, brittle fingernails, loss of appetite, insomnia, mania, depression, suicidal thoughts. That was one of the darkest months of my life. How loud the loneliness and insanity were.  

I finished ‘Medusa’ during this solitude. I didn’t think I would live long enough to release it. 

Q: Was there a particular support system of family, friends, therapists or colleagues that you could rely on as you moved toward recovery? 

It has been a lonely road. These days, I have people I can talk to, but I was raised in an environment where asking for help bore consequences. When I was growing up, my dad shamed and scolded me for my episodes, having depression, and setting a bad example for my younger siblings. I couldn't talk to my mom about feeling suicidal or wanting to self-harm without being pressured to try medication again. As my symptoms worsened over the years, I cut out more and more friends. 

Initially, I moved deeper into the darkness. In the weeks following the diagnosis, I felt a pressure to ‘be okay’ or ‘be healed’ which estranged me from many people. My performance had been slipping at work. My boyfriend and I were constantly fighting/breaking up/fighting/not talking. My feelings of worthlessness amplified and I chased them down bottle after bottle after bottle. Just over a month after I got the diagnosis, I was in the emergency room. I had cut open my arm to the tune of 27 stitches. I had spent the past week going crazy on a mixture of alcohol, heroin, Adderall, promiscuous sex, and prescribed medication. I hated myself for thinking someone should care about me. I was dying for help. For someone to care enough to heal my broken heart and mind. To take away this fucking pain once and for all.

After watching the blood and crying for a few minutes, I called my mom to tell her I had just cut myself open. A few calls later, a friend was driving me to the emergency room.  

I didn’t really begin taking my recovery seriously until a little over a year later, when my relationship finally ended and dodging my own best interests suddenly didn’t seem like the best way to keep living. 

Q: What has helped you most in your recovery? 

Transcendental meditation, which I only began doing a year ago, has transformed my life. It has allowed me to live beyond my programmed emotional responses and created space for growth within me. Mindfulness and gratitude generate purpose and fulfillment.  

In the years before I took the T.M course, things that aided in my recovery were/are: cannabis, exercise, gratitude journals, flower arranging, poetry, and creating new music. 

Accountability and honesty have helped me recover as well. Remembering where I’ve been, puts things in perspective. You can only move as far as you allow yourself to see. A lot of people will keep themselves in the dark because seeing who they are in the light is embarrassing or shameful. I’m here to reiterate that you will not always be right in your life. Learning how to apologize, ask forgiveness, and change your behavior is AS important as learning how to forgive, dissolve resentments, and create healthy boundaries in your life.  

Start by forgiving yourself.  

Q: Music continues to be a passion and means of expression, as showcased in your 2018 Medusa album with songs such as Ulcer, Destroy, Splinter and Fallen. What feedback have you received from others who are coping with the same feelings? 

Mostly, I get thanked. Whenever I meet someone with BPD, I feel like I already know them. I understand a lot of the pain and confusion that associate with overwhelming emotions and fragile friendships. Diagnosis is good for clustering similar symptoms but I also acknowledge that many people who don’t have BPD still have similar shared experiences.

 This is why ‘belonging’ to any particular group isn’t necessary to understanding the human experience. People from all walks of life have found truth in my words. Every time someone shares a bit of their story with me or a word of thanks, it means a lot. It’s one of my favorite things that I do in this life. Speak the truth. Say the words. Sing the songs. 

Q: What might you want to convey to others struggling with mental illness or BPD? 

Remember to be gracious with yourself. This is a one-of-a-kind journey you are on. Celebrate challenge and accomplishment. Seek adventure and accept it in its many forms. All lessons will challenge you differently. Listen to your inner voice. Not the one that talks shit to you. It’s important to continue showing up for yourself. Treat self-love as a discipline. Know that your work is never done. This is comforting because it acknowledges we exist to enjoy our journey, not to ‘arrive’ at self-acceptance because we no longer have flaws. There is so much beauty in flaws. So much rarity in your human condition. Take it seriously enough to goof off. It is brave to love you for who you are. Source your strength fellow warrior, it’s time to howl at the moon <3. 

This is a © 2021 publication of Emotions Matter Inc., and may not be reproduced, excerpted, or distributed without express written consent of Emotions Matter Inc.  All rights reserved. 

 

Click here to go to BPDFest virtual event website: https://www.accelevents.com/e/EmotionsMatterBPDFest2021

Click here to go to BPDFest virtual event website: https://www.accelevents.com/e/EmotionsMatterBPDFest2021

Supporting Students with Borderline Personality Disorder (BPD)

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Emma* was a sophomore in high school struggling with severe social anxiety, recurring suicidal thoughts and self-harm behaviors. She became very upset in specific classes where she had issues with her peers, and it became disruptive to the learning environment. Emma also had difficulty completing assignments, and would often skip class, leading to failing grades. Her teachers had no idea how to help, reporting Emma’s struggles to the school based support team.

When school administrators met with Emma’s parents, they learned Emma had recently been diagnosed with Borderline Personality Disorder (BPD), and was at high risk for suicidality.  Emma’s parents asked the school for support services, but with only one social worker for all the students, and a lack of information about BPD accommodations, the school was unsure how to proceed. They were concerned about Emma’s safety, and her ability to manage the demands of high school along with her symptoms.  

This is the situation many educators find themselves in when confronted with students diagnosed with BPD. BPD is a complex and debilitating mental disorder, found to be affecting 3% of adolescents (Guilé et al., 2018), characterized by emotional dysregulation, impulsivity, identity confusion, difficulty with interpersonal relationships, and suicidality. BPD is defined by any five of the nine criteria (See Table 1) in the Diagnostic and Statistical Manual for Mental Disorder, Fifth Edition (American Psychiatric Association, 2013).   

Table 1: DSM-5 Diagnostic-Criteria for BPD

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  • Frantic efforts to avoid real or imagined abandonment

  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

  • Identity disturbance: markedly and persistently unstable self-image or sense of self

  • Impulsivity in at least 2 areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating)

  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

  • Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate, intense anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

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Over the past decade, there has been increasing evidence that BPD should be diagnosed and treated during adolescence when symptoms often emerge. Children as young as eleven have been diagnosed with BPD, with prevalence in diagnosis increasing with age (Guilé et al., 2018), and peaking in early adulthood (Kaess et al., 2014). 

New research about the neurobiology and developmental trajectory of BPD reveals that diagnosing and treating BPD in adolescence can improve long-term outcomes. Treating symptoms as early as possible with BPD specific treatments and early intervention are critical for recovery. The earlier treatment for BPD can occur, the more successful the results will be, since an adolescent’s brain is still developing and malleable (Kaess et al., 2014).

Leaving BPD untreated, however, can be associated with serious consequences. 50-80% of those with BPD have a co-occuring substance use disorder (Trull et al., 2018), and 10% of those with BPD will die by suicide (Soloff & Chiappetta, 2012). Moreover, Adolescents with BPD have higher rates of self harm and suicidal behavior, as compared to adults (Kaess et al., 2014).

Educators can be on the front lines of recognizing the symptoms of BPD. While those with BPD are often highly intelligent and creative, symptoms can impair their learning and daily functioning in school. A student impacted by BPD may have a significantly more difficult time than a typical teenager managing relationships, academic pressures or anxiety.  It is critical for educators to be aware of the symptoms of BPD and how it may manifest in the school setting. 

Common areas of concern for a student with a BPD diagnosis may include test taking, group projects and class presentations, recess and lunch time, teacher expectations, communication with teachers and peers, and lateness and truancy. These challenges are often caused by the student’s emotional sensitivity and regulation issues, interpersonal and communication difficulties, impulsivity, or anxiety, medication side effects, and sleep disturbances. The earlier a student is recognized as needing extra support, the sooner the school can work with them through a lens of understanding and compassion, rather than blame and punishment. 

Emotions Matter Inc., a 501c3 non-profit organization to support those impacted by BPD, created a new resource which offers individuals, parents and professionals information on how to to understand BPD in the school environment. This resource offers an introduction to the process of seeking accommodations for a student with BPD, first-hand testimonials from those with lived experience, and strategies for handling transitions and interruptions to education. 

"Receiving accommodations for my disabilities including BPD has helped provide a structured, accessible, and supportive learning experience.  In part due to my accommodations, I have found school  to be a wonderful and enjoyable experience." - Student with BPD

“My daughter had tremendous social anxiety with BPD.  Accomodations made her feel good about herself and interact with others.”  - Parent of Child with BPD

Although balancing the demands of academics and treatment can be challenging for students, schools can support BPD recovery by providing daily motivation, socialization, and structure, mitigating isolation often associated with suicidality.  Schools can build students’ self-esteem through creative, active and academic pursuits, fostering their unique identity as individuals whose lives will continue beyond the stigmatizing psychiatric diagnosis of BPD. 

The vast majority of those diagnosed with BPD recover and live meaningful lives.  Support from educators can play a vital part in their long-term recovery.

This resource is available as a free downloadable PDF here, or in print here.

For more information, email outreach@emotionsmatterbpd.org

* This is a fictional story that represents a common profile of an adolescent with BPD. 

 

This article, written by Emotions Matter, Inc. first appeared in Healthy Young Minds, a publication of the MHANYS School Mental Health Resource and Training Center in February 2020

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

Guilé, J. M., Boissel, L., Alaux-Cantin, S., & de La Rivière, S. G. (2018). Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies. Adolescent health, medicine and therapeutics, 9, 199–210. doi:10.2147/AHMT.S156565

Kaess, M., Brunner, R., & Chanen, A. (2014). Borderline Personality Disorder in Adolescence. Pediatrics, 134(4), 782–793. doi: 10.1542/peds.2013-3677

Soloff, P. H., & Chiappetta, L. (2012). Prospective predictors of suicidal behavior in borderline personality disorder at 6-year follow-up. The American journal of psychiatry, 169(5), 484–490. doi:10.1176/appi.ajp.2011.11091378

Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline personality disorder and emotion dysregulation, 5, 15. doi:10.1186/s40479-018-0093-9