Complex PTSD, borderline personality disorder and the value of labels

Sometimes labels are good and necessary if they can help us find the right treatment. But I’m also not entirely sure they’re helpful, either, and may be overused.

I’ve read a lot about the link between Complex PTSD and borderline personality disorder, and how the difference between the two can be complicated even for therapists to distinguish.

My husband often thinks that my interest in the topic of personality disorders is unhealthy, especially since I’m so often trying to diagnose myself with one. I can kind of see his point.

The truth is that aspects of my childhood were pretty fucked up. I have since made peace with and forgiven my parents because I now understand that they were doing the best they knew how and didn’t intend to hurt me. At the same time, that forgiveness doesn’t erase the fact that some things I experienced did hurt me in lasting ways.

Socially, my environment was even worse. Being one of the brightest but poorest kids in a wealthy magnet school exposed me to a lot of bullying. I very definitely have complex PTSD from that, no questions about it.

These things are now my issues to heal from. Blaming people won’t fix me. Recognizing where my struggles came from just points me in a direction for healing.

My meeting with the neuropsychologist last week was also very enlightening. He said that given my verbal IQ, if I’d had a more nurturing home environment and my talents were allowed to bloom at school (rather than being the reason for my bullying, causing me to hide them), I likely would have grown up to become very professionally successful. He said that I had a very strong core capability that, properly developed, would have enabled me to earn graduate degrees and have a career that used them.

The ironic thing is that I wanted to be a doctor when my oldest child was a baby, but I thought I was too old to get started at 24. (Ha!) I still regret that I didn’t do it; I would’ve been good at it. And I have a theory that my MS wouldn’t have required me to stop working if I had gone that route.

When I went back to finish my degree, I graduated magna cum laude and I very definitely wanted to go on to even earn a doctorate. I never intended to stop at a bachelor’s degree but I did. That now leaves me with what all of my kids see as a “useless degree,” a cautionary tale rather than an achievement.

But the opportunities for grad school just weren’t there. Not where we lived at the time and it would have taken a Herculean effort to relocate for school with a husband, three kids, and no money. My husband and I talked about this extensively at the time. It was a dream I had to consciously give up.

And my brain was already so used to the cycle of trying and getting defeated that I couldn’t overcome it at that point.

Graduating college with a 3.76 and thinking I’d go on to graduate school and a great career got my hopes up. Being stuck in that crappy town and not being able to get any job until I got in part-time at Starbucks 8 months after graduation was par for the course of my life. The success in school was the anomaly.

It’s really clear why I’m depressed. Maybe I truly have had dysthymia/”persistent depressive disorder” since kindergarten. Maybe it’s a chemical imbalance in my brain that needs to be drugged all to hell until I can’t feel anything anymore.

Maybe I have a personality disorder because I need a lot of reassurance and fear rejection and I just really want to be liked but expect that I won’t be.

Or maybe it’s that I was a plant potted in hostile soil, trying hard to bloom and flourish in spite of where I was and what I was up against.

Getting back down here to Texas where there are more job opportunities was part of my perpetual effort to keep getting back up and trying again. I went really big that time. I had some crucial help from friends, but like college, it was also a time where I put in a huge amount of effort to achieve a goal.

Yet somehow I wound up back at home again with a low-paying patchwork “job” that I didn’t want. Just like in the place I left.

Up until my horrific MS relapse in August 2017, I was still trying to rebuild. I still had hope that I could do something with my life that mattered. I got my acceptance into a Masters of Social Work program while I was lying in the hospital. I obviously had to turn it down. At first, I thought I was just postponing it, but now it’s pretty clear that I’m not going back.

The degree of memory loss this disease has caused me has pretty firmly nailed shut the doors to grad school and all my career plans.

If I’m depressed, is that really biochemical? Or am I just still in mourning? Things were always hard, ever since I was a young kid. And I always kept getting back up, heroically trying anyway. Fighting against whatever harsh circumstances I was put into. And it doesn’t look like that will change for me anytime soon.

So bringing this back to the topic at hand: does it really matter what label you give to someone with mental illness? You may see the outward manifestation of it and that might be very disruptive and unpleasant. But if you scratch the surface, there’s almost always some type of unhealed trauma. There’s almost always some other explanation.

In earlier generations, there was less awareness of personality disorders. Anais Nin, for example, is a textbook case of histrionic personality disorder. She was manipulative and selfish and thought her diaries were fascinating just because they were her thoughts. She cheated on people repeatedly, even being married to two men at once. Her incestuous relationship with her father was clearly the trauma that explained why her behavior was so destructive to others. But back then, they just said she was “eccentric” and “libertine.”

The grandfather I knew who had now-obvious undiagnosed and untreated PTSD upon returning from the war just terrorized his family. They didn’t know what PTSD was back then. There wasn’t any psychological support for him or his family. It just was what it was and they just tried to cope.

I don’t actually think any more people have personality disorders now than they did before. (I do think that certain things in our modern culture celebrate traits that could be called narcissistic, though. Selfie culture is normalized but not healthy.)

We do have more depression now, in part because our social support networks have all eroded. And because the internet (lovely, lovely internet…) has made it easier to be isolated and have hundreds of “friends” we may never meet.

But I believe the same basic traits have always been present in society. There have always been people who jumped from one relationship to another in short succession, but now we might look for other coexisting traits so we can assign a label like borderline personality disorder. It’s still considered largely incurable, so what is the point of the label?

We don’t have more personality-disordered people now. We’ve just come up with ways to classify people who have always existed. The people who could be defined as having these “disorders” always thought they were fine the way they were before. Even if their traits made their lives harder and caused pain to their loved ones, it was just who they were. In that regard, most people with so-called personality disorders haven’t changed much. The people who don’t want help won’t seek it out.

But the worst thing is seeing any of these traits in yourself and wanting to get rid of them. Sometimes all that requires is time to grow up and mature a little bit. But sometimes it also needs therapy, lots and lots of therapy. And this society’s mental health fabric is absolute shit, so only people with enough disposable income will get the help they need. And the rest of us are left fighting hard against occasional suicidal impulses, trying our best with sketchy DIY treatments that don’t work very well.

The rest of us will muddle along, trying to get better, trying to both cause and experience less pain. If that’s you, like it is me, I don’t have any good advice. But in case nobody’s told you today, it’s okay. It’s all okay. You’re doing the best you can in a world that’s sometimes pretty harsh. Breathe.

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