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.

Mental illness recovery and self-love struggles

I was a mess when I was younger. It’s gradually dawned on me over the years that I needed to get better. I had some traits that definitely fit within the borderline and histrionic personality disorder categories.

As an aside, I’ve written a lot about the demise of my longest friendship, which was ultimately very destructive for me. I had a very unique link with her that I could never quite understand. And I’ve finally put my finger on it: we both had tendencies toward borderline and histrionic personality disorder when we met.

I figured it out and was ashamed of my past behavior but I wanted to get better. I made the changes I could and still work on it, although that has so far been limited by my lack of access to good therapy. I changed a lot and took it upon myself to also help her, which wasn’t my job and wasn’t appreciated. Part of that is that I enjoy helping people, but part of it was also a bit codependent (assuming I believe codependency is real, which I’m not sure I do.)

On the other hand, she doubled down on those attention-seeking and dramatic traits in herself. Defended them. Avoided therapy. Her life got more chaotic, her personality more outlandish, her closest relationships more broken.

I felt like being in frequent contact frustrated me immensely to see how little positive growth she had made. In many ways, she was still looking back to her teen years as the best time of her life. Even though she got married last year, it seemed afterward like she wanted to recapture the freedom of youth rather than settle down.

I’ve read a ton of stuff about these personality disorders over the past several months; I could probably write a book about the subject. I know that few people with these disorders want help or seek it.

I also know that people with these disorders are not bad people and they often feel a great deal of pain about the thought of hurting others. So instead of dealing with it and trying to change, they’re more likely to shove it down deep and pretend it doesn’t exist.

I’ve never been officially diagnosed with this, so maybe they’re just a couple of selfish traits I have (and had to a greater degree when I was younger.) I do know that I have gotten better and I want to continue getting better. But I also feel a lot of shame over how my actions affected people I love and it’s hard to forgive myself for that.

Interestingly, though, I got a lot more attention when I was less aware of what I was doing to others. I was less self-conscious. I was actively a much more selfish person, but I had a lot more people I regularly interacted with, especially online.

I don’t know if that’s just because the internet itself has changed so much since the early days. When my kids were small, blogging was still very new. It wasn’t as hard to get an audience as it is today. Now everything has moved to social media and is a lot more visual.

Ironically, being narcissistic and putting your life on display is way more acceptable now. It’s nearly impossible to get much of a following unless you do so. Only now, what people want is to see selfies and pictures and YouTube vlogs and to hear your voice rambling on a podcast.

Even traditional old-school blog entries are now supposed to be short and interspersed with lots of pictures. It’s way less introvert-friendly now. And I just don’t have the desire to put myself out there that much. I’m not big on attention-seeking.

In part because I am self-conscious and in part because of the damage to my self-esteem from that one friendship, I’m isolating myself. I feel like I don’t know how to be the kind of person people want to be around, especially because I’m still often so depressed.

I don’t know how to get better until I can find a good therapist, which I have no hope of affording any time soon. I know that cognitive behavioral therapy is my best bet. I also have a dialectical behavioral therapy workbook that helps with emotional regulation, but to be honest, that’s the part I had already done a lot of work on.

I’m in this weird space of not being enough of a train wreck myself to be interesting anymore, but not yet healed enough to be wise and ready to heal others.

At the same time, I also wonder about how many of my issues were or are related to my brain illness. Was I mildly personality disordered just because I grew up in an emotionally neglectful home? Was it that I was relatively normal and just way too young when I got married (since my worst behavior was in my teens and the first five years of marriage) and I’ve grown up since then?

Or was it that my brain was already damaged by the MS? Based on when I first felt like I had symptoms, that was 18 years ago. My brain could have been damaged all along.

I guess ultimately it doesn’t matter why I am the way I am or even if I have a diagnosable personality disorder.

I need to learn how to forgive myself and love myself, first and foremost. I’m not sure how to do that. My husband used religion to heal himself, but it’s not completely connecting for me in the same way. Faith is a component of my healing and sometimes a source of comfort, but I’m not internalizing it as giving me a sense of self-worth.

And while the fact that he is treating me much better than he did before is helpful and appreciated, he can’t fix me. It’s still my job to learn how to fix myself.

Considering the fact that he is both my best friend and the caregiver for me in my illness, that makes us a bit enmeshed. But I don’t want to be dependent on him in an unhealthy way and sometimes fear that I am a bit already. I want to be healthy and independent and self-actualized, to whatever degree my illness will let me. Finding that particular balance is tough.

I have to learn how to get better. I know what needs to be done, and I’ve already made a lot of progress. But I’m not sure how much more of this can be a do-it-yourself effort. I think I need some help.

The dialogue around mental health

I have determined after a great deal of research that most of the information online about how to deal with mental illness and especially personality disorders is incomplete or downright inaccurate.

I read a lot about how antidepressants and therapy are the only way anyone can get better with mental health issues. And to be clear, these methods help a lot of people and I’m not knocking them or trying to say there’s a better way. We all do what we have to do and mental illness is nasty enough to live with as it is.

But at the same time, they don’t help everybody. It can be hard to figure out what will help. A lot of the stuff online is extremely discouraging, especially with regard to personality disorders. That’s even truer when it comes to the famously difficult “cluster B” personality disorders: narcissistic, borderline, histrionic, antisocial. Most of what you read about any of these would make you think that if you get diagnosed with one, you might as well give up because you’re untreatable (and by the way, you’re also ruining everyone else’s lives.) That’s what the things online say about them, but I am not sure it’s accurate.

This all started because I had a friendship with someone who was almost definitely somewhere on that spectrum. She convinced me that she was fine and didn’t need to change anything, and I was the one with the dysfunction, not her. So I set out to learn everything I could and to try to see if I fit the definition. (I didn’t meet the diagnostic criteria for any of them, but did have a couple traits on the list which I trace back to depression and emotional immaturity, both of which I’m trying to manage. I think I might have fit more of them when I was younger.)

Even though I think she may have those issues (only a professional could know for sure), I think she could get better if she put in the effort rather than denying the problem. In fact, I know this is a bold statement, but I believe a lot of people with the “Cluster B” personality disorders could get better. It comes down to having the courage to face your issues and then work on them, which is the real obstacle. But maybe if we gave people hope that improvement was possible, they might actually try.

Are there people who are truly narcissistic, who ruin their closest relationships? Yes, of course. Are there people who have been on the receiving end of this behavior and been scarred by it, even left with PTSD over it? Absolutely. The people on the extremes can be dangerous.

I do know someone who I believe to be a full-fledged narcissist (not the same person I mentioned above) who is getting worse with age, not better. It’s very difficult to have a relationship with her because it’s so one-sided. She doesn’t seem to be aware of her behavior or how she affects people. But I believe that if she was aware of them, she could get better – even if the process was slow and incremental. People like her might never be “normal” but I think they could have healthier relationships with more give-and-take if they worked on it.

But at the same time, I think we’re overusing terms like narcissistic and gaslighting and bipolar and borderline.

What we really have is a growing number of people who aren’t able to cope with the world, who don’t know how to have healthy social relationships, who are encouraged by social media to live their lives in a very shallow way. The outcomes of all of these behaviors are now very normalized in society, but many of them may look like personality disorders at first glance. But that doesn’t mean that they’re hopeless. It doesn’t mean they won’t ever get better if they really try.

I see a lot of people online who have been diagnosed with one of these infamous Cluster B personality disorders (especially at Quora) and many of them do feel bad and want to change. I don’t think the mental health community and the unqualified members of the public are helping by issuing these blanket statements that people are untreatable and will never get better.

Can you imagine hearing that? Given that one of the hallmarks of most personality disorders is poor emotional regulation (and many have suicidal impulses as well), I can’t imagine how devastating it would be to get that diagnosis and still have the courage to hold yourself together.

Maybe I’m naive or maybe I’m a Pollyanna (I probably am) but I think all people deserve better than to be told they’re hopeless. I think there’s hope for nearly everyone to get better. Even if people are difficult, they didn’t make themselves that way.

That’s not to say it’s always a good thing to be in a relationship with someone who is broken in this type of way. It can break you in the process, too, so you should definitely get away if you recognize you’re being hurt. Just because they have things to work through, doesn’t mean you have to be along for the ride.

But I think we should change how we talk about people with personality disorders and mental health issues. The most important factor, from what I’ve seen, is the person’s desire to change. If they have that, there’s hope they can get better.

Mental health is only getting worse around the world for so many reasons. And yeah, sometimes other people’s illnesses have collateral damage. But they’re still human underneath it all. So maybe we should just have more compassion for those who are struggling to overcome issues. Worldwide mental health is likely to continue to get worse from everything I’ve read.

So we need to change the dialogue. Be hopeful and encouraging to those who are trying to heal. Sometimes for our own sakes, we might have to lend that support from a safe distance. But I think we need to do a lot less telling people they have unfixable illnesses. There’s always hope that even the blindest, most destructive narcissist will come to realize what they’re doing and work on getting better. What good does it do to tell them improvement is impossible?