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Writer's picturejane doe

beyond the borderline: bpd unveiled

Volatile, cold, reactive, unstable, space-case, distant, fraught, irritable, agitated.


The rostromedial prefrontal cortex is the furthest back point of the prefrontal cortex. It is primarily responsible for dictating our personality, and our values. The rostromedial prefrontal cortex is responsible for a processing stress and regulating immune and autonomic functions. In those with BPD there is abnormal or less activity in the rmPFC causing a heightened response to distress and rejection. The rostromedial prefrontal cortex responsible for a great deal of our personality, when the prefrontal cortex displays irregular activity or becomes damaged we may find ourselves with devastatingly intense emotions such as mania, anger, rage, depression and anxiety as emotional regulation becomes hard with unusual or abnormal brain activity, specifically in areas like the amygdala, hippocampus and orbitofrontal cortex. In someone with BPD the parts of the brain responsible for our emotional regulation and impulsivity are either underdeveloped or presenting unusual activity resulting in disordered thinking and feeling. Apart from the mental distress caused by borderline personality disorder, someone with BPD may live 20 years less than someone without the disorder and there is suggestion that middle-aged individuals diagnosed with BPD may be at a higher risk of heart attack and cardiovascular disease as chronic stress and emotional dysregulation can put strain on the cardiovascular system, potentially increasing the risk of heart-related problems over time.


Approximately 2% of Canadians live with the pervasive, impairing disorder often along with one or more co-morbid disorders.


To be diagnosed with borderline personality disorder someone must display at least 5 of 9 symptoms listed in the dsm 5. The criteria are as follows:

  • Intense fear of abandonment

  • Unstable relationships

  • Shifting self-image

  • Impulsive, self-destructive behaviours

  • Self-harm

  • Extreme emotional swings

  • Chronic feelings of emptiness

  • Explosive anger

Borderline personality disorder is a cluster B disorder, it is characterized by a persons inability to control their emotions and behaviour. It may appear it wouldn't be hard to diagnose with 9 main symptoms, and only needing 5 of 9 to be diagnosed but the challenge that often arises for sufferers and the caregivers of the disorder is discovering the co-morbid disorders that affect them from the sidelines. Some common co-morbid disorders are eating disorders, psychosis, anxiety, depression and (C)PTSD. Among other metnal health concerns there is suggestion people with BPD may also deal with autoimmune disorders, while the link is not fully understood, there is evidence suggesting a possible connection between BPD and autoimmune disorders. The chronic stress associated with BPD may contribute to immune system dysfunction and increased susceptibility to autoimmune conditions. A compromised immune system can be caused by chronic stress and the emotional turmoil experienced by individuals with BPD can weaken the immune system, making them more susceptible to infections and illnesses. Treatment of BPD often consists of a combination of therapies and medication to help manage mood swings, agitation, depression and anxiety.


Being diagnosed with the disorder at 17 didn't mean much then, but as I got older the symptoms intensified and new ones seemed to have come out of the woodwork. Extreme sadness, agitation, and anger, crying from perceived abandonment or rejection were a few of the emotional symptoms I experienced, as I got older, anger turned to rage when pushed too far, splitting (black and white thinking) became apparent in many situations, and feeling separated from real life became the most intense and debilitating symptoms while my doctor and I sought out treatment options. Misdiagnosed with only major depressive disorder and GAD for about two years I couldn't figure out why my depression and anxiety made me feel so much more volatile than someone else with the same diagnosis, my symptoms were more than I could have bargained for, for a long time. Being misdiagnosed meant I spent a lot of time seeking out treatment for something that yes, I have, but there was still a different angle to work.


Being reassessed lead me to a diagnosis of borderline personality disorder with several co-morbidities that required their own treatment route. Upon the discovery of my BPD my treatment regime changed and included a lot more medication, a lot more doctors visits, bloodwork and therapy. Fortunately, it is possible for someone with BPD to go into remission from symptoms, meaning they lessen in intensity and the person works to become a better, healthier version of themselves. Much like physical ailments, remission can turn to relapse. During 5 years of an intense medication regime I found myself feeling better and then worse and would repeat the cycle several times before feeling stabilized for my longest bout yet. At 24 I was stable enough to be pulled off my lithium prescription because it was often making me more lethargic, sad and existential. As I mentioned earlier, BPD can be related to a slew of other health problems related to poor lifestyle. For some time I was barely able to get up to do laundry, cook dinner, or go to the grocery store because the stairs, pulling open the car door and walking around in public was the least interesting thing on my agenda. Following the discontinuation of lithium, I have remained relatively stable for about 3 months with a few hard days in between.


At one point, my disorder was running so rampant I was having "episodes" triggered by stress, and a "faulty" relationship. When my partner and I would argue and an episode came into play I would feel my insides burning up to the point I remember running outside barefoot in the snow and sitting down to sob and "cool down". I felt like I was melting from the inside out, my muscles would contract throughout my abdomen and I would feel physical pain from these episodes for days following. While I have negativism towards my disorder most of the time, I also have a love for many of the traits I embody because of BPD. While I don't like having to choke back medication every morning and night, bi-weekly therapy sessions or the bad days- I do have an admiration for my empathy, capacity for love, willingness to get better and my unwavering resilience.

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