I began to educate myself on Borderline Personality Disorder (BPD) about a year ago, first by reading the popular book “Stop Walking on Eggshells” and then by supplementing that with other books and online resources. What motivated me to do so was the growing suspicion that my sister-in-law suffers from a mental illness of some kind. After discussing her behavior extensively with my own therapist and consulting other family members, we concluded that her patterns of behavior best matched the criteria for Borderline Personality Disorder.
More than once in the course of my reading, I came across the concept of “high-functioning” vs. “low-functioning” BPDs and became convinced that my sister-in-law fell into the “high-functioning” category. I believe this may be the biggest obstacle to her seeking Borderline Personality Disorder treatment.
High- vs. Low-Functioning BPD
If you are not familiar with the “high-functioning” vs. “low-functioning” concept of Borderline Personality Disorder, allow me to very briefly explain. A lower functioning person with BPD may exhibit more overtly troubling behaviors such as self-harm or debilitating depression, which are both obvious signs of serious mental illness and may preclude the person from holding down steady employment or performing day-to-day tasks. A “high-functioning” BPD may be more adept socially and able to perform in a work environment.
A “lower-functioning” BPD cannot hide the severe symptoms of their disorder and it is very likely that they will end up hospitalized or in the presence of a mental health professional at some point and be diagnosed or treated. On the other hand, a “high-functioning” BPD can often hide their disorder more effectively and are less likely to get needed BPD treatment.
Barriers to BPD Treatment
One of the things that resonated with me in “Stop Walking on Eggshells” was the recognition that many times it is only the people closest to the person with BPD who witness their most problematic behavior. When my brother reached a desperate moment about a year ago and reached out to his wife’s friends and family for support in dealing with her increasingly disturbing behavior, no one believed him. We had witnessed incidents by then of what amounted to child abuse, but when her parents (who live out of town) were informed, they chalked it up to moments of poor judgment. Her friends who were also mothers simply thought that my brother had no concept of how difficult being the primary caretaker actually was.
We had hit our first roadblock: those who only saw my sister-in-law socially or spoke with her on the phone occasionally had never witnessed her most extreme behavior. They hadn’t experienced the rages, the verbal and physical abuse, or the complete disconnect between her perception of events and what other’s perceptions were of that same event.
My sister-in-law remains undiagnosed by a psychiatrist and has sought no Borderline Personality Disorder treatment. After a marriage counselor recommended that she see her own therapist privately, my sister-in-law denied any need for that and then decided that she no longer wished to attend marriage therapy, either.
Her friends and family simply do not see what we see, but they do hear a lot of “projection,” which is how many people with BPD deflect feelings of guilt or avoid responsibility for their actions. They simply accuse others of exhibiting the offensive behavior. In her version of events, it is my brother who refused to amend his behavior according to their therapist’s recommendation.
I found out about Clearview Women’s Center a year ago and am still hopeful that one day my sister-in-law may have a breakthrough moment of self-reflection and enter Borderline Personality Disorder treatment. Until then, our family is fractured and we suffer as much as she does with Borderline Personality Disorder.
Contributed by Alicia Danielle.