I’ve been thinking about diagnoses and what they mean to the one receiving them. Usually they come with a sense of relief: I’m not crazy. These symptoms do mean something. But what happens when the diagnosis means you are crazy? What does that mean? I’ve been fighting the BPD diagnosis for years. Never had a therapist agree with it, though I’ve received the diagnosis from more than one psychiatrist. Recently there has been a movement in the trauma treatment community to change it to Complex Post Traumatic Stress Disorder. My current therapist, who is a gift sent from wherever such things come from, explained it to me in a way that made me feel a lot better. It’s not that I’m not fixable, which is the prevailing feeling among most old school practitioners; it’s just that my brain needs a different way of fixing it. I’ll never be neuro-typical. But I can learn to adapt and rearrange the way I process information.
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. (wikipedia) The resulting symptoms closely mirror that of BPD. The key difference between BPD and C-PTSD is that symptoms of BPD stem from an inconsistent self-concept and C-PTSD symptoms are provoked by external triggers. The inconsistent self-concept happens as a direct result of the early childhood trauma or ongoing trauma with no escape. Combine the two, you end up with a very fractured sense of self. Typical therapies for BPD used are DBT (Dialectic Behaviour Therapy) and CBT (Cognitive Behavioural Therapy), neither of which address the underlying trauma.
I grew up always afraid of my father. I don’t remember a time when I wasn’t. That’s how early the abuse started. He was never physically violent to my mother, but he was very much emotionally and verbally abusive. In typical abuser fashion, he never started until after they were married and she was “trapped” with a baby. My therapist explained to me that babies can pick up what’s going on around them, so if my mother was anxious, sad, or afraid, I would’ve understood something was wrong. When asked why she stayed, she recently told me she couldn’t admit to her mother that her mother was right. So her pride ruined my life. Well, my life up to this point. I’m taking charge of it now, and learning to say no to the shit I don’t have to put up with.
Add to the mix a cousin who taught me things no six year old should ever be aware of, a very abusive relationship at a young age with a much older man, and a more recent sexual assault, is it any wonder that my sense of self is fractured? I’m now learning that I matter, that what I want and feel are valid. Novel concepts to be learning at 45. I wish I had the confidence of my young sons. They know they’re important, they understand body autonomy, and while they may not yet know what it is, they live their lives with a purpose.
I long for the day when I can live beyond the day to day, minute to minute, second to second it takes to survive sometimes. But everyday I’m getting stronger. A solid therapist with strong boundaries is key. I’m very fortunate to have found one. She holds the space while I try to feel whatever emotions are coming up. She holds it without judgement and without forcing it. Which is what someone who has suffered much trauma needs. I am doing EMDR, (Eye Movement Desensitization and Reprocessing) along with a combination of other modalities. I take a mood stabilizer to boost the effect of my anti-depressant, and I take an alpha blocker, which helps prevent the nightmares. Being taught coping mechanisms (Babette Rothschilde is an amazing source for this), I can even manage my panic attacks and flashbacks. I’m in a stable relationship, I’m a pretty decent parent, and a damn good friend. None of which should be possible if I was truly only suffering from BPD.
So what does the diagnosis mean to the one receiving it? In my case, nothing at all. It bothered me at first, and if I had received it years ago, before I started working with my current therapist, it might have destroyed me; taking away any hope of ever getting better. Now, it’s a label that might help my disability claim, but that’s all it is. It doesn’t define who I am as a person. It changes nothing. My trauma work is the most important thing I can do for myself, and in doing it, I will free myself from the bindings of a difficult diagnosis with a less than helpful prognosis.