College and Borderline Personality Disorder

College is a time of life that is one of self-discovery and self-definition. It is a time where people make friends that last them a lifetime and oftentimes meet the person that they will one day marry. College is filled with so many new experiences from college parties, fraternities/sororities, more difficult classes, and a whole lot more independence. What usually accompanies all of these things? Stress, and lots of it. College can be the best time of someone's life.
But for someone who has Borderline Personality Disorder or BPD, college can be a tumultuous time of their life. Borderline Personality Disorder is defined in the DSM as "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms"

Borderline personality disorder generally has traits that appear during adolescence but the actual diagnosis cannot be made until someone reaches the age of 18, which usually is the age of a college age student.
One thing to keep in mind with the diagnosis with BPD is that someone needs to have 5 of the 9 symptoms to be diagnosed. There are a total of 256 combinations of the symptoms that can be present for the diagnosis to be made so all of the following suggestions may not be applicable to every person with BPD.

What does this mean for a college student struggling with BPD?
1) Relationships look different. This is the hallmark of BPD. For some, it is easy to make friends while for others it is difficult to make friends. For almost all, it is extremely difficult to keep friends. Relationships are extremely rocky in nature because of the kind of thinking that comes with it and the patterns that follow the thinking. One characteristic thinking pattern is all-or-nothing thinking also known as black or white thinking. This includes the extremes of idealization and devaluation. This means that one day someone can be put on a pedestal and the moment they do something wrong, they are the worst person ever. Another way this may happen is that when someone is in the idealization stage, all faults may be overlooked until something becomes so obvious that it cannot be and the flip to devaluation occurs. It may also occur with devaluation. Someone may view someone in such a negative light that nothing positive that they do can change the way they view them. What this leads to is tumultuous relationships. Tumultuous relationships can add extra stress to those who struggle with BPD, making college even more stressful. However, they crave human connection and need it.
2) Self-image related situations. People who have BPD struggle with maintaining a stable self-image or sense of self. This can mean that college students frequently change majors as their interests change frequently as their sense of self changes. For example, one semester they may study education because they want to be a teacher. Then they decide they want to study business. Then they decide they want to be a writer. The frequent change of majors is often related to the fact that they don't know what they are truly interested in and don't have a stable sense of who they really are. Another aspect of self-image related situations is perfectionism or apathy. Again, it is usually in extremes. They can be either perfectionistic, high achievers in their studies and do exceedingly well, or be apathetic and have poor performance. They can also go back and forth between the two.
3) They have to be careful. One symptom of BPD is impulsivity. This can include substance abuse (including alcohol and drugs), over-spending, driving recklessly, or being promiscuous. While it may be okay for some to have a few drinks every now and again, some people who have BPD cannot do that. It can lead to a pattern of impulsivity that can become dangerous quickly.
4) They need extra support. This is the most important. Getting treatment for BPD is so important and the earlier the treatment begins, the better. Having support from peers is critical to making it through college and being successful. It is also sometimes a key aspect in getting treatment. Many times students with BPD are afraid to seek treatment because of the stigma out there that exists but are more inclined to go if someone goes with them.

So what can you do as a college student or a college professor who knows someone struggling with BPD?
1) Offer support. This can come in a variety of ways. This can mean going out to lunch or coffee with them. This can mean getting together to study with them. This can mean just lending a listening ear when they are struggling.
2) Offer to go with them when they do seek treatment. This can be critical to them feeling more comfortable when it comes to seeking treatment and following through with treatment.
3) Be consistent. This is probably the most important thing when connecting with someone who has BPD. Part of having BPD means intense fear of real or imagined abandonment and if someone is not consistent in their relationship, it can be mistaken as abandonment which can lead to catastrophic consequences. This does not mean it is not all on one person either. It does not mean being there every moment of every day. It just means not randomly dropping out for periods of time without letting them know what is going on.
4) Take care of yourself. There is the saying on airplanes that one must "put on your own oxygen mask before helping someone else". This applies to life in many ways. You must take care of yourself and not run yourself down into the ground to help someone else because it will only make the situation worse. So make sure your oxygen mask is on first.

Again, please note that all of these do not apply to every person with BPD as no one with BPD looks the same.
The one thing that should be kept in mind through all of this: There is hope, no matter the diagnosis or the situation and help is available after a diagnosis.
Overall, BPD can make college more difficult and more complicated, but it does not have to take away the rewarding experience that it can be. College can be a fun and exciting period in life for anybody. It can be a challenging experience for anybody. The same applies for people with BPD.

The Reality of Psychiatric Hospitals Part 1

Many people do not understand the realities of staying in a psychiatric hospital. Many do not understand what goes on inside a psychiatric hospital and how challenging those stays can be. I've even known people to refer to my hospitalizations as "vacations" because that's how they saw them when they are the furthest thing from that. This may be a long piece that I may have to break up in segments but here is a start.

Being admitted to a psychiatric hospital:
This can be done in 2 ways. The first is through the ER or medical hospital. The second is done directly through the psychiatric hospital. I have done both and have very different experiences with both.

Being admitted through the hospital directly is much simpler in the long run. This is because most of the time when you admit yourself to the hospital, you are there voluntarily which means there are many extra steps you don't have to go through to be discharged (more on that later). The process of being admitted usually follows a set of steps.
1) You research and determine which hospital you would want or need to be admitted to. This can be influenced by a number of factors. The primary one is if they take your health insurance or not. Other factors include location, availability on beds, doctors and programs available, as well as reviews. As my experience went on through my series of hospitalizations, I began to take all of these factors into consideration when looking into a hospital.
2) You call the hospital and ask for the admissions department. This is usually followed up with either making an in-person appointment for an evaluation or doing an evaluation over the phone. One hospital I went to did evaluations over the phone. Others required it to be done in person.
3) You go through an evaluation. This evaluation is used to determine the necessity of you needing hospitalization. This evaluation goes over various points in your mental state and takes all into consideration about whether a hospital stay is necessary. When doing a phone evaluation, there is a risk one takes and that is that if the admissions staff determines you need help right away, they will call 911 and send someone out to your house which will lead to you being taken to a local ER and evaluated there (more on this shortly).
4) Hospital sends your case to the doctors and the doctors will decide whether to accept you as a patient or not. This is generally the most nerve-racking part of the whole process because if you don't get accepted, the process starts all over again. Usually, the admissions staff will present your case to the psychiatrists there and one will accept you. This is usually the doctor you get assigned to for your stay there.
5) You are from there admitted into the hospital and fill out a bunch of paperwork that goes over rules and regulations, insurance stuff, contact information and emergency contact information.

The other way to being admitted to a psychiatric hospital is through the ER or medical hospital. This usually takes place when people are hospitalized after a suicide attempt or when they go to the ER reporting suicidal thoughts. This can also take place if someone calls 911 because they are worried about your safety. This includes crisis line staff, admissions staff at hospitals and friends and family. Anyone can really call 911 on you and tell them that you are suicidal and usually both police officers and EMTs will show up at your place. From there, you are asked a series of questions about your mental state and if you agree to go, you will be transported by ambulance to the closest hospital that is designated to handle psychiatric patients. (Note: This may not be the closest ER. Many places have certain hospitals that are designated to handle psychiatric patients in the ER and when you are determined to be a psych patient, that is where you are brought.) Once you arrive at the hospital a number of things take place.
1) You are evaluated in the ER by a social worker or psychiatrist. Many hospitals don't keep psychiatrists on site anymore so it is usually done by a social worker or through a video chat with a psychiatrist. This evaluation will determine if you are involuntarily committed or not. Many times there are other things added prior to being evaluated depending on the hospital. Blood work is usually taken and a medical clearance is done, especially if they anticipate putting you on commitment papers. Certain hospitals require you to change into paper scrubs to further show that you are committed and then turn in all your belongings. Security will lock up your valuables and the rest will be kept in the ER behind the nurses station. This means that you are not allowed to have your cellphone or any other personal items with you during this process.
2) If you are put on involuntary commitment, a few things take place to make this happen: the report by the person who evaluated you is used to fill out a bunch of forms explaining why you need to be committed, then you are informed that you have been committed and are no longer considered voluntary, then social workers in the hospital begin looking for a hospital to accept you as a patient.
3) When you are accepted by a hospital, you will be cleared medically and then transported by hospital cop to the designated hospital. Before leaving, your belongings will all be turned over to the hospital cop who is assigned to transport you. Sometimes you have to stop at the hospitals belongings desk to sign for some of your belongings. Depending on the cop, you may be restrained during your transport to the hospital. This can be through padded cuffs on hands and feet. It all depends on the cop, the hospital and your demeanor whether or not you are restrained during the transport. The drive itself is very uncomfortable if you are tall or a bigger person because the cars are equipped just like cop cars with protection between you and the driver. There is also a camera that the cop can use to monitor you throughout the drive. Because of all the protective equipment, there is not much leg room. Occasionally, depending on the time of day and the drive and the cop as well, you may be granted a pillow and blanket for the drive. This all depends on the cop and the situation. Other than the pillow and blanket, you are not allowed to have any personal belongings in the car with you. Sometimes the cop is nice enough to let you choose the radio station, sometimes not so much. This is one thing that made my drive even more difficult because I'm triggered by certain music so if the cop decided to listen to classic rock it was a very difficult drive. The drive is usually very quiet and you spend most of it in your thoughts, which considering the situation is usually a horrible situation to be in. I have cried during my transports, I have prayed, I have tried to do everything to keep my mind occupied during the drive, even if that means watching the GPS and road signs. It is a miserable trip. Once you arrive at the hospital, the cop escorts you to either the general entrance of the hospital or in some cases to the designated unit. From there, they hand your paperwork to staff at the hospital and you go into the admitting process. 4) The admitting process is usually the same whether you are voluntary or involuntary. You still go through a series of questions as to why you are there and have to fill out paperwork regarding general information (sometimes it is bypassed though depending on commitment paperwork) This concludes the process to getting admitted to the hospital. Next post will be what the intake process is like and examples of rules and regulations in hospitals. Please note: This is all based on my personal experiencess. However, I have been in 8 different psychiatric hospitals and multiple ER's belonging to different hospital companies.