Friday, November 25, 2016

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.