When I became disabled I, hands down, thought the biggest fight would be having my limitations and successes recognized by other people. Or, you know, high shelves and stairs. But when it came down to it, the biggest challenge was my Borderline Personality Disorder. Interestingly enough, when I was first diagnosed, my BPD purred like -well- a kitten. Finally! Something, internally and out of anyone's control, was working harder than my malfunctioning mental health at destroying my life. Alongside the unmitigated fear of missing everyone I loved, my job, my independence there was this unimaginable sense of relief. And I clung fast to that relief because it distracted me from every other emotion attributed to receiving a diagnosis of Motor Neuron Disease. That relief made me feel invincible and strong. I was utterly convinced that being able to face it with a glowing smile and a cavalier attitude to meeting my maker was genuine bravery. Big gold star for me!
"It's not always easy because there isn't a gauge for empathy when only 20% of the world's population is experiencing what you are to different degrees."
In the beginning, it was constructive. I raised money for my wheelchair, I continued to live life fully and openly. For a while. As time went on, I realized that I was making desperate attempts to embody that bravery every step of the way even if it meant doing things that my brain and body couldn't manage. You wanna use me as your therapist for the 5th day in a row? I got the time! Do you wanna get hammered every Thursday? Pass me my beer! Do you need me to complete that assignment for you? I need no sleep! Why? Because I am NOT going to let this disability crush me! I'm not even going to let it touch me! I am INVINCIBLE! In BPD, it's difficult to notice when an emotion deemed universally positive- such as 'bravery', becomes toxic. I had only told one single person the shameful secret that I was happy with my diagnosis once in passing. I sat silent as members of my related family called me a liar, a drama queen, a hypochondriac. I offered counsel to people mourning my news at the cost of giving it to myself. I accepted ridiculous levels of flattery for benign things like breathing and existing. At the cost of maintaining a sense of "bravery," I was patronizing myself. And, when you patronize 99% of the time, you're antagonizing someone.
"Honestly, this often involves a lot of hurt faces because people feel compelled to help and insist on helping before actually considering why or how."
Like most toxic emotions, it didn't reveal itself with a whimper, but with a screaming match the day after my 33rd birthday where I became sick of everyone else around me being sadder than I was, grieving me way ahead of where I was grieving, or in other circumstances, ignoring the news altogether. Oh, I'm sure my BPD was impressed; it had fooled everyone into thinking I was consciously managing my situation. It was feeding comfortably on my internalized stigma steeped in disability. If you're not putting up any fuss, you're winning! I was not winning. My boundaries were a mess, my feelings and emotions were invisible to everyone because I had made them that way, and my mental exhaustion only compounded the challenges of my disability. I had to turn to the BPD and kick her back into touch. I had to accept that it is possible to have both at the same time; a mental disability and a physical one. And that I had to learn to manage them both.
Here are some of my experiences, and how I manage them with Dialectical Behavioural Therapy!
1. The BPD Emotional Distress Challenge
As someone with BPD, emotions often feel like a category 5 tornado. We're talking uprooted sense of self, up-turned identity, the same mooing uncertainty swirling in a vortex with me right in the middle. Now, imagine that storm intensifying when you face the additional challenges of a physical disability. Enter the DEARMAN skill.
DEARMAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate):
I'm learning to describe how my physical disability affects my emotions and daily life, openly express my feelings without self-judgment, assert my needs and boundaries confidently, and reinforce my self-respect by advocating for myself. Staying mindful during conversations and appearing confident even when discussing difficult emotions are game-changers. And negotiation? Well, that's about finding common ground and compromise. It's not always easy because there isn't a gauge for empathy when only 20% of the world's population is experiencing what you are to different degrees. Which brings us to the next part.
2. The Relationship Challenges
Maintaining stable relationships is difficult for your average Joe. Nice sprinkling of irrational fear of abandonment and some emotional over-seasoning, and socializing becomes a lot less palatable. So throwing the complexities of a physical disability on top of it is kind of like dressing up a turd and calling it a hot-fudge sundae. With the FAST skill, I'm finding a path to smoother relationships.
FAST (Fair, No Apologies, Stick to values, Truthful):
I make it a point to treat others fairly, avoiding unjust accusations and unrealistic expectations. I've learned not to let excessive apologies weaken my stance and self-image. Staying true to my values and principles, even in the face of challenges, has helped me build trust with those I care about. And, of course, honesty—being honest and truthful in my communication has been the bedrock of my relationships. This one proves tricky sometimes. I have to resist the urge to be overly precious with other people's values because I don't want them to be sad or feel helpless at the cost of my health or safety. One of the smaller changes was "No apologies". "Excuse me," has taken some practice to implement but it is offering me the respect I deserve.
3. The Self-Image and Identity Challenge
Self-image and identity have always been complex for someone with BPD. Introduce a physical disability, and it's like adding more pieces to an already intricate puzzle (not to mention additional mobility devices). This is when I try to use the GIVE skill to put some of those pieces together.
GIVE (Gentle, Interested, Validate, Easy manner):
I'm prioritizing approaching myself with self-compassion and kindness, understanding that I'm doing my best. Showing genuine interest in understanding my own emotions and experiences is giving me a greater sense of peace in independence and dependency. Self-validation—acknowledging my feelings and experiences without judgment—is liberating and in many cases life-saving. Maintaining a relaxed, non-judgmental attitude toward myself is fostering self-acceptance.
4. The Coping Mechanisms Challenge
Coping mechanisms are essential for anyone dealing with BPD. Sometimes, though, the urge to resort to self-destructive behaviors becomes overwhelming, especially when you're facing the added stress of a physical disability. Those self-destructive behaviors erred towards hysterical crying and obliterating relationships with sincere prejudice. Mainly because my physical disability often prompts others to think and act on my behalf, without my consent or input, several times a day. So I practice the STOP skill more often than anything else.
STOP (Stop, Take a step back, Observe, Proceed mindfully):
I've learned to hit pause when that urge strikes—just to acknowledge it without acting on it. Physically stepping back from the situation (literally halting my wheels), if needed, has given me a fresh perspective. Observing my thoughts and emotions without judgment has been like seeing through a different lens. And choosing to proceed mindfully with healthier coping strategies that align with my values has been a powerful shift. Honestly, this often involves a lot of hurt faces because people feel compelled to help and insist on helping before actually considering why or how. And nobody likes to be interrupted. And I don't like interrupting. But sometimes proceeding mindfully is to stop what is going on and feel comfortable with it.
5. The Treatment Complexity Challenge
Therapeutic interventions are a lifeline for individuals with BPD, but introducing a physical disability can add layers of complexity to treatment. However, by combining DEARMAN, FAST, and GIVE, I've found a way to navigate this intricate path.
I've used DEARMAN to describe my treatment needs, express my emotions, assert my requirements, reinforce my self-respect, stay mindful during discussions, appear confident in my decisions, and negotiate a treatment plan that considers my physical disability. Ensuring that people treat me fairly, in alignment with my values, and with honesty has been crucial. And I use GIVE to manage and assert my sense of independence and pride (and, sometimes, to excuse a full ASOS cart). Re-approaching the therapeutic process with gentleness, genuine interest, self-validation, and an easy, non-judgmental attitude has been the key to my progress.
So, to sum it up, dealing with both Borderline Personality Disorder and a physical disability? Yeah, it's a bit like reinventing the wheel. But re-acquainting myself with Dialectical Behavior Therapy is giving me much-needed boost in resilience and self-compassion to move through life with both neurodivergence and physical disability rather than letting it roll over me- if you pardon the pun.