Month: July 2018

“I felt like he was going to leave me. I felt like everyone was going to leave me.”
Ashley, 32, was in a new relationship with a man she really liked. She had no reason to believe anything was wrong—and no reason to do what she did.
“For days, I tried not to let him out of my sight,” she says. “I tried to hold on, but I kept feeling more desperate. It didn’t matter. I was sure that he was going to leave, so I told him I was going to [hurt myself]. He told me to get help, and for once, I listened. I don’t know why. Maybe I thought that was the only way to make him stay.”

Ashley had many of the signs of borderline personality disorder. She depended heavily on others for her identity, which led to dramatic moments where her relationships broke apart in front of her. She couldn’t regulate her emotions, and she couldn’t hold onto a stable sense of self.
According to the National Institute of Mental Health, about 1.4 percent of U.S. adults can be diagnosed with borderline personality disorder. That’s a shockingly high number—and it’s even more distressing considering the large amount of misinformation surrounding the condition.

Borderline personality disorder (also known as BPD or emotionally unstable personality disorder) is a serious, long-term condition characterized by mood swings and dangerous behavior. Like many personality disorders, it’s extraordinarily complex, with environmental, genetic, and social factors contributing to the development and progression of the disease. Women are significantly more likely to suffer from BPD than men.
The good news is that the condition responds well to psychiatric treatment. The bad news: Because mood swings can accompany a variety of physiological diseases, people often misinterpret the signs of BPD.
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After all, it’s a hard distinction to make, even for a trained psychologist; is a person experiencing one of the dramatic breaks commonly associated with BPD, or are they simply going through a tough time? Will their behavior eventually change—or do they need professional intervention?

To be clear, nobody should try to diagnose a mental illness on their own (or any other illness, for that matter), but recognizing the symptoms is the first step toward getting treatment. We looked into some of the commonly missed signs of this disease with the help of psychiatrist Alex Dimitriu, MD.

1. People with BPD have extreme instability in their personal relationships.

“Signs of BPD include unstable relationships, generally with significant drama,” Dimitriu tells HealthyWay.
Because people with BPD have difficulty regulating emotions, they have trouble maintaining a healthy baseline. That means their personal relationships become unstable—and, in a sense, they seek out and create that instability.

“Unstable attachments can often manifest in splitting, or having very intense feelings that can quickly change from love to hate,” Dimitriu says. “Rage inevitably occurs, and people with borderline personality disorder can be very harsh on both themselves as well as those around them.”
For people who don’t have the illness, those changes can be extreme and frustrating. People with BPD might be emotionally cruel, or they might completely disengage from relationships.

2. That instability also carries over to their sense of self.

“I had hobbies [before I received treatment], but they changed all the time,” Ashley says. “If I had a new boyfriend or best friend—they were always ‘best’ friends—I was obsessed with whatever they were obsessed with. But my moods changed almost constantly, even throughout the day, which made it impossible to focus on anything other than those relationships.”

Those symptoms are fairly common among people with BPD, who might even go so far as changing their beliefs, principles, and (gasp!) political affiliations in an effort to fit in.
“[Another symptom] is an unstable sense of self, resulting in ‘melting into’ various groups or fads, and outside observers may at times feel the borderline [person] is like a ‘chameleon,’” Dimitriu says. “Because of an unstable sense of self, combined with the intensity or rage episodes, it is not uncommon for people with BPD to do self-damaging things.”

To put that another way, a person with borderline personality disorder might move from group to group in an effort to fit in and feel comfortable. They’re looking for an environment that will provide some sort of stability and sense of identity.
Ironically, moving from group to group will likely cause instability with their interpersonal relationships.

3. People with BPD often engage in self-damaging behaviors, which aren’t always easy to spot.

Generally speaking, BPD behaviors aren’t exactly subtle. However, they can be difficult to identify as symptoms of a mental illness. To friends and family members, a person with BPD might simply seem like they’re being unreasonable in the moment. As with other mental illnesses, it’s difficult to separate the disorder from the person.

“[BPD behaviors] can range from impulsively sending an email that could result in getting fired, to fighting or being dramatic in relationships, to threats of suicide or self-harm in the form of cutting or medication abuse,” Dimitriu says.
Of course, a person can present some of those symptoms without having a mental illness, and psychologists don’t make a diagnosis from a single incident. One of the defining features of BPD is that it persists over long periods of time and through multiple relationships.

“Most commonly, these symptoms or tendencies have been present for a long time, often since teenage years, and it is not uncommon to have a family relative with a similar coping or personality style,” Dimitriu explains.

4. People with BPD often have unstable upbringings.

That brings us to another common symptom—and a root cause—of BPD: a family history of unstable behavior. While a variety of factors contribute to the illness’s development, familial instability seems to be one of the bigger factors.
“On a most fundamental level, it is believed that borderline children never knew they could trust their caregivers to be present consistently,” Dimitriu says. “This leads to patterns of acting out, neediness alternating with rage, and fears of abandonment. Inconsistent as well as overly intensive parenting is sometimes to blame. These parenting conditions often result in a child’s distrust of their own self and ability to relate to people in the world.”

According to a paper published in The Lancet, borderline personality disorder is frequently associated with adverse events that occur during childhood. Those events might be the result of parental negligence or abuse.

Psychologists also believe that BPD has a genetic component. However, that doesn’t mean the situation is hopeless; while some people may be genetically predisposed to BPD, they can still respond well to treatment.

The good news: People with BPD have options for treatment.

There’s no standardized treatment for borderline personality disorder, but cognitive behavioral therapy (CBT) seems particularly effective. One paper found CBT provided a “gradual and sustained improvement” in outcomes for BPD patients, reducing serious incidents and improving social functioning.
CBT, by the way, is a type of psychotherapy administered by a trained psychologist. The patient is compelled to challenge negative thought patterns, eventually reducing the feelings of instability that drive their actions.

“I was worried about taking medication, but for the most part, my [therapy] sessions were the biggest part of my treatment,” Ashley says. “It’s still a struggle. I think it’s always a struggle, but it’s a lot easier to get by when you understand where the negativity is coming from, and what you can do to sort of stick a wedge in it.”
With that said, before seeking treatment for BPD, it’s important to make sure a person actually has the condition. We’d really like to stress this point: Only an experienced psychologist or psychiatrist can make that diagnosis.
[pullquote align=”center”]“Don’t tell them that they’ve got this condition or that condition, just get them to a therapist’s office. There’s no reason to live in misery. My mental health problems don’t run my life—I run them.”
—Ashley, a 32-year-old diagnosed with BPD[/pullquote]
“Before anything is called a personality disorder, it is important to rule out true psychiatric conditions—such as depression, anxiety, or bipolar disorder—which can often overlap with BPD,” Dimitriu says. “Reducing stress and improving mood can play a big role in mitigating symptoms that may look like borderline personality.”

As Dimitriu explains, psychological issues are complex, and a single self-harming incident doesn’t mean that a person has BPD or that they need to pursue a particular course of treatment. However, major mood swings should be taken seriously.

Don’t assume a person’s simply acting out to be dramatic.

“Desperate people do desperate things,” Dimitriu says, “and I often give the example to my patients of how irrational a drowning person may appear. There have been instances of a desperate drowning person drowning their rescuer [or] lifeguard; reducing depressive symptoms or anxiety can definitely lead to less desperate thoughts and actions, which can certainly improve, to some degree, the rage and instability seen in borderline behavior.”
Because the symptoms of BPD overlap with the symptoms of other conditions, psychologists will need a detailed patient history in order to recommend treatment.

“An important point worth noting is a higher incidence of bipolar disorder in borderline personality,” Dimitriu says. “One key difference is that bipolar patients will have longer periods of time during which they appear ‘stable.'”
Bipolar disorder also needs treatment, of course. The most important takeaway: If you know someone who may have BPD or who experiences major mood swings, urge them to get help.
“Don’t tell them that they’ve got this condition or that condition, just get them to a therapist’s office,” Ashley says. “There’s no reason to live in misery. My mental health problems don’t run my life—I run them.”

You’re sitting at dinner, just about to bite into that delicious macaroni salad, when your in-law casually throws out the old, “So…when are you two going to have kids?” It’s a question that’s been asked what seems like a million different times by pretty much everyone you know and in a multitude of very creative ways.
Maybe it’s something like, “It sure would be nice to have a grandchild…,” paired with a longing glance at a cute pair of baby-sized shoes. Or perhaps it’s a, “Wasn’t he cute as a baby?” wink-wink-nudge-nudge while flipping through old pictures in what you thought was an innocent and hilarious journey down memory lane. It could even be from an acquaintance you hardly know who cavalierly asks, “When do you think you’ll start popping ‘em out?”

Here’s the thing. Whether someone has children is a deeply personal, highly intimate—and sometimes medically sensitive—decision made between two people. For some reason, though, it’s a topic that makes its way into the conversation with the kind of casualness with which you discuss the latest episode of Game of Thrones.
If you repeatedly find yourself on the receiving end of these questions and you’re straight up over it—or you’re someone who’s guilty of asking—the following breakdown will benefit you.

Why do so many people ask this intimate question?

Christen Reighter summed it up perfectly in a 2017 Ted Talk she gave about her decision to have a tubal ligation in her 20s. “I recognized the roles that were placed on me very early,” she said. “One persistent concept that I observed—existing in our language, in our media—was that women are not only supposed to have children; they are supposed to want to … There are countless reasons a woman may have for choosing to abstain from motherhood. The majority of them? Not self-prioritizing. But it is still socially acceptable to publicly vilify women as such because none of these reasons have made it into the social narrative.”

Those reasons can range from a concern about the ecological impacts and overpopulation to an inability to provide the right resources for a child. Or they may be medically-fueled concerns about passing on congenital or psychological traits—or simply being dealt a hand where they’re unable to conceive.
The question is consistently on the tip of people’s tongues. It often begins as small talk but, depending on your audience, can deteriorate into a debate that feels not just personal, but sometimes offensive.

“The reason why it’s such a casual conversation topic is most likely influenced by values and conditioning of upbringing and personal beliefs that when two are together in a relationship, there is an assumption that children will be a part of the family,” notes Lisa Bahar, a licensed clinical counselor and marriage and family therapist based in Newport Beach, California.
If you’re often on the receiving end of this question, she says it’s important to try to understand that these are not personal attacks against you. Rather, they’re assumptions that the individual has been conditioned to believe (as frustrating as they may be).
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For those who are guilty of asking the question, really think about the reason why you’re asking to begin with. If you simply view it as small talk, there are certainly less personal conversations you can have with others, including about work, travel, and hobbies. You can avoid awkward conversations and potentially offending or striking a nerve with someone by removing the “when are you having kids” topic from your small talk arsenal altogether.
If you’re talking about it because it’s an interesting topic to you and you are eager to hear someone else’s perspective, broach it that way. Refrain from interjecting a “you should do it this (read: my/society’s) way,” and don’t prod or try to poke holes in the other person’s (highly personal) decision.

We argue the best practice is to avoid this conversation altogether unless the other person brings it up. Then, if it does inadvertently come up, engage your empathy and be sensitive.
Whether you’re an asker or an askee, the below anecdotes might help broaden your perspective and equip you with a keener set of social skills when it comes to this topic.

Actively Choosing Not to Have Children

We’re living at a unique time in history when actively [linkbuilder id=”6805″ text=”choosing not to have children”] has become the more popular choice but still intersects with a strong societal conditioning that assumes women and couples automatically have a desire to procreate. As a result, the “we’re not having children” conversation has proven tricky to navigate.

Sarah Feuerborn, 26, and her husband, 29, have been together for nine years and married for three. They decided years ago that they didn’t want to have children but still find themselves on the receiving end of this question.
“People ask us all the time when we’re going to have kids,” Feuerborn tells us. “Our families are fine with it at this point, but we still get the occasional ‘You’ll change your mind.’ With strangers, if they ask if we have kids, we usually politely respond with, ‘Oh no, no kids.’”

If the conversation ends there, then all’s well, she says. However, that response usually leads people to ask when they will.
“I usually respond with, ‘Actually, we don’t really want kids.’ Sometimes I’ll add a ‘We may change our minds, but at this point, we don’t see them in our future.’ At that point, people usually say, ‘Oh you’ll change your mind! You’re still so young!’ which I respond to with, ‘Maybe!’”
“It’s definitely interesting to see how people react,” she says. “I don’t really argue with people much about it. If they’re insistent about it, I get more stern, but I typically say something to politely brush it off and try to change the topic. Many people, especially those with kids, get offended when I say I don’t want them, so I try to be as polite and delicate about the subject as possible.”

Joanne Williams, 36, has a slightly more aggressive approach to this conversation. She made the decision to be child-free when she was 19 years old.
“I realized how life-altering children truly are to people and their lives,” she said. “I realized that I’m more career-oriented than I am maternal, and ultimately, I am too selfish to have kids. I like to have freedom to come and go as I please, without having to focus on the needs and commitment of others.”
While her parents and friends don’t pester her about her choice, having the conversation with those she’s never met before is a different story.

“Strangers that have asked always seem slightly confused. It’s as if I’m alien since I have zero desire to have children. I’ve been pretty curt with the answer to this, [saying] that I simply do not, and never have, wanted kids. I feel like it’s been effective for the most part,” she tells us. “I have had a few friends’ parents, [including] my best friend’s mom, ask me when I’m going to get married and have kids. I’ve told her in jest that I’ll do it after her other daughter—who is three years younger than me—does first.”

For Jenn Schaeffer, who’s in her 40s, the decision to not have children came later in life.
“I was never against having children and actually pictured myself as a mom quite often when I was younger. Though I am nontraditional in many aspects of my life, I had a traditional mindset when it came to having kids: I wanted to be married when I had kids,” she explains.
[pullquote align=”center”]“There have been—and continue to be—so many times that I feel like a failure, despite all of my other accomplishments, because I haven’t had children.”
—Jenn Shaeffer[/pullquote]
“Well, I didn’t meet my husband until I was 38, and we didn’t get married until I was 41. I had sort of a rule for myself that if I didn’t have children by the time I was 40, I wouldn’t have any. Yes, modern medicine has advanced so that you can have children at a very late age, but that wasn’t something I wanted to do.”
She says she gets the “When are you having kids?” question all the time, especially since she works with older people who are inclined to ask.

“I had a woman even say, ‘Don’t you know it’s your obligation to populate the earth?’ Wait, what? A lot of times I kind of laugh it off and say that ‘We are sticking with fur kids.’ Oftentimes, though, I feel angry that people just expect me to have children because I am a woman,” she confides.
“There have been—and continue to be—so many times that I feel like a failure, despite all of my other accomplishments, because I haven’t had children. I am slowly coming to terms with not having kids, but it definitely has not been easy, especially when I am continuously asked why I don’t have kids. As if there is something wrong with me. Guess I will someday get used to being in the small club of not having children despite what society dictates.”

Sometimes I feel like a failure because I'm pushing 25 and don't have a kid.

— s (@runteachtape) September 24, 2015

It’s easy to see from these personal experiences why this conversation topic can trigger a host of feelings ranging from frustration to guilt to even sadness. If you find yourself on the receiving end, understand that there really is no such thing as the perfect response. However, one route you might consider taking is simply being honest about your decision.
“The truth is the straightest path. Rather than make up reasons or ways to dodge the question, why not answer truthfully?” advises Alex Dimitriu, MD, a double-board certified psychiatrist based in San Francisco. “It helps to spend a minute—or 20—thinking this through and understanding one’s own reasons. With an understanding of what drives this decision, it should not be hard to express to someone. The truth shall set you free.”

Behar agrees, adding, “Be open to talking, if you want, about your decision in a non-defensive way and think in terms of your truth and how that can help another expand their awareness of what it means to be having children.”
And if you don’t want to talk about it with someone at all? Politely tell them, “I’d prefer not to discuss it.” Most people will respect that, and if they don’t, you have every right to walk away.

When Medical Issues Interfere with a Desire to Have Children

Not having children isn’t always an active decision. For example, pregnancy or childbirth could lead to potentially life-threatening medical issues for the mother or result in passing down ailments or defects to their newborn. In some cases, not having children is an undesired reality for those who’ve desperately tried to conceive but have struggled with infertility.
In this situation, being joyfully asked, “When are you having kids?” can be particularly painful. This is something Rachel Schroeder can personally attest to.

“I have struggled with infertility, and I’ve suffered a miscarriage,” she tells us. “I was diagnosed with polycystic ovarian syndrome (PCOS) when I was 19 and have had pain and irregular cycles and other related issues since then. PCOS is one of the leading causes of [linkbuilder id=”6803″ text=”infertility in women”], so I was prepared that pregnancy may be difficult for me. I also have complex regional pain disorder, a nerve condition that causes chronic, severe nerve pain. This condition may or may not be genetic, and if it is, I do not wish to pass it along.”
In the 11 years of marriage to her husband—along with 10 years working in childcare—she’s been asked countless times when she’ll have children of her own or why she hasn’t already.
“It’s a super personal question, and my answers have varied over the years as I have struggled to decide how much to share and with whom. And honestly, my answers have changed as I have come to terms with the fact that the plans I had as a child to be a parent have not happened and may not happen at all,” she says.
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“Sometimes, I simply say not yet. Other times, I am more forthright and say that it has been a struggle. Other times, I go into more detail about the financial and circumstantial roadblocks that have come our way as we considered adoption.”
An interesting perspective surrounding this topic—and one that isn’t often considered by askers—is that sometimes mothers who have one child experience medical issues that prevent them from having another. Such is the case for Ashley Kenney, whose child turns 12 this year. She had her son “accidentally” at the age of 19 and has since been diagnosed with PCOS. She also recently had a hysterectomy.
“I get asked at least once a week. I’m told that I should at least give my son one sibling. That only children aren’t as well adjusted. Or they will just straight up say, ‘Why aren’t you busy making that little boy a brother?’ which feels like such a personal question in so many ways. Are you asking me why I’m not having enough sex?” says Kenney, “It’s been really hard. My husband and I tried for six years before being told that it wasn’t going to happen and that I needed to take steps to prevent developing cancer.”

She says she usually just responds as kindly as she can, explaining that her pregnancy journey hasn’t been an easy one. And that, as much as she’d love to give her child a sibling, it isn’t an option for their family.
“Most of the time, people feel awful for having asked,” she says. “I think people just think it’s all in fun for the most part, and until they meet someone who tells them otherwise, they just don’t think about what the underlying reasons might be. Recently, I had someone say they will pray for us to get pregnant. As though even without a uterus it could still happen by the grace of God. And I try to appreciate the sentiment, but mostly I just want to scream that it’s none of their damn business.”
[pullquote align=”center”]“There is so much focus on babies that mothers often get overlooked for the healing and caring process, but that’s a whole other issue. This continued battle I am fighting for my voice to be heard is hard enough without the constant ‘when’s the next child coming’ questions.”
—Lauren Christie-Veach[/pullquote]
Lauren Christie-Veach has a similar story. She had her daughter a year and a half ago and has been eager to have another, but medical roadblocks have made that journey difficult. She says she is overjoyed to have had a healthy daughter and easy pregnancy, but that birth “destroyed her body.” Within 14 months of having her child, she’s experienced a range of medical complications that include ovarian cysts and [linkbuilder id=”6806″ text=”thyroid problems”].
“I get asked all the time when we are having another. Usually, it’s, ‘She’s so sweet and happy. When’s the next one coming along?’ Usually, I just smile and make some stupid small talk comment, but the last time I was asked, I burst into tears,” she says. “There is so much focus on babies that mothers often get overlooked for the healing and caring process, but that’s a whole other issue. This continued battle I am fighting for my voice to be heard is hard enough without the constant ‘when’s the next child coming’ questions. We want another baby, but there is a chance it won’t happen.”

While we wish we could make the habit of asking such a personal question disappear, we, unfortunately, cannot. However, for those who are asked this question under medically complicated circumstances, you have every right to respond with a simple, “I prefer not to discuss it.” Alternately, if you’re feeling up to it, you could take the “speak your truth” approach.
“Honesty helps bring awareness and also acceptance of the challenges of being medically unable to have children,” says Behar. “People can learn from one another if the answers are real and genuine.”

TL;DR?

If there’s one thing you take away from all this, it’s that asking someone when they’re going to have a child, or when they’ll have another, could affect them in ways you might not fully appreciate. And if you’re on the receiving end of the question, we know you’re frustrated, annoyed, and maybe even hurt every time you hear it. You have every right to feel that way. When the topic comes up, you can refrain from talking about it altogether, or respond from a place of honesty to further the progress regarding the topic at large. It’s a long road until these conversations are a regular and fully accepted part of the social narrative, but we’re getting there by having open conversations—like this one.