this post was submitted on 10 Sep 2026
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Borderline personality disorder (BPD). Its a very hard condition to live with and very stigmatized, even within mental healthcare (some therapists refuse to see patients with BPD). I have a friend with the condition and I love her very very dearly; she works her ass off to manage the condition, which I imagine is a little easier now that she knows she has the condition and can understand a bit more what's going on and what might be productive in improving things.
The reason its relevant is that a large component of BPD is relational volatility. And additionally, an unstable or fluctuating sense of self, persistent feelings of emptiness, relational paranoia, intense emotions and difficulty regulating them resulting in emotional volatility, impulsivity, and higher risk of suicidality and other impulsive high risk coping strategies (dangerous driving, risky sex, self harm).
Though in the perspective of my friend there are also other large components of the condition that are less often engaged with or discussed because they aren't what affect other people, which she feels has been much of the focus in how people try to adress BPD, rather than the patient's experience of distress, not all of which is relational. For example psychosis is very common in people with BPD but very rarely discussed. She has explained BPD as being, in some ways, like a cocktail mixture of other personality disorders.
It's also my understanding though, that when the patient is seeking to adress the condition (which is not always easy with personality disorders), BPD is very responsive to treatment, which is really cool :)
https://www.nimh.nih.gov/health/publications/borderline-personality-disorder
https://pmc.ncbi.nlm.nih.gov/articles/PMC9005124/
Please take all of this with several grains of salt, this is intended to be a rough overview because my love for my friend gives me an interest in talking about the condition compassionately, but I'm not a researcher or healthcare professional. I just care about my friend a lot, and much of the therapy I've done (DBT, dialectical behavioral therapy) was developed in part as a treatment for BPD
I had a stay in a rehab facility for 3 months after having severe psychiatric issues, and there i met a bunch of borderliners who were also on rehabilitation there. They really don't have it easy, but it was good to see how much they improved when getting adequate care. As you say, as with any severe psychiatric disorders, the patient has to want to get better, which includes even realizing that something is wrong.
These things are the largest barriers for successful treatment in many psychiatric conditions, e.g. paranoid schizophrenia which suffers from abysmal compliance rates, often leading to a cycle of "on meds -> feeling well, but the meds have side effects -> dropping the meds to get rid of the side effects -> back to the start, but with the idea that the doctors want to poison me".
To be clear, with many psychiatric disorders, the disorder itself can influence the patient to not want to get better. For example, a patient who is responding well to treatment but stops taking their meds because their condition makes them believe that the meds are the problem.
Yeah, after i read my comment again i edited it to reflect that - you are absolutely right. And from personal experience with psychiatric medication, i can fully understand it. One of the medications i was on when depressed to the point of being suicidal was Quetiapine, and you feel absolutely dead inside. It was preferrable to the state i was in before, but for someone who isn't depressive as fuck this can be a negative thing.
And there is always the issue with psychiatrists thinking they always deal with people that are non-compliant when issues arise. I have been suffering from sleep disorder where i would be so tired during the day that things just fell out of my hands because i fell asleep for fractions of seconds during the day (so called somnolence), and abnormal nightmares/night terrors (normal nightmares you have nearly forgotten at the point of waking up. I was able to recite the complete plot incl. small details days after these, and they were horrific.) up to the point that i had a phase where i simply did not want to go to sleep anymore, resulting in a phase with recurring sleep paralysis.
I was complaining about this to my psychiatrists, who responded by prescribing me sleeping pills - but those only caused me to be disoriented when i woke from my nightmares, and being completely lethargic on the next day. During this time (a duration of around 8 years) I was on a pretty high dose of Duloxetine, also known as Cymbalta in the US as a mood stabilizer to prevent sliding back into depression. But what none of my psychiatrists informed me about was that Duloxetine has pretty common side effects on sleep, including somnolence and abnormal nightmares. A few months back I was reading up on my medication by random chance, and saw the list of common side effects.
I instantly started halving the dose i took, because my dose was the one cited with the highest incidence of sleep disorder. My nightmares became less and less during the next weeks, and for the first time in years i was able to get a satisfying amount of sleep. Afterwards i talked to another psychiatrist who i knew (but wasn't the one who prescribed these meds), who - after a few sentences, i wasn't even able to complete what i wanted to say - acknowledged that she already suspected that i might suffer from the side effects, but since i was the active patient of another psych, she did not want to interfere. (I do not blame her - messing with things that are not really your business is a bad idea in the medical field)
I made an appointment with my psych, and they confirmed that they knew for YEARS that my issues were because of the meds, and that they decided that informing me about this fact might cause me to simply dump the meds and opted for trying to suppress the side effects without success.
I have an avoidant personality disorder, making it very hard for me to trust anyone, but i am one of the few psychiatric patients who know that a statistic does not say anything about a specific patient. I would have tried to work with these meds even with the side effects. I would have tried other medication. But they took the easy way, which resulted in me having dropped the medication (slowly - you can't just stop these things) and now looking for a Psychiatrist that respects my autonomy. For now, i feel fine because my life circumstances have changed a lot and many of the stressors in my life are gone (and i never was a problem for others, only for myself) outside of getting wet eyes when i watch series that tug on my heart tendons lol. But if i were someone prone to psychosis or paranoid schizophrenia, i would never take anything again. My trust has been violated and abused, just to make their job easier.
I won't trust any psychiatrist blindly again. This wasn't a single psych, this is an organisation paid for by the city of Vienna where i had 4 different psychs over the years, with an attached day center for people like me, with ergotherapy groups, movie groups, physiotherapy and so on. It hurts to leave all this infrastructure behind, but being in the center means i have to be a patient of their psychs. None of them considered the damage to my meager trust that i have to actively work for to sustain when they hid the truth from me.
I've been fortunate to have never had to deal with psychological issues personally but I've had friends that have. I'm glad you seem to be doing well now. Interestingly, I am currently taking Duloxetine for back pain. The original dosage was too strong for me, it knocked me out for hours when I took it. Now I've cut the dosage in half and only take it at bedtime when being knocked out is a plus. No nightmares, though, fortunately.
I very rarely have nightmares in the classic sense. For just over two decades, I owned my own business and it was a very stressful job. I've moved on now, but during the final few years before I sold it, I would have what I called work-dreams. Basically, it was like a really bad day at work. The absolute worst possible, yet realistic, work disasters I could imagine would occur in these dreams and I would wake up as stressed as if they had actually happened. Luckily, I was eventually able to self medicate with tiny doses of cannabis gummies.
By the way, psychiatrists are not the only ones who fail to mention side effects. I have a number of medical issues I'm being treated for with a variety of drugs. I've taken to looking up all of them when they're prescribed so I know what to watch out for. Most of my physicians don't mention possible side effects unless they are very common ones. I suspect that they worry that people will be more likely to suffer the side effects if they know about them due to a version of the placebo effect so they just don't bring it up unless asked. I always ask now.
The abnormal dreams only hit 1 in 10 people, the somnolence about 23% at the dosage i received. There are many people out there that do not understand that statistics say nothing about any specific person - but i have had mathematics and statistic courses during my university time, because molecular biology (and most other sciences) needs statistics to produce actual results. Out of the thousands of patients they have, i would've been one of those who understood these facts, and i would've never declined any medication just based on the chance of side effects.
And they would not even have to actively inform me about them, but one of the 4 psychs i had there over the years should have reacted the moment i explained that i avoided going to sleep because i had so much fear that i would have another of these nightmares. These dreams were brutal, filled with fear, violence, death and gore (rated 18+ for sure). I don't ever watch such stuff, but my dreams still were able to produce it. I never before had such graphic dreams, and the worst of them took days to shake off, because i could remember them so well.
One of the sleeping meds i was prescribed "funnily" was preventing me from sleeping - my nose became so stuffy that i only could breathe through my mouth. So i was laying there, half-conscious, fearing the dreams and being held awake by my nose. Fun times.
Not actively informing to prevent patients from just not taking the medication is one thing, and possibly needed in some psychiatric conditions. But not informing when their patients suffers severe side effects from the meds they prescribed and instead trying to suppress these effects with ineffectual additional medication is something i can't forgive. This medication was planned to be taken until the end of my days - if its a medication for something acute, i would just deal with it. But giving up a good nights rest for the rest of my life is not an option.
I've had a lot of different medications too in my life, and most doctors at least told me to watch out for the most severe of them (Lamotrigin e.g. can lead to very bad, potentially deadly complications in some patients). And most of the time i was pretty lucky - i tend to not have side effects or they are negligible. The only other case where i had to discontinue the med was Aripiprazole, a.k.a. Abilify. Mentally, my mood was fucking great - i loved it and really liked how positive i became. But i wasn't able to sit or stand still anymore, even on 1/2 tablet of the smallest available dosage per day. I was running around in circles for hours and couldn't stop, because sitting still was torture.
It's good advice to always ask for side effects, i will do that for sure going into the future. I just hope i can find a psychiatrist that i can build a working relationship with, because currently i wish every one of them an itching rash on their butts that doesn't go away.
I have a transmasc friend who developed BPD because of transphobia (he's from Chile, where there's a really conservative culture [thus sexist, transphobic, homophobic, etc.] and associated bullying).
Recently, my older sister went to the psychiatrist with me for the first time in her life, and she apparently likely has BPD, and maybe is autistic as well.
So I can only agree with you. I hope people become more aware and learn more about mental health issues so they grow more empathetic and the stigma decreases.
Yeah I've had friends who got their BPD under control and are awesome. On the other hand I have some mental scars that I'm working on in therapy from two people with it who fell for me.
I think it's important we be compassionate to folks with it, but also acknowledge the harm they often do before treatment. The volatility is brutal on both ends of it and can easily lead to them pressuring people into things they don't want and other very damaging behaviors.
I didn't know it responded well to treatment, that's good to read. Many women with autism are mistakenly diagnosed with it as some sort of modern day hysteria diagnosis, it fucking sucks.