Balancing on the Borderline

[MusicalCoffee]

Let me just say that I am 24 years of age, which is relatively young. I first noticed something was wrong with me when I was about 12 or 13 years old. I suffered alone, though, because I had no idea what it was and my parents didn't think anything of it. Long story short, I was diagnosed with major depressive disorder, borderline personality disorder, and anxiety disorder at age 16.

That's a lot of disorder for a 16 year old and I was terrified. I had no idea what any of that meant and I was more than a little concerned. Once explained, the problem was that I didn't want to stay on medication. After a certain amount of time, I assumed I was "better" because I felt better. After a few more visits, my doctors would phase me off of them.

The thing is, sometimes I'll wake up and just be super happy. I'll have so much energy and feel like I can do anything. I'll be excited and looking forward to my future, thinking that everything was going to be fluffy bunnies and rainbows. I'd do all this work, clean, organize everything, and literally love life.

The extreme difference in my thought process and emotions used to freak me out because I couldn't understand why I was suddenly happy and believing everything was golden when just yesterday I couldn't get out of bed.

I started realizing the pattern, though, and know these happy days never last, so when they come along I enjoy them. It's a welcome relief from the pain, never-ending negative thoughts, and sporadic mood swings.

I try so hard to stay positive and stable. I thought once I found out what I wanted to do with my life and placed myself in a healthier environment, I would be alright. I was so happy and excited to be starting nursing school.

I had finally found my place.

I love my classes, I'm soaking up as much knowledge as I can, and it's just fun. It's a lot of work, but I love it. It's so interesting and amazing and I was hoping everything was going to work this time.

Only it all started to fall apart again, just like it always does. I sink down into this big black hole, and it's unbelievably dark. I can't function or concentrate on anything. I don't eat, I can't sleep. I just lie in bed in sort of a coma, for lack of a better word. I feel so worthless and hopeless.

I don't understand it, either, because I was just doing well the other day, happy as a clam, and suddenly it's all gone. I can't even remember what it felt like to be okay.

Now I'm struggling just to get my assignments in on time. I don't even want to think about what grades I'll be getting because I'm pretty sure I'm incoherent in most of my answers and explanations. I don't want to ruin this for myself because I know getting kicked out of nursing school would make me feel even worse and send me deeper down. I just don't get it.

I've made positive changes that make me happy and I'm still battling the same issues. I'm considering going back on medication and hopefully finding a proper combination and dosage so I can focus and concentrate on my classes again.

I'm terrified these disorders are going to ruin my life. I feel completely out of control.

My emotions and moods have a mind of their own and I just can't get it together. I'm also debating whether or not to try therapy again. I never stick with it, though, because I can never be completely honest with the person, compliments of my severe trust issues. Time will tell, I suppose.

I guess I'm just wondering if anyone else has had some of the same issues. I'd love advice or to hear what works for you. At this point, I'm willing to try anything and everything I haven't already.

[jadelpn, LPN, EMT-B]

I believe BPD to be trauma based, and a part of PTSD. Find a good counselor, and see your doctor. Maybe a combination of things will get you to a functional level that makes sense for you. Unfortunetely, from what I have learned and people that I have worked with for some time--as I understand it, part of BPD symptoms are sabatoge and setting ones self up for failures. This is in polar opposite of what one needs to get through a strict college program of study. As one of the PP suggested, perhaps a leave of absence is what is needed, or perhaps with some therapy, coping skills and the like, reasonable accommodation, an IEP....See your student advisor or guidance counselor. Best of luck to you!

And BTW, there are many, many people who go through the same types of situations that you are describing. Do NOT feel embarrassed at all. You shouldn't--if you had diabetes and had to eat in a class would you feel embarrased? Probably not, so don't think mental illness is all the stigma that seems to follow it. Again, best wishes.

[Balice5]

I'm sorry you've been really struggling with this. Although I can't give medical advice, like @Sadala said there is a ton of progress being made in the research of both anxiety and BPD. Therapy sounds like a great option and if you look up some information on Dialectical Behavior Therapy and Acceptance and Commitment Therapy I think you'll find that this may be helpful. They are both help you to accept your anxieties and learn coping skills you can use daily. Don't give up on your dreams of being a nurse, talk to someone who specializes in these disorders and make a structured plan to help you live your life the way you want to live it! Not sure where you're from but I know Mclean Hospital and MGH both offer free seminars/talks on BPD.

Be well and good luck!

National Education Alliance for Borderline Personality Disorder

[plasmatix]

Musical Coffee, I am very sorry that you're going through this, especially now that you have the stress of nursing school to contend with. I've never had to deal with a condition like yours, that is characterized by long-term depression and/or mood swings. However, two events in my life gave me a tiny glimpse of what it may feel like.

About a week after my first child was born, postpartum depression began with a mid-day crying jag, and very quickly expanded to include overwhelming anxiety, severe insomnia, and irrational thoughts. Fortunately, the condition spontaneously resolved a week later, and I didn't suffer a recurrence following a subsequent birth. Then, several years later, I descended into a profound depressive state for 24 hours when going through a rapid withdrawal from corticosteroids on the advice of an incompetent physician. From the onset of both episodes, I recognized their underlying causes, but my nursing knowledge did not insulate me from the feelings of helplessness AND hopelessness that are hallmarks of severe clinical depression. It’s been more than 30 years, yet I can still remember how frightening the experiences were.

Both of these were brief episodes from which I recovered quickly and completely. However, they provided me with first-person experiences into the effects of changes in brain chemistry, and I believe that they made me a more enlightened and empathetic caregiver to patients. I was able to recognize the level of pain in patients suffering from conditions characterized by severe clinical depression, because I could distinguish between what it was like to be "down in the dumps", and the much more frightening, out of control feeling of an imbalanced brain chemistry.

I advise you to see your physician and/or mental health professional immediately, and follow their advice (if you don't like or trust your caregiver, than get another). But don't try to go this alone. What you are going through is complex, and the reasons for it remain poorly understood, despite many advances in research over recent decades. There are a great number of people, besides you, having these symptoms and difficulties - even psychologists and psychiatrists!

I get the feeling that you may feel like medication is a cop-out, that it's a crutch ("Once explained, the problem was that I didn't want to stay on medication. After a certain amount of time, I assumed I was "better" because I felt better.") and you're weak if you take it. It also appears that you may think that this may indicate some inherent "weakness" in you, and that it's up to you to make the necessary changes that will "get you on track" ("I try so hard to stay positive and stable. I thought once I found out what I wanted to do with my life and placed myself in a healthier environment, I would be alright."). If so, you are misguided on both counts.

I don't know anything about the meds you're on, or what the reasoning was in prescribing them. However, what I can tell you is that most of the medications being used in treating clinical depression these days work by correcting a presumed imbalance in the chemistry of the brain. If you are currently in nursing school, you should be familiar with this concept: what the meds are, and their modes of action. These are not quick fix meds, nor are they the "mother's little helpers" of 50 years ago. However, it can be very tricky coming up with the right med, or combination thereof. Even if you're on the right combination and dose that's had you feeling great for two years, keep in mind that the body's chemistry is very subject to CHANGE, from both internal and external forces. I'll repeat: find a doctor(s) you like, and follow their advice. And I'll add one more very important thing: PARTICIPATE in your care. If you gained admission to nursing school, you should be capable of researching your condition, and educating yourself so you can become an equal partner in your healthcare.

Re: the choices you make to "improve" your symptoms: Remember that, if you are going to take care of other people who are ill, you have to care for yourself first, and make sure that YOU are healthy. I won't tell you that you shouldn't be a nurse, because there are just too many things I don't know about your situation. However, keep a few things in mind:

(1) Be open to the idea of taking a medical leave of absence from school, to get your current symptoms under control. No matter how good a student you were earlier in the term, the stresses of nursing school will only serve to exacerbate your current symptoms of depression and anxiety, and, in most places, you can't go back after the fact, and ask them to remove low grades from your record.

(2) Nursing school is NOT (notnotnotnotnot) a healthy environment. They TEACH you about how to keep OTHER people healthy, but almost never in a way that does your health any good. There is nothing about an education in nursing that is healing to the human body. It's a tough row to hoe.

(3) Many people choose to go into a profession (particularly health services) because they believe that their experiences will enable them to recognize similar suffering in other people, and help them get through it. However, if the individual has not been treated and healed, they'll be entering a profession LOOKING for help and healing, instead of being ready and equipped to give it. I'm not saying that this describes you; I'm just recommending that you give it some thought.

Musical, I truly feel for you, and I know that you are hurting badly. Please....cut yourself some slack. Your condition and its symptoms are NOT the sum total of you, and not a reflection of your worth as an individual. Think about it: if you had type I diabetes, you'd take insulin, wouldn't you? I mean, would you consider insulin injections a "crutch" since you body no longer produced it on its own? No, I don't think so. Your body has an hormone imbalance, so you correct it by adding some from an external source. Well, your body - your brain - has imbalance of the chemicals it needs for optimum mental health. So get yourself some competent treatment, and get some semblance of your life back. Then you'll be able to decide what it really is that you want to do, and be in shape to do it!

Wishing you the best.

plasmatix

[LadyFree28, BSN, LPN, RN]

I believe BPD to be trauma based, and a part of PTSD. Find a good counselor, and see your doctor. Maybe a combination of things will get you to a functional level that makes sense for you. Unfortunetely, from what I have learned and people that I have worked with for some time--as I understand it, part of BPD symptoms are sabatoge and setting ones self up for failures. This is in polar opposite of what one needs to get through a strict college program of study. As one of the PP suggested, perhaps a leave of absence is what is needed, or perhaps with some therapy, coping skills and the like, reasonable accommodation, an IEP....See your student advisor or guidance counselor. Best of luck to you!

And BTW, there are many, many people who go through the same types of situations that you are describing. Do NOT feel embarrassed at all. You shouldn't--if you had diabetes and had to eat in a class would you feel embarrased? Probably not, so don't think mental illness is all the stigma that seems to follow it. Again, best wishes.

^ true, BPD is trauma based, like PTSD.

I have PTSD, and bipolar trait. I was exacerbated with my PTSD while I was in nursing school. I started when I was one year post-trauma. I did exceptionally well, until about the beginning of my spring semester, I was struggling. My program was fully aware if my situation when I was interviewed for the program, and accepted me and was super supportive. I sought out a counselor for my therapy, and still with this therapist for two years. My job is aware as well, and is super supportive.

Everyone has giving you spectacular advice. Keep yourself healthy, there are many options that have been given. Once I claimed my PTSD, I was able to talk about it openly, and get the help I needed. I still continue to work in a high stress environment (PICU), and have coped well, because I have support, as well as I stay aware to take care of myself. And learn to leave what has happened at work for that day; I decompress by meditating as well, and some techniques I learned in my therapy....and I also decompress there, and leave it there.

We all have traits of mood disorders in us...they are "traits" that occur. I have embraced my "traits" which have helped me become a better nurse. 5 years post-trauma, I am at a place I feel as though I have come full circle in a good way, yet still continue therapy to help process. It will get better. Make sure you take care of yourself! Good Luck!!! You have LOTS of support! :)

[SCSTxRN]

I would look into another doctor. I'd also suggest some reading:

"Feeling good feels great" Dr. David Burns

"I hate you, don't leave me" (a good book on borderline personality disorder)

Finally - all I'm going to say is I went through some of the stuff you're going through, and I've been diagnosed as Bipolar, major depressive, and at one point was on my way to a borderline diagnosis. I'm currently medicated for ADD. I feel more stable than I ever have, and most of the cycles have stopped.

[TerpGal02, ASN]

Mental illness absolutely does not have to ruin your life. First you have to understand you are dealing with a chronic disease and have to manage it. Just like if you had htn you have to take your meds everyday whether you feel good or not. You have to seek therapy as personality disorders usually respond best to therapy. If you can look into Dialectical Behavioral Therapy I would strongly suggest it. You, more than any other nurse or nursing student need to know yourself very well and learn what triggers your symptoms and have a plan in case you start to destabilize. You have to take really good care of yourself. For safetys sake, I would focus on getting your mood stable before trying to deal with school, but absolutely you can do this if you are committed to managing your disease.

How do I know this? I am a nurse and I have bipolar disorder. I know I can never ever stop my meds. I know my triggers and my early warning signs. I work my butt off.in therapy to keep myself healthy and safe to practice. I am also a psych nurse. I have been hospitalized 3x for my condition and was inspired to become a nurse because of the excellent care I received from those nurses when I could not help myself. So he's, it can be done.

[siRNita, BSN, RN]

Just like there is no shame in taking anti-hypertensives, there should be no shame in taking mood stabilizers (SSRIs, SNRIs). Do what you need to do to stay afloat! Taking time off, a reduced load, figuring out the right balance of meds, exercise, downtime, joining a support group... I have seen these all work for different people.

Nursing IS stressful, but so is life. Wherever you go you are going to face stress. Find the coping strategies that work now, while you're in school, and that will help you manage your mood the rest of your life, whatever you end up doing.

[imaginations]

I haven't read all the replies to your thread so I don't know if this has been mentioned or not but I would very strongly advise on relying on medication as a cure or a fix for borderline personality disorder (which probably underlies, rather than coexists, with your anxiety and depression -- ie. if your borderline were to suddenly disappear, the anxiety and depression would too, or at least be incredibly minor compared to what you experience in conjunction with your borderline symptoms.)

Borderline personality disorder is not a disorder that is related to pathological alterations in neuro chemistry. Therefore treating it solely or primarily with psychoactive drugs is unlikely to change things for you in the long term. Borderline is characterized by extreme states of emotion, particular thought patterns (fear of abandonment, social insecurity etc) and impulsive behaviour. There is no drug on the market that has been proven to help with these things, particularly in the context of BPD.

However, DBT, or dialectal behavioral therapy, has been clinically proven to help people with BPD, particularly, to help people with BPD regulate their emotions (those that are often incredibly intense or swinging), and manage self destructive urges.

I would encourage you to find out more about DBT. It was developed specifically for people with BPD and has been clinically proven to work for people with BPD. Medication has not.

I also wanted to add that people with BPD are perfectly capable of achieving whatever they set their mind too, just like the next person.

You can do it :)

[amygarside]

Maybe you need to talk it out with a psychiatrist or someone that you really can trust.

[VivaLasViejas, ASN, RN]

Thank you all for the replies and well wishes; I appreciate them. I understand what some of you are saying about nursing school and the profession adding salt to the wound, if you will, but I know if I don't try to succeed at it, I'll regret it. Nursing is something my heart really is in. It makes me feel good to be learning how to help and take care of others, which is why I have a hard time understanding why the rest of me isn't feeling that happiness. However, I will definitely look into alternatives and take the suggestions given into consideration because if it turns out I cannot be a nurse, I would at the very least like to be in the medical field helping in some way.

I will also see what I can find on my school's policies on accomodation, though I'm a bit embarrassed to have to bring that up to my advisor. I'm not looking for special treatment and I don't want to be viewed differently because of this. I work very hard to maintain my grade point average, but at the same time, if something can help, it's worth a try. I feel a bit better knowing there are others going through similar experiences. Not in the misery loves company way, but rather it's nice knowing I'm not the only one feeling this way, even if I don't know any of you personally. I do plan on getting back on track, and again, thank you all for your comments.

I know it's hard to ask for accommodations. Usually we just grit our teeth and hang on desperately until the world falls out from under us, and THEN we wonder what the deuce hit the fan. It's happened to me I don't know how many times, and I never understood why until recently, when my employer decided to offer me "reasonable accommodations" for my illness, rather than allow me to continue floundering as I had been.

About a year ago I was diagnosed with bipolar 2, which unfortunately is proving somewhat difficult to manage. I've probably had it most of my life, but like a lot of type 2's I got away without being dx'd properly until the disorder was completely out of control. Now I'm on five different meds just for the BP, and although I'm vastly improved from where I was a year ago, I still struggle with it. So when I recently came under fire for my uneven performance on the job, I wasn't shocked when my illness was mentioned during the discussion of how to fix things. I've been very open about my health issues, and in a way I'm glad because now I'm getting what I needed to do my job better.

Yeah, it's a little tough on the pride to accept "accommodations", because that means admitting we need the help. But as people have already said, if you're diabetic and you have to check your BG every few hours and make sure you eat on a reasonable schedule to prevent hypoglycemia, no one would think twice about it. Why should disorders of the brain be any different?

[Florence N]

Nursing is extremely stressful. Some nurse/co-workers have depression and anxiety, and I wish they could be put on something to help them cope. Make sure that you have a calling for nursing and that it's something you absolutely want to do.

[dirtyhippiegirl, BSN, RN]

If it makes you feel any better, I was dx'd with BPD at 16. Struggled a lot as a teen and young adult, including the first semester of nursing school.

I wasn't expected to "make it." I made it through some very hard times, including multiple back to back hospitalizations, etc.. I no longer qualify for a BPD dx. Older, and wiser.