The coronavirus disease (COVID-19), caused by a new-to-humans viral strain in the coronavirus family, has led to the pandemic we are currently experiencing. For many of us with mental disorders, such as borderline personality disorder (BPD), we may be disproportionately impacted.
Sudden changes in plans. Social distancing. Isolation. Loss of structure and routine. Canceled therapy appointments and treatment schedules. Separation. These experiences arising from the pandemic are some of the precise triggers for those of us with BPD.
Borderline personality disorder (BPD) is a mental disorder characterized by emotion dysregulation and extreme emotional hypersensitivity. People with BPD tend to experience intense emotional reactivity for long periods of time, with a slow return to a stable emotional baseline.
The specific symptoms impact major areas of functioning, including emotional, behavioral, interpersonal, cognitive, and sense of self and direction. Just a few of the main symptoms include chronic emptiness, mood instability (For example, intense anger to idealization to anxiety all within a few hours), recurring self-injury, suicidal ideation and impulsivity. Other symptoms include stress induced dissociation, paranoid ideation and hallucinations.
People with BPD often find themselves having extreme reactions to real or imagined abandonment or rejection. A mundane event, such as a brief separation at work or being perceived as a failure on an ordinary task, may exacerbate symptoms.
The perception of impending separation, rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition and behavior. These individuals are very sensitive to environmental circumstances.
The APA further highlights the importance of structured work and school situations, which can severely impact performance and BPD symptoms.
With the social distancing, school closings and isolation, there are sudden threats to external structure, the human need for connection and pursuits that I grasp with a sense of purpose and stability. As a result, I have noticed a dramatic increase in my borderline personality disorder symptoms.
To add onto it, I am also graduating college this year, and I have been trying to look and move forward in an already difficult transition and threat to that structure and stability.
On a typical day, it might feel like my loved ones and sense of familiarity are about to be taken away from me by a UFO. I have abandonment-themed nightmares of people disappearing or rejecting me. I have difficulty completing day-to-day tasks when I cannot focus with emotional turmoil and preoccupations of abandonment. I may make frantic efforts to avoid abandonment, such as begging my friend not to leave. Sudden emotions may flood me when people simply leave the room.
Changes in routine and structure are some of the main triggers for BPD, not only because of the difficulty adapting and regulating emotions, but also because change to us may signify abandonment, separation and loss.
I need whoever is reading this article to understand that these BPD symptoms are part of my regular. Then, the COVID-19 stress is proving to be an added challenge and trigger for me. Others may find that since these intense emotions are part of their regular, they may additionally sometimes appear unusually calm, only to crash later.
Each time I see the words “separation,” isolation and “social distance,” I am reminded of abandonment and loss. Each day it gets harder.
And then I started to notice the urge to self-injure again. The rumination. The extreme stress and fear of the unknown. The desperation. Insomnia. As I write, it is currently 10:24 a.m., and although I have always struggled with insomnia, it is not always this bad. I have not slept yet today.
Loss of hope for the future with every canceled event, such as national conferences, that I had prearranged to attend or was invited to speak at for the first time.
I glanced at a headline that announced hospitals will not allow visitors. I can relate on another level to the people who are inpatient at a psychiatric facility right now. I remembered what it was like each day when I checked the clock and anticipated the sight of my mom and big sister and just wanted to feel loved. Now, in the middle of the pain and unfamiliar place, there are no visitors, more uncertainty and additional stress.
The stress was accumulating, and I broke down.
It is not to say I disagree with important measures and precautions that need to be taken. I myself am considered higher-risk and disabled, and I frequently experience inaccessibility issues as part of my daily life.
But, those of us with BPD may be severely impacted in various ways right now, and I believe it is important to share that experience, connect and support each other. Now is the time to deliberately use my tools, even if I am not perfect at them all the time. Progress, not perfection.
Therefore, I also gathered a few coping ideas that people in the BPD and mental health community may find helpful.
1. Stay in contact.
Video chat, message or call family and friends, or play with a pet. It may help restore feelings of connectedness and alleviate feelings of abandonment. Other resources for social connections in the BPD community include the Twitter hashtag #BPDChat and The Mighty community. Perhaps you could have the option to meet with your therapist on video.
2. Find an outlet or activity.
Writing, word games, reading or audiobooks, exercising, going outside, painting, movies or other activities that can help occupy your mind, process your thoughts and emotions and release nervous energy.
3. Therapy Skills.
There are several online resources for therapy skills, including dialectical behavior therapy (DBT), the current form of treatment I receive for BPD. A few specific DBT skills from the Distress Tolerance Module that I have currently found helpful include the distraction ACCEPTS skill and Self-Soothe. From the Mindfulness Module, One-Mindfully
may help you focus on the present moment and activity. Remember it is human to experience fear and anxiety during these times.
Laughter has helped me cope and ease the rumination and tension. Here are some ideas to try out: Check out a comedian’s new special, or watch a funny TV show or movie.
5. Virtual Tours and Events.
Just a few of these include live cams from the San Diego Zoo, Smithsonian’s National Zoo, Monterey Bay Aquarium and live opera streams. Planet Fitness is offering free live-streamed daily workouts on their Facebook. The Mighty is planning a series of virtual events, including writing workshops, fun events for kids, and interactive Facebook Live videos.
To do lists, a schedule, long-term goals or an intentional morning routine could help return some feelings of consistency and form structure. Remember to rest.
7. Limit media.
For me, it is important to be informed to alleviate anxiety and stay safe. However, I noticed I needed to deliberately alter my time on media. Be mindful of the source credibility, such as the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO).
If you live with BPD or another mental disorder right now, remember you are not alone. We can get through and take responsible measures, in solidarity.