Domestic violence victims and the misdiagnosis of Borderline Personality Disorder

Explicit language warning.

Victims and survivors of domestic violence are let down by the systems meant to protect them over and over again. For me one of the worst violations happened by my psychiatrist. There is mounting evidence that adults who have been traumatised as children are being misdiagnosed as having personality disorders or mental health illnesses without recognising that trauma is in fact driving the symptoms, and recovery can’t be achieved without the real underlining causes being addressed. I’ve found less research on domestic violence victims being misdiagnosed except for anecdotal accounts by professionals working in the field and other DV survivors (if you have links to research please leave them in the comments section). I can tell my story in the hopes it helps someone else in a similar situation: I was misdiagnosed with having Borderline Personality Disorder (BPD) whilst I was in the midst of my abusive marriage, and it nearly destroyed me.

It’s taken me a while to start to grasp the enormity of the emotional and psychological abuse I’ve suffered. My abuser was smart. He created an environment where I initially opened up to him about all my insecurities, all my fears. He listened, he encouraged me to talk, he comforted me and seemed to understand because he said the right things, he gave the correct responses. He was a master intel gatherer. He rode that goodwill for a while to later use me then drop me as it suited him. Eventually, though, I started to occasionally criticise him or become hurt that he was happy to kiss me, tell me all his problems, cry and tell me how tortured he was by the way his ex-fiancé had hurt him, then freeze me out at the drop of a hat. I supplied him with comfort then he would discard me the next day until the next time he needed me. And “coincidentally” as I started to voice my concerns he started to become concerned that I had mental health issues. He used my insecurities to push past sexual boundaries. Eventually we had a big argument and I finally snapped after almost a year of being lead on. He graciously forgave me but I had to go see a psychologist if we were to reconcile to deal with my issues.

Reading it back now it seems so pathetic, so obvious. But damn, if he wasn’t a master at making me think being with him would be the best thing that ever happened to me. He groomed me: according to him I was oversensitive, I had toxic anxiety, I was too critical, I was damaged by my parents. His abuse was covert and subtle and he worked his way into my body and he became the main voice in my head.

Being with him was hell. I can’t describe the torture of sensing something was wrong but having all my concerns explained away, twisted so as to be made my fault. He used body language and tone of voice to give conflicting messages to what he was saying and I felt like I was going insane. A few years into the marriage I was deteriorating. It felt like I was losing my mind. Nothing was making sense, everything was stressing me out. I ended up being referred to a highly respected psychiatrist, one that other psychiatrists sent their patients to when they couldn’t make their own diagnoses.

As he started treating me I deteriorated further and one weekend I found myself on the floor, kitchen knife at my wrist, not knowing what else to do. There was something wrong, my mind was lost and ending it all seemed the only option. But I didn’t want to kill myself: I needed what was wrong to end. When my ex found me he phoned my parents and with their help I was able to make the decision to phone the psychiatric hospital my psychiatrist worked for and asked for an emergency admission. Eventually I was diagnosed with BPD as well as a suit of other conditions, but BPD was the most damaging to me.

I have some strong memories about my psychiatrist, though much has been pushed down or lost in the fog of illness and over-medication. I remember some irrelevant things like how his office was ordinary and drab but he had overly decorative and expensive furniture, clearly expensive but tacky-looking expensive. He dyed his hair and moustache blackest black to eliminate any trace of grey hairs and I remember thinking that that had to have taken dedication, the moustache is a tricky, fast growing, finicky patch of hair. I wondered how often he has to dye it and at what age he would decide to finally transition to owning his grey.

I remember getting my diagnosis for BPD and being partially relieved: there was a reason things in my life and marriage weren’t working. But on the other hand, they were because of me. I was sick. I was told to accept I might never be able to work the hours I used to, to adjust my expectations for my life, that mine would be a lifelong battle to get my condition under control.

Here are the nine signs of BPD:

1. Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. Even something as innocuous as a loved one getting home late from work or going away for the weekend can trigger intense fear. This leads to frantic efforts to keep the other person close. You may beg, cling, start fights, jealously track your loved one’s movements, or even physically block the other person from leaving. Unfortunately, this behavior tends to have the opposite effect—driving others away.

2. Unstable relationships. People with BPD tend to have relationships that are intense and short-lived. You may fall in love quickly, believing each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships either seem perfect or horrible, with nothing in between. Your lovers, friends, or family members may feel like they have emotional whiplash from your rapid swings between idealization and devaluation, anger, and hate.

3. Unclear or unstable self-image. When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don’t have a clear idea of who you are or what you want in life. As a result, you may frequently change jobs, friends, lovers, religion, values, goals, and even sexual identity.

4. Impulsive, self-destructive behaviors. If you have BPD, you may engage in harmful, sensation-seeking behaviors, especially when you’re upset. You may impulsively spend money you can’t afford, binge eat, drive recklessly, shoplift, engage in risky sex, or overdo it with drugs or alcohol. These risky behaviors may help you feel better in the moment, but they hurt you and those around you over the long-term.

5. Self-harm. Suicidal behaviour and deliberate self-harm is common in people with BPD. Suicidal behavior includes thinking about suicide, making suicidal gestures or threats, or actually carrying out a suicide attempt. Self-harm includes all other attempts to hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.

6. Extreme emotional swings. Unstable emotions and moods are common with BPD. One moment, you may feel happy, and the next, despondent. Little things that other people brush off can send you into an emotional tailspin. These mood swings are intense, but they tend to pass fairly quickly (unlike the emotional swings of depression or bipolar disorder), usually lasting just a few minutes or hours.

7. Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there’s a hole or a void inside them. At the extreme, you may feel as if you’re “nothing” or “nobody.” This feeling is uncomfortable, so you may try to fill the hole with things like drugs, food, or sex. But nothing feels truly satisfying.

8. Explosive anger. If you have BPD, you may struggle with intense anger and a short temper. You may also have trouble controlling yourself once the fuse is lit—yelling, throwing things, or becoming completely consumed by rage. It’s important to note that this anger isn’t always directed outwards. You may spend a lot of time being angry at yourself.

9. Feeling suspicious or out of touch with reality. People with BPD often struggle with paranoia or suspicious thoughts about others’ motives. When under stress, you may even lose touch with reality—an experience known as dissociation. You may feel foggy, spaced out, or as if you’re outside your own body.

Those mostly sounded right. And he was the expert. I trusted him and committed to my recovery. As well as outpatient groups I did a Dialectical Behaviour Therapy (DBT) course. I did talk therapy with my psychiatrist. I was medicated on two types of antidepressants, mood stabilisers, strong anti-psychotics and eventually sleeping pills.

But here’s the problem: I had internalised my abuse. I didn’t understand what my abuser was doing to me. In my mind all our problems were my fault so the way I spoke to my psychiatrist was poisoned by that and it warped my sense of self and my perception of the dynamics in my marriage. There was also a small rebellious part of me was also uneasy and whispered that my ex might be doing things wrong too and I found myself unhappy and unfulfilled in my marriage. From that the conclusion I came to was that I was a terrible person: I was the cause of the issues in our relationship yet some part of me was wanting to leave, to blow up what what we had built when my ex was so graciously putting up with the broken piece of crap that I was. What a stupid, stupid bitch, I ruin everything. Those feelings of disgust and confusion were brought into my therapy as well, and trusting my psychiatrist, I let all my doubts and self loathing spill out unfiltered.

Here’s what being domestic violence can do to mess with your head:

1. Fear of abandonment. My ex was so disappointed in me, I couldn’t do anything right. He always seemed so frustrated and I kept messing up. He’d left me before when we were pre-dating (a complicated story needing its own blog post). When we were married he told me had a limited tank of energy left and I was depleting it. When I confronted him about something and it went badly the level in the tank lowered. When I was too sick to work and had to cut back more hours it depleted the tank more. I was aware that I had to be careful, one day he would be completely depleted and, well, he never actually said what would happen but I knew it would be bad. He would also go for days, sometimes weeks freezing me out, even when I begged he would say nothing was wrong even though it obviously was. I was terrified my defects would eventually make him leave me, and I was so broken who else would love me? I was so physically unwell, how could I support myself? He’d sown seeds of doubt that my parents could not be trusted to be there for me. I found myself pushing my friends away. Sometimes I would be so desperate for him to un-freeze me out I would beg, cry, sometimes yell. That just made him more annoyed with me. He was all I had. No one had ever made me feel the way he did, I needed him.

2. Unstable relationships. I had had issues with my parents when I was a teenager but my friendships were all as stable as teenage relationships can be. As an adult I was (and am) non-confrontational and loved my friends, though I saw less of them than I would have liked. My ex had things to say about many of my female friends, offhand comments, criticisms in the car on the way back. It became too difficult. So that aspect of my life didn’t fit a BPD diagnosis. But was my marriage unstable? Hell yes. I was being abused and I was bloody confused. My ex had made me feel like he was the answer to all my problems, he promised me a love like no other and it was intense and kind of addictive. But my other relationships like friendships were average, normal, stable so I didn’t really talk about those in therapy. It was my marriage that was causing me distress so that’s what I discussed with my psychiatrist. It seemed “perfect or horrible, with nothing in between” because my abuser made it that way. The love-bombing moments were the sun and the moon and all the stars in the sky. When he was punishing me and withdrawing and gaslighting it was a dark void where there was no escape.

3. Unclear or unstable self-image.“When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don’t have a clear idea of who you are or what you want in life.” When you are being abused you lose who you are. Your abuser messes with how you see yourself, they try to impose their own versions of who you should be onto you. They gaslight you and mess with your sense of what you think you know or feel. You hate yourself because they project their own self hate upon you and make you the cause of their unhappiness. You don’t know what you want from life because what you want isn’t allowed, it is slowly replaced by what they want you to be. But you can’t be that, it’s just not you, so they hate you and you hate yourself for failing.

4. Impulsive, self-destructive behaviors. If you are being abused sometimes you do crazy things to make yourself feel good, maybe to feel like you do have some power even if it is driving in your car just a little too fast on the freeway. You may harm yourself because your abuser is messing with you and you feel the need to physically enact the self-loathing you feel. You may feel desperate and upset but not know why so might act out in ways that seem attention seeking, but you instinctively know something is wrong, you just don’t know what, so you can become like a child: crying, screaming, not knowing what you need but knowing you need help.

5. Self-harm. You’re in a prison you can’t see when you’re being abused. You’re in prison but you don’t realise it. You can feel so worthless, so confused and trapped that suicide is the logical end point. Maybe you want to kill yourself but you don’t understand why and it can seem like you’re being dramatic or making threats for attention. You want attention, but the type that will explain what’s going on. You may cut yourself because you feel so worthless and such a burden.

6. Extreme emotional swings. Unstable emotions and moods are common when your abuser is constantly changing the mask they wear. Will they be kind? Can you feel one of their rages coming on? What will it be today that you do to disappoint them? You’ve internalised it so when you tell your psychiatrist how you were looking forward to a date night but your husband said something, you can’t quite pinpoint what it was what but you felt immediately gutted, devastated, you started to cry. Your abuser sighed and you sank deeper into depression. An hour later they gave you a hug, whispered something sweet and the world was right again. You ask your psychiatrist why are you so sensitive? Why does one offhand comment send you off the deep end? Why are you always riding stormy waves of emotion seemingly out of your control? What’s wrong with you?

7. Chronic feelings of emptiness. Nothing is real when you’re abused. No feeling or emotion can be relied on because it can go in a second, invalidated by your abuser. You feel constantly on edge. You start to go numb, happiness leaves. You are losing yourself as the abuser, like a vampire, drinks your energy, your dreams, your sense of self. You are there to be a vessel for them. You try to feel. You might be self destructive to do it, but you deserve the punishment anyway, you really are nothing. And what you feel, your gut instinct whispering that they’re doing something wrong leads to punishments if you voice your concerns so you stop listening to yourself. You bury your feelings lest they cause an argument and then a punishment.

8. Explosive anger. You do your best to make them happy. You’re damaged, you’re failing, they’re patient to put up with you. But sometimes the real you who still lives, though buried deep within, senses that they are doing something wrong. You bring it up. They dismiss, evade, twist. No, that’s not what you meant. They tell you you’re too sensitive, you’re suffocating them, you’re so demanding. No, no. That can’t be true, you know how much you try. They talk in circles, you become so confused, the wise voice inside you is being muffled, you can’t hear it above their wicked words, their word gymnastics, their veiled insults and you snap, you yell at them. You might occasionally scream at them. They look at you in disgust, you feel disgusting. You go to your bedroom crying, ashamed you lost your temper again when they were so composed. It really must be your fault. You tell your psychiatrist that you snapped again, you yelled at him. You hate being like this, there’s something wrong with you.

9. Feeling suspicious or out of touch with reality. You love your friends but your abuser tells you things about them. They complain about your family, stir up old feelings of resentment. They warn you not to confide in them about your marital problems: they’re your parents, they won’t ever be able to ever give you objective advice. You start to mistrust your family. Somewhere deep down you feel like your abuser is wrong, is doing something but you can’t explain it. He tells you it’s your fault. You become so tired. You don’t know what’s real. If you can’t trust your feelings about your spouse what else about the world are you misunderstanding? It’s easier to check out. Just stop thinking. It’s so confusing. Let go, just stop fighting. Your body becomes alien too sometimes. You can sit in a restaurant with your friends and look at them and feel like you’re not really there. Who are these people? Why are they your friends? It’s so noisy. You sink inside yourself. You are a paper cutout of a human and a strong wind will one day blow you away.

My psychiatrist met my ex on several occasions. He warned me the relationship was toxic and off the record suggested to me that we both had personality disorders (he said my ex had Narcissistic Personality Disorder so maybe he wasn’t completely useless) and we were codependent, both of us at fault, but I was the one who was most unwell. He said quite a few times we should break up but probably never would. He sometimes smirked when he said that, like it was funny, pathetic. He had me on so many meds I wasn’t able to function. He wouldn’t let me come of the anti-psychotics he had put me on. He strongly encouraged me to stop seeing a psychologist I really liked and who was kind and understanding, telling me she was too involved. Worst of all he handed my ex the tools and language he needed to destroy me. My ex used my diagnoses like weapons. He used the language of BPD against me, telling me being around me was like “walking on eggshells” when that is actually a classic sign of how an abuse victim feels. He finally had verifiable proof I was the one destroying the relationship. He had his proof that I was the one ruining his life and worthy of the full brunt of his quiet and toxic rage.

During our separation I had to unlearn all the things I’d blamed on myself. My current clinical psychologist, experienced with abuse survivors and abusers, told me emphatically I didn’t have BPD and I messy-cried because I finally had the confirmation that it really wasn’t my fault. I didn’t deserve to be blamed. Later I sat in my bedroom and cried tears of rage at the health professional who didn’t see the abuse, who legitimised it by assigning my suspicions of wrongdoing as cluster traits of a personality disorder. My psychiatrist dulled my mind with chemicals. He talked down to me like a child. He handed my abuser both a weapon to keep me obedient but also to tarnish my reputation, to preemptively make sure any future claims of abuse would be coming out of the mouth of someone perceived as mentally unwell, with BPD, a condition associated with manipulative and overly dramatic behaviour.

So fuck you, Dr Dyed Moustache. You spend so much time making sure not one grey hair in your perfectly manicured moustache betrays your age, as if signs that your body cannot fight the pulls of age and decay somehow lessen you to your patients. Fuck your tacky, expensive furniture, your smirks, your lectures, the pills and the refusal to listen to your patient. You have blood on your hands. The blood of the years wasted, the damage done by the bullets you handed my abuser for him to load into his gun. The blood of my many near suicide attempts. How could one of the most experienced psychiatrists in Melbourne not see the abuse? What good are you if you can’t tell the difference? You made things worse. You should have helped me. It’s your job to tell the difference between a personality disorder and trauma. Shame on you. And all the other doctors out there that come into contact with abuse victims and mistake trauma for other things. You re-victimise us. You empower our abusers. You are part of the problem and you need to do better.

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