Borderline Personality and Vigorous, Competitive Exercise

One component of Marsha Linehan’s DBT worksheets is the “PLEASE” acronym (see page 2). The final “E” stands for “get regular exercise, working up to 20 minutes a day”.

The benefits of consistent exercise cannot be overstated: walking, jogging, biking, weight lifting, swimming and most fitness programs (Crossfit, etc.) can provide immense benefits, both physical and psychological.

After exercising, I feel less edgy, more focused, and occasionally euphoric. Exercise days also make falling asleep easier. I can use exercise time to process emotions or “lose” them altogether: focusing on my body effectively disrupts whatever was in my head. Often I’ll return home wondering why I was feeling frustrated 40 minutes earlier, now suddenly calm and positive.

BPD and Intense Exercise/Competition Can Feel Different

Balance is key. Those who take exercise to competitive extremes will face different emotions compared to someone exercising moderately. Exercise should almost always be a positive experience, even when you’re pushing yourself. I say almost because there will be days when you’re frustrated with your body’s performance.

Always “check in” with yourself before, during, and after intense exercise to asses your state of mind. Never dismiss positive feelings, work through the negative ones.

Why Would Someone with BPD Constantly Run, Workout or Lift Weights?

Positives are global:

It can be personal time, escape from work, fresh air, socialization, and improving competitive performance.

Negatives are multi-layered, pervasive:

Some days, hard workouts border on self abuse. The idea of “punishment as motivation”, and “no pain, no gain” often cuts athletic aspirations short. These notions are toxic motivation for people with BPD.

Those prone to self-image problems, e.g. Body Dysmorphic Disorder, may exercise too much and eat too little. Tough workouts are followed by inadequate nutrition, fearing much-needed calories will cause weight gain.

Some BPDs exercise for vanity, due to some healthy narcissism, no pun intended. 🙂Most fit people are viewed as sexually attractive. For BPDs, this makes starting relationships easier. They will – at a superficial level – feel that validation they have long desired, all due to working out. Fit body = Easy dates = A relationship. The logic is sound. However, a BPD’s partner will eventually feel misled: “I gave this girl many chances because she was beautiful”. Or, “This guy at the gym was hot and really intense, the sex was great, I enjoyed his body, but the rest was unpleasant.”

Strict workout schedules can be part compulsion, part avoidance, part escape and self-isolation thrown in. From doorstep to post-run shower, 10 miles on Saturday can easily kill 2 hours that can’t be recouped elsewhere in the week. Most of this time is spent alone under physical stress. The “I’ve gotta do this” thought butts heads with Linehan’s other axiom: “Avoid Avoiding” (page 25). If you’re lonely, having relationship issues or just need to relax, this isn’t a wise use of time. Instead, consider whether you’ll feel better socializing, going to therapy, talking with your partner, journaling or just relaxing.

Finally, achieving fitness goals can feel like the validation you’ve always wanted, but extra balance is needed with BPD. Just did your best bench press? Great! Make sure that feeling is thoroughly enjoyed and celebrated. However, if you find yourself depressed afterwards or “not yourself away from the gym”, you could be neglecting other aspects of your mental health.

What Emotions Do People With BPD Experience While Doing Hard Workouts?

I can only speak for myself, having experienced just about everything in my head. Intense workouts are as much mental as they are physical. With BPD, the mental part can be extremely baffling, frustrating and volatile.

Exercising Alone and BPD

My Tuesday long-run arrives. I begin feeling pretty good. Halfway through, I slow down. My motivation vanishes almost immediately. I start feeling anxious, bitter, angry; my self-talk becomes demeaning. By the end I’ve missed my goal and feel terrible. Why am I doing this? Why am I alone? What a waste of time, I’m exhausted, pissed off and feel terrible. Isn’t there more to life? Is this really what I want?

Good runs aren’t an antidote. Even after a great workout, the positive feelings are fleeting. Within a couple hours I feel anxious and obsessed with the next challenge. Then a slight desperation arises: Why am I doing this to myself? What is causing the good feelings to dissipate? I begin to question myself while experiencing painful emotional whiplash.

These feelings are less problematic in people without BPD, because their self worth is more intrinsic. A bad workout – even a bad competition – doesn’t equal a bad person, wasted time, or a signal to quit.

Exercising With Others and BPD

Everything from “Exercising Alone” applies, plus interpersonal stress.

My friend coaches me in the weight room. He’s tough, uncompromising, and a stickler for form (the hallmarks of a superb trainer). Similar to romantic relationships, the non-BPD won’t comprehend the BPD’s dramatic emotional reactions.

One day my friend was really pushing me. I was recounting a stressful night with my diabetes and he started lecturing me about proper nutrition. It was out of love and concern. I knew that in my core because he is a wonderful human being.

But as I was straining through some chest presses, listening to him trying to motivate me, I snapped. I slammed some heavy dumbbells and got up. He was rightfully aghast by my reaction. We were walking on eggshells for the rest of the workout.

Later I called and unconditionally apologized, knowing full well I lost control. Our friendship has since improved. I’m more mindful of my emotions during tough workouts, making sure NOT to hurt others who are only trying to help me.

People with BPD have to know who the good people are, and do their best to treat these people well. Ignore the bad ones.

Moderate exercise can be extremely beneficial for people with BPD. However, those taking exercise to a more competitive level must be aware of their emotions at all times. Exercising should be positive and helpful. If you experience negative emotions while exercising, work through them. Never forget the good you feel or dismiss it as unimportant. Finally, remember interpersonal relationships are still vulnerable during tough workouts, especially if emotions are running high. Exercise doesn’t turn BPD off, but it will provide an opportunity to catch problematic thoughts and socialize in a healthy manner.

I have Type 1 Diabetes and Borderline Personality Disorder

Welcome to an exclusive club: In 2012, between 1.6%-5.9% of the US population was estimated to have BPD. Meanwhile roughly 0.4% of the population had diagnosed Type 1 Diabetes (using 2012 total population). That number is actually higher when accounting for undiagnosed cases.

Having Type 1 Diabetes is easier if your mental health is in order. Likewise, as difficult as BPD is, having good physical health improves treatment outcomes.

Both at the same time? Well, now you have an epic silent struggle on your hands.

While the stigma of Type 1 Diabetes is decreasing, it is still quite high for those with BPD. Having BPD is hell on earth. Suicide rates approach 10%. Few people will care to help you. Like Type 1, it is a self-managed condition, in conjunction with a superb therapist. Marsha Linehan’s DBT (Dialectical Behavioral Therapy) is noted as efficacious psychotherapy, while some meds can decrease comorbid feelings of anxiety, depression and poor mood regulation.

Is Mental Illness Common with Type 1 Diabetes?

First, it’s important to note many Type 1 diabetics will experience depression and anxiety in their lives. That doesn’t mean they have BPD. Rather, it is collateral damage from the stress and demands of managing chronic illness. Incidence of depression, in particular, is more common among those with poor glucose control. That said, these conditions are fully treatable and beatable.

Throwing BPD into the mix complicates things: the sadness, rage and emptiness of BPD make managing Type 1 a herculean task. Why bother pricking fingers, taking insulin and eating healthily if your world is falling apart? If you just want to die? If you feel misunderstood, alone, dejected and miserable?

In 18 years with Type 1 and 14 years with BPD, I will admit it: I pondered overdosing on insulin just to end it. And who would know? At least I went out due to physical illness, not some perceived character defect. People would feel bad: “He had diabetes…”. Opposed to angry: “He was a manipulative, awful piece of sh!t…”.

These feelings have dissipated as both my Type 1 and BPD management improved. Both conditions require taking immense responsibility for your life, relationships and health. You don’t have to “get there” on day 1, just realize that’s where you’re eventually headed.

Type 1 is best treated one finger stick at a time. When your numbers approach normal, you will experience mood improvements. If my BG is 51, I’m irritable and incoherent. If I’m 251, I feel depressed and miserable.

But at 101, my body is back in the game. I don’t feel physically stressed, only my BPD remains.

How Does My BPD and Type 1 Diabetes Present Itself?

At present, my Type 1 is in good control, my overall physical health is excellent and I continue treatment for BPD.

The cost of taking greater responsibility for myself, however, has been increased sensitivity to healthcare providers offering constructive criticism, making objective observations or pushing me to improve.

BPDs can be thin skinned, and I’m no exception. This is compounded when a physician makes the *slightest* offhand remark, like “you’re too low at 2 PM”, “you take too much insulin at dinner”, or “your A1C is only above-average, we have some patients with better control”. ENOUGH! It’s like I’m being burned alive!

Here’s a good example in dialogue. I use an insulin pump, so “bolus” means taking a fast acting insulin dose.

Doctor: “You’re bolusing 26 times a day, that’s a lot higher than average…”

Me: [immediately taking offense inside, because it felt like an attack] “Well, I should talk to my shrink about that, I might have an OCD problem. I’m on that thing more than my cellphone.” [smirk, snide joke intended]

Doctor: [awkward grin] “I’m concerned you’re stacking your insulin, producing lows later on in the day. Fast-acting insulin lasts up to 4 hours in your system. Frequent boluses might lead to up-and-down glucose readings. Your CGM shows some swings.”

The doctor wasn’t outwardly upset at my remark, but I realize it was out of line. She was only trying to help me, but my emotional sensitivity got in the way.

A week later I went to individual therapy. I caught myself doing another BPD tactic: pitting healthcare providers against each other.

I recounted the same dialogue to my therapist. At first he asked if I should apologize. I didn’t feel my doctor took much offense. Even after my odd remark, our appointment was routine and cordial. Eventually I confessed I felt maligned, that her comment was unempathetic. Now I was playing victim, when nothing had happened. After a few minutes my therapist was still trying to make sense of it, questioning what I got out of going to the diabetes clinic. Voila! BPD manipulation, victimhood and projective identification in less than 10 minutes!

Therapy has taught me most physicians mean well. It is my BPD that conjures these dramatic emotional reactions. Had I raged, insulted the doctor or burst into tears, I would have made an apology.

This is BPD small ball, an improvement over many years of therapy and introspection. For some, the same comment would have sparked a much different reaction.

How Do Others With Type 1 Diabetes and BPD Present Themselves?

I’ve never met anyone else with Type 1 and BPD, so the following are from various medical journals. In general, the authors paint a gloomy picture of the Type 1 Diabetic BPD patient.

1. She doesn’t take care of her diabetes and blames others for it. Codependent spouses might be blamed for not taking care of the Type 1’s prescriptions, glucose meters, etc.

2. A1Cs are out of control. Metabolic Panels, Cholesterol tests, etc. out of normal ranges.

3. Patients refuse to follow medical advice, not because it is bad advice, but because they’re having a personality conflict with the provider.

4. Appointments are frequently missed and canceled. Office staff spend inordinate time taking care of BPD patients, coordinating and enforcing office policies.

5. Patients jump from clinic-to-clinic after a blowup or feeling offended. Arriving at a new clinic, she states, “I know you’ll be the best doctor I’ve ever had.” (Victim-Rescuer Dynamic)

6. BPD patients do not follow rules and expect special treatment. Full medical records are requested “STAT”, opposed to a 3-7 day wait most people experience.

7. Nasty complaint letters or phone calls will be made against the physician’s office.

8. Healthcare providers are pitted against themselves. The psychiatrist will get one story about the Endocrinologist; the Endocrinologist will get another story about the psychiatrist. The therapist is stuck in the middle. 🙁

Some diabetes clinics will actually “tag” a BPD patient’s file, so they know to be prepared when he/she arrives for treatment. This is for their own sanity, because they know the interaction will be more emotionally charged than normal.

Read more:

1. Borderline Personality Disorder and Diabetes: A Potentially Ominous Mix
2. Treating Patients with Borderline Personality Disorder in the Medical Office

Is there hope for people with Diabetes and Borderline Personality Disorder?

Yes. I sincerely believe there is hope and improvement for anyone battling both of these conditions.

I started this blog calling it an exclusive club. That was an objective compliment, because it is a rare combination. Of course, I’d rather be rare for different reasons than my health problems. But give yourself a break: these challenges are well beyond what most people face.

If you’re worn out from both conditions, start working on one first. Personally, I think diabetes is easier and more approachable. It sows seeds of structure, responsibility and management necessary for BPD treatment. With better BG numbers, your physical health, energy levels and mood will improve. Next, sit down with a skilled psychiatrist and therapist for the tough work coping with BPD entails. DBT groups, psycho-analytical group therapy and applicable meds for depression and anxiety will help.

Realize your rarity means most people will never understand your struggles. Furthermore, that few doctors will have experience with both conditions at once. Accept – for now – that progress will be slow and hard fought; but it will be worthwhile.

Finally, don’t let the perfect be the enemy of the good. Set reasonable diabetic and therapeutic goals. Anyone who is telling you to “snap out of it and eat better” is grossly misinformed and ignorant. This all takes immense time and energy. Don’t defeat yourself at the outset with the expectation of feeling great – physically and mentally – in a couple months.

Find qualified health professionals and cut them slack. They are doing their best. So are you. Sometimes emotions run high on both sides. Therapy will provide insight and coping mechanisms so that productive healthcare relationships aren’t ruined.

Feel free to ask questions in the comment section below. Good luck to everyone.