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.

Pre-Race / Pre-Competition Anxiety: Remember Your Self Worth

The intersection of low self esteem and pre-race anxiety robs us one the one thing we can control: how we feel about ourselves.

How it started

This all started in high school when I joined the cross country and track teams. While I enjoyed being fit, racing produced immense anxiety, to the point of being physically sick and mentally exhausted.

I was not a standout athlete. I made some state meets, but wasn’t recruited by any university. At times, I enjoyed practicing more than competing. I had to continually find external ways of motivating myself, because my internal doubt and anxiety were eating me alive.

Immediately before some races, I would have diarrhea, vomit and feel depressed. When I stepped to the starting line, I felt as if I had been awake for days without sleep. After a race, I had little reinforcement for myself. No performance was ever good enough, and any positive thoughts were fleeting.

15 Years Later, As An Adult

These thoughts have persisted into adulthood, now 15 years later as I ponder running local 5ks for “fun”. My stomach is churning as I write this. In 2013 I did a non-competitive 5k, my first in 13 years. Prior to the race, I was sick in the bathroom for 2 hours.

I want try another race in a couple weeks, but the moment I start searching for one my anxiety level cranks up. So I’ve been doing some thinking, trying to process why my feelings are so irrational, why I can’t give myself positive feedback, why something relatively trivial feels so consequential.

Sifting through the anxiety and self criticisms was difficult, but the following streams of thought sum them up:

If I don’t run XX:XX time, my years spent getting back into shape have been wasted. I will be a wimp, a failure and worthless. There’s little value in anything unless it is objectively impressive. It’s do or die. Don’t get your ass kicked by some schmuck who jogs 3 days a week when you train hard 6 days. Don’t be last, the courtesy clap is embarrassing. Don’t drop out, that’s embarrassing and you’ve already finished several training runs 8 miles or greater. The time you’ve spent exercising should result in XX:XX, if you don’t hit that, WTF is wrong with you???

Know what you can’t control at a race

Examples follow. If eliminated from thought and/or managed with reasonable preparation, they are less worrisome. Of course, some things are simply beyond our personal control no matter what we do:

I can not control: the weather, course conditions, water stations or spectators. The number of other competitors, how fast or slow they are, if they are friendly or complete jerks. If said competition makes me finish in the front, middle, or dead last. If the event is poorly organized, if the start is congested, if the race schedule is changed with little notice.

I can somewhat* control: What food I eat, my bedtime, if I leave my apartment on time, warming up properly, my pre-race blood sugar (Type 1 Diabetes), having extra clothes for the cold, getting directions to the race, bringing enough food and water.

SOMEWHAT is key. Even if I’m hyper prepared down to where I park my car, things can still come up. Part of competing (and training) is occasionally addressing unexpected situations.

Low self esteem and pre-race anxiety robs us one the one thing we can control: how we feel about ourselves

I can COMPLETELY control: How I feel about myself!

No matter what, I am in control of my own self worth.

No time, no measurement, no value judgment from others…NONE of those things – good or bad – can ever give me my own satisfaction. Imagine letting your happiness be determined by race times, a coin flip, compliments from others, stern critics, research data, fitness “standards”, or whatever the crowd is chanting: Yikes, 🙂 you’d rarely feel good about yourself, and your personal identity would be nonexistent.

When I cede control of my self esteem to other people or other standards I have taken away my greatest source of strength; and ironically let something else determine the only thing I can control.

THAT is why anxiety and low self-esteem are so insidious. The obvious, universal truth about ourselves is traded for worry about things beyond our control, largely meaningless to our lives and who we are.

Thousands, even millions may worship a world record holder, showering her with praise and accolades. But away from the racecourse, the words of others won’t make her any happier with herself.

We must realize our self esteem is one of the few things we can control, and why allowing external forces to manage it only sets us up for frustration, despair and ultimately feeling hollow. Take ownership of the most important thing you can control: your thoughts about yourself!

A little pre-race nerves and adrenaline mean you care. Profound anxiety and self doubt, however, mean you are in fear. That fear is unfounded and not real. Liberating yourself from it will not only improve your performance, but also make you feel dramatically more satisfied with life.

Please share any advice, thoughts, or breakthroughs you’ve had to manage pre-race anxiety, low self esteem, or any other irrational fears below.

If you have BPD – and Feel Guilt or Remorse – An Apology Is Never Too Late

After visiting home in November, I brought my college computer (circa 1999) back to my apartment. My hope was to get it running and review my old emails, papers, and random diaries. I knew it would be painful because this particular computer accompanied me when my BPD erupted in school, later sending me to involuntary inpatient treatment.

Booted it up successfully with some elbow grease. The mother lode would have been my emails, however I think I erased them many years ago. Still, there were plenty of papers, a couple files containing written work I did for my psychiatrist and other random mementos.

Upon reflection, I felt extreme remorse and guilt for my behavior (more than 10 years later). These feelings started passing through my mind a couple years ago, but seeing that snapshot of my dysfunctional college years made them much stronger.

In effect, reading and reliving the rage and depression confirmed some progress: I knew what I did was wrong, and needed to make it right.

An Apology – Correctly Worded – Is Never Too Late

I decided to write letters to people I hurt and offended. This was difficult to do without venturing into cliche statements about “recovery”, “responsibility”, “one life to live”, etc. So I spent considerable time composing 2 page letters broken into three sections:

1. Re-introducing myself (these people have had thousands of students) and recounting my history with them. This was hard, because I buried some of these memories, but felt it would be better to include all of them. If I didn’t, the letters would NOT be authentic and sincere.

2. Expressing remorse for my actions, including any attempts to violate their personal integrity and discredit their better judgment. Then, I explained the treatment I began after college. I wanted them to know I’ve made a diligent attempt to improve myself.

3. Expressing gratitude for their decisions which ultimately led me to a better place, then wished them continued success and happiness.

Receiving letters a decade after-the-fact might strike some people as strange, so I made every attempt to minimize any concern that I was seeking attention or simply checking off steps in a recovery program.

Instead I wrote personally, honestly, and authentically. I revealed my BPD diagnosis and all that it entailed. This disclosure to people familiar with college students would – in part – explain why it took so long for me to apologize.

The facts don’t change, but the perception might have

Surprisingly, I received responses. They were thoughtful, thankful and glad I had engaged in treatment. These responses made the exercise even more worthwhile, though just sending the letters off in the mail felt like a load off my back.

I suppose a degree of guilt can move someone to a more positive place, as long as it is transformational. Obviously, living in a constant state of guilt would be unproductive. Stopping for a moment to acknowledge it and make amends to others, however, is productive.

I told my current therapist about my letters. He seemed encouraged, yet also said “some letters are better written than sent”. I understood his point: re-opening old wounds is disruptive to others, even if my apology is well intended.

With that, I believe arriving at a point where I can acknowledge my poor behavior, apologize for it and give others credit for their guidance represents a milestone in my BPD recovery.

Should I write letters to every single person I wronged many years ago? Not necessarily. There has to be a balance to this cathartic experience, and learning to measure how to communicate with others is another skill people with BPD must acquire.

As I write, I’m NOT patting myself on the back. Rather, I’m holding my head a little higher, knowing that I am taking responsibility for my actions and letting others know that I’m sorry for hurting them.

Writing apologies isn’t about padding one’s ego. Rather, it is about being brutally honest, expressing remorse and thanking others. As for me, I believe I have reclaimed an important part of my own dignity, one long ago lost to my initial BPD implosion.