Tips for handling Borderline Personality Disorder in College

I entered college as an “normal” person, although BPD was already brewing in my system. After an enormous public rage my Junior year and subsequent hospitalization, I graduated college with an official BPD and depression diagnosis. BPD is extremely difficult to tolerate no matter what stage of life you’re at, but I think it is most troubling during college/university years when social conformity and peak performance (academic, athletic, musical or whatever your discipline is) is necessary. I don’t agree with my father about a lot of things, but one thing he said about college was VERY true: “It’s a four year pressure cooker”. Lump in BPD, and you’ve got a recipe for potential disaster if you don’t take care of your mental health.

Next year will be my 10th reunion. Over the past nine years, I’ve spent a lot of time thinking about how I could have done things differently in college. For one, I didn’t know I had BPD, and that was a strike against me from the get-go. Second, I put myself in social situations that were very demanding and prone to disappointment. Third, my family and I were slow to recognize that I had mental illness either out of denial or ignorance (or both). Therefore, I’ve put together the following list of tips that might be helpful for those entering college with a BPD diagnosis, and a tip for those who are having mental health issues that *might* be undiagnosed BPD.

If you’re entering college with BPD already diagnosed:

  • Research your school’s mental health support system – Not all schools have an infirmary for treatment of common illnesses (flu, colds, sore throat, minor injuries), let alone a mental health counselor. Before you set foot on campus, know if your school has a mental health support system. Alternatively, see if there is a psychiatrist or outpatient clinic nearby. Write this information down or save it in an email to yourself: it will be invaluable if you start to have difficulties and need help. Make sure you talk to the campus doctor and advise him or her of your condition so that they can help you if an emergency situation arises. The last thing you want to happen in the event you have a BPD rage is getting thrown in the back of a police car. Instead, advise medical professionals first so that they can intervene and provide health care opposed to some sort of punitive action by the authorities.
  • Tell the Dean of Students and your Academic Dean about your diagnosis – At my school, dormitories were governed by an residential adviser, who were supervised by a Dean of Student Life. These individuals were charged with looking after my well being and adjustment to college, particularly during the Freshman year. If you already have a BPD diagnosis, tell these people about your condition. If something happens and you need help, these people need to be on your side and knowledgeable about how to provide support. Also tell your Academic dean about your condition, using a letter from your doctor or an in-person meeting. Some schools are very strict about academic standards. If you have an emergency and must leave campus, make sure your Academic dean knows that it is mental health related and that you’re leaving to get treatment. That way, the Dean and your professors will not penalize you for missing class or assignment due dates. It’s better to tell these people FIRST, opposed to them finding out after something dramatic has happened.
  • Make a list of your doctor’s phone and email address, plus any other mental health professionals that can provide support outside your campus – When I had my rage, campus officials were incredulous and didn’t know who to call. As a result, I was strapped to a gurney and taken away to the nearest emergency room. For all they knew, I was an angry drunk, high on drugs, or had homocidal/suicidal intentions. Head off any potential crisis before it happens. Have your doctor’s office phone number and emergency number (beeper or cel phone) handy. Also include your regular family doctor’s phone number as a backup. Your medical history and recent treatments would greatly help anyone responding to you in the event something bad happens.
  • Know where the nearest pharmacy is – The instant you set foot on campus, your world will start moving very fast. There will be classes, parties, friends to make, and various other demands that will no doubt occupy much of your time. With the “college experience” on your mind it can be hard to remember to refill your prescriptions and get them at the pharmacy. First, see if they can be sent in the mail to you. This is very easy and nearly every school has a post office. If this option isn’t available, have your doctor call the nearest pharmacy and put all of your meds on file. The last thing you want to do is miss class, avoid social opportunities, or become an outsider because you have to make frequent trips off campus to get your meds from home or from your psychiatrist. Take care of your meds before school begins: it will save you a lot of stress.
  • After 5-6 months at school, tell a friend about your situation – Some people make friends easily, while others need time to build a rapport with others. If you add a mental health problem on top of this, trusting newly made friends at school can be hard. If you become close and trusting with your roommate(s), tell them that you sometimes have stress attacks or react acutely if you’ve had too much to drink. Alternatively, tell any other new friends you trust that you have a hard time controlling your emotions sometimes. Note that I’m suggesting to tell others that you have trouble with your emotions opposed to a mental health condition. Despite the fact we’re living in 2011, people with mental health label inevitably attract a stigma to themselves. Use very general, bland terms with your new friends, particularly if you start drinking on the weekends or smoke pot. This type of experimentation is natural at school, but can get out of hand if you’re trying to balance your BPD and medication as well. None of your schoolmates need to know the inner secrets of your life; just tell them at an appropriate time and place about your “moods” before you have an emergency. This will allow them to act faster and get you the help you require.
  • If home is nearby and safe, don’t be afraid to leave campus for a break – For me, going to college was the first extended period of time in my life that I was away from home. I didn’t do residential camp in the summertime as a youth and always traveled with my family. As a result, I told myself that I would not visit home at all unless there was an official college break during holidays or between semesters. I thought this personal mandate would help me acclimate to the campus and learn to fend for myself. Home was a “safe” distance away, just 30 minutes by car and I still felt a sense of independence while at school. If you ever start to have mental health difficulties AND your home is a SAFE place to go (meaning your parents and siblings understand your situation) feel free to visit when you need support. For those that live hundreds of miles away from their home, don’t be afraid to visit any relatives nearby or call your family on a routine basis. In some cases time at school away from a tough family life is a blessing to some people. In other cases, home can be a safe place to retreat when things get difficult. I’m not saying run home every weekend – because you’ll miss campus weekend life and parties – but allow yourself to go when necessary. There’s nothing wrong with giving yourself a break from the fast paced lifestyle that college brings.

If you’re entering college WITHOUT any diagnosed mental health condition but feel you are unwell:

  • Only one critical tip: SEEK HELP RIGHT AWAY – I didn’t know anything was wrong with me until it was too late. If after a few months at college you feel overly tired, sad, emotionally volatile, or troubled, get help IMMEDIATELY from a school counselor, residential adviser, or nearby psychiatrist. Your Dean of Student Life should be able to recommend a well regarded doctor to see, and in most cases your health insurance will cover any diagnostic visits. Don’t put it off or ignore any potential symptoms of mental illness, no matter what they are. Many times, the stress of being away from home living the “college” lifestyle makes mental illness surface for the first time. Take care of yourself first. Find help, talk with your family or friends, and move forward.

I realize this is a long entry so I’ll finish up with a tip that summarizes almost all of what I wrote: Tell people in positions of authority at your college or university about your condition FIRST before a crisis develops. They will not only appreciate your honesty, but will also know how to help you if and when the time comes. Above all else, seek help if you feel mentally unwell, your grades start slipping, or you are self medicating with drugs or alcohol. You only have one college experience in your lifetime. It doesn’t have to be perfect (because almost everyone’s isn’t) but it does require that you take time for yourself and stay well.