Anatomy of a BPD breakdown
I was working at a stainless-steel butcher block refurbished by my partner into a kitchen table. The afternoon sun filtered in through the apartment’s dining room window to rid the space of its morning shadows. My partner had just returned from a café. He breezed through our open-concept living room into our book-shelved office that overlooks the backyard. With him, the tension that had poisoned our morning from narrowly avoiding one of my emotional outbursts returned to thicken the air with unspoken frustration.
People with borderline personality disorder (BPD) are prone to intense outbursts or meltdowns. Each individual’s BPD looks a little different, but my meltdowns feel like emotions so strong it’s as if my blood is boiling. I feel cooked alive. These episodes present in panic attacks, tears, screaming, flashbacks, and, at their worst, self-harm.
“I know there’s something wrong,” I repeated over and over. I insisted on it. “How do I fix it?” An urgency to find peace eclipsed the day’s work and my ability to empathize. My focus narrowed to a pinpoint.
“Nothing’s wrong,” my partner said. His voice was cautious and halting. “I’m stressed from work. That’s all.”
A meltdown usually starts with emotional lability for me. Psychologist Daniel J. Fox defines emotional lability as unstable emotional experiences and frequent mood changes. These are emotions that are easily activated and/or out of proportion to circumstances that preceded them. My emotional lability is precipitated by a mix of internal and external factors like emotional dysregulation in others, which triggers my urge to “fix” or find peace immediately to prevent harm. It’s similar to a fight response, which is a physiological reaction to real or perceived danger.
Had I paused at that moment to assess my feelings, the next few hours would have unfolded very differently. Ideally, I would have asked myself why I felt the need to correct my partner’s mood and practiced the DBT skill opposite action—doing the opposite of what an emotion urges me to do. Alternately, I could have practiced acceptance, maintained a calm demeanour, or gone for a walk to get my emotions back to a baseline level.
Instead, I barrelled straight toward the next stop in a BPD meltdown. I heaved in my seat. My breath was blocked. My hands and feet tingled with pins and needles. I dug my nails into my palms as hard as I could but felt nothing. It seemed my limbs were no longer a part of my body. I flapped my arms frantically over the dining room table. My partner froze in the office doorway. His eyes were twin disks of fear.
When I don’t successfully manage my emotional lability, anxiousness overtakes me. Anxiousness during a BPD meltdown is intense nervousness or panic that often occurs as a reaction to interpersonal stress. I worry about all the negative effects of past unpleasant experiences or relationships and future negative possibilities. I feel afraid and threatened by uncertainty and the strength of my emotions, which leads to limited-symptom or full-symptom panic attacks.
The only effective DBT skill I can practice without help during panic attacks is TIPP, specifically the “temperature” part of the acronym. Ice cold water flowing freely from a faucet or contained within a wrung-out washcloth shocks some feeling back into my numb body. It also cues the mammalian diving reflex, which causes my heart rate to drop and my parasympathetic nervous system to activate producing a relaxation response.
With my partner’s guidance, the “paced breathing” part of the skill becomes accessible. He models the skill by breathing deeply through his nose for about four seconds and out through his mouth for about six seconds to encourage me to do the same. He simultaneously draws his hand up and down in time with his breath to give me a visual cue to hang onto when I’m already overly activated. He practices additional de-escalation techniques like giving me lots of personal space and using clear language to mitigate these episodes. But the more I rely on my partner to manage my BPD meltdowns, the less likely I am to use my skills.
“Listen,” my partner said. He held open both palms like a peace offering. “I’m obviously upsetting you. I’m going to go to the backyard to give you your space so you can go back to having a nice afternoon.”
In addition to giving me my space, my partner was trying to calm himself to a point where he could be helpful. We call it the airplane mask principle, a term borrowed from a support group he attended for family and friends of people with BPD. The basic idea comes from those safety videos you see at the beginning of a flight. If the oxygen masks drop, you’re supposed to put on your own before helping others with their masks. This is also true of navigating a BPD meltdown or living with a loved one with severe mental illness. You must take care of yourself first.
Unfortunately, perceived physical abandonment triggered my intense separation insecurity, which can also be activated by feeling misunderstood or from the fear that springs from feeling completely dependent on another person.
“Please don’t go,” I cried. My partner threw up his hands. Frustration or exhaustion pained his face, which only made my sobs heavier. “I’m sorry. I won’t cause any more problems,” I said.
A whisper that came from beyond my body taunted me. ‘You deserve to be alone,’ it repeated. A sweat broke out on the back of my neck. A carousel of my loneliest memories rotated across my field of vision. Beyond the images, my partner came over to reassure me but I couldn’t hear him. His words sounded like they were travelling through water. I hit the sides of my head with clenched fists to try to stop the chaos.
Typically, this far into a BPD breakdown, medication is the surest way to calm me down. Ativan is a benzo used to treat anxiety and severe agitation. It’s highly addictive. Once medicated, the Ativan can dissipate a meltdown with the dense clouds it creates in my mind, but my actions become so distant from me that I only trust myself to sleep under its influence. It’s a last resort. Often, I keep trying to use TIPP or distraction skills to avoid taking it.
I put off medicating that afternoon, sobbing in protest when my partner offered it. Panic attack after panic attack crashed over me in steady waves. I pressed myself into the corner of our kitchen like a frightened animal that’s only ever lived in a box. At last, I acquiesced and took the Ativan when another swell of panic threatened to crash over me. I was too exhausted and weak to do any different. My face was puffed and red and slicked with tears, drool, and snot. Hours after it began, my meltdown finally wound down.
When I reflect on that day now, my mouth fills with the tangy metallic taste of guilt, shame, and self-loathing. I grow clammy from embarrassment. It’s a series of feelings familiar to most people with BPD following a meltdown when our behaviour seems so far beyond our control. And it’s a series of feelings that are easy to follow back into emotional lability, which traps people like me in an exhausting cycle. So, I keep going back to that day. I analyze what I did wrong and strategize prevention and de-escalation techniques so it won’t be so severe next time. I draw up cheat sheets and diagrams of what I can do and what my partner can do during each stage of a BPD breakdown. I seek input and advice from my therapist. BPD can feel like an extreme lack of emotional intelligence but that gives me hope. Hope that I can learn to live with the disorder better. And help others through my experience.
Mad History:
This issue: Ice water and agitation
Cold water has long been used as a means to control agitated people with mental illness. In the 1800s, various forms of ice water treatment were thought to subdue and create more obedient patients. Designs like the “Bath of Surprise,” which plunged unsuspecting people into ice cold water, or the water douche used at the Salpêtrière, France’s largest hospital, which shot a stream of freezing cold water onto a patient’s anus, often caused heartburn, the desire to vomit, sudden shock, and, in some cases, death by drowning.
These methods evolved into hydrotherapy, which was used extensively throughout institutions in the 20th century. Methods for delivery varied, but hydrotherapy often involved restraining a person with mental illness and dousing or soaking them in hot or cold water, sometimes for days at a time. Professionals administering water-based treatments considered them therapeutic, though there was little evidence to support this.
Eventually, hydrotherapy was replaced by chemical means of sedation—medication, which is still used today. Medication is viewed by the general population and medical establishment as a humane method to control psychiatric agitation; however, I’d argue that any treatment administered against a person’s consent is more likely to cause harm than good.
Recommended Viewing
Purge the Urge
By: Daniel J. Fox
Daniel J. Fox’s video, Purge the Urge, soothed my desperation to find relief from my BPD meltdowns. Fox, a psychologist who specializes in personality disorders including BPD, breaks down the causes of BPD meltdowns and helps viewers identify their triggers. The reflective exercise allowed me to develop strategies my partner and I use during each stage of a BPD outburst.