Compass

Tag: Therapy

  • Waiting For The Other Shoe To Drop

    Waiting For The Other Shoe To Drop

    Spring Light

    My dearest daughter. I am writing this on the most glorious spring day. The house is full of light for the first time in months. The dog is curled up on top of his crate in a sun patch. Outside, the clematis has erupted into a wall of white flowers. The washing machine is chuntering away. You are fast asleep upstairs. All feels curiously well with the world.

    I am having a delicious week off work. And for the first time in what seems like forever, I find myself able to do things around the house.

    Clearing Out

    I’ve gone through two kitchen cupboards and taken out all the years-old spices, the packets of beans never used, the detritus that has collected over the past years. I’ve taken all my clothes that no longer serve to the charity shop and the tip. I’ve completely cleared the bed in the front garden where the new shed will go — all those pestilential dogwoods, gone at last.

    And you have gone through all your clothes too. A far bigger job than mine. The chaotic floordrobe we’ve both survived with for the past year is no more, the carpet is back and we have functioning wardrobes again.

    Something has shifted. Not dramatically. But enough that we are both, it seems, ready to do some things differently.

    What’s Changed For You

    This week you worked four days in a row — unheard of. In the past you weren’t given that many shifts. I get the impression that you are more confident now and able to do more – I wonder if that’s why you’ve been offered the extra work? Also, you previously turned down shifts you didn’t get plenty of warning on — you’ve needed to know what you’re doing well in advance, which meant you missed out on work. Last night you agreed to another shift for tomorrow! Just working two shifts at the weekend used to be enough to leave you in bed for days, recovering. No wonder you are still asleep upstairs…

    I’d say I’ve noticed a change in you since you started DBT group therapy. You have of course been doing one-to-one DBT for a couple of years, but the group therapy is new. I wonder if you’re getting more out of it because you’ve already gone through a lot of the skills in your individual sessions – you’re not having to learn everything and process the group dynamics at the same time.

    I’d love to understand more about what’s helping. But I’m also scared of somehow spoiling this good thing if I prod at it too much. It feels so young and delicate, this change, and as much as I want to know the inner workings, I get that it’s also personal and private and maybe more for observing than understanding at this stage.

    What’s Changed For Me

    You’ve pointed out that you think I’ve changed too. That I’m “better” now. I’m not sure if I am, exactly, but I am trying.

    I’ve been taking a course called Managing Suicidality and Trauma Recovery, run by NEABPD (an American charity) for parents living with on-going fear about their child’s safety.

    It’s been tough – I’ve felt a bit sorry for myself having to stay up late in the evening because of the time difference (you know how I like an early night), but I haven’t found anything equivalent in the UK. And talking to strangers about something so distressing — trauma, shame, fear, all of it — that’s my idea of hell. A lot of the time I’ve been dissociating, not really taking it in. It’s only now, as the course ends, that I feel more comfortable and able to listen. But something must have been sinking in despite this.

    I’ve also been working on building something — an app to support caregivers of people with BPD. Still very early days, but the process of thinking about what I’d actually want to support me, and trying to apply what I’ve learnt from this course and countless other sources over the years, has been surprisingly helpful. More on that another time.

    The Other Shoe

    As I write this, something has started to tug at me. The fear of jinxing it. It’s not just the changes in you that feel fragile — it’s the changes in me, and in our relationship. Is it right to talk about it all when it is so new?

    I guess I’m waiting for the other shoe to drop. We’ve had peaceful times before — the odd day, even the odd week — and then it all descended into chaos, conflict and distress again. How long have we got this time?

    And yes, I say this fully aware that this ‘easier time’ hasn’t been perfect. We’ve had our descents — times you’ve been dysregulated, times I’ve triggered you by saying or doing something or other — and things haven’t escalated the way they have in the past. Which suggests we may be travelling somewhere new – still a bumpy road, yes, but not the dirt track full of crevasses and jagged rocks we’ve been careening down thus far.

    And yet, and yet… what if it’s not? What if you wake up today and everything goes wrong, reverts back to how it was before?

    OK, I had a bit of a spiral there so I used one of my new found skills… I redirected my attention to my surroundings – the dog in his sun patch, a fly buzzing against the window. And I remembered a slide from the course that has stuck with me: Interrupt fear patterns by gently saying to yourself ‘I don’t know’.

    I don’t know how this will pan out for us, my dearest one. And I’m trying to learn to sit with that.

    One thing is for sure though: Wherever you are, whatever you are going through, I’m still here for you — not perfect, not particularly wise, but trying to do better.

    Crikey – who knew that things feeling a bit easier could be so challenging?

  • When It’s Not Just BPD: What We Know About Overlapping Conditions

    When It’s Not Just BPD: What We Know About Overlapping Conditions

    Introduction

    If you have borderline personality disorder (BPD), there’s a good chance other conditions are part of the picture too. That’s common: it’s having BPD and nothing else that’s relatively unusual.

    This article summarises what we know (and don’t yet know) about comorbidity in BPD, and why it matters when you’re trying to get the right help.

    How common are comorbidities?

    One large American study suggests that 85% of people with BPD have at least one additional psychiatric diagnosis. Over a lifetime, most people with BPD will experience more than one other condition alongside it.

    Commonly co‑occurring conditions include depression, anxiety disorders, post‑traumatic stress disorder (PTSD), attention‑deficit/hyperactivity disorder (ADHD), eating disorders, substance‑use disorders, and autism.

    These conditions don’t just sit side by side. They can amplify each other, complicate diagnosis, and make treatment harder to access or sustain.

    Why does this happen?

    No one knows for sure, but a few well‑supported explanations are often discussed:

    • Shared vulnerability (including genetics). Some people may inherit a higher baseline sensitivity to emotional dysregulation, impulsivity, anxiety, or mood instability.
    • Trauma and chronic invalidation. Adverse experiences can increase risk for multiple mental health difficulties, including BPD traits.
    • One condition can raise the risk of another. For example, untreated ADHD can lead to repeated failures, conflict, and shame, which may increase vulnerability to later difficulties.

    The diagnostic puzzle

    Mental health services often use categories and labels, to help decide treatment.  And many people want a label to make sense of what they’re experiencing. But symptoms rarely fit neatly into one discrete box.

    For example, difficulties with emotion regulation can be seen in BPD, ADHD, autism, bipolar disorder, trauma‑related conditions, and more.

    In one study, 40% of people with BPD had previously been misdiagnosed with bipolar disorder – which suggests to me that the current labelling system faces huge challenges in correctly identifying what’s actually going on.

    The latest NHS mental health report (APMS 23/24) made a point of highlighting the additional issue of diagnostic overshadowing: when having one diagnosis stops a clinician from investigating whether a behaviour may actually be caused by another condition.  The same report also acknowledged that BPD can overlap with autism and complex PTSD.

    Why the system struggles

    In practice, support is often commissioned and organised around single diagnoses (for example, ADHD, autism, eating disorders, or in some areas personality disorder services). People with complex presentations can fall between services, or face eligibility rules that make it hard to get care that matches what they actually need. For example, personality disorder services often exclude people with active substance misuse.

    NHS talking therapies are also generally time‑limited. Specialist treatments like Dialectical Behaviour Therapy (DBT), where available, vary in length depending on where you live, what is available and what is deemed suitable (from skills groups of 2 or 3 months to full programmes lasting roughly a year).

    Transitions between child and adult services can be another weak point. For example, a young person with ADHD does not automatically transfer into adult ADHD care everywhere; reassessment waits can be long. During that gap, distress can escalate and additional problems can develop.

    What does the research suggest about treatment?

    Treating co‑occurring conditions can improve outcomes. For example, someone whose ADHD symptoms are effectively managed may find it easier to engage in therapy for BPD.

    DBT was developed for chronic suicidality and BPD, but it has also been adapted and studied for related problems such as depression symptoms, eating‑disorder behaviours, and PTSD/trauma‑related presentations.

    While DBT has evidence for treating multiple conditions, this doesn’t mean every DBT therapist is equipped to treat every condition. Finding someone with expertise across a specific combination of conditions can be genuinely difficult, and this gap isn’t always acknowledged.

    What does this mean in practice?

    If you’re seeking help for yourself, or for a loved one, it can help to keep these points in mind:

    • BPD alongside other conditions is common. If things don’t add up, consider whether something is being missed.
    • Choose your battles. Pushing for multiple assessments at once can be exhausting; it’s OK to prioritise.
    • ‘Complex needs’ can feel vague, but it often reflects reality—and it usually means there isn’t a quick fix.
    • If a short course of therapy hasn’t touched the surface, it doesn’t mean you’ve failed. It may mean the offer wasn’t matched to the level of need.

    Conclusion

    You’re not imagining it: ‘something else’ may be going on alongside BPD, and that’s common.

    Complexity is hard—but understanding it can help you advocate for the right treatment for you or your loved one.

    There is a growing understanding that BPD often comes with other conditions – and that treatment needs to reflect this. The frustration is that services haven’t caught up with this new understanding – yet.

  • Bold Beautiful Borderline

    Bold Beautiful Borderline

    PODCAST DETAILS

    Title: Bold Beautiful Borderline

    Host: Sara Abbott

    Platform/Availability: Spotify, Apple Podcasts, and all major podcast platforms

    Episode: Borderline Rage “I will ruin your fucking life”

    Year: re-released 7th December 2025

    Host background: Sara is a Licensed Clinical Social Worker with lived experience of BPD.

    1. WHY I CHOSE TO LISTEN TO THIS

    I decided to see if I could find some podcasts about BPD and this was one of the first to come up in the search. A therapist with lived experience is such a powerful combination and I was keen to tap into her wisdom.  

     I picked this recent re-release episode as a starting point because I find rage extremely challenging – both my own and other people’s. And my daughter experiences a lot of rage.

    2. WHAT IT COVERS

    Sara breaks down in detail a recent argument she had with her husband: what she was feeling and why, and how it was resolved. She then goes back and gives examples from her past of when she experienced rage and dealt with it less well. She reads out responses she had from people with BPD as to what rage feels like to them. She goes into some of the theory behind BPD rage, DBT skills and guidance for people who might be on the receiving end of it.

    3. STRENGTHS

    Sara is highly articulate and speaks passionately and with great clarity about her own experience and as a therapist. I loved the ‘case studies’ from her own life.

    4. LIMITATIONS

    FYI there is the occasional swear word – in case you’re thinking of listening to it in a public space!

    Sara does give some brief advice to people who are on the receiving end of BPD rage, but this isn’t the focus of the episode.

    5. TONE AND SENSITIVITY

    She describes her podcast as raw, honest and sometimes humorous and that’s what I got from this episode. She has great empathy for her listeners who have BPD – their strengths and their struggles.

    6. PERSONAL REFLECTION

    I think I’m going to re-listen to this episode as there was so much for me to digest. Listening to her journey – things she did when she experienced rage when she was younger, to how she handled it in this recent argument with her husband left me with hope. My daughter is working so hard in therapy, but it’s a long, slow haul and sometimes it’s hard to see the progress, so it’s heartening to hear from someone who has stuck with it and is now in such a different place.

    7. WHO IT IS FOR

    I think it’s primarily for people with lived experience of BPD, but as someone supporting a loved one with it I also found it really useful.

    8. STANDOUT QUOTE

    It’s OK to feel anger for longer periods of time, it’s OK for all of those things to live there, it’s just simply what we do with it.

    9. FINAL THOUGHTS

    This podcast is now on my subscribed list!

    LINKS

    🎧Listen to the Podcast
    📷Sara on Instagram

  • The Pecking Order of Distress

    The Pecking Order of Distress

    I keep thinking about a conversation we had earlier, dearest daughter. The one where I told you about the recent NHS survey suggesting that as many as 1 in 10 young women may have Borderline Personality Disorder (BPD).

    I’m not sure how I was expecting you to react – I think I hoped it would make you feel less alone. But your initial reaction was disbelief. You pointed out that you don’t see hordes of young women having episodes out in public — and surely you would, if there were really 10% young women out there with the condition.

    I got defensive

    I’d spent so long looking at the report, trying to understand what it was saying, how the screening for BPD worked, that you refusing to believe it felt like you were saying my article was wrong — even though I was just reporting the results.

    And I got that familiar feeling of frustration that has come from many years of me saying something and you automatically saying the opposite. Like disagreement is your reflex — even when I’m not arguing, just reporting.

    Athough, in this instance, I think you have a point. One in ten young women potentially having BPD does seem impossibly high. But even it’s an overestimate and the real number is closer to one in twelve, or one in fifteen, that’s still a huge number of people.

    Quiet suffering still counts?

    Wanting to defend the statistic, I suggested that maybe some had a different, quieter form. After all, there are many different “flavours” of BPD — not everyone explodes in public.

    You replied with your trademark bluntness: then they don’t really have a problem and shouldn’t count.

    TikTok and self-diagnosis

    You talked about TikTok and how frustrating you find it, seeing people doing posts, self-diagnosing themselves with serious mental health conditions like BPD — the “oh I get anxious and I wanted to kill myself once so I must have BPD” brigade.

    I can see why this would irritate you. The not understanding. The seeming desire to jump on a bandwagon. The undeserving taking a slice of your pie.

    But I also hate pecking orders of distress. The way people like to judge suffering and decide whether it is ‘better’ or ‘worse’ than an imaginary legion of others. It wouldn’t be so bad if these judgements were kept private, but they never are. People feel honour-bound to tell you your suffering isn’t as bad as someone else’s. You get put in your place — usually to shut you up.

    I say this because it’s definitely not just you who judges, I do it — we all do. It has been part of society since forever. Perhaps it’s worse now because of social media. I don’t know. What I do know is that it needs to stop. There has to be another way.

    A spectrum, not a tick box

    I reflected on this new way of thinking about personality disorder — how it is now to be seen as a spectrum, not a tick box. This new framework may be more accurate but I fear it will turn people’s suffering into one long pecking order of distress.

    Given that the NHS has limited resources, how will decisions be made as to whether you qualify for treatment for a personality disorder? How far down the continuum will you need to be? Will there be a magic algorithm that sifts through all the crisis team referrals and the hospitalisations and decides who is deserving? Not saying the system is any better now of course, but if the system is going to change, I’d like it to be for the better.

    TikTok and your diagnosis

    But then you talked about how TikTok was useful in your own journey to diagnosis.

    You were at college and struggling and saw all these videos where people were describing what they felt and did. They called it BPD and you thought they meant bipolar. But when you looked up bipolar specifically, you thought: this isn’t me. So you were confused, and you talked to me about it.

    I said BPD stands for Borderline Personality Disorder, not bipolar. That you having a BPD diagnosis was something I’d discussed with CAMHS a few years before, but they were reluctant to assess you at that age because emotional intensity and instability can look like ‘normal teenage’ stuff. But that maybe it was time to get you properly assessed – you were 19 at the time.

    So I found a psychiatrist privately. Things were so bad I didn’t want to wait months or possibly years to find this out. And hey presto, we’d both been correct. Or rather, the psychiatrist agreed with us. She diagnosed you as having BPD.

    Diluting the experience

    The other thing you said that gave me pause: you refused to believe the 1 in 10 statistic because if it was true, it would give people an excuse to treat it as less serious. Like the volume somehow diluted the severity of experience.

    And maybe what you were really reacting to wasn’t the statistic at all, but the risk that other people would use it against you. That they’d hear “mainstream” and translate it as: Not that bad. Not that urgent. Not worth resources.

    Bandages

    It made me think of the times we used to go to therapy after I adopted you. When we got ready for the journey home, you’d sometimes fake a fall and insist on bandages for an “injured” limb.

    Even when we all knew what you were doing, you still needed it. Because pain that can’t be seen has a habit of being doubted.

    Mental ill-health and trauma can feel brutally lonely for that reason: it’s invisible. And you found a clever way of making the invisible visible.

    You’ve fought so hard to get me — and others — to understand how serious your pain is. So I can see why anything that hints your suffering is now commonplace might feel like it’s pushing you back into being unseen.

    But what if….

    … there are hundreds of thousands of young women like you out there — suffering and not being understood?

    Maybe at the heart of this is a dialectical truth: you can be desperately unwell — and you can be one of many. Both things can be true at the same time.

    If 1 in 10 young women do have BPD, that statistic doesn’t make it trivial. It makes it very, very urgent.

  • Finding Our Way

    Finding Our Way

    I know you don’t want to read this right now, my dearest daughter. 

    I asked you to take a look because, well, it’s my first post and I’m worried I might have said something that unintentionally upsets you. But maybe that isn’t fair. You said you fear reading it might trigger you and that you couldn’t cope with that right now. I get that. 

    After all, you have no idea what I’ve written, and perhaps you’re expecting the worst. Maybe we both need to keep the right not to read what the other has written. And yet, I’ve written things here I really want to talk about with you — because they’re about our future lives, and how we might make them better. 

    Fair warning: I want to use this journal to dissect things down to the bone — to pull apart what we’re going through, what BPD is doing to both of us, and to our relationship. So, no doubt it’ll get sticky at times. Sticky, but not a whinge-fest — there’s enough of that in the world already. 

    It feels far too “us and them” out there — people with BPD and their loved ones in two separate camps. My dream is to build a more collaborative way for us to work together. A way that might make all our lives better. 

    I’m already panicking that it’s too lofty an ambition, but surely it’s worth a try. 

    The Invisible Woman 

    I’m also being selfish. I don’t just want this project to help others; I want it to stand as evidence that I exist. Somewhere along the way I became invisible. It happened long before you came along — from a time when I had to prioritise someone else to survive. 

    And then adopting you gave me an excuse to stay invisible. Your trauma was so great, your needs so all-encompassing, that it was easy to let them become everything — to forget about me and focus on fixing you. But I can see now that this has harmed us both and must change. 

    N Is For Needs 

    It’s a plain fact of life that we all have them. Just like bodies, needs come in all shapes and sizes — and just like bodies, they’re nothing to be ashamed of. I say this for the record because I don’t think either of us has a particularly healthy relationship with our needs. 

    The trouble is having needs can make a person feel vulnerable. Especially if the adults around you were bad at meeting them when you were little. Some people react to that vulnerability in extreme ways: by becoming hyper-independent and refusing to rely on anyone (that’s me), or by swinging the other way — becoming hyper-reliant on others to fix things (does that ring any bells with you?). 

    The Scale Of Your Feelings 

    I know you feel things on a scale most people can’t imagine — the highs as well as the lows. It’s like your feelings rise like mountain ranges to other people’s foothills. 

    You’ve been like this ever since I adopted you. I hoped that having me as a loving, constant mum — combined with all the therapy to process why you were taken into care — would take away the rages, the hypervigilance, the terror. But it didn’t. If anything, it’s got worse over the years. 

    And for that, I am truly, deeply sorry. 

    There’s a theory that people who develop BPD are born supersensitive — that they notice and react to everything more strongly. Having unmet needs in childhood then hits them harder than most, and that in turn shapes the BPD. 

    This theory makes so much sense to me now. I look back and wonder what I could have done differently, what might have truly helped you. I don’t have the answers — only regret, and a desire to seek out understanding to help other children in the future. 

    Standing In The Foothills 

    Given how huge your feelings are, it’s very easy for me to slip into feeling insignificant. And my biggest challenge, after all these years of invisibility, is to learn how to speak up for myself and what I need — while standing on my own little emotional foothill in the shadow of your mountainous needs. 

    I must look small from up there. But if you do look down, you’ll see me — still here, waving up at you. 

    B Is For Boundaries 

    I’ve read a few books aimed at the loved ones of people with BPD. They talk a lot about setting boundaries — how we, the long-suffering ones, must impose firm rules to protect our needs, and the person with BPD will learn, somehow, to adapt and get better through us doing this. 

    I get that boundaries are important in relationships, but that kind of thinking feels wrong to me. It’s punitive. Cruel, even. 

    But what’s the alternative? 

    I don’t have the answer yet. But I think it has to start with kindness flowing both ways — and a shared effort to problem-solve and negotiate boundaries together. 

    Is that possible? I don’t know. If we set sail on this course, we’ll be heading into unknown territory — but maybe this is our compass, the way we learn to navigate BPD together.