TWO-HEADED GIRL
Everyone has an identity - but what happens when yours is defective? A stark look at different personality disorders reveals stories of lives split in two.
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t started when I was fifteen. I had just ended my first ever relationship with a depressed and emotionally abusive boy. I remember riding the bus to school the morning after our breakup, blasting Walking on Sunshine by Katrina and the Waves in an attempt to alleviate or block out the feeling of impending doom - but it was stronger and truer than anything I had ever felt. I’m still convinced that, during that fateful moment on the bus, I had felt my heart physically sinking. I was restless with overwhelming fears of abandonment and loneliness, both foreign to me until then. At school, I threw up lunch, locked in the bathroom for at least twenty minutes afraid that others would notice my swollen glare peppered in blood. At home, I cut myself for the first time. I was fifteen when I found out that I had a personality disorder. Every year since then has been a living hell.
“We lead a double life: half of ourselves exists only in front of other people” The four defining features of any personality disorder are distorted thinking patterns, problematic emotional responses, over- or under-regulated impulse control, and interpersonal difficulties. These traits then combine to form the ten disorders - split into three clusters - identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). To be diagnosed with a personality disorder, one must necessarily suffer impairment due to these prevalent traits, and must find it difficult to function normally within society. It is estimated that about 1 in 20 people in England are wired this way. We are also far more likely to suffer from multiple disorders within the same cluster, even if we’re just diagnosed with one of them. The first defined cluster classifies sufferers as odd and eccentric, the second tends towards dramatic, emotional and erratic beings, and the final group gathers an anxious and fearful bunch. Many of us won’t ever fully recover. Though 40-60% of psychiatric patients are di-
By Luana Salles agnosed with a personality disorder - thus making it the most frequent of all diagnoses - many of us still find our condition to be invisible. The known stigma around mental health is, more often than not, drastically magnified when personality disorders come into play. Our diagnoses are used as adjectives: your tidy and organised friend likes to describe herself as “very OCD” after cleaning her house; your mother called you antisocial for not spending enough time with the family; that one beautiful girl in school is said to be narcissistic because she is excessively enamoured of mirrors. Similarly to depression and anxiety, the names of different personality disorders have been normalised to such an extent that they have now been absorbed into informal everyday parlance. Yet differently from other mental health conditions, personality disorder diagnoses are far beyond exclusionary: they can catapult us into a spiral of self-doubt. We’re forced to confront the very nature of our existence by regularly asking ourselves why our minds work so differently to those of others. Not everyone has depression, not everyone has schizophrenia, but everyone has a personality – and it just so happens that ours is defective. Because of this, our negative traits - building blocks of a far bigger problem - can sometimes overlap with those of mentally healthy people. Even they can resort to bad habits or struggle to control impulses. People may binge eat because they’re stressed, yell at their partners in an unprecedented bout of rage, or wake up feeling the need to avoid others - but these aren’t the norm. They’re just previews, small-scale representations, of what it’s like to be disordered. Their exceptions are our whole lifetime. Yet many of us find in these exceptions - the overlaps where healthy people act like us - an opportunity for camouflage. We try to keep our disorder at bay to mask how deep the problem really goes. Sufferers of personality disorders are forced into leading a double life: half of ourselves exists only in front of other people, hiding diagnoses, attempting to control atypical characteristics, pretending we’re alright. The other half is our best-kept secret.
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CLUSTER A: ODD (schizoid, paranoid, schizotypal)
SOCIALLY ISOLATED
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luster A, the first cluster, includes schizoid, paranoid and schizotypal disorders. The latter has been proven the most common of these: though broadly categorised as odd or eccentric people, those who suffer from schizotypal personality disorder are particularly aloof and solitary. Differently from those who are paranoid - and who are therefore skilled observers -, schizotypes feel drastically anxious about social interactions. They generally don’t start or maintain relationships with others, regardless of their nature. Their difficulty establishing bonds and their perceptual and cognitive delusions feed into each other so intensely that the schizotype will resort to isolation as a means to alleviate their anxiety. They are often described as superstitious beings who worry excessively about unconventional things, such as paranormal phenomena. Schizotypes may also believe they have special powers, such as telepathy and the ability to control other people’s emotions. They are the ultimate outsiders. Schizotypal disorder is found to be tightly related to schizophrenia, where the former is genetically linked to the latter. Because of this,
schizotypal disorder is often mistaken for an early stage schizophrenia - yet it is said to be relatively stable throughout the life of the sufferer. The disorder has even been traced back to attention deficits in children. When kids struggle to retain information, they may find social interactions strenuous: conversations require a basic grasp of interpersonal cues and attention, both of which the child lack and can therefore grow to fear. An eventual withdrawal from interactions can lead to serious asociality, one of the defining characteristics of the schizotype. They may start to prioritise computer games over going out with friends, and their only social interaction might come from online chat rooms. In an attempt to conceal their odd and eccentric behaviour, schizotypes might lie about how many ‘real-life friends’ they have, often mentioning people you have never heard of or seen them talking to. Those affected by the disorder are at a greater risk of developing major depressive disorder, dysthymia - a mild yet long-term form of depression - and social phobia. As comorbidity is prevalent with personality disorders, schizotypal disorders may co-occur with obsessive-compulsive, borderline, paranoid, and avoidant disorders.
SCHIZOTYPAL PERSONALITY DISORDER TRAITS
• Odd beliefs or magical thinking that influences
behaviour and is inconsistent with subcultural norms (e.g. superstitiousness, belief in clairvoyance, telepathy, or “sixth sense) • Unusual perceptual experiences, including bodily illusions • Odd thinking and speech • Suspiciousness or paranoid ideation • Inappropriate or constricted affect • Lack of close friends or confidants • Excessive social anxiety that does not diminish with familiarity fears
CLUSTER B: DRAMATIC (antisocial, borderline, histrionic, narcissistic)
VAIN AND EGOCENTRIC
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hen Ananda Muylaert was diagnosed with narcissistic personality disorder, all she thought was that she, somehow, had known about it all along. She didn’t feel the agonising weight of having a personality disorder - portrayed as an objectively negative thing. Of all things her therapist told her that day, that feeling - or lack thereof - was the strangest part. Ananda had been previously diagnosed as suffering from
Between a few swigs of lager in a dimly light pub, Ananda opened up to me about the ins and outs of her disorder - but not once did it feel like an intimate confession. She glided with ease through the monologue - conversation would be a stretch - and not once made me feel like we were having a heart-to-heart of any kind. Asked about it, she said it’s because she feels immensely better than everyone else. “It doesn’t matter if they’re a
“I had sex with four different men in four days and I still felt unsatisfied” a bipolar disorder type I and, when she started taking medication, felt a huge relief - she’d finally found an explanation for acting so strange and feeling even stranger. Yet holding in her hands a neurological and pathologic explanation for feeling like she’s better than everyone else was simultaneously comforting and scary - not relieving, but most definitely not saddening. The scary part of her diagnosis came about with the fear that all she was and all that she felt was just a product of her disorder. “It’s haunting to wonder if maybe what I think I am and what I see in the mirror are only there because something went wrong at some point in my life,” she revealed to me. “But, in all honesty, the fear of not being true to myself is the only bad part about being a narcissist.”
“I was led to believe that my intellect is just more developed that anyone else’s,” she said. Things have not changed much since then: she’s still an avid reader and, as she matured, she unearthed aptitudes she didn’t know she had. Ananda learned how to paint, cook, speak other languages and play a wide array of instruments. People always seemed to be impressed by her abilities, and she always believed their many compliments. “I might have let that belief take over me in a way it shouldn’t have.” Surprisingly, Ananda coped with severe self-esteem problems throughout her teenage years. She developed an eating disorder when she was thirteen and eventually started attending therapy. By the age of fifteen, she was recovered and saw a boost in her self-confidence; yet her bipolar disorder was taking its toll on her life.
stranger or a close friend. I’m prettier, smarter, friendlier and more talented than anyone I’ve ever met - at least that’s what I believe.” While Narcissus fell in love with his reflection in the water, Ananda fell in love NARCISSISTIC PERSONALITY with both what she sees in the mirror DISORDER TRAITS and with what she knows about herself. • grandiose sense of self-importance When she was • preoccupied with fantasies of three years old, she unlimited success, power, brilliance, started showing signs of being a giftbeauty or ideal love ed child. She learned • believes that they are special or how to read and write unique on her own, skipped • requires excessive admiration two years in school, and started reading • has a very strong sense of about geography and entitlement economics, news• is exploitative of others papers, and lots of • lacks empathy poetry. She grew up amongst adults who • is often envious of others would praise her for • regularly shows arrogant, haughty her intelligence.
behaviours or attitudes
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Because of the constant shift between manic and depressive episodes, her self-esteem began to fluctuate; yet it was during these manic episodes that she began to develop her narcissism. “This fluctuation between long, intense episodes of mania and severe but brief episodes of depression went on until I turned 18 and started taking medication. I then began to get manic more often,” she told me. As a result, she began to appreciate her reflection. She thought her hair looked shiny, her thighs muscular, and her breasts perfectly round. Her self-confidence grew bigger every time she looked in the mirror something she had begun to do frequently. Yet this obsession with her own looks and personality proved to be sexually dangerous. Being overly confident meant she thought she could attract anyone - and then came the promiscuity. She broke up with her boyfriend and started searching for new sexual partners everywhere, making it a game for her personal satisfaction. “It got to the point where I had sex with four different men in only four days and I’d still feel unsatisfied. I deliberately made people fall in love with me when I just wanted to have sex with them, or to feel like I was desirable,” she told me.
“Being truly in love with someone seems out of this world to me - perhaps because I’m already too busy being in love with myself.” Though she often benefits from her disorder, she revealed that it ruined a healthy, loving
“Being in love with someone seems out of this world to me” relationship just because she wanted - or needed - to attract other men. Her mother also began warning her of how bossy, patronising and arrogant she sounded at times, and her closest friends began to see her self-assertive, egotistical behaviour as a joke. “I feel like I have a good heart, even though I’m basically a freak show of mental disorders,” she said. “But it can be difficult to show that when my ego is so damn loud. “I try my best to avoid hurting the people I love, and this usually means not acting like myself. I don’t think I’ll ever be able to talk about my disorder openly without getting side-eyed.”
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IMPULSIVE AND UNSTABLE
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he first time I looked at the clinical criteria for borderline personality disorder, I cried myself to sleep. It read like a concise description of the person I had become after my first relationship ended, but most of it echoed back to traits I’d had ever since I was a child. I hated myself for as long as I could remember. I’d always had a difficult time socialising with other kids because I would be too preoccupied with how I looked and how they perceived me. I was overly aware of both how I portrayed myself and how other people reacted to what I said. My awareness of other people’s emotions and my ability to analyse their bodily responses mid-conversation had always felt like a superpower - in the worst way imaginable. If I sensed someone else physically or emotionally rejecting me, I would close up. It was suffocating - the urge to disappear was consistently overwhelming. As a result of my hypersensitivity to people’s bodily and facial expressions, as well as my urge to over-analyse what they meant, my mood had never been stable. It felt like I was in a roller coaster, and I still haven’t learned how to get off. Between the ages of one to seven, I had a babysitter who took care of me while my parents were both at work. She fed me a lot of sweets and was always eating my vegetables for me if I complained they tasted bland. I never learned how to stop eating and she never saw a problem with that. When I was eight, I was officially an overweight chid. My mother tried taking me to nutritionists to redefine my eating habits, but it was always fruitless. I learned that eating was bad for you, and I learned to feel scared and ashamed if
BORDERLINE PERSONALITY DISORDER TRAITS • overwhelming feelings of distress, anxiety, worthlessness or anger • difficulty managing such feelings without self-harming • splitting or black-and-white thinking • chaotic relationships • markedly disturbed sense of identity • intense of uncontrollable emotional triggers • unstable interpersonal relationships and self-esteem • concerns about abandonment • impulsivity • emotions come about easily
anyone saw me eating. I developed a fear of eating in public and remedied this by hiding bags of candy in my room. My experiences with binge eating only changed when I was fifteen and first starved myself for a year, losing twenty pounds in just one month. I became anaemic, had hypothyroidism, and developed an eating disorder. My experiences with food, like my experiences with people, became another roller coaster. Starving myself at fifteen coincided with the end of my first relationship. It had been a cha-
“Being self-aware only makes me feel like more of an outsider” otic and intense year, especially considering my young age: we started dating when I was about to turn fourteen, even before I had learnt how to kiss for the first time. I learned it with him. He also taught me what depression was, even though, differently from kissing, I hadn’t asked for that. The boy, also fourteen at the time, had a troublesome relationship with his parents and developed severe psychological scars from it. He was depressed, dramatic, overwhelming, even, with a dark yet captivating personality that shined through ever pore of his acne-ridden, pubescent face. He was mysterious, impenetrable for everyone who wasn’t me - and I loved the attention. I loved being loved. We lived five hours away from each other, each in a different state, and were only able to meet up once a month. Because of it - and because I’ve always had an addictive personality - we spent every second of every day glued to our computer screens. I wasted my first trip to Europe looking for internet cafés so that I could speak to him, even if just for a few minutes. It was sickening. When he broke up with me a year later, I was an empty shell of who I used to be. I had no recollection of how I used to live and what I used to do all day before I met him. It was the first time - of many to come - where I ever experienced full-blown loneliness, a very tangible feeling of abandon and emptiness. I felt worthless most of the time, even more so than I had during my childhood; my self-esteem, already remarkably low, became inexistent. After him, I was no longer myself. I began acting recklessly and impulsively, engaging in activities wildly inappropriate for my age range. Amongst these activities - ranging from promis-
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cuous behaviour to drug abuse - was starvation. I never again learned to separate hunger from emotions. My relationship with food was directly correlated to my mood, and since that changed drastically every hour or so, I was always shifting from over to underweight. My high school nickname was concertina. When I was seventeen, I fell in love with a sociopath. I dated him on and off for two years, and it’s safe to say that it affected my borderline more than all other traumas with food, romance and body image combined. It was an abusive relationship. I was afraid of losing him, feeling an even stronger fear of rejection than I had with my first boyfriend, so I would make up excuses for every hurtful thing he did to me. I hated him intensely every time he manipulated me, but I woke up the next day certain that he was the best person I’d ever met. I never saw anything in shades of grey: I either hated or I loved, and thought him, as well as everybody else I knew, either hated or loved me. For anyone who has ever come across a sociopath before, they will understand why I was so attracted to him, despite the abuse. Sociopaths, like borderlines, are enthralling and hypnotising - and as the intelligent beings that they are, they know exactly how to use their charm to reel you in. He taught me a lot about psychology, including my own disorder, and helped me put a name to my so-called superpower of analysing people’s emotions - microexpressions, they were called, a term coined by psychologist Paul Ekman. He helped me better understand myself, which, in hindsight, deeply aggravated my disorder. Being intelligent myself, I also learned much from his manipulative and cunning ways. Since I couldn’t leave him - he made me feel like I emo-
“I never saw anything in shades of grey: I either hated or I loved” tionally, physically, psychologically and spiritually needed him - I ached for personal, unspoken revenge every time he mistreated me. Whenever I found out he had cheated on me, I cheated on him too; when he lied to me, I lied to him right back. I never told him about any of it and I never felt remorseful or compelled to do so. He didn’t need to know about my revenge, and I certainly didn’t want to risk him breaking up with me. At times, in order to make him stay, I’d tell him I was pregnant or that I wanted to kill myself. I behaved like this for the sake of my own health, whilst simultaneously being incapable of seeing the bigger picture and realising how lethal our
relationship was. As a result of our inconsistency - and my innate susceptibility to chaos - I was never mentally stable. During one of our most turbulent periods, I slashed my wrists with a pocket knife in an attempt to feel numb. I sat on the bathroom floor of my University room watching myself bleed out. My mother saw it the next time I went back home and told me I was immature, dramatic and irresponsible, making sure I understood how disappointed she was in me. I never told her that I had also tried to kill myself the day after I cut my wrists. From then on, every time I wanted to self-harm to cope with tumultuous emotions, I’d either choke myself or smoke my lungs to sleep. I managed to let go of his chokehold two years later, in January of 2014. Unfortunately, I didn’t have the personal satisfaction - and psychological maturity - to break up with him, but I’m thankful he did it for me. My mental health skyrocketed and I felt like borderline was a mere illusion from the past; I convinced myself that I had never been disordered in the first place. The truth quickly caught up with me when I continued showing the same signs as always: disordered eating, capricious moods, impulsivity, recklessness, loneliness, and the inability to stay with the same person for long. I began dating the perfect girl in the second semester of 2014 - she was the kindest, most genuine person I had ever met - and it still wasn’t enough to tame my instability. I woke up one day feeling nothing towards her, and she soon sensed I had fallen out of love. When I found someone new to replace her and fill in the holes of my loneliness, I let her go. That is my signature pattern - break and be broken. Reading about borderline and talking to other sufferers has never alleviated the disorder; if anything, being self-aware only makes me feel like more of an outsider. Holding relationships is nearly impossible and my impulsive behaviour has nearly gotten me arrested three times. The invisibility of my disorder means I can never open up to my parents, and my behaviour is perceived as dramatic and crazy by other people. I try to control it as best as I can around everyone, but, like other sufferers say, that only keeps me from being myself. Who I am is viewed by society as unacceptable and insane, and I have to learn how to deal with that stigma alone. My only hope lies in dialectical behaviour therapy, a cognitive-behavioural psychotherapy developed to target borderline personality disorder specifically. It is not publicly funded and I have no idea when I’ll be able to afford it. With borderline, I feel like there are many people living inside of me at once - and most of the time, I want them all to be dead.
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CLUSTER C: ANXIOUS (avoidant, dependant, obsessive-compulsive)
OBSESSIVE AND COMPULSIVE T he first thing you feel in the morning is the urge to step on the floor with your right foot. If you stepped out of bed with your left foot first, you’d have a terrible day. Actually, you cannot step outside of any room, or through any door, with your left foot. You cannot open doors or grab certain items with your left hand. When you shower, you have to wash everything twice. When you go through a door, you have to go back through it and out again. These are just a few of your many ‘superstitious rituals’. Your ‘organisational rituals’, on the other hand, include scrutinising your surroundings to make sure all the keys on your wardrobe knobs are turned completely and laid out horizontally. All your writing utensils in your pencil case have to be facing the same way, usually to the right. Everything on your table has to be placed in their due spots before you can start doing any work, and everything had to be put back in its exact place before going to bed, usually in relation to right angles. You’d likely get up in the middle of the night to re-arrange something you believed to be out of place. Your writing has rituals, too. You need to make your sentences look balanced on the page, which influences the way you write essays for University. You attend to the actual aesthetics of each sentence, sometimes including unnecessary punctuation, such as commas or dashes. They make the sentences more harmonious and symmetrical. As you write, you underscore the words you would like to italicise so that the text is, momentarily, more aesthetically pleasing to you. Similarly to your ‘organisational rituals’, you also write every single word at least twice, and re-write a whole paragraph if you need to begin a new sentence. The physical act of writing is painful and you do not progress until the obsession subsides. That is the life you lead with an obsessive-compulsive disorder.
English Literature student Georgia Nasseh first realised she had OCD when she was around nine or ten and started researching her rituals online. “It has developed as a means of coping with situations in life that are beyond my control, such as my parents’ turbulent marriage and personal relationships. Since I could not control the way people felt about me or each other, I used the rituals to convince myself that there was something I could do in order to maintain influences over these aspects of my life,” she said, in an emotional confession of a side of her disorder she has always kept secret. “I felt like if I performed a particular ritual, I would either avoid something I thought was bad - such as my parents splitting up or not getting good grades - or increase the chances of something good happening.” She believes OCD develops in people who have insecurities when dealing with external situations and wish to deceive themselves into thinking they’re in control. Today, her disorder is less aggravating than it was at first, but not only thanks to her daily prescription of Rivotril: “I feel comfortable saying that one of the main reasons why I have become less reliant on medication is due to marijuana. It had an invaluable influence on my anxiety and control issues.” OCD had seeped into every aspect of her routine, proving impossible to accomplish simple tasks in a normal amount of time. “Since today I am a much happier person as a result of my control over the obsessions and compulsions, I believe I would feel even better had I not the remaining residues of the disorder. Yet I do not think I can ever be fully recovered from it.” Georgia cannot see a positive side to the disorder. The perfectionism it demands of her is both counter-productive and alienating. She feels the need to hide her rituals from others lest she be mocked and shunned, and has always understood that her disorder must forever remain a secret.
THE OBSESSIVECOMPULSIVE DISORDER CYCLE • Obsession: where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind • Anxiety: the obsession provokes a feeling of intense anxiety or distress • Compulsion: repetitive behaviours or mental acts that you feel driven to perform as a result of the anxiety and distress caused by the obsession • Temporary relief: the compulsive behaviours brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the cycle to being again
Source: NHS.uk
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