How borderline personality disorder makes it harder to hold down a job

Extreme emotional turmoil, fears of abandonment, huge amounts of stigma… These factors can make navigating a career when you have borderline personality disorder really tricky. But Rosie and Enya are making it happen. Today, how to navigate your working life when you have BPD. We hear from Enya, a listener who works on fishing boats while receiving treatment for her BPD, and Rosie, a teacher and author who decided to disclose her diagnosis with her workplace. How has borderline personality disorder impacted their careers? And what advice does an occupational therapist have for people with BPD entering the workforce? This episode includes mention of self-harm and suicide. Please take care while listening. Guests: Enya Rosie CappucinoAuthor, Talking about BPD https://www.talkingaboutbpd.co.uk/book Dr Suzanne DawsonOccupational TherapistSenior Research Fellow, Caring Futures InstituteFlinders University Credits: Presenter/producer: Sana QadarSenior producer: James BullenProducer: Rose KerrSound engineer: Bethany StewartThanks to freesound.org https://freesound.org/ users digifishmusic and Scott_Snailham. You can catch up on more episodes of the All in the Mind podcast with journalist and presenter Sana Qadar, exploring the psychology of topics like stress, memory, communication and relationships on the ABC Listen app (Australia) or wherever you get your podcasts. Support services: Lifeline https://www.lifeline.org.au/13 11 14 Beyond Blue https://www.beyondblue.org.au/Australian BPD Foundation https://www.bpdfoundation.org.au/

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  A heads up, this episode mentions self-harm and suicide. Take care while listening.

• 0:46Speaker 04

  I grew up on a sailing catamaran from about the age of four with my parents and my brother. And I grew up in the Whitsundays mainly and up in the Torres Strait. So I was home schooled for the majority of primary school and then we sort of stopped sailing and came into Cairns and went to high school there. But yeah, right through primary school, it was pretty special.

• 1:10Speaker 03

  Before Enya's emotional world was thrown into chaos, her childhood was unusual and idyllic.

• 1:18Speaker 04

  Lots of swimming, lots of diving, lots of times on the beach. Yeah, I come from a loving family. So with my mum being a nurse and my dad being an electrician, they'd pick up work as we sailed up and down the coast and they might work for a few months and then we'd go sailing for a few months.

• 1:36Speaker 03

  Yeah, it sounds magical. What were you like as a kid?

• 1:39Speaker 04

  Well, I think, it's hard to know because you are in such a small and confined environment. But I think as I reached my teenage years, I became a little bit difficult. I've always been, I believe I have a very loving, loving nature, but yeah, a bit of emotional instability.

• 1:58Speaker 03

  To be fair, you could probably describe every teenager ever as emotionally unstable and a little bit difficult sometimes. But if you probe Enya on what exactly this looked like during her teenage years, this is what you'll find out.

• 2:13Speaker 04

  My emotions were starting to become very extreme. So I could go from extreme euphoria and happiness to, at times, suicidal allegations or just absolutely horrific amounts of emotional turmoil. And I didn't really understand why.

• 2:32Speaker 03

  And that would be within the space of a day sometimes?

• 2:35Speaker 04

  That would be in the space of hours.

• 2:37Speaker 03

  Oh, my gosh.

• 2:38Speaker 04

  Yeah. And as time went on and I heard the whisperings of borderline personality disorder, to be honest, when I was diagnosed, it just made it even worse because it just sent me even further into the depths of despair.

• 2:56Speaker 03

  Borderline personality disorder is one of the most stigmatized of all mental illnesses. It's characterized clinically by impulsivity, emotional instability, and difficulties in personal relationships. People often have a massive fear of abandonment and they can shift suddenly from idealizing someone to despising them.

• 3:18Speaker 04

  Oh, I could end up in screaming fits of rage and reassurance-seeking relentless.

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  If the disorder can leave someone's personal life in disarray, just think how hard it can make it to hold down a job.

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  I thought that if my employers knew about my diagnosis, that I'd be not offered a job or not trusted.

• 3:39Speaker 04

  I was still maintaining my job and my career, but I was starting to self-isolate and not speaking to anybody.

• 3:45Speaker 03

  Many people with BPD struggle to work at all, and the disorder is associated with high rates of unemployment. But that's not to say a job or even a career is out of the question for everyone. So how do you manage a career when you're balancing it with BPD? Enya actually posed this question to us. She's a listener who wrote in. And this is an interesting question because it's an aspect of living with borderline that doesn't get much attention.

• 4:13Speaker 05

  So much that you hear about BPD is you're an attention seeker, you're manipulative, you're a monster, you're the colleague from hell. The struggle that people with this diagnosis have is how to untangle yourself from these stereotypes and these messages.

• 4:29Speaker 03

  So today, we've got the stories of two women who've navigated a diagnosis of borderline personality disorder while surviving and thriving at work.

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  Over the years, I've felt safe enough to actually tell the truth. Those moments have been really scary.

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  Those bouts of intense rage, they're few and far between. I'm a much different person.

• 4:54Speaker 03

  From ABC Radio National, this is All in the Mind. I'm Sana Qadar.

• 5:05Speaker 04

  I started driving boats at about age 23 or 24, which was quite a natural progression, I feel, just given my upbringing. So yeah.

• 5:15Speaker 03

  By her early twenties, on the outside, it looked like Enya was doing great. She had a job, she was functioning.

• 5:21Speaker 04

  I feel like the first few years of that, I was absolutely fine and performing as normal, taking a lot of pride in my career, absolutely.

• 5:32Speaker 03

  But as time went on, on the inside, a different story started to unfold.

• 5:37Speaker 04

  I started behind the scenes, which I'm not sure if anyone noticed, but self-harming behaviour, like cutting myself. So that would be even in the workspace, you know, I'd hide it very well. But going through such intense emotional turmoil, it's self-injurious behaviour can be one of the ways that we use to cope with that. And unfortunately, I felt at the time that it did help. Now I know that there are other ways to cope with such intense emotions. And also self-medicating, which is, it's common for BPD to have co-occurring like alcohol use disorders or addiction problems. And I was certainly experiencing that.

• 6:22Speaker 04

  It severely impacted my daily functioning and, and yeah, I just slowly started to lose interest in work.

• 6:31Speaker 03

  When did you get a diagnosis of borderline personality disorder?

• 6:35Speaker 04

  At about age 26, I went into hospital. I presented a few times being suicidal. So I was taken into the emergency ward and this was happening quite frequently at that point. And a psychiatrist diagnosed me with borderline personality disorder, which my parents, actually, especially my mum, she'd sort of alluded to that.

• 6:59Speaker 03

  Oh, wow.

• 7:00Speaker 04

  You know, in the months and years before. So she's worked in the mental health sector and she sort of picked up on it. And I just didn't want that diagnosis at all. I wanted to run as far away from it as I could. It was so foreign and scary to me.

• 7:15Speaker 03

  Was there a particular crisis that led to the diagnosis? Or was it just an accumulation of visits to the, you know, hospital that finally someone was like, let's look at what this is?

• 7:26Speaker 04

  I think the accumulation of visits and also I was just, I still wanted to be here despite, I guess I always called it like the magnetism of the suicidal ideation. It was just all consuming, all consuming. I'd just be in tears every day at work and it's, you just cannot, or I felt that I could not relieve it from my head. It was just this evil devil on my shoulder.

• 7:58Speaker 03

  If suicidal ideation was like a devil on Enya's shoulder, on her skin, was evidence that she was a monster. She was diagnosed as well with having body dysmorphia. And the nature of her dysmorphia made it even harder for her to stay in her job, driving boats.

• 8:16Speaker 04

  When I'd look at my hand, it was quite delusional thinking. I'd almost see my skin crawling in front of me. Like it just, I just felt, as I said, I was a monster and just looking at my hands would make me burst into tears.

• 8:31Speaker 04

  I did take about nine months off working and that was just so bad because I couldn't even go outside in the sun. I just completely retreated indoors.

• 8:44Speaker 03

  Eventually, Enya managed to recover from the body dysmorphia through therapy, and she was able to return back to work.

• 8:52Speaker 04

  Working on boats and driving small ferries, which I just thoroughly enjoyed.

• 8:57Speaker 03

  And for a while, again, things were fine, until they weren't.

• 9:01Speaker 04

  In later years, when I became very, very ill with the borderline personality disorder, I was taking multiple trips to the doctors, to the emergency room. And I reached a point where I just, I just could not continue. Yeah, I just, I just stopped working altogether. I, I didn't feel that I deserved to be on any sort of benefits. I'm not even sure if I could receive them with what I have.

• 9:27Speaker 03

  How old are you when you stopped working altogether?

• 9:29Speaker 04

  Thirty years old. And so that was, yeah, two years ago. And I spent, yeah, a whole year just partaking in dialectical behaviour therapy and, and yeah, really nurturing myself back to health. And I, I feel incredibly privileged because I know that this is not everybody's opportunity. Yeah.

• 9:52Speaker 03

  There are so many factors that can make holding down a job especially hard for someone with borderline personality disorder. Enya's story covers off some of the factors, like battling suicidal ideation and self-harm. But then there's also issues around dealing with interpersonal relationships. I said earlier that people with borderline often have a massive fear of abandonment and rejection. They can also feel a chronic sense of emptiness and low self-esteem. And all of that can manifest in really unhelpful ways at work.

• 10:25Speaker 06

  We might, when we're starting a job, feel like it takes us a while to understand what the tasks are.

• 10:32Speaker 03

  Mm-hmm.

• 10:32Speaker 06

  Feel that, you know, our manager or supervisor might be observing how we're going. That will be much more personalised and the person will be more likely to feel scrutinised, criticised, potentially misinterpret feedback that they're getting.

• 10:47Speaker 03

  For a person with BPD, it becomes what, much more of a reflection of their core self or what?

• 10:53Speaker 06

  Yeah, it does. And also like just an overwhelming emotional response that can be really difficult to manage.

• 10:59Speaker 03

  This is Suzanne Dawson. She's an occupational therapist and senior research fellow at Flinders University and the Southern Adelaide Local Health Network. She's noticed that people with borderline often churn through many jobs because of this kind of emotional sensitivity. And so what do you specifically do with people in your role as an occupational therapist? Because I think for a lot of people, when they think of an occupational therapist, they think of someone who like helps you get the chair and desk height right or something, you know? So like, what is it that you're doing in this space?

• 11:31Speaker 06

  Yeah, so in mental health space, occupational therapists are a core member of the team. We very much have a lens on supporting a person to engage in whatever is meaningful for them. So I think the OTs in the teams, occupational therapists, are really good at keeping employment on the agenda as a genuine possibility. I think health professionals can have low expectations for people living with a mental illness, including BPD. So I think OTs are good at challenging that.

• 12:01Speaker 03

  And because employment is a social determinant of health, Suzanne views helping a person get work and stay in work, if that's what they want, as a health intervention.

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  For all of us, it gives us something to get up for, it gives us financial security, social connection.

• 12:18Speaker 03

  But for people with borderline personality disorder, sometimes the challenges begin before the job even has a chance to.

• 12:25Speaker 06

  So at that sort of interview stage, I know one of our employment specialists was working really intensely with someone who had a lot of skills and they had an interview arranged and they just didn't even actually feel able to make that interview. And then they dropped out and lost contact with the services, mental health services, the employment supports for about a month.

• 12:47Speaker 03

  Oh, wow.

• 12:48Speaker 06

  Because they felt a lot of shame that they hadn't gone. In terms of that work, I think there was someone, this person's coping strategy was if they felt stressed, they would go home and use drugs. They didn't have the best supportive networks perhaps. And so that then impacted on them being able to return the next day. So then you would have a knock on effect of feeling that they couldn't then return two or three days later to a job that they'd just suddenly not phoned in sick for or anything like that.

• 13:15Speaker 03

  There's a stigma with BPD, isn't there?

• 13:17Speaker 05

  Yes.

• 13:17Speaker 03

  And there's this idea that people with BPD are just nightmares and too hard basket. And I wonder if managers tend to perhaps take that approach when they find out an employee has this, or they're dealing with the volatility of an employee. Do you have any sense of how managers deal with this?

• 13:36Speaker 05

  Yeah, well, we actually don't encourage people with any specific mental illness to necessarily disclose what the diagnosis is.

• 13:44Speaker 03

  Right.

• 13:44Speaker 05

  Because of what you're talking about, the assumptions that just exist in the community. So it's the same with someone who has a diagnosis of schizophrenia. There's a lot of stigma there as well. So what we tend to encourage people to do is talk about having a mental health condition or mental health issues and being very specific on how that impacts them in that work situation. So kind of avoiding that need even for there to be judgment around a specific diagnosis because you're 100% right.

• 14:19Speaker 05

  It really frightened me because I thought that if my employers knew about my diagnosis that I'd be not offered a job or not trusted, or somehow seen as dangerous or dishonest or manipulative, all of the stereotypes that are associated with BPD.

• 14:36Speaker 03

  This is someone who goes by Rosie Cappuccino, a pen name. She got her borderline diagnosis while at university in her twenties. And these days, she's a successful teacher and author in the UK. But for a long time, she wasn't sure that would ever be the case.

• 14:52Speaker 05

  I did have a few moments where I thought, is my career going to not happen? Because I knew I wanted to work with children. And to work with children, you obviously need to be trustworthy. People need to see you as able to care for others, have loads of positive qualities that are associated with working with children. And I think I knew deep down that I had these, that I was able to do it. But I was just so worried about how I'd be viewed. And I remember one interaction that I had with a doctor, which was really positive. She was my GP at university. And she said to me, Rosie, I think you'll be really good working with children with special needs, but I think that your empathy will help you connect with these children.

• 15:34Speaker 05

  And for me, that was, that was such a moment of hope that I'd seen somebody in a position of power, trust me and see me for who I was, not see me for the stereotypes that are associated with BPD.

• 15:50Speaker 03

  In her work as a teacher, Rosie has grappled with the exact dilemma that Suzanne Dawson mentioned a moment ago, whether to tell people about her diagnosis and how.

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  Especially when I was younger, I would find it easier to talk in more vague terms.

• 16:05Speaker 03

  But over the years, as her confidence has grown, Rosie has felt comfortable sharing with some colleagues.

• 16:11Speaker 05

  Those moments have been scary, really scary, because nobody wants to be misrepresented by a label. And it's, it's emotional to even, to even talk about how much it means to me to kind of have somebody to say that they, like, they accept you and, you know, that they don't see you as any different and they value your work and they value you and they, like, they value the experiences that you bring and the diversity and the kind of perspective that you bring. And I just wish that every person had the opportunity to feel like that way in their workplace.

• 17:04Speaker 03

  You're listening to All in the Mind from ABC Radio National. I'm Sana Qadar. Today, managing a career when you have borderline personality disorder, one of the most stigmatized of all mental disorders.

• 17:19Speaker 03

  Now, I mentioned earlier how navigating interpersonal relationships can be especially hard for people with BPD. And there's one common symptom of the disorder that can really wreak havoc on relationships. It's a behaviour called splitting. And this is something that Enya struggled with, both in her personal life and at work.

• 17:41Speaker 04

  So splitting, I guess, is just very black and white thinking. So whether it's going from idolising someone to completely devaluing them, there's sort of no in-between. And I certainly, when I was very unwell, I experienced a lot of splitting. Splitting can happen for hours on someone, can happen for months. In my experience, unfortunately, I still am healing this, but I've split on someone that's close to me and that's been years. And I'm working through therapy to see that there are shades of grey, it's not just black and white. So if you're splitting in the workplace on someone, you're going from maybe being a good friend and colleague to absolutely not liking them or not agreeing with what they're

• 18:26Speaker 04

  saying. It's, it's, it's can be a trauma response, but it can be very difficult for that colleague to really understand why you've gone from being such a great person to them one day to maybe not the nicest the next. And yeah, that's difficult to work with.

• 18:43Speaker 03

  Would that happen often with you?

• 18:45Speaker 04

  My BPD was quite internal, so yeah, it would happen often, but I wasn't necessarily voicing it. But I'd feel it, I'd definitely feel it, but I'd try to hide it, yeah.

• 18:56Speaker 03

  And so would it be like, you know, over like a somewhat minor thing someone might do, you know, people are annoying in the office or, you know, wherever you're working often? Would it be small things that led you to do this kind of splitting?

• 19:07Speaker 04

  Probably like small or big things, just now I can catch myself and realise, oh, I'm splitting. And I will actually say it to my partner, who I work with. Or he'll say, "Enya, you're splitting." And then I use my skills and I bring myself back. But yeah, it can be over anything.

• 19:28Speaker 03

  These days, Enya spends most of her year working on a small commercial fishing boat. From March to December, she's at sea.

• 19:37Speaker 04

  We did a lot of exploration last year, so roaming around the Gulf of Carpentaria, finding new fishing locations.

• 19:44Speaker 03

  The only crew members on her boat are herself and her partner.

• 19:49Speaker 04

  Pretty much spend 24 hours a day together.

• 19:52Speaker 03

  And the days can be long and exhausting.

• 19:55Speaker 04

  We wake up at about 5 and start heading out to our fishing grounds for the day, which could be 20 minutes or two hours away. And then, pretty much depending on the tide and the bite of the mackerel, you might be straight on. You'd just be flinging large mackerel onto the deck of the boat and putting them in the brine. And you wouldn't stop. You want to hope that you'd had your coffee for that morning and you wouldn't, you wouldn't stop for like four hours.

• 20:21Speaker 03

  It's only once their brines are full that Enya and her partner stop fishing.

• 20:27Speaker 03

  But that's not the end of the day. Then they have to move on to immediately processing the fish.

• 20:32Speaker 04

  Onto the knife and start filleting. So that could take us about five hours to process. That's an ideal day, but maybe the bite is later. So we'd spend all day listening to music, then not catch a single thing until 5pm and then it's on.

• 20:49Speaker 03

  And then are you going back to harbor at the end of the day to drop off your catch? Or what happens?

• 20:54Speaker 04

  No, sometimes we go two weeks without seeing anybody.

• 21:00Speaker 03

  It's just her and her partner and the fish on this boat where there isn't really anywhere to escape to if you're not getting along. Enya still sometimes experiences those big flares in emotion that she talked about earlier. But now she has the tools for dealing with them.

• 21:16Speaker 04

  Now using my skills from DBT to just walk away, even though you can only probably walk about 10 metres away, but just at least walk into the cabin and, and take some time to cool down and, and yeah, go through my little mental checklist of how to bring myself back into a bit more of a wise minded state.

• 21:37Speaker 03

  Is dialectical behaviour therapy. It's a talking therapy that is the first line treatment for people with borderline. It's based on cognitive behaviour therapy, but it's been modified for people who feel emotions extremely intensely. It emphasises skills like tolerating distress, considering different perspectives and regulating emotions. Enya does it online and she says the skills she's learned are literally life-saving.

• 22:03Speaker 04

  So we meet once a week and it's in a group session. It's conducted via Zoom. There's a core component of mindfulness, so learning about the wise mind as opposed to being an emotional mind or a rational mind. But something called the wise mind, that's the balance between the rational and emotional. And it helps to recall that just to bring yourself back from extreme emotions. And we also do something called distress tolerance. So there's several skills associated with distress tolerance, emotional regulation.

• 22:38Speaker 03

  What skills did you learn in order to tolerate distress better?

• 22:41Speaker 04

  Things like using temperature. So I'm quite a fan of just cold water, splashing it on my face or holding ice to ground myself. Something called radical acceptance, which just helps me to accept a situation as it is.

• 22:59Speaker 03

  DBT has been around since the seventies, which means there's plenty of research on it. It's very effective at reducing anger and self-harm and improving the general mental health and function of people with borderline. And whereas before you had these skills, would that kind of state of anger just sort of drag on? Or yeah, how is it, how different is it to how things were for you before?

• 23:22Speaker 04

  Oh, I could end up in screaming fits of rage. It's, it's, yeah, I feel ashamed of it, of course. Like, I don't like to associate with that sort of behaviour, but it is part of the illness. If you're, you know, you're not in a state of healing. So yeah, screaming fits of rage and reassurance seeking. It could just be relentless. I would not give up. And then eventually, as always did happen, I'd just end up in tears. And then, you know, following on from that, I'd end up, you know, hitting myself or cutting myself to deal with the shame of my reaction. Um, yeah, it was just, it wasn't, it wasn't right.

• 24:04Speaker 04

  It definitely wasn't normal behaviour, but it was very real and scary.

• 24:09Speaker 03

  And now you can sort of nip that in the bud early on.

• 24:12Speaker 04

  Definitely, yeah. It's a much healthier place to be and I'm genuinely happy. And those bouts of intense rage, inappropriate anger, they're few and far between. I'm a much different person and I look forward to seeing who I'll become in five or 10 years, you know?

• 24:34Speaker 03

  Like Anya, Rosie has also done DBT. For both of them, it's been a critical part of what's enabled them to work and build their careers. And in turn, working has given them so much.

• 24:47Speaker 05

  I've derived strength sometimes from getting out of bed in the morning and just going to, going to my job and seeing the children smiling and deriving just joy from that. I did have a time in my life when I was struggling so much and I didn't know how I was going to get up in the morning. I was crying late into the night, every night, very distressed, even suicidal. And somehow going to work the next day and just trying to kind of like, I guess, put on a brave face. I found that really, a really useful thing to have that structure as well. And to feel like I was contributing something because I've had so many times in my life when I felt like

• 25:31Speaker 05

  a waste of space, worthless, suicidal, bleak, destitute, everything, even though I wasn't. I know I wasn't. I had people who cared for me. I had people that I loved. But there was just something inside of me that felt so worthless. So I think having that job where I could go and see, see that I was having a positive impact on other people, that, that was really valuable.

• 25:56Speaker 03

  Her advice to other people who have BPD and who might be feeling unsure about their work prospects is to have patience.

• 26:04Speaker 05

  It's all about finding the right role for you, the right workplace for you. If mistakes happen or something doesn't work out, you've got plenty of time ahead of you to find something new. But I would say, don't be afraid of working with people if that's what you want to do, because it might turn out to be like the making of you. You might be really good at it and that might become a source of self-esteem and pride for you like it is for me.

• 26:31Speaker 03

  And occupational therapist Suzanne Dawson has some practical advice as well.

• 26:36Speaker 06

  I think it's very much up to you, the person, whether they want to disclose specific information about the diagnosis. But certainly create a wellness plan. So what keeps you well on a day-to-day basis? What are possible early warning signs and/or triggers for relapse? And look at strategies that help you manage your mental health and wellbeing. I guess just really believe that work is possible and that you have a lot to contribute.

• 27:05Speaker 04

  I feel grateful that I didn't end it all and that I'm still here. I feel proud of my partner that he stuck it out with me. And yeah, I feel genuinely happy now and I feel stable. And so that makes me proud. When I, it is difficult to recall just how extreme the roller coaster ride was. And when I compare it to now where I still have my days or half-days, but I'm able to pull myself back with the skills I've used and the support of my therapist and my partner. And, you know, I'm a very loving person, but I struggled with friendships for a long time.

• 27:47Speaker 04

  I've recently made a beautiful friendship and I just love it a bit. And, you know, it's, all of these things have been life-changing. I could never have dreamt that when I was so unwell that this would be where I'd end up on part of the healing journey.

• 28:08Speaker 03

  That is Enya, who works in the maritime sector and lives with borderline personality disorder. You also heard from teacher and author Rosie Cappuccino, and occupational therapist and senior research fellow at Flinders University, Suzanne Dawson. Now, one thing I wanted to mention that we didn't get to in this episode is that historically, and probably also contemporarily, borderline as a diagnosis has been wrapped up in a lot of sexism. Women are far more likely to be diagnosed with borderline personality disorder, but that's not to say that the disorder doesn't exist either. It's a really meaty angle on this topic, and it's something I'm keen to explore in a future

• 28:52Speaker 03

  episode of All in the Mind. So if you have any stories relating to sexism and borderline, or perhaps misdiagnosis, send us an email on [email protected], and we will aim to potentially include your story in a future episode. That's it for All in the Mind this week. Thanks to producer Rose Kerr, senior producer James Bullen, and sound engineer Beth Stewart. I'm Sana Qadar. Thanks for listening. I'll catch you next time.

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