You must have come across or even presently know an individual whose views about the world or other people are so disconnected that they simply beg the mind to take a second look at the person. We have them as neighbours, sharing the same apartment blocks, as co-tenants, as friends and colleagues at work and as spouses. At work, therefore, at places of worship and in our homes, people who behave out of the norm that convention recognises are right there before our very eyes. In many instances, it takes a while before we accept the fact that these are different kinds of people. They are described as people who have borderline personality disorder, an illness that is characterised as a mental health condition that impacts the way you think and feel about yourself and others, causing problems in the pattern of behaviour in everyday life. It is a mental illness that severely impacts a person’s ability to regulate their emotions and how they address others. It is the most commonly recognised personality disorder. Their impaired emotional control or loss of it can lead to the development of often intense, negative emotions that become evident to everyone around them from time to time.
It is common for people who suffer from this condition to feel suicidal with despair and then begin to have positive feelings about themselves in a matter of hours. They experience intense mood swings over a short period of time. The pattern varies from one person to another but many of the sufferers feel better in the morning while feeling worse in the evening. In other people, the pattern is a complete reversal. However, the bottom line for most victims of this condition is that their mood swings in unpredictable ways during which they can degenerate from elation to despair in a short while. Mostly, their emotions are negative. They are also capable of intense negative emotions and they can range from shame to terror to panic and then to rage. Then, they sink into long-term feelings of loneliness, lack of achievement, emptiness and despair. There are some key symptoms of having this mental health condition and it is important to stress that not all of them need to be present in an individual before they are diagnosed with the condition. Some of these symptoms are as follows:
1) Extreme emotional swings
2) Chronic feelings of emptiness
3) Fear of abandonment or of being left alone, whether real or imagined
4) An uncertain image of self or a shifting self-image
5) Unstable relationships with others even though they are often intense
6) Explosive anger
7) Self-harm
8) Impulsive, destructive behaviour
9) A lack of self-confidence and low self-esteem
As stated above, people with this disorder could suffer from shifting emotions. They may be aggressive and hurt themselves. They experience such a desire sometimes, to hurt themselves in order to attract attention, and they may abuse drugs or alcohol. In women, their self-identity can degenerate into feelings of low self-esteem. Her long-term goals in life can shift constantly with confusion over how to proceed with literally anything. Career plans, working opportunities, friendships and even relationships with loved ones are unstable over time. Even her values are shifty and uncertain and often change. In this way, certain principles which she may hold dearly onto as irreducible yardsticks are often at variance with what other people value as important. These sore points are often guaranteed, therefore, to generate conflict. Women tend to receive this diagnosis far more than men and the potential causes leading to the condition include a genetic predisposition and past traumatic experiences. Some research work indicates that women are three times more likely than men to have the diagnosis. Other workers say there is no difference in incidence between males and females. The causative factors are obviously likely to be multiple, ranging from certain structural abnormalities in the brain to environmental factors such as early childhood trauma.
Some of these traumatic events include such things as physical, emotional or sexual abuse during childhood. Or the subsequent behaviour may be due to domestic violence witnessed in childhood, bullying at school, neglect, family divorce, separation or death of a parent. Current research indicates that there is also a significant link between such childhood trauma and the later development of borderline personality disorder. In nearly half of all cases, such trauma is likely to be due to sexual abuse, which makes it all the more likely that this problem is more commonly seen in females. This is not the exclusive cause, of course, and it may not even play a role. But it is always important to explore that angle when such a diagnosis is suspected. Many such women are alternately talkative and severely quiet in an interchangeable way. There is a tendency to also believe only in their truth and they often will twist events, and recreate others, all in order to win an argument or emphasise a point. Despite their relatively poor academic records, they are anxious to prove that they are also clever and that they have an understanding of common things and complex ones. Frequently unwilling to accept any wrongdoing, they are quick to blame others and also lampoon them for falling short of certain values.
The value system that these people have colours their impression of the people around them and their own self-worth. They often feel fragmented and experience real or imagined episodes of victimisation. They could even generate a crisis within a relationship and somehow want to assume the role of the victim. In the context of a relationship with others, this is often a reason for friction. In an emotional relationship which is already a complicated space, the drama associated with someone who suffers from borderline personality disorder can vary from sincere admiration to hatred in a matter of days. Their feelings about others can then shift from admiration or love to anger or dislike after what they may perceive as a disappointment. When they believe they have lost some esteem in the eyes of someone they value, all those emotions can be freely expressed within the context of their values. It is usually not an easy thing to try to reason with them because in their eyes, they are correct. Therefore, within such a relationship, there are increased levels of chronic stress and conflict, decreased satisfaction of romantic partners and increased inability to find common ground. This is referred to as splitting.
In a working environment, this range of emotions undermines cohesion in the office and promotes conflict. It also shakes the very idea of family relationships and impacts negatively on family bonds. The irony of their mental status is that they desire to be close to their colleagues and strongly crave intimacy in an emotional setting but in reality, when they are placed in such an environment, they become ambivalent and insecure and wish to avoid contact. Such women will view the world around them as dangerous and even malevolent. People with BPD have a lot of trouble seeing their identity clearly. They may not recognise what they truly value, believe, prefer or enjoy. Long-term goals are never certain with them, and they are often more likely than not to feel empty and lost. As a result, their self-image can change very quickly from a healthy positive to an ugly negative. In this way, they can just regress into a cocoon such that even their facial and vocal expressions can become expressionless as they become distracted and impervious to all kinds of stimuli, including emotional ones. Finally, these folks have trouble keeping any job. Their treatment involves plenty of talking to let them know that nothing is wrong with them and that they could do better. But that is not an easy task.
Questions and answers
Dear doctor, you have not replied to my message of February 26, 2023, when I said that a friend is seeking advice from me that he doesn’t discharge sperm whenever he has sex whereas he gets an orgasm. He does not ejaculate, but he is on drugs for prostate (duadant). 080331****
I have searched through my messages but did not find yours. It is probable then that it was not delivered. The name of the medication is Duodart and it is used in the treatment of those men who suffer from benign prostatic hyperplasia. It works by relaxing the muscles around the prostrate so that the flow of urine is made easier. A common side effect is called retrograde ejaculation in which the semen that is ejaculated flows backwards into the bladder. It is then passed out later during urination. This is what your friend is probably experiencing.
Dear doctor, how are you doing? Congratulations on your 10th anniversary in advance. Thank you very much for your Sunday tonic; may the good Lord continue to strengthen you and increase your wisdom. I have contacted you twice some time ago for advice and you obliged. I support the suggestion of one of your readers that you should produce a compendium of your writings to mark the anniversary. It may not be possible now but put it in mind to be done later. 080565****
Thank you very much for your prayers, comments and support for me and this column over the years. I appreciate you immensely and know that nothing we have done here would have made any impact without people like you who read the essays and feed us back.
Dear doctor, please I need your help with something odd that developed in my two wrists about four days ago. Both wrists are swollen and painful. Movement is difficult and I cannot lift most things. I will send you a picture of the wrists. I don’t know what to do about it and that is why I am sending this message. I am presently out of the country and here, no hospital will attend to me unless it is an emergency, or with the way it is, I might get a long appointment, so if you can just tell me what medicines to get across the counter that will help me, please do so. 08164****
Thank you very much for your question. From the pictures, you probably have a kind of arthritis more commonly seen in women. We will not bother you with the name. However, as we have no indication of your age, my suggestion will be that you obtain Diclofenac gel at the neighbourhood pharmacy and apply it twice a day to both wrists by just rubbing it in gently. Also, you should get Ibuprofen tablets at 400mg twice a day after meals for 10 to 14 days. Depending on how severe the pain is, you can even take this medication along with Tylenol. All of that should help control the pain until you return to Nigeria.
Dear doctor, please I need your attention. I went for a lab test and the results show that my cholesterol level is high (290) and I am H.pylori positive. I took the results to a hospital and the doctor I saw there gave me only one type of drug. When I received the drug from the nurse, I went back to the doctor to confirm because to my untrained mind, I was having two problems (H.pylori and high cholesterol), but the doctor said to me that he prescribed medication for the cholesterol only since I was not having any pain inside my stomach. He even advised me to minimise the intake of salt and pepper and to make sure I always ate on time. He told me that if I did all these, there was no need for drugs. I was not comfortable with that explanation and even as I got home, I discussed it with my wife and we decided to reach you here. Kindly assist me to take care of this H.pylori before it grows more than what Nigerian hospitals can handle, sir. 080234****
Well, you ought to get treatment for the H.pylori. It is a good thing that you do not yet have any symptoms. However, that is actually an infection and it is curious that a doctor is refusing to give you medications to get rid of it. There is a triple regimen of medications, which includes at least two different antibiotics and a proton pump inhibitor that are used for this purpose. I am assuming you are an adult since you mentioned having conversations with your wife, so that even though we do not have the benefit of knowing how old you are, you can safely use those medications. My advice to you is to take your results to another hospital, preferably a public hospital, so that you can get the prescription you need. Good luck.
Dear doctor, stroke is a very deadly disease. It is an incurable disease which crippled the legs of my late dad. What is your view? 080638****
Your assertion is not completely true. The early diagnosis of a stroke and early arrival in a hospital that is equipped to deal with issues like that can avail much. With such treatment, early surgery where that is deemed useful and early institution of physiotherapy, many people these days are surviving strokes. Somebody like Margaret Thatcher had a series of strokes in the latter years of her life and survived all of them until she finally succumbed to the last one. I know it’s a different story in our country.
Dear doctor, my father is a 75-year-old man and he has a hernia beside his penis. We are told that he needs an operation. Is it necessary for him to do it? Is it not too dangerous? We are actually concerned about this because he is quite old. 080232****
It is not dangerous. It is quite safe considering modern anaesthetic techniques. He will not need to be put to sleep in order to get this operation done. There are far more dangers involved if you allow time to pass and complications develop. So, heed his doctor’s advice and brace yourselves physically and psychologically for the operation.
Dear doctor, I am 58 years of age. I have one daughter aged 13 years. I weigh 61kg even though I am not that tall. Is this normal? I don’t feel like I have energy most of the time, so please advise me on what to do. Thank you. 09014****
It all depends on if that is your stable weight, or you have lost some. If you have lost weight, then how much and over what period of time? In this kind of scenario, it is far more useful for you to go to a hospital, probably a private one, where they will have the time to examine you properly and determine your ideal weight. And if you have recently lost a large amount of weight, to determine what is responsible for that.
