Unstable Identity – A Nonbinary Experience of Borderline Personality Disorder
By Eliza McCubbin (they/them)
The transgender experience of Borderline Personality Disorder (BPD) is an intersection rarely discussed. Despite the impacts it can have on relationships, wellbeing, and health care. I want to share my experience with BPD. And explain how coming out as nonbinary has impacted my mental health.
Note: This post mentions suicide and suicidal feelings.
When I was unwell, my life was chaos. I experienced sections, crisis teams and intensive therapies. I was forced to drop out of education. Countless relationships were obliterated. And I almost lost my life.
My moods would bounce from severely depressed to hypomanic. I hallucinated bugs crawling under my skin and I heard voices in my head. I would dissociate for hours and believe that people were out to hurt me. I cut people from my life out of fear, and I clung to those who were left. I felt totally out of control and didn’t see the point in continuing.
Over a number of years, I did manage to recover, and today I am managing my mental health well. Finding the right combination of medication, restarting education, and having positive relationships has really helped me. Mental health is no longer the only thing in my life, and I know my life is worth living.
BPD and Gender Identity
As I came out of the crisis years of BPD, I began to question my gender. BPD had confused my general sense of identity. I dyed my hair different colours and legally changed my middle name. This contributed to my general distress. And it prevented me from realising what was actually wrong.
Hallucinations and dissociation further complicated my sense of self. When I dissociate, I experience a disconnect. The world around me feels unreal and time moves more slowly.
When I dissociated regularly, the connection between my body and myself felt severed. I no longer knew who I was. Regularly hearing the voice of a man in my head made me believe my gender confusion was just another psychotic experience. It stopped me from acknowledging the reality.
Gender dysphoria is a condition where people feel discomfort and unease with the sex they were assigned at birth and their gender identity. Gender dysphoria in nonbinary people is complex, because they don't necessarily conform to masculinity or femininity.
For me, gender dysphoria feels like I'm in an alien body. Phenomenologists believe bodies are not just our organic matter. For example, a wheelchair user’s chair may be part of their extended body. They might therefore feel violated when someone touches their chair without their consent.
And some people might not recognise parts of their organic matter as their body. A trans-masculine person may feel disconnected from their breasts and not recognise them as belonging to their body.
What I recognise as ‘me’ is not fully represented by what I see in the mirror. It’s not that what I see in the mirror is objectively ugly. I just feel a sense of dis-ease existing in a body that isn’t me.
Dysphoria and other challenges
Experiencing gender dysphoria as someone with BPD is incredibly difficult. People with BPD can experience extreme emotions, and this can amplify sensations of dysphoria. Such intense feelings of dysphoria can cause dangerous impulsions.
Relationships change when you transition, and the process of ‘coming out’ is painful. People are sometimes estranged from their families and friends for being trans. So you carry a pervasive worry that this might also happen to you.
People with BPD already struggle with worries of abandonment. So when there's a reasonable chance this might happen, it can be oppressive.
Even beyond the initial ‘coming out’ conversations, there's a constant need to advocate for yourself. Most people have never met a trans person before, so you're forced to adopt the role of educator. Even when you're the one that needs support.
My girlfriend has taught me to advocate for my name and pronouns by correcting anyone who misgenders me. Without her, I wouldn't have been able to do it.
Most people seem unaware what is and isn't appropriate to ask someone who is trans. There's a desperation to categorise people into ‘women’ or ‘men’.
Anyone who doesn't stereotypically conform to this can face interrogation about their genitals or sexual preferences. I feel scared every time I enter a single sex space because I've experienced hate. And I'm likely to experience hate again.
People with BPD are regularly described as being like burns victims. What for most people is a light touch can be excruciatingly painful for us.
The inappropriate comments and discrimination I face hurt so much more because of my BPD. The constant misgendering and offhand remarks never leave my head. I was lucky I transitioned when I did, as I don't know how I'd have coped when I was unwell.
The biggest thing that has affected my mental health in recent years is the lack of trans health care. I need hormones and surgery to relieve my dysphoria and live comfortably in my own body.
After dealing with dysphoria for a long time, I went to my GP in 2022. My GP treated me with respect and referred me to a gender identity clinic. I later found out that the clinic has a waiting list of more than 7 years and only saw 2 new patients in 2022.
As of today, I'm still not on the waiting list because they haven't read my application. Dysphoria affects my mental health, so without trans healthcare, it's harder to manage my wellbeing.
I'm not alone in this – the Human Rights Campaign found that 41.8% of non-binary youth in the US have attempted suicide.
My dysphoria was reaching an unbearable point and I knew I needed to start hormones. Buying hormones on the internet isn't illegal, but it's dangerous and unregulated.
To start hormones safely, you need psychological evaluations and blood tests by professionals. Unregulated hormones have no oversight, and you can't be sure what's in them.
But it's common in the trans community to buy hormones online. Because private healthcare is unaffordable for many and NHS waiting lists feel eternal. This can lead to life-threatening complications.
Fortunately, my GP service was one of the few practices in England offering bridging prescriptions. Bridging prescriptions are hormones given to trans people at risk of self-administering hormones. GPs aren't qualified to administer this medication. But they recognise the risk of leaving trans people on a waiting list and see it as a harm prevention strategy.
If the GP did not give me a bridging prescription (as most surgeries don’t), I'd likely be on unregulated hormones. I'm on long-term psychiatric medications, so I'm concerned what this would have done to my body.
It's easy to think, ‘don’t take the medication’. But it's important to understand that lots of trans people need hormones to function. So the risks associated with unregulated hormones seem worth it.
The solution is to give better access to trans healthcare, but for most people this isn’t an option.
BPD and Discrimination
Trans people can face barriers when dealing with healthcare. And people with BPD can also be directly discriminated against. I'm concerned the gender identity clinic will refuse to see me, because they reject people with significant mental health problems. Even if my gender dysphoria exacerbates these problems.
My referral letter said my gender dysphoria was likely because I'm mentally ill. And because of that, my GP barred me from accessing medical support.
As someone who's had psychotic experiences, I've been trained to devalue my perception of reality in favour of what medical professionals think. It's taken me a long time to trust that my identity isn't a product of my mental health conditions. It's a result of my recovery.
The data is ambiguous on whether BPD and being transgender are linked. So it makes no sense to screen people with BPD out of gender services. Having BPD doesn't make you pretend to be transgender. And the extra barriers for people with BPD make life harder.
While coming out as nonbinary has posed a lot of challenges, a lot of good has come from it too. Knowing that a lot of the dysphoria I felt was because I was nonbinary is helpful. I know this is something I can solve, rather than something that's ‘wrong’ with me.
I hope to start a bridging prescription of hormones in the next few weeks. I've needed this for a long time, and it gives me hope for the future.
Coming out has also given me a sense of identity that BPD deprived me of. I'll always be more vulnerable than other people, but I've learnt to regulate myself and live a good life. The process of coming out has helped me to understand my identity beyond my mental health diagnosis.
This post is part of the Communities Team's Borderline Personality Disorder Awareness Month project.