What Is the Hardest Mental Illness to Live With?

Determining the “hardest” mental illness to live with is subjective and can vary greatly from person to person. The impact of a mental illness depends on a multitude of factors, including the individual’s personal circumstances, the severity of the symptoms, the effectiveness of available treatments, the support system in place, and how the illness affects their daily life.

However, certain mental illnesses are often noted for their particularly challenging nature, either due to the severity of their symptoms, the difficulty in treating them, or the way they impact one’s life. Some of these include:

Schizophrenia

This chronic mental disorder can be very disabling, characterized by delusions, hallucinations, and other cognitive difficulties. Schizophrenia can make it challenging for individuals to distinguish between reality and fantasy, manage emotions, make decisions, and relate to others.

Severe Bipolar Disorder

This involves extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). These mood swings can affect sleep, energy, judgment, behavior, and the ability to think clearly.

Borderline Personality Disorder (BPD)

Characterized by difficulties in regulating emotions, which can lead to impulsive actions and unstable relationships with others. People with BPD often have an intense fear of abandonment or instability, and they may have a hard time tolerating being alone.

Major Depression and Treatment-Resistant Depression

While many people with depression respond well to treatment, those with treatment-resistant forms may struggle significantly, as common treatments like medication and therapy may not provide relief.

Obsessive-Compulsive Disorder (OCD)

OCD can be particularly debilitating when the compulsions become severe and time-consuming, and the obsessions are distressing.

Eating Disorders

Disorders like anorexia, bulimia, and binge eating disorder can have severe physical and psychological consequences, and they are often linked with deep-seated psychological issues.

Post-Traumatic Stress Disorder (PTSD)

This can develop after a traumatic event and can lead to severe anxiety, flashbacks, and nightmares that significantly impair daily functioning.

It’s important to remember that with appropriate treatment and support, individuals with these and other mental illnesses can lead fulfilling lives. The “hardest” mental illness to live with is highly individual and depends on personal experiences, the effectiveness of treatment, and the support systems in place. Mental health is complex, and it’s crucial to approach this topic with sensitivity and an understanding that each person’s experience is unique.

The world of mental health has come a long way this past decade. Now, psychologists are better equipped to treat mental illnesses. People are also more open to talking about their issues without fearing stigma.

So, What is the hardest mental illness to live with? And why?

Despite being a subjective question, one can argue borderline personality disorder makes a strong contender.

It induces severe symptoms and has challenged professional psychologists for years. So, let’s see what it is and how it affects patients.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental illness characterized by a lack of control over one’s emotions. A BPD patient’s mood can shift from emptiness to anger to paranoia in a few hours.

That lack of control doesn’t just affect patients’ moods, though. It can also cause several behavioral issues. People with BPD are usually quite sensitive and can react to benign events with the most intense emotions.

That’s why it’s difficult for them to build long-lasting relationships. Some patients even believe interpersonal relationships are impossible to begin with.

What Causes Borderline Personality Disorder?

There isn’t a definitive cause that can trigger BPD. In many cases, it’s a combination of several factors.

Genetics

Studies show that several mental disorders can be genetically inherited. If one has a close relative with a personality disorder, they’re at risk of developing the same illness.

Of course, that’s not a decisive factor. It’s merely one of many influential variables.

Dysfunctional Brain Chemicals

It’s no secret that abnormal brain chemistry is one of the primary causes of mental illnesses.

In this case, it mostly has to do with the substances that control our emotions and behaviors, specifically estrogen and serotonin.

The unstable fluctuation of these substances can cause several behavioral issues.

Childhood Trauma

Most BPD patients have experienced a traumatic event that triggered the distress, anger, and emptiness related to the disorder.

These traumatic events include physical abuse, being forcefully separated from parents, or being neglected as a child.

What Are the Common Symptoms of BPD?

Mood swings and increased stress levels aren’t the only signs of BPD. There are various other symptoms psychiatrists use to identify it.

It’s worth noting that most of these symptoms aren’t exclusive to BPD. They’re merely common signs of the illness.

1. Fear of Abandonment

Being abandoned or neglected as a child can be reflected in a BPD patient’s fear of being alone. If they’re separated from their loved ones, even if it’s for a trip or a vacation, they feel an intense fear and anger.

They might even prevent people from getting too close to them so they don’t risk getting hurt in the future.

2. Distorted Self-Image

BPD patients usually have an unstable self-image, a feeling of not knowing who they are or what they believe in. That’s why they’re constantly changing their opinions, values, aspirations, or careers.

They might even bounce between different friend circles, hoping to find a place where they belong.

Sometimes, that unstable self-image plays into their fear of abandonment. They try to be whoever their loved ones want them to be so they don’t abandon them.

3. Dangerous Impulsive Behavior

The lack of emotional control often forces BPD patients to resort to harmful, impulsive behavior. That includes gambling, reckless driving, fighting, or excessive eating.

Some can go as far as substance abuse, suddenly quitting a good job, or ending a relationship.

4. Disassociation

As the name suggests, disassociated patients disconnect from reality. Their body can still move and do all the needed work/chores, but their mind won’t be present.

It’s the brain’s way of dealing with the overwhelming emotions BPD patients are experiencing.

5. Self-Harm

Some believe BPD patients think self-harm might help reduce the overwhelming anxiety they’re feeling.

Others want to voice their suffering and reach out to people but don’t know how. So, they hurt themselves in obvious spots so people can see they need help.

6. Recurring Suicidal Thoughts

BPD patients are in constant pain, stress, and emotional turmoil. They also often think they’re a burden to others. When these feelings accumulate over time, they believe suicide might help relieve them and their loved ones from this suffering.

7. Emptiness

Many BPD patients experience unrelenting emptiness, a feeling of being bored and emotionally unfulfilled.

8. Paranoia

BPD can drive patients to paranoid thoughts, leading them to think their friends and loved ones are deceiving them. These ideas aren’t usually built on a logical train of thought.

This paranoid lens can force BPD patients into going out of their way to try and find threatening meanings in genuine remarks.

9. Anger Management Issues

Anger is BPD patients’ reaction to emotionally triggering events, such as neglect, abandonment, or feeling like a failure.

Whether it’s physical violence, property damage, or aggressive sarcasm, they can express this anger in different ways.

Some exhibit these rage episodes to prompt their loved ones to respond with an act of love, giving them the reassurance they need. Unfortunately, it usually backfires, causing people to be more frightened and distant from the patient.   

Why Is BPD Hard to Live With?

The symptoms of BPD aren’t the only hardships its patients face. The illness has several therapeutic challenges that can make the healing process harder.

Psychiatric Stigma

Mental health stigma isn’t unheard of. It’s why many don’t express they’re mentally struggling or refuse to try therapy in the first place. However, these patients can expect to feel safe and validated once they enter a psychiatrist’s office.

Unfortunately, that doesn’t always apply to BPD patients. Surprisingly, personality disorders face a fair amount of stigma, even in the realm of psychiatry.

A 2015 study shows that BPD patients face more stigma from therapists than those seeking treatment for other personality disorders.

Needless to say, this makes the healing journey difficult for these people. The question is: Why are psychiatrists stigmatizing BPD?

Fear of the Unknown

BPD patients aren’t easy to deal with. Being sensitive to benign actions/words, they might get defensive when therapists try to offer any insights.

That could potentially lead to them lashing out during the sessions, which takes an experienced therapist to know how to deal with.

Inconsistent Recovery

As we’ve already established, BPD patients lack control over their intense emotions. That could lead to an inconsistent recovery journey.

They can make gradual progress in their sessions, then suddenly decide to quit therapy and cut all communication with their psychiatrist. Unstable relationships are too inconvenient for mental health professionals, so they tend to avoid them.

Difficulty to Diagnose

Unlike physical medicine, psychiatrists don’t depend on MRI machines and CT scans to diagnose mental illnesses.

They mostly depend on their observational skills to identify the illness and psychiatric practices to treat it. Unfortunately, this leaves little room for confusion.

Mental illnesses aren’t always distinguishable, especially a personality disorder like BPD. It usually doesn’t occur alone but is accompanied by several comorbidities.

Psychiatrists aren’t sure why that’s the case. Some speculate it’s because its symptoms overlap with those of other disorders. Either way, it makes it difficult for an inexperienced psychiatrist to identify and treat BPD.

What Are the Comorbidities of Borderline Personality Disorder?

There isn’t a definitive set of comorbidities that come with BPD, as they differ from one patient to another. The following six, however, are the most common ones.

1. Bipolar Disorder

Bipolar disorder is a mental illness that prompts sudden mood swings, forcing its patients to shift from hypomanic to depressive episodes. Bipolar patients don’t have much control over their emotions, which results in dangerous impulsive behavior.

Yes, these are the same symptoms of borderline personality disorder. In fact, a 2017 study shows that 20% of patients with bipolar disorder have BPD.

It’s that resemblance that makes it crucial for psychiatrists to take their time analyzing their patients. They need to consider their self-image, relationships, and worldviews to make an accurate diagnosis.

2. Major Depressive Disorder

A 2021 study shows that, in one large group of BPD patients, 83% showed signs of depression. That’s only natural, given that both disorders induce a lack of interest, emptiness, fatigue, and sleep problems.

The primary difference between the two is that low mood is the primary symptom of depression. However, it’s only one of nine symptoms BPD patients can exhibit.

3. Anxiety Disorder

Anxiety disorder is a mental illness characterized by a combination of fear, worry, and panic.

Anxiety patients are usually overwhelmed by these emotions and often feel they’re uncontrollable.

Psychologists still don’t know why anxiety co-occurs with borderline personality disorder. Some believe BPD patients develop social anxiety due to their inability to maintain long-term relationships.

Others believe it’s because of their lack of confidence. A poor self-image can prompt numerous fears and worries, increasing the risk of developing anxiety. 

4. Post-Traumatic Stress Disorder (PTSD)

PTSD occurs when people experience a traumatic event at one point in their lives, be it an accident or physical/sexual abuse. As previously established, trauma is one of the primary incentives of borderline personality disorder.

A 2015 study shows that 53.11% of BPD patients exhibit symptoms of PTSD. These include constant vigilance, emptiness, and negative self-perception.

Professional psychiatrists believe that genetics plays a role in the relationship between the two disorders. Traumatic events can prompt biological vulnerability, increasing the chances of developing BPD.

5. Substance Use Disorder

The lack of emotional control BPD patients experience prompts them to engage in dangerous, impulsive behavior. That includes indulging in substance use.

Psychiatrists can only say a BPD patient has SUD if their drug/alcohol intake is negatively affecting their daily lives. If they only consume it casually, they don’t qualify for SUD.

However, BPD patients usually engage with substances to relieve the pain and stress they’re feeling. So, it’s easy for them to go overboard, increasing the chances of developing substance use issues.

A 2011 study shows that 72% of BPD patients develop a substance use issue at one point. An experienced psychiatrist can distinguish between BPD and SUD through their patients’ behavioral patterns.

BPD patients exhibit impulsive behavior in more than one way. Besides SUD, they can drive recklessly, go on spending sprees, or constantly engage in fights. 

6. Eating Disorders

BPD patients tend to exhibit signs of eating disorders. Those could be anorexia, bulimia, or EDNOS. Some patients engage in excessive eating to cope with the overwhelming emotions or fulfill the emptiness they’re feeling.

Others can approach it as a means of self-harm. Cutting oneself isn’t the only way BPD patients can harm themselves. Although it’s not as extreme, binge eating and obsessing over one’s weight can be physically and mentally draining.

That said, a 2010 study shows that BPD patients with eating disorders experience a gradual remission over the course of 10 years.

How Is Borderline Personality Disorder Treated?

Treating BPD is challenging. It’s a chronic illness, after all, so it can’t be cured. However, with time, commitment, and a positive attitude, patients can regulate their symptoms and lead a healthy life.

Psychotherapy (Talk Therapy)

Psychotherapy helps patients understand the nuances of their illness and how to overcome it.

That said, there are different forms of psychotherapy. Mental health professionals follow different paths depending on the patient’s case.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy aims to help patients understand how their thoughts and feelings affect their illness. Psychologists work with patients to help them overcome self-destructive behavior and develop healthy coping mechanisms.

Dialectical Behavior Therapy (DBT)

DBT was developed specifically to treat people with BPD. Through a multi-layered, skill-focused approach, DBT arms patients with the necessary skill set to fight BPD.

Psychiatrists teach patients to be mindful of their feelings and how to regulate them. They also learn how to build healthy relationships through effective communication.

Medication

Psychiatrists don’t always resort to medication to treat borderline personality disorder, as their effects are unclear. However, some can prescribe medication to reduce the severity of the anxiety, depression, and mood swings that come with the disorder.

Wrapping Up

Ultimately, the question of: “What is the hardest mental illness to live with?” is a subjective one.

However, one can look at how challenging it is for psychiatrists to treat BPD and determine that it’s one of the top contenders.

With uncontrollable mood swings, paranoid thoughts, and impulsive behavior, patients can find it hard to stay consistent with therapy as well.

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