Some background: I'm a medical student who thought my ex had depression, anxiety, OCD, BDD, TTM, EDNOS, and a picking disorder, which were then officially diagnosed by a psychiatrist. He also has ASPD, but we unfortunately broke up right before that official diagnostic meeting. After our last meeting, when I went to get my stuff, I realized that he either likely has BPD or BPD-like traits.

We both grew up in abusive households, so I have a lot of empathy and understanding for him. I have some BPD-like traits myself (an intense fear of abandonment, among other issues) and I used to be diagnosably ASPD, though I no longer fit the criteria. I also struggle with co-dependency.

The first 5 months of our relationship were magical. I thought that I had finally found the kind of person I was looking for. I fell in love. At 6 months, I realized that he had been lying about things throughout our relationship, and helped connect him to a psychiatrist and a psychologist for diagnosis and therapy. 

The next year of our relationship was a toxic push-and-pull, where his problems would trigger my BPD-like traits, which would then make him miserable. I didn't feel seen, safe, and secure, and I would threaten to leave him all the time because I was afraid he would leave me. He kept lying to me because he didn't feel safe either, and it culminated in my suddenly blocking him for a month after I found him texting another girl in the bathroom.

After I unblocked him and tried to talk to him again, the relationship was over. He felt abandoned, and he had replaced me with someone new.

I'm trying to deal with the aftermath, with the loss and the pain, so I sent him this email:

Hi -----,

Yes, it's another long email! I know, right? "This desperate ho" or as ----- says, "1-800-HELP-A-HO." Sometimes, when he checks in to see if I'm doing OK, his first message is, "Dialing 1-800-HELP-A-HO." It's not exactly inaccurate. 

First, thank you for meeting me Tuesday night, and for speaking to me candidly. Every time we talk in-depth, I learn something new about you and about myself. I am very grateful and appreciative for that. 

I think I understand better now. From your perspective, I disappointed, failed, and abandoned you. Just like your mother did, and everyone else you've ever been close to has. You feel like I broke your trust and abandoned you, and you responded by putting up permanent walls against me. When I hugged you on Tuesday, I felt no warmth in return. I have become yet another disappointment that has been relegated to the past: I am "out of sight, out of mind" as you begin to emotionally attach to a new girl.

Part of you also hates yourself, and you feel unlovable and ashamed. You opened up to me more than you have to anyone else, and you feel like I betrayed you. Underneath your beautiful, successful surface, underneath the glossy job and the expensive clothes, you are deeply unhappy, and you sincerely doubt if you'll ever be happy. You feel like you will always be alone, and you use steroids and turn to new women on Bumble to try to fill that emptiness and self-loathing inside yourself.  

You are not alone or wrong to feel this way--the reason I can be insightful and accurate is because your thoughts are textbook. After our talk, something pinged my gut instinct, and I did more research. I am not qualified to make this full diagnosis, but at the very least, you demonstrate a large swath of criteria for Borderline Personality Disorder (BPD). Up to 6% of the U.S. population has it, so you are not an anomaly. BPD and ASPD share many overlapping features, and it's possible to be both. Again, I am not saying you definitively have BPD (woohoo, another psych diagnosis!), but at the very least, you display a large proportion of criteria, which are:

"A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

•1. Frantic efforts to avoid real or imagined abandonment. &lt;-- You're incredibly afraid that everyone you love will abandon and leave you. 

•2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. &lt;-- This is how I went from being "the best person in the world" (idealization) to someone who doesn't matter (devaluation).

•3. Identity disturbance: markedly and persistently unstable self-image or sense of self. &lt;-- Self-image problems such as with your BDD, etc.

•4. Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating). &lt;-- substance abuse, prior reckless driving (DUI), spending, diagnosed eating disorder

•5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. &lt;-- "I want to jump off a building. I wish a car would hit me."

•6. Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). &lt;-- I'm not sure how much your mood swings are BPD and how much are steroids and your anxiety. Too many confounding variables, but we've already reached 5 criteria.

•7. Chronic feelings of emptiness. &lt;-- 100%

•8. Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, recurrent physical fights). &lt;-- Yes.

•9. Transient, stress-related paranoid ideation or severe dissociative symptoms." &lt;-- You can turn off your feelings like a light switch. 

I also have borderline tendencies, though I don't have the full diagnosis--like ASPD, our coping mechanisms have been shaped by our childhoods. If we don't understand our problems, we will never be happy, and I want you to be happy. I'm not 100% sure if you have full BPD or just a large section of criteria, but regardless, there is hope: 91% of BPD patients experience remission with sustained therapy, and the single biggest predictor of success is a sustained desire to change.

BPD textbooks say that patients need 2 things in a partner: 1) the partner needs to accept you for who you are while also positively trying to help you become a better person and not be a doormat or enabler 2) the partner must be strong enough to love you unconditionally while also having her own life together. 

I think I have the capacity to do the first. I have realized that I likely can accept the steroid usage, the minimizations and lies, the past relationship with -------, and the instinctive reflex to re-open Bumble when things get hard. I can accept that you would inevitably inflict pain on me over and over again, and be mature enough to realize that you would not be coming from a place of deliberate malice or self-awareness. I made a mistake in trying to threaten you with the Equinox membership; I wanted to help, but real love does not coerce or intimidate--it guides and supports.

However, my current self cannot fulfill the second criteria. I can love you almost unconditionally, accept you for all that you are, good and bad, but I am too weak to do it while maintaining my own life. I am not strong enough--we both know I'm flawed and have enormous emotional baggage. You would lose respect for me--if you haven't already--because I don't respect myself. You managed to pass the ------ while I have been so busy thinking about your problems that I have chosen to let my own exam falter. I need to get my own shit together so that I can be a better person for other people. No one ever said change is fun or easy--it will be hard and boring and painful and go against all my avoidant instincts--but I want the results.

I know you neither believe me nor care anymore, but I really do love you. Words are cheap, but I have shown you through my actions--from trying to comfort you during your MRI appointment to helping you mend your relationships with your family, I have always loved you. Unfortunately, I am also kind of a "sad failfish" as ------ says, and I need to evolve. Even though I have a fever, I studied a little today, which is a big step for me.

Thank you again for being candid on Tuesday. I know you don't believe it right now, but the type of partner you need is out there. I have read about people like that, I have met people like that, and I am going to try to be that kind of person. They are rare, but they do exist. Thank you for helping me grow and for helping me realize what kind of person I want to be. 

Love you,
-----------