In late 2016, Pete Davidson started having what he called "blind rage" episodes.

He was 22, an SNL cast member, smoking a lot of weed at the time.

The episodes were bad enough that he checked himself into rehab. Doctors diagnosed him as bipolar and put him on medication. It didn't help.

A few months later he had another major episode and went back to his doctors.

This time, in 2017, a psychiatrist diagnosed him with Borderline Personality Disorder.

From his first symptoms in his teens to a correct diagnosis at 23, Davidson spent close to eight years being treated for an illness he didn't have.

And this is Pete Davidson. He had access to the best psychiatric care money can buy. It still took eight years and the wrong medication to get to the right diagnosis.

May is BPD Awareness Month. I want to talk about what the same illness looks like when you take it out of Manhattan and put it in Indore.

BPD is a serious mental illness where a person feels emotions much more intensely than most people, and takes much longer to come back down from them.

A friend not replying for a few hours, a partner cancelling plans or a parent making a sharp comment.

Most of us notice these and move on quickly. Someone with BPD can experience the same moment as a serious rejection that stays with them for days.

BPD also includes a deep fear of abandonment, relationships that swing between idealising someone and feeling betrayed by them, an unstable sense of self, impulsive decisions, and sometimes self-harm.

Symptoms typically first show up in adolescence, which is when families start using words like moody, dramatic, and difficult.

75% of diagnosed cases are women.

Men with BPD are heavily underdiagnosed because the same illness shows up in them as anger, drinking, and recklessness, which gets labelled as something else.

BPD is more common than schizophrenia and bipolar disorder combined. And most Indians have never heard the term.

A 2010 study in the Journal of Psychiatric Research found that nearly 40% of people diagnosed with bipolar disorder had BPD.

The two share mood swings and impulsivity.

The difference is how long the swings last.

Bipolar mood swings last days or weeks while BPD mood shifts last hours, and they're almost always triggered by something happening in a relationship.

A patient describing mood swings, without being asked how long each one lasts or what set it off, will most often get diagnosed with bipolar.

Lithium and mood stabilisers get prescribed but they do almost nothing for BPD.

A 2024 study tracked the journey of BPD patients.

On an average, symptoms first appeared at 12, and correct diagnosis came at 30.

An 18-year gap of being treated for the wrong illness.

Davidson got his answer in eight, most people don't.

In India, the mislabeling goes beyond bipolar.

ADHD, depression, and anxiety are all common misdiagnoses for BPD.

Many patients never reach a psychiatrist, instead they go to temples and dargahs first.

We don't even know how prevalent BPD is here.

One of the largest Indian outpatient studies on personality disorders reported a prevalence of 1.07%, a recent one reported 11.1%.

Same kind of population, ten times apart.

India doesn't have the diagnostic infrastructure to know the real number.

Most Indian families don't have language for emotion as illness.

Sadness has slowly started getting recognised as depression in the last decade.

But emotional dysregulation, where a 22-year-old can swing between euphoria and feeling worthless within an hour, doesn't have a name in most homes.

So it gets read as personality.

A daughter with intense relationship breakdowns every few months gets called sensitive, her self-harm gets called attention-seeking and her anger gets called spoiled.

These labels that might seem intentionally cruel are what families reach for when there's no clinical word in the conversation.

Hindi has a separate word for nearly every kind of family relationship: bhabhi, bua, mausi, jeth, devar, sasur.

There's no Hindi word for emotional dysregulation that doesn't double as an insult.

The cost falls hardest on women. Female anger and grief get dismissed as drama or hormones.

The symptoms that should be sending a family to a psychiatrist end up getting pointed back at the daughter, who eventually starts believing the problem is her.

Two decades of research keeps finding the same thing.

70 to 80% of BPD patients report some form of childhood abuse or trauma.

A 2024 paper from Manipal surveyed 305 young Indian adults. 82% reported childhood betrayal trauma.

Among those who screened positive for BPD, the figure was 97%.

Betrayal trauma is harm caused by someone the person depended on for safety, like a parent or a long-term partner.

In Indian households, such harm is often dismissed as discipline.

Hitting a child to correct behaviour was, until very recently, considered standard parenting in much of the country.

The child whose emotions get invalidated or punished doesn't grow out of it, and they grow into the very pattern we keep calling difficult.

Davidson's own diagnosis was tied to childhood trauma.

His father was a firefighter who died on 9/11, when Pete was 7 years old.

The most effective treatment for BPD is Dialectical Behaviour Therapy, or DBT.

It's the only therapy specifically built to address emotional dysregulation.

Davidson, among many other public figures, credits it with teaching him how to manage his condition.

The treatment works for most patients completing the entire protocol.

The problem in India is that almost nobody can.

A private psychiatrist in a tier-1 city charges between ₹2,000 and ₹5,000 per session.

DBT is typically a six-month course of weekly sessions, plus a separate group skills component.

Most Indian health insurance doesn't cover psychotherapy at all.

Years ago, an Indian woman named Pooja Krishnakumar was diagnosed with BPD.

She told an interviewer she couldn't afford to keep paying for therapy, so she signed up for a Udemy course on DBT and taught herself the techniques.

That sentence is what India's mental health access problem looks like.

A real diagnosis, evidence-based treatment, and a Udemy course as the only path she could afford.

Now multiply Pooja by every Indian family that doesn't even know what to look for.

If there's someone in your life whose emotions feel disproportionate to what's happening, the most useful thing you can do is stop labeling and start asking.

Ask what's going on, or what happened to them.

The person carrying this almost always knows something is wrong with how they're feeling, they just don't have the words.

And they've learned by now that asking for help gets them "you're being dramatic."

If you've been calling someone difficult for years (like a sibling, child, or an old friend), take this month to ask whether they might be unwell.

Davidson's line has stayed with me. "When somebody finally tells you, the weight of the world feels lifted off your shoulders."

Most people in India awaiting this sentence will never hear it.

Hit reply and tell me what you've called drama that wasn't.

I read every email.

Until next week,
Ritesh

P.S. If you or someone you know is struggling, the iCALL helpline (9152987821, Mon–Sat, run by TISS) and the Vandrevala Foundation (1860-266-2345, 24x7) both offer free counselling. Tele-MANAS (14416) is the government's 24x7 line, available in multiple Indian languages.