EDIT – I have since had this diagnosis retracted, and have a combined Autism and Attention Deficit Hyperactivity Disorder diagnosis with Complex Post Traumatic Stress Disorder. I’m leaving this post up as I felt like this at the time. It is also very common for women with ASC/ADHD/c-PTSD to get misdiagnosed with BPD.
Before Christmas, I got diagnosed with Borderline Personality Disorder (“BPD”). ‘What’s that?’ I hear you ask. It’s a mental health condition which causes a range of symptoms, including:
- overwhelming feelings of distress, anxiety, worthlessness or anger
- difficulty managing such feelings without self-harming – for example, by abusing drugs and alcohol or taking overdoses
- difficulty maintaining stable and close relationships
- sometimes having periods of loss of contact with reality
- in some cases, threats of harm to others
This diagnosis, once I had completed my own research, doesn’t come as much of a surprise to me. I have always had (technically) unreasonable emotional reactions to things which happen in my life, from crying for over an hour solid because someone cancelled plans to have a coffee with me, to trying to kill myself because the guy I wish I was dating slept with someone else.
What most people don’t seem to realise, however, is that I have absolutely no control over this. I can appear to be manipulative, I am extremely impulsive, emotionally labile (not just with negative emotions, I have been known to laugh until I can’t breathe at something that’s only slightly funny to most), often believe I wasn’t supposed to ever exist, and have severe rejection issues. While I know that many of these thoughts and feelings are irrational, they are all consuming and when I’m at the extremes of my emotions, it’s like another person has taken over and I’m watching from the sidelines.
When I was working, I was the team member who, although good at their job, struggled to maintain good relationships with co-workers. I could be snappy, cried extremely easily, and often behaved in an unprofessional manner, shouting at people when I was angry, and having to run off to the toilets when I was upset. What my former colleagues won’t realise is I found all this behaviour just as frustrating as they did. I wished more than anything that I could remain in control of how I was feeling, and not be “that person”.
I had similar experiences in school. I’d flit between social groups, never becoming a fully integral member of any of them, and with some members of those groups, loving them one minute and hating them the next. I would panic if I didn’t have plans with people for lunch, in sixth form I skipped lessons if I didn’t have a friend in them (and therefore screwed up my A-levels) because I was so scared of having to sit on my own, and was generally an emotional mess. I felt like I didn’t fit in anywhere, but was terrified of being alone. I would become extremely clingy with some people, and wasn’t able to understand why they’d want to do something without me. These are issues I still face in my daily life.
As many as 80 percent of people with BPD have suicidal behaviours, and about 4 to 9 percent commit suicide. (NIMH, www.nimh.nih.gov/health/topics/borderline-personality-disorder/)
I have attempted to take my own life at least six times, after each of these attempts I was taken to hospital, usually in an ambulance, always with the same outcome. My feelings were minimised, most attempts were recorded as “accidental overdoses”, and I would say anything I could to the on call psychiatrist to get them to discharge me. I also have a long history of self harm, yet after each attempt, I was just discharged without any psychological follow up.
I have had several appointments with mental health crisis teams over the years, each of them dismissing me with depression, changing and/or increasing my medication, and basically being told to “think positively” or “think of my children”. It didn’t occur to any of the health professionals who have seen me in the past to consider that there could be more to my mental health issues than “just depression”. (Please don’t think I’m minimising depression, I have it and anxiety as co-morbid diagnoses with my BPD. Depression is crippling, there is no “just” about it, except in this case, when the recommended treatments are different, and my emotional lability can produce very different symptoms.)
I had been doing some research regarding alternative psychotherapies, when I came across Dialectical Behaviour Therapy (“DBT”). It sounded really interesting, and looked as if it would be extremely beneficial to me as it teaches you how to regulate your emotions.
“Dialectical behaviour therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.” (NIMH, www.nimh.nih.gov/health/topics/borderline-personality-disorder/)
In fact, the NICE guidelines for BPD include:
“188.8.131.52 For women with borderline personality disorder for whom reducing recurrent self-harm is a priority, consider a comprehensive dialectical behaviour therapy programme.” (NICE, www.nice.org.uk/guidance/cg78/chapter/1-recommendations)
I thought that my diagnosis would open this door up to me, which it might, if I complete a managing anxiety and anger management course (not through mental health services) first. I then have to complete a “managing your emotions” course before I’ll be considered for the treatment that NICE clearly suggest.
While I understand that there is a lack of funding, and they’re hoping that the other therapies will provide me with enough coping strategies that I don’t require the DBT, there are very few other conditions that this same logic would be applied to. It’s like telling a type one diabetic that trying to control their blood sugar levels through diet alone is sufficient, unless they nearly die. In no case would that be suggested. They’d be put straight onto insulin (the recommended treatment) and be reviewed on a regular basis by their medical team. There wouldn’t be any arguing “well, there are other people with unmanaged diabetes who have your symptoms, but when they follow a good diet, they go away.” It would be accepted that type one is very different to type two, and although they can initially present similarly, type one is significantly more deadly if it is not dealt with correctly. BPD is significantly more deadly than anxiety, perhaps being told to go on a course for people with anxiety isn’t going to be the long-term fix that is so needed.
“Community mental health services (community mental health teams, related community-based services, and tier 2/3 services in child and adolescent mental health services – CAMHS) should be responsible for the routine assessment, treatment and management of people with borderline personality disorder.” (NICE, www.nice.org.uk/guidance/CG78/chapter/Key-priorities-for-implementation)
I got discharged from mental health services in the same sentence that contained my diagnosis. I have been told that if I am in a crisis, I will have to contact my GP, get an appointment, see them to get referred to the mental health team, and wait for an appointment to be sent through the post. During my last major crisis, I took 16 paracetamol in the time it took to have two swigs of cola. I wish I could say I was surprised to be discharged, I’m not. Mental health services in this country are in a dire state and I am by no means the only person in this situation. What isn’t considered by those in charge of the distribution of money is that someone with a diagnosed mental health condition who is not able to contact the crisis team directly when they are in crisis are going to be seeing (potentially) GPs, A&E staff, In-patient psychiatric staff, Police, Social Services, or maybe even a Mortician. I’m sure these services are far more costly (and overworked/understaffed) than what it would take to be kept on a database which allows you to directly ring someone who may actually be able to help.
It’s taken me over a month to write this post, and I wouldn’t consider it to be my best piece of writing either. It’s a bit of a jumble of emotions, thoughts, and frustrations which I needed to get out. I congratulate you if you have read this far, and have only one request: please try to understand I don’t mean to be so emotional, and I am trying to get it fixed, it’s just going to take some time.