Archive for June, 2012

Borderline Personality Disorder (BPD) Diagnosis

30 Jun

I’ve not blogged for a couple of weeks. I’ve wanted to but I’ve just had a lot going on and not managed to do it. So in the last couple of weeks I have successfully made it to America (and back again) which was no mean feat at all. I am going to do a separate post on my time there with some pictures so I won’t go on about it now!

On the saturday before I was due to fly on the monday, I had a panic as I needed to put my medicine in to a smaller bottle to carry on board but it meant it would be unlabelled. I was worried they would take it off me at security so I called the duty worker and asked if I could have a copy of my prescription that my psychiatrist had written a few weeks before. He couldn’t find it and so instead gave me a copy of the last letter that was sent to my GP from my psychiatrist which has medication on it as well as a list of current diagnoses. As well as the ones I had been told about, there was also one that said emotional instability disorder (also known as borderline personality disorder).

The name had come up before a while back as my care co-ordinator (cc) said I had been diagnosed as having traits of it. I was always fine with this, I didn’t look in to it too much as she told me not to and that she thought I’d be ‘pissed off’ if I did. She also said that it could be argued that everyone has traits of some kind of personality disorder and so I just left it at that.

However, learning that a) I had diagnosed with something new without it being explained and b) not really knowing a lot about it, I decided to go ahead and look at what makes up a diagnosis. I checked the ICD-10 which gave an extremely wooly explanation that I didn’t really get and so I looked up the DSM-IV diagnosis criteria and that’s what I use below.

Let me say from the outset; I don’t agree with the diagnosis and I am going to explain why below. I went through this list with my cc as well and she suggested we talk about it with my psych in my next appointment. She also apologised for me finding out the way I did (not something I was bothered about). So here is what the DSM-IV says (and my comments under each one in blue):

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:

Well firstly I am 31, I have never had any psychiatric problems apart from mild depression (not even enough to have counselling) twice before so ‘beginning by early adulthood’ isn’t true.

(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. I don’t see me in this one at all.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Again, I don’t see this one. My relationships have never alternated between extremes. The only thing I can potentially see in this is that I have, in the past, been confused about whether to have the involvement of services. This is purely because I feel I have gotten worse since seeing them, not because of any kind of idealization and then devaluation.

(3) identity disturbance: markedly and persistently unstable self-image or sense of self. There is nothing unstable about my self-image. Yes I feel worthless and yes I hate myself but these are stable thoughts, they don’t change depending on who I am with!

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. I agree with this one.

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. I agree with this one

(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). I’m not sure on this one, the moods are usually related to flashbacks and so surely that comes under my ptsd diagnosis?

(7) chronic feelings of emptiness. I have times of feeling numb, but these are not what I would call chronic.

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Again, this is not me. I feel angry at times with myself and this comes back to me hating myself, but there is no outward anger towards anyone else (and cc agreed with me on this one).

(9) transient, stress-related paranoid ideation or severe dissociative symptoms. I wasn’t sure about this one as wouldn’t class symptoms as severe but my cc reminded me of how I was around my 2nd anniversary (I was convinced it was 2009, not 2011) and so I’ll agree with this.

So looking over the criteria, even if I add in number 6, that is only 4 out of 9 and again this is ignoring the fact that it should be based on long-standing problems. I have never in my life cut myself until last year when I didn’t know how to deal with things going on in my head (which I now realise were flashbacks). The same is true over suicide. These symptoms are in direct correlation to being raped, not long-term ones.


Anxiety Levels

02 Jun

Normally, sitting around my apartment, I would say my anxiety level is about a 2/10. I feel safe in here and unless I need to do something that I struggle with, the level is relatively low.

When I go out with a worker for graded exposure work, my anxiety about going out usually raises to about a 7/10 and by the time I get back to my home, is around a 5/10. It then slowly drops over about an hour until I’m back around the 2/10 level.

The reason I’m mentioning this is to give a baseline of where my emotions usually are and where they are now. With my impending trip to America, I have felt my anxiety creeping up and up as the date comes closer (only 9 days away now!).

On Thursday night, I took a call from my remaining client (my main income) who told me they needed me to start going in to their office one day a week. My initial response was to say ok (I have this problem saying no, even when it’s screaming at me as the only answer!). So because I agreed, I then had to call back and say I’m sorry but it’s just not possible. Bear in mind, this is a client. They never want to know about anything personal going on, it’s business and I’ve separated my life in exactly that way. When I was in hospital, I worked so they didn’t know any different and think that’s the way it should be.

However, I needed to now explain why I couldn’t drive for an hour and sit in a busy office (shared with other companies) without it making me sound like I wasn’t capable of any work. Last year when I first started to feel things were getting bad and I went to my GP, I also decided to take 2 weeks off. Naively, I thought that’s all I would need and things would be ok again and so I arranged to meet with this client to say I wouldn’t be available and handover anything that was needed. During this meeting they essentially told me that if I took the 2 weeks then they would have to get someone else in and I’d lose the contract. From that moment on, I knew I could never be open about it all with them.

Bearing that in mind, I knew that I had to explain myself as to why I couldn’t go to their office. I told him about my social anxiety and how I’m trying to overcome it, but that I have to put myself first. As expected it didn’t go down very well – his response “that’s a load of bullshit, you’re going to America in a few days” (of which by the way, I’ll still be working over there!!). I tried to keep calm and explain that I had been working hard to allow me to go to America and that my family are waiting at the other end and that’s a huge motivator.

He basically said that he’d have to speak to his business partner because that’s the role they have and if I can’t fulfil it then they’d have to get someone else in!!

So back to my anxiety levels. Normally I’d be a 2/10 and something like this would take me to a 5 or 6/10. However, because of America my starting level is about a 6/10 and this raised it to 8/10. I struggled through thurs night, I wanted to speak to someone but couldn’t pick up the phone as I was already too anxious. I waited until Friday morning and called to speak to my cc. She wasn’t in, so I spoke to duty. I just wanted someone to say my reaction was normal but they were too intent on telling me to distract myself. This wasn’t a time when I needed distraction, I needed to talk. After being told to make a piece of toast and a cup of tea (I don’t drink tea!), I said I was fine and left it there.

I guess what I’m trying to say in this really long winded post is that because my baseline of anxiety is quite high, any little thing is currently throwing my emotions in to turmoil. Like the fact that my GP has designated my prescription to one pharmacy and so because I couldn’t get there yesterday to collect, I’ve got to wait until Wednesday to get my meds. So now my anxiety is high, I’ve no medication to help and I might be out of work. Can you see why I felt my only option was to just get drunk and try and forget all about my emotions!!!