Tag Archives: personality disorder

DBT; a realisation.

Sat in the corner of my room, tying a ligature round my neck. Pinned to the floor and injected. Lying on a bed being wheeled through for ECT. Fainting and being sent to hospital for glucose multiple times. Being watched 24/7 for over 8 months, no privacy at all. Having a CT scan after headbanging. I came into hospital very unwell and there’s a lot I can’t remember, but I’ll never forget these things.

Thankfully I’m so much further on, the idea of tying a ligature is so far away, I never kick off. I am compliant. Those baby steps I mentioned in my last post? They’ve turned into giant leaps. I’m sat here at home on overnight leave, I’ve been out to town with mum and exercised my debit card! I’ve helped cook lunch. I’ve cleaned the kitchen. This time last year I was just starting to have home leave, escorted by a member of staff for 8 hours only. Now I’m a completely different person.

On Wednesday I completed my second and final cycle of DBT. I remember a year ago starting on the programme I was so, well, obstinate that it wouldn’t work. I didn’t understand it. I couldn’t open myself to it. Now I look back and it has helped me so much.  There were four modules; emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness. Each taught me skills I can use to live with, control and maybe even overcome my illnesses.

Through DBT I found a way to manage situations where I needed or wanted specific outcomes. I learnt how to voice my opinion and ask for my needs to be met without shutting down or disregulating. I started being able to take part in my treatment and to get my needs heard and met. Mindfulness taught me how to recognise my emotions, how to observe them and employ my most effective skills to deal with that emotion, or, simply stop and watch the emotion pass by. I learnt to use pros and cons of a specific situation or behaviour to balance out whether the urge I was having would actually be effective.  I went from feeling awful all the time and reacting immediately  to being able to stop, use my skills to recognise that I was feeling bad and instead of self harming or ligaturing I would distract myself. I would ‘radically accept’ I sometimes cannot change the situation (for instance I have to come back to hospital after time at home) but I can employ techniques to help.

I never thought I’d say thank you to DBT. I really struggled to grasp it, it didn’t really fit with my illness but with help I could use skills from DBT anyway and slowly that opened up a way for me to engage in DBT. It’s very weird thinking I won’t have anymore DBT but I’m so thankful for it. And to anyone starting DBT, stick with it. Don’t let anyone derail your recovery by telling you horror stories of DBT. It’s hard, you will probably cry with frustration, you won’t understand at times, you’ll feel stuck. But, for me, there’s almost a sudden moment when I realised, I do understand this and I am actually using the  skills. I can only say thank you to the therapy team for not giving up on me.

And so from baby steps, this is a giant leap. I’m on the home run.

On self harm

Yesterday was Self Harm Awareness Day, a day when we aim to reduce the stigma and secrecy surrounding the topic of self harm. I wanted to mark the day by doing something, but couldn’t think of anything I was brave enough to actually do. So instead I’m going to blog about some of the stereotypes, falscities and misconceptions surrounding self harm as I experience them.

“Self harmers are dangerous, if you can do that to yourself what can you do to other people?”

Self harm is not an indication of a dangerous person. Yes some dangerous people self harm, many dangerous people don’t, some self harmers are dangerous, the vast majority are not. Self harm is often a way of turning strong emotions back on yourself rather than expressing them outwardly. Where someone may feel angry and shout or scream or throw something or slam a door, I turn to self harm as a way of punishing myself without risking hurting other people. Many people who self harm feel other people’s emotions acutely and desperately try to avoid expressing emotion that might hurt others.

“Scars are a sign of how strong you are.” “Your scars are beautiful”

For me this isn’t true. I don’t want to be told my scars are beautiful or a mark of my strength or a reminder of all the times I’ve survived. They are not tragic.  I hate the way people look at me with them and do a double take. The scars on my wrists do not remind me of the times I have survived but of the times I have failed. Self harm is not glamorous or beautiful, it is not tragic or any other such word. It is messy and tiring. It is failing again and again. It is black thread buckling your skin. It is iron tablets and transfusions. It is itching, constant itching and scars that blister. It is wearing your weakness on your skin for everyone to see, and that hurts. It is looking at your skin and seeing the time you were sectioned. The time the nurse called you attention seeking. It is being reminded of your darkest times every day.

“Self harmers don’t feel pain”

I’ve been asked if I don’t feel pain countless times. Many people have said to me “oh I couldn’t do that to myself, I’m rubbish with pain!” Truth is so am I. And I do feel the pain, I just experience it differently. For me when I’m self harming the pain is a focus and a “good” thing (I use good loosely here), I don’t experience it as meaning “stop, this is bad” but “keep going, you’re bad and you deserve this”.It’s like being in an altered state, I still feel pain. It hurts like anything and especially after. And I will still wince at stubbing my toe or getting a papercut too!

“You’re a pretty girl, why are you doing this to yourself?/ You have a loving family, why are you doing this to yourself”

I don’t really need to expand much on this. Mental illness doesn’t discriminate between pretty people and non-pretty people- after all beauty is in the eye of the beholder!- and neither does it discriminate between people lucky enough to have loving and stable upbringings and those who didn’t. I couldn’t have asked for better parents and yet I still got ill.  I read somewhere that genetics loads the gun and life pulls the trigger when it comes down to mental illness. And those life experiences can be anything, not just family issues. And for some people there is no discernible experience which triggers mental illness.

“It’s just attention seeking”

This one really gets me angry. In my last inpatient admission I was told my self harm was attention seeking and manipulative, a way of eliciting care from others. My self harm was never about attention seeking. I feel so self concious rolling my sleeves up in case people think I’m deliberately showing my scars off. For me I self harm out of distress and desperation, in hospital I self harmed despite being on 1:1 observations because I couldn’t live in my head without doing something to get the badness out. Also, when did attention seeking when you’re unwell become unacceptable. When we are ill with a cold we tell everyone about it, seeking attention. When we’re unwell with mental illness, however, seeking care and attention is seen as a negative. That shouldn’t be the case.

“It’s just a phase”

This was said to me when I first started age 14, ten years later it’s still something I struggle daily with.

“It’s not a serious cut, it’s not that bad.”

ALL self harm is serious. From the slightest scratch to the most gaping wound. My self harm got worse and worse as time went on, but the emotions and feelings behind it were as difficult to deal with when I was scratching as when I was requiring stitches several times a week.

As I say, these are only my experiences of self harm and the misconceptions surrounding it. It is different for everyone, but it always needs to be taken seriously.

Positivity

Have you ever stood in the centre of a room and span around as fast as you can, your arms flung out either side and just enjoyed to freedom and speed of the movement? And the way when you stop the room continues to tilt beneath your feet and swirl in front of your eyes. I always think there’s something joyous in that, something very free.

That’s how I feel now. Now the cloud of depression and anxiety is finally lifting. I feel almost giddy with the relief of feeling a bit more normal. Instead of spending hours researching how to kill myself I’m looking up room rents for when I move back to London and comparing the two courses I’ve applied to.

I start my job on the 3rd of March. It’s only a part time job at a supermarket petrol station but it’s a job and it’s having a purpose again. After two years of being in and out of hospital I’m excited to become a functioning member of society again, someone who is contributing even if only in a very small way. It’s a first step which after failing to pass occupational health for another job before Christmas I doubted I would get to do.

And more than that I’m allowing myself to be my age. I’m seeing a guy and am letting myself enjoy and be flattered by the attention. I’m talking to friends again and arranging nights out. Things that have featured far too little in my life over the past few years.

The bell jar has lifted and I’m enjoying it. It’s nice to come out of appointments feeling motivated by the journey I have ahead of me rather than depressed by it. To have people say ‘well done’ and to genuinely believe it.

Taking back control

My admission to the day hospital was my 5th admission. I’m determined to make it my last. Being in hospital, even just as a day patient, is hard and depressing. Whilst I did find this admission helpful it also makes it harder to see a way forward, to imagine a life that isn’t dictated by mental health problems. When you live your life as a patient it’s hard to see a future that doesn’t involve regular admissions, medication and therapy.

On Friday I was discharged back to outpatients with the CMHT. A few weeks ago I was feeling broken and defeated, convinced I had no way forward and the only way out of this was to kill myself. But unlike other relapses, I didn’t lock myself away and allow myself to sink deeper and deeper into my illness. I talked to my team and asked for help, I let my family help me. I admitted I was struggling rather than trying to do everything on my own.

And I feel like it really helped. Whilst I’ve a long way to go and I still struggle with suicidal thoughts and low mood a lot of the time I feel like I’m looking up, not down.

When I described the assault to my therapist I imagined it as a large black monster, all spiky and sharp and clawed, stood behind me. And I was too scared to turn round and look at it. But by pretending it was not there it was always in my mind, I was always aware of it being stood just behind me but I didn’t know what it was or how dangerous it was. And that made my mental health worse, I had no control over the situation and felt powerless. It was the assault that had all the power and so therefore my mental health problems had all the power and owned me.By talking about it, I feel now that I’m turning round, I’m not quite facing the assault yet but I can see it out the corner of my eye so I know where it is, and that gives me a little bit of power. And that gives me some ability to take ownership of my mental health. I am not powerless any more.

I’m learning slowly to let people in, to voice my struggles and let others help me to help myself. I have mental health problems but I am not a victim, I can make changes which will help me manage them better. And that feels really empowering.

You should get a boyfriend, then you wouldn’t be depressed

As said to me by the crisis team doctor a couple of days before I was sectioned…

There’s been a lot of discussion on the #crisisteamfail and #crisisteamwishlist hashtags on twitter about peoples’ experiences of being under the crisis team. It makes an interesting and at times shocking read. I’m not going to bash the crisis team in this post. I don’t think it’s helpful or constructive. Instead I’m going to share my experiences of being under the crisis team, nothing more or less- simply my experiences from which you can draw your own conclusions.

I first heard of the crisis team when I had my first brush with mental health services age 13. However I never had any involvement with them until earlier this year. I had just been discharged from a week long hospital admission and had no follow up care except my regular eating disorder therapy appointments. My ED therapist was my care coordinator but my care was a bit complicated because I fell under one areas CMHT and another areas ED services and for some unknown reason that made liaison between services complicated. I saw my GP later that week, still very wobbly and struggling to cope and was referred to the crisis team.

My very first experience with them had been a week prior when I was admitted to the ward but that had been the extent of their involvement with me. I was lucky that my referral took only two days and I was almost immediately seen by the CMHT doctor and assessed for treatment under the CMHT. However it was decided that I needed a higher level of input and I was asked to stay and be assessed by the crisis team and it was agreed that they would visit me daily and take control of my medication, starting from that day.

In all honesty my first visit from the crisis team was terrifying. Not because anything particularly noteworthy or interesting happened but simply because there is something inherently frightening about letting two strangers- both men- into your house to sit and talk about your feelings when you’re already feeling vulnerable. I was too scared to let them any further into the house than the kitchen- we were a maisonette- and we spent the next awkward 10 minutes sitting in the kitchen, me hoping my flatmate wouldn’t come out of his room and them watching me as I twisted my hands and jiggled my leg with anxiety and barely spoke. They watched me take my meds and then left. This style visit was pretty much the norm over the next two weeks. There was one visit where I talked a bit more but that backfired and ended with me in floods of tears after a nurse told me the reason I was gaining weight is because diet coke has loads of calories in it….

Usually two people came but then I had a visit where S came on her own and it was probably the most helpful visit I had from the London CT. She talked to me like I was a person, not a diagnosis and seemed to understand me a lot better than the other team members I’d bet. It helped that she was young and female, I found it hard to connect with the older male CT members I’d been seeing. Although the meeting ended up with me being in A&E after I admitted I’d overdosed it was the first time I felt I’d been heard. S came to A&E with me and waited until I’d been checked in to make sure I actually went. A week later S was also the one to be involved with calling the police on me and resultingly the sectioning but despite that she was still the best member of the crisis team I’d seen.

In all honesty I’m not really sure how the crisis team works in keeping people out of hospital. For me it seemed that they just watched me falling and then when it looked like I would end up killing myself pulled the plug and hospitalised me. I never really felt they helped me find better coping methods (other than ‘make a cup of tea’ or ‘get a boyfriend’) but instead just made sure I took my medication and checked I was still alive each day. Maybe I wasn’t in the right place to use them to their actual purpose and maybe that was all they could do to me, but in many ways those few weeks seeing them were torturous. I was falling down the rabbit hole faster than I ever had before and I knew it and I knew they knew it but it felt like they were stood at the top of the hole looking down, occasionally calling my name, as I plummeted to the bottom.

That period with the crisis team ended the night I was sectioned, which I blogged about before (Losing my freedom). But when I moved back to Oxford after being discharged I was once again placed under the crisis team- or “Step Up” team as they call it here. They were okay. I hate the word ‘okay’ but it’s the only way to describe them. They were primarily an end-of-the-phone support service. The idea being that when you were distressed you should phone them before self harming/ ODing etc. Problem is i’m terrified of the phone so it never really worked for me. I’ve seen them face to face two or three times and they’ve been helpful but it feels like the service is overstretched and underfunded.

This is not my best post and depression is clouding my ability to write right now but if you’re interested it’s definitely worth checking out the twitter hashtags #crisisteamfail and #crisisteamwishlist for a far more eloquent view of being under the crisis team.

Two Beccas

I would like to think that I can get to a place where I look forward to the day. Where going to bed isn’t a monumental tussle between being able to switch off and bringing the morning closer. Where my day isn’t spent watching the clock until the next time I can eat/ not eat / binge/ purge.

Something I find very difficult to explain to the professionals is the two sides to Becca. There is coping surface Becca. She has a close group of friends who she talks to regularly. She is applying for jobs and masters degrees. She’s the Becca who turned up every day to the lab and carried out her dissertation work carefully and precisely. Who smiles and laughs at the right times and tries to be ultra helpful.

And then there’s Becca not coping. She’s the one I actually identify with. The Becca who saves up her medication and plans the day she’ll take it all. Who is drowning in her eating disorder and who spends every day curled up in a ball unable to leave the house. The one waking up having had another nightmare about inpatient. She’s the one who is making her family’s life hell and who is struggling to cope.

The two Beccas are incompatible and I struggle to make sense of them. It sounds utterly ridiculous to say I want to kill myself when the same day I agree to go on holiday with my friends or apply for a masters. It’s even harder to explain how I can text my friend, laugh, and then put my phone down and pick up a razor blade or stick my fingers down my throat.

The only way I can describe it is through this:

Untitled

That is how I feel. People see the outside of Becca but at the moment it’s the dark inside that is taking over. The scales have found their way out of their hiding place and the weight is trickling off. There’s a stash of pills building up on the side where I pretend to take my iron tablets every night and instead put them back in their box. I struggle to even care that without them I’m risking landing myself needing a blood transfusion again. And yet I’m doing and saying all the right things. I’m making plans with friends, I’m going to Rome in less than two weeks. It doesn’t make sense and I hate it.

There’s Becca coping and Becca not coping. Everyone chooses to see Becca coping and yet it’s Becca not coping who’s running the show.

Diagnonsense

I have many things I like to rant about. Not least among them is the practice of diagnosing mental health problems.

I don’t actively have a problem with diagnosis per se. I think diagnosis can be very helpful in guiding and directing treatment, I have no doubt that if I had been picked up and diagnosed when I first became ill at 14 things may have turned out very differently for me. As it was, I wasn’t.

The thing with diagnosis is it’s not as clear cut as the ICD-10 or DSM would lead us to believe. My first ‘official’ diagnosis was bulimia, even though I was slowly sliding toward anorexia because my BMI was above 17.5 I was diagnosed with bulimia. This meant I was a low priority case and spent a year waiting for treatment. During that time my weight slide below that magical number 17.5 and continued to drop. When I was next seen by the ED service my diagnosis became anorexia binge purge subtype. In effect the only thing that had changed was my weight but that completely changed how quickly and how I was treated. Fast forward to earlier this year and the binge purging had started again. My BMI was teetering around 17.5 meaning there was a good month where each week I moved between an anorexia and a bulimia diagnosis. My mental health was the same irrespective of diagnosis, but my weight meant that despite having all the anorexic cognitions I was rediagnosed bulimic which is where I currently am.

Back in June I was sectioned with depression. On my admission to the ward, when I was pleading with them to discharge me and give up so I could kill myself they told me ‘we never give up on patients’. My admission was a rocky one and four weeks in I was rediagnosed with borderline personality disorder. Everything in the manner they were treating me changed- suddenly the outlook became hopeless and the impression I was given was ‘we give up’. Strongly at odds with their earlier proclamation. My self harm and suicide attempts which were previously treated as a result of my being seriously depressed were rebranded as manipulative and attention seeking, a fact I still strongly disagree with. My admission completely fell apart after that diagnosis. My parting words to the wardround when I was discharged were ‘this has been the worst experience of my life and ever since being diagnosed BPD everyone has acted as if I am manipulative and a nuisance when it is my biggest fear to be that’.

The problem is, having a BPD label attached means professionals approach you very differently. I experience daily depression, I fulfill all the criteria for depression and anxiety and yet when I talk about this with the services it’s put down to my ‘experience of emotional instability’ and the reason I got worse in inpatient was due to my BPD and feeling as if I’d be saved in IP- completely wrong, I fought so hard in inpatient because they were stopping me from doing the one thing I was dead set on doing, committing suicide.

I still struggle to accept the BPD diagnosis, I feel that because I’m female, with an ED, a self harmer and a history of trauma I was pidgeon holed into that diagnosis because it was the easiest thing to do. And because that way I can be written off as just another personality disorder patient. I don’t feel I fit the criteria but arguing my case leads to conversations about how that’s a BPD trait. So I’m stuck.

I do think diagnosis have their time and place, but I also think they can be incredibly damaging when used wrongly.