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.
Rape and PTSD 
Mike
June 30, 2012 at 9:18 pm
Seems fairly typical of a closed ‘we know you better than you know yourself’ establishment view.
It seems that you might want to state to these people (as you do above) that you didn’t have serious mental health issues before being raped. I guess it might be easier for them to suggest that you did because they might think it’s easier to ‘treat’.
What really upsets me and makes me angry about your situation is that you’re suffering because of the actions of other people — and you shouldn’t be made to feel as if it’s somehow something down to you rather than something criminals inflicted on you.
femaleptsd
June 30, 2012 at 9:22 pm
What it feels like to me is that I have these symptoms that don’t seem to fit with PTSD and so they just want to put me in to a nice little box to explain it to themselves! People just don’t/can’t just fit in to pre-prescribed boxes!!
@Sectioned_
July 4, 2012 at 12:09 am
Here are some thoughts I wanted to share when I read your blog post. Hope they’re helpful!
From what I’ve read, there’s a lot of controversy around the diagnosis of BPD, for a variety of reasons. One, it’s mostly applied to women. Men who’ve experienced trauma get diagnosed with PTSD whilst women get labelled with BPD. So there’s a bit of a feminist discussion around that one.
Two, it’s a bit of a bucket diagnosis: ie chuck someone in that bag when they don’t quite fit other diagnoses. A diagnosis is only useful insofar as it guides you towards effective treatment and management of troubling symptoms, so a bucket diagnosis is unhelpful.
Three, therapists tend to think of people diagnosed with BPD as nightmare clients they’re never going to get any results with, so seeing a diagnosis of BPD can make them want to avoid you. Clients diagnosed with BPD can end up feeling they’ve been written off as having an untreatable personality disorder.
Four, just because someone uses an unhelpful coping mechanism like drug or alcohol abuse or cutting doesn’t automatically mean they have a personality disorder. Yet sometimes people get diagnosed with BPD for exactly that reason, which seems pretty sloppy.
I remember a couple of months ago I DM’d a link to an article by the inventor of DBT, this amazing therapy developed for BPD. When I read it, I remember thinking the therapy (DBT) could be of use to you (more use than the therapy you were writing about at the time anyway!). BPD seems a stretch to me, given you don’t score high enough on the symptom tick list, but what do I know? However DBT still looks worth checking out.
Last point: my psychiatrist copies in every letter he sends to my GP as a matter of Trust policy. Might be worthwhile asking if this could be applied to you. After all, you’re equal partners on the mental health journey: your psychiatrist is the expert on mental health but YOU are the expert on you so you should be working together.
femaleptsd
July 4, 2012 at 3:06 am
Thanks for the reply. I totally agree with you on your points! I think it is a lazy diagnosis and it really would be an intersting stat to find out how many males diagnosed with PTSD are also diagnosed with BPD versus women. From what I’ve read, it seems to go hand in hand as a diagnosis but again is this just because it has become a kind of norm than any real diagnostic skill!
I worry about the BPD label and it’s impact on how people in the ‘services’ will view me. I expressed this concern to my cc and she said whilst she isn’t going to say it doesn’t exist, it is much less than it used to be. She went on to say that it was frowned upon if anyone showed that attitude when dealing with a diagnosis. However, the cynic in me doesn’t believe attitudes can be changed so quickly and it is therefore just brushed under the carpet!!
I like the idea of me being copied in to my letters so will bring that up in my next appointment – thanks for that tip!
Mrs A. (@idva12)
July 25, 2012 at 6:45 pm
I work with victims of domestic abuse. Many of the people I support have been diagnosed with BPD – in my opinion wrongly, as symptoms are similiar to PTSD which in itself is very common in people affected by domestic abuse, especially physical/ sexual violence component of it. I think you are right in questioning the diagnosis. Take care x