For people who follow me on twitter, you will know how difficult this past week has been for me. For the first time since I joined, I actually had to stop going on as I was worried people would see how close to suicide I was. I don’t know how, but with the help of some really good friends on twitter, I managed to get through it. I think it was the closest I’ve been to non-impulsive suicide plans. However, I am now coming out the other side and want to write a more positive post.
Today I had the long awaited psychiatry appointment where I wanted to discuss the bpd diagnosis that I accidentally found out about on my records. My appointment was only half an hour long and I was conscious that once we had gone through the ‘usual’ questions I wouldn’t have much time. However, I was proven very wrong!
When I brought it up she apologised for how I found out. This really didn’t bother me, it was a total misunderstanding and I get that these things happen. She went through my diagnoses and explained briefly each one:
PTSD – delayed onset
Recurrent major depressive episode
Emotional instability disorder
I asked her to expand her reasoning behind the last one as I wasn’t entirely sure I understood it. She asked what I did know and I explained I looked at the ICD-10 (International Classification of Diseases from the World Health Authority) but it was so wooly that I looked to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association) for a more in depth diagnosis criteria. As a side point, it was also the DSM-IV that I used on my previous post on bpd.
I had taken my iPad a long and we looked at my last post and she said she could understand why I had been so put out as she didn’t believe I fitted in to 5 of the criteria which you need for a diagnosis. She explained how she perceives (using the ICD-10) the diagnosis and that I have things going on that she can’t put under the PTSD or depression heading and therefore used bpd. So essentially here is her reasoning:
– I can be push and pull with help. Sometimes my cc visits and I’m all ready to do whatever is asked of me and another time it can seem like I’m just going through the motions.
– The fact that I feel like I’m unhelpable (if that’s even a word!!) makes me extremely difficult to manage.
– That I visit my abusers to be re-abused because I feel I deserve it and am not worth better. She said that’s really complex and doesn’t fit anywhere.
– That when I was in hospital, I didn’t eat for 5 days because I wouldn’t go up to the dining room and then within a week I was asking for leave so I could go to an important business meeting.
– That I feel so hopeless about it all that I’m constantly battling suicidal thoughts.
I thanked her for explaining and said in my head they were all for different reasons than she is seeing:
– I agree I’m push-pull but I am so scared of letting people in to help as its something I have never done before. I’ve always just got on with things and dealt with them in my own way and that this is a learning curve for me.
– points 2 & 3 are really together. I feel worthless. That’s the basis of my belief system and it drives the things I do. So yeah, I don’t feel I’m worth helping and revisiting them just backs up that belief – gives me another stick to add to my collection for beating myself up with.
– I realised in hospital that the sooner you adhered to their rules, the sooner you would be discharged. So for example asking for leave to do with work showed I was thinking of the future.
I also explained that I felt like because they didn’t fit anywhere else, I was being put in to a box that doesn’t fit purely for labelling purposes. She told me that if both herself and my cc were off and someone needed to know more about me, that there had to be something in the diagnosis area for these other symptoms and that was another reason it was there.
We discussed the points for quite a while and at no time did she cut me off or make me feel like she’s the doctor and therefore how dare I be questioning her. Instead, she listened and took my views on board. She said maybe she should have used traits rather than disorder (so emotional instability traits) and I said I’d be a lot happier with that as a diagnosis.
The outcome was that she promised to revisit my notes and give it a lot more thought. I personally believe this was the system working as it should. My appointment lasted close to an hour and not once did she look at her watch or make me feel hurried for which I was truly grateful.
So i guess my point is, just because it has been given as a diagnosis, if you don’t agree with it or need more explanation then please ask. However, as with anything in life, go in to the conversation knowing that a) there might be things said that make you feel uncomfortable (it wasn’t pleasant hearing some of the things about me) and b) that the best approach is a civilised, adult one. It is not about arguing, it’s about discussing. And remember the psychiatrist is on our side – although I admit at times it’s not felt like that!