I know I have covered this in a previous post where I discussed the DSM IV and how I felt the diagnosis of borderline personality disorder didn’t fit my symptoms. This diagnosis is only a recent one (within the past few months) as my psychiatrist thought I was displaying behaviours that weren’t part of either PTSD or depression.
I had a good chat with her at my last appointment before my last hospitalisation and she agreed to re-look over my notes and see about the diagnosis. However, I then saw her un-expectantly the week after when I had taken a turn for the worse and was told I was going in to hospital. Due to this, our conversation has been forgotten about and so here I am again, trying to get the diagnosis changed.
Since my last conversation with my psychiatrist I have done a lot of reading and watching of seminars to truly understand the different diagnoses so I can still keep our conversations at an educational level and not just about me saying I don’t agree. And so I have put together this diagram that uses the DSM IV criteria for BPD (I know in the UK, we use the ICD-10 but for this, the list of criteria is easier to work with). I have then listed the symptoms of complex-ptsd as written by the Royal College of Psychiatrists and then married the two together. There are a lot of similarities, but they also have their differences and it came as no surprise to me that the behaviours my psychiatrist said didn’t fit anywhere were in fact the ones that were in both bpd and c-ptsd (the ones in the middle in the below diagram (you might need to click on the actual picture to see it fully).
I am fully aware that complex-ptsd isn’t in either the DSM IV (or upcoming V) or the ICD-10, however it does have its own section on the Royal College of Psychiatrists leaflet for PTSD. My main point of doing this is to show that just because 4 of the 9 behaviours are shown as BPD, there are actually other explanations for them (I am not even touching on the fact you need 5 or more of the behaviours to be diagnosed!)
OK, so that’s ok if I was in America, but I’m not and the DSM IV doesn’t apply and so I have taken the diagnostic guidelines of the ICD-10 for Emotionally Unstable Personality Disorder, also known as Borderline Personality Disorder, and made 5 citations (not sure if you can see on the picture so will write below as well) of how I don’t fit this:
1) ‘Conditions not directly attributable to another psychiatric disorder’ – I have answered this above.
2) ‘abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness’ – This is not long standing, the behaviours my psychiatrist mentions are purely since my trauma and to be honest, even more recent than that.
3) ‘abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations’ – They are basing this diagnosis purely on seeing one hour per week where we discuss my trauma. Absolutely none of the behaviours are outside of this (ie in social situations).
4) ‘the manifestations ALWAYS appear during childhood or adolescence and continue in to adulthood’ – I have capitalised always as this is extremely important. Until the age of 30 I had never come in to contact with secondary mental health services. I had never cut myself, wanted to take my own life or struggled with inter-personal relationships. Until I pushed people away after my trauma, I had a large set of friends in different social circles and never struggled in this area. I had been to university and got a decent degree and grown a successful business, which involved a lot of rejection, as does every business, and never once did I see or feel worried about rejection in any area of my life. Since my trauma, this has all changed; I cut myself (the reasons of which are outside this remit), always fighting suicidal thoughts and have pushed everyone away so I don’t have to deal with people. My business is also very close to failing. This is all SINCE my trauma, not ALWAYS!
5) ‘the disorder is usually associated with significant problems in occupational and social performance’ – I think I’ve answered this one above. I’ve never had problems with my occupation and stayed in employment long term until I started my own business, which I have run for 7 years. Socially, before the trauma I was out most weekends with friends, I was the secretary of my football team and had a lot of goals that I was working successfully towards.
So, all in all, as you can probably see from this post, I strongly disagree with the diagnosis. I have only had these behaviours since the trauma and so I struggle to see how a developmental illness can be diagnosed. Some people will argue that this trauma triggered this illness but all I can say is I am the expert in me and I know how I used to be – my mental health team can only see me now and therefore might assume this is how I have always been. I think it is up to me to show them this isn’t the case hence all of the above.
I am seeing my care co-ordinator tomorrow and want to show this to her and ask that she relays it to my psychiatrist so I can discuss it at my next appointment in November.