Getting my Borderline Personality Disorder Diagnosis
Trigger warning: mention of suicide.
2015/16 was a rough time for me. Recurrent suicide attempts, dissociation, losing time, self harm, frequent binge drinking and bulimia. It was easily one of the worst points of my life in terms of my mental health, and it was because of this particular period that I ended up being diagnosed with Borderline Personality Disorder (known as BPD or EUPD, Emotionally Unstable Personality Disorder, in the UK) in the July of 2016.
I started this blog while I was under the care of the community mental health team, before I received this diagnosis. Living in the UK I am extremely blessed and grateful to have the NHS to help me and without it I can safely say that I would not be alive today, but unfortunately, as with any service that is free and dependant upon government money, it is severely underfunded and waiting lists for any kind of treatment are extremely long.
Before my BPD diagnosis I was diagnosed with PTSD, depression, anxiety disorder, and bulimia, and had been in and out of mental health care since I was 14. I had been dealing with these for so long that although it seems ridiculous to say now, I didn’t seek help or even actually realise my decline until after I tried to kill myself for the first time that year.
Normally getting help with those conditions goes something like this: you go to your GP and discuss your problems, they do an assessment, check that you are safe and that there is no need for inpatient treatment, explore medication if necessary, and then either signpost you to charitable organisations if possible (the wait times tend to be shorter) or refer you to the relevant team. They give you the crisis numbers, arrange regular check ups with you, and off you go until the next appointment.
However, I didn’t seek help. I (accidentally) retreated and became gradually swallowed by everything causing me stress: university, personal life, bulimia. Mostly, a complete inability to manage my overwhelming emotions and impulses.
Following the first suicide attempt I was assessed in hospital by adult liaison psychiatry where I told them that although I was struggling more, it was just a blip. I had attempted a handful of times in previous years, and it was documented that I had long standing mental health issues. We agreed that I would engage with my GP to avoid it happening again, and once I was safe, that was that. I was discharged.
Truthfully though, I did not engage with my GP very actively. I went to a few appointments and started some medication, but I really just bullshitted my way through them or cancelled them due to being too depressed to do anything. I worsened even more and the medication I was given became something that I used in my suicide attempts, in what eventually escalated into an almost weekly cycle.
Looking back, although I was at a baseline low, I can see that my attempts were mostly an impulsive reaction to a very intense but short lived mood swing. I would almost always change my mind some hours later and present myself for treatment, after that ‘rock bottom’ moment had passed and I had calmed down.
After the second attempt I did get referred to the community team but unfortunately the waiting list was so long that I was going to be lucky if I was seen within 3-6 months, and following subsequent attempts I was always discharged on the basis that afterwards I was in a calmer, better frame of mind and was not an immediate risk to myself, and, of course, I was on the waiting list for treatment anyway.
It took from September until November, almost weekly attempts to kill myself, until the ALPS decision was that I needed some immediate intervention and I was referred to the day hospital.
The day hospital was a turning point and I will be forever grateful to all of the staff who helped me there. Aside from the one-to-one support, many of the group sessions were helpful or at least just a welcome distraction, and the hospital gave me a safe space to try to cope with my feelings. They biggest help was that they monitored my eating and had me see a dietician – the first spark to the end of my purging.
For the most part, I blended into the background and behaved myself, tried to study and catch up on university work. It was here, reading books on musicology, philosophy, and classic literature to pass the time that I really got inspired to improve myself and really wanted to get better. It was like I found hope in myself and my future again.
Eventually I was discharged and immediately fast tracked into community care, with mention of a dissociative disorder. I technically had bimonthly appointments, although really they were every three weeks. However, from the moment I met my care coordinator there, she talked about ‘emotionally unstable’ tendencies and suggested that it would be worth exploring if I might have a personality disorder.
Now, being called ‘unstable’ felt like a huge insult to me. It felt like she was picking a fault with me as a person and not trying to address my actual issues, and from that moment I didn’t trust her. The more that the topic of a personality disorder came up during my treatment, the more I switched off. The idea of there being something was wrong with what makes me fundamentally me was like the biggest slap in the face and it felt like they were ignoring the trauma that I’d been through and instead were placing the blame on me, ultimately leading me to feel that I was to blame for it even happening.
The moment I was actually given the label, I was done. I stopped engaging and decided I hated the whole system because ‘they clearly weren’t actually trying to help me’.
It sounds ridiculous but unless you’ve experienced that way of thinking and that dramatic split, the suddenly hating something/body with your whole heart, you probably won’t understand. Looking back, that reaction was almost classically the reaction of somebody with BPD, and it’s the benefit of two years of growing up and finally accepting my diagnosis that I can say that they were right and I was very wrong.
Understandably after a few months they just discharged me because I wasn’t trying, with some self referral forms for DBT and personality disorder treatment. I was happy with this decision, although furious about the forms, because I stubbornly and stupidly decided that I could look after myself anyway as I was in a marginally better place, wasn’t trying to kill myself every week anymore, and actually wanted to get better.
I’d love to tell you there’s a happy ending to this, that I finally came around to my diagnosis and got help, but that’s not quite the case. I did eventually come around to my diagnosis after things started to worsen again, and after I started talking about it with the mental health nurse in my university who actually took the time to explain it to me properly and show me in my own behaviours how it manifested in me: anger, interpersonal issues, mood swings with suicidal urges, self harm, food issues, and impulsivity. She showed me that it didn’t mean I was broken and that it wasn’t meant to be an insult, and now I just wish I could apologise to my care-coordinator for the way I behaved.
Proper help remains to be received and unfortunately I think it’ll be a long wait, but accepting my diagnosis and just taking a step back to evaluate whether my behaviours and urges are related is helping me to manage. Outwardly I’m coping much better than I used to (honestly, partly out of fear of conforming to the stereotype of BPD), but internally, it’s the hardest battle.
I’m not sure it will ever be easy, but I’m just taking each day at a time.