At some point in the last five or so years, a second diagnosis was added to my primary one of recurrent depressive disorder: BPD, or borderline personality disorder.
It was added without any discussion – without the psychiatrist even informing me. And it’s left significant mental scars.
I’ve seen a succession of psychiatrists throughout my time under mental health services: mostly junior doctors on short rotations who had no real chance to get to know me. It was one of these who gave my the BPD diagnosis by stealth.
There’s a set of criteria that can lead to a diagnosis of BPD. One in particular – the tendency to self-harm – fits me; the majority of the others don’t.
These include difficulty forming and maintaining relationships (I’ve been married 17 years, have close female friendships and still see my childhood friends every Christmas); extreme mood swings that can veer from elated to depressed within a matter of hours (my periods of depression last weeks or even months); and outbursts of intense anger (sure, I shout at the kids, but I’ve never been one to throw screaming tantrums).
BPD is also often associated with past trauma – and my history is trauma-free.
When it came to diagnosing me, however, I believe the psychiatrist – the one who was in the early stages of training, and who’d seen me perhaps three times, for 20 minutes at a time – made the simplistic and lazy decision that self-harm = BPD and saddled me with a label that has hugely affected my self-esteem and already poor mental health.
There’s nothing quite like being slapped with a PD diagnosis to make you feel like utter crap about yourself. Imagine being told that your personality – the very essence of who you are – is fundamentally flawed. That there’s something inherently wrong with who you are as a person.
Self-hatred is something that I battle with anyway, and being told that I had a disordered personality only served to ramp those feelings up. I became even more convinced that I was evil at heart, filled with badness. I felt as if I didn’t deserve any of the good things in my life, including my husband, kids and friends. I pushed them away, certain that everyone would be immeasurably better off without my toxic presence. I was sure everyone was judging me, talking about me behind my back, looking for ways to extricate themselves from their relationships with such a poisonous individual.
Attitudes towards people with BPD are overwhelmingly negative. They’re seen as melodramatic, attention-seeking, needy and manipulative. Self-harm and suicidality is considered impulsive yet calculated to achieve maximum effect: ‘Be nice to me or I’ll kill myself.’ It’s a common belief that BPD sufferers can’t be helped – or aren’t deserving of help.
Worryingly, many mental health professionals subscribe to this definition of BPD – and that creates very dangerous situations when it comes to treatment and support.
My BPD label has put me at serious risk. I’ve been sent home from hospital immediately after suicide attempts with no follow-up. I’ve been discharged from the crisis team at the same meeting where I told them exactly how and when I planned to kill myself – and I followed through with those plans. I was discharged from inpatient treatment despite pleading with the psychiatrist to keep me in for my own safety, because ‘we can’t help you here’ and ‘you have to take some responsibility.’
I literally felt that my life was disposable.
Would any of this have happened if I didn’t have a BPD diagnosis? Would I have been treated with such disdain and even contempt? I don’t think so.
I’ve seen the way other people with BPD are treated in psychiatric units, too. ‘There goes another phone; that’s the second one she’s thrown across the room this week.’ ‘Oh, is she head-banging again?’ accompanied by a roll of the eyes and a barely concealed smirk.
The other problem with a BPD diagnosis is that trying to get it overturned often adds ammunition to the case against you. At times, I’ve been extremely angry and upset about how I’ve been treated by professionals. I’ve walked out of meetings and demanded the crisis team leave my house.
These emotions have – in my view – been entirely reasonable and appropriate responses to receiving inadequate, inappropriate or unprofessional treatment, but have been interpreted as me being irrational, emotionally unstable and manipulative: all traits that are associated with BPD.
BPD is undoubtedly used as a punishment diagnosis, applied to people who don’t respond to conventional treatment pathways, or who dare to challenge a system that treats them poorly. Women are much more likely to be diagnosed with it than men, like hysteria was in the past. It reduces us to hysterical, histrionic beings who aren’t in control of our emotions: irrational, unstable, and most likely hormonal. It’s insulting, simplistic and belittling.
People have said to me that my BPD diagnosis didn’t matter, that I didn’t even need to tell anyone about it. But you know what? It mattered to me. Even if I’d been the only person ever to see those letters on my medical records, it would still have mattered to me.
It hurt me. It harmed me. It could have led to my death – partly because of how awful I felt about myself, and partly because services treated me as if my life wasn’t worth bothering with.
In the past few months, though, something huge has happened: I’ve been assigned an experienced consultant psychiatrist who is, in my opinion, an absolute wonder. He’s knowledgeable, considerate, kind, wise, and committed to getting to know me.
He also LISTENS.
Today, I found myself having a discussion with him about the BPD label, the harm it’s done me, and the impact it’s had on my treatment. And, having explained my feelings and my case against it, and discussed the pros and cons, he agreed to remove it from my diagnosis.
It feels like a major, major win.
Of course, my mental mind being what it is, I’m now questioning myself. Was the doctor annoyed with me? Did he agree to scratch the diagnosis just to shut me up? Had I, in fact, demonstrated the very traits that I was protesting against, and showed myself to be manipulative and demanding?
I get so sick of my brain sometimes. I wish I could just be happy that the diagnosis has been overturned, and not overthink the reasons behind it.
There’s a vocal movement amongst mental health patients against the BPD label even existing. Many people express the same feelings towards their diagnosis as me, and report the suffering that it’s caused them, and its implications for treatment: for example, not being offered the trauma therapy that they so badly need. But do I think the diagnosis as a whole should be scrapped?
I’m not sure. For all of us who’ve been damaged by it, there are also those who feel it represents them, explains their struggles and helps them become more self-aware. It’s an incredibly complex and delicate matter, but does the harm that the diagnosis causes to some justify taking it away from people who feel informed and enlightened by their BPD diagnosis?
I’m not suitably qualified to say. But I’m 100% certain that what is not okay is to diagnose people with BPD by stealth. To apply it to people with no discussion or negotiation, and refuse to listen to their opinions. To use it to justify poor treatment, disrespect and even off-rolling, leaving people at risk. To slap it on people who are harder to treat, or who rightly feel upset or angry that their needs are not being met.
My diagnosis has been removed, and it’s a relief; the psychiatrist has agreed to treat my self-harm and suicidality – which can be impulsive – as separate entities to BPD. But striking it off my records now doesn’t undo the psychological damage it’s caused me. I’ll always have that feeling of ‘what if I *am* a terrible, flawed, repugnant person?’ and my BPD diagnosis has fed that feeling and helped it ferment.
Preventing a wound is always better than patching it up after the event.
How I wish that I’d been afforded enough respect to have had a discussion about the diagnosis before it was applied to me.
Lucy's Depression Diary 