Adventures in Psychiatry : disagreeing with a diagnosis of "emotionally unstable personality disorder"

Oh how the medics within the mental health care system frustrate me...

Following on from my last post, where I mentioned that I had yet to get an appointment with my new psychiatrist, I have discovered the reason why. For reasons that I really don't understand, this doctor took it upon himself to 'assess' me based on what I imagine are very out-of-date and inaccurate notes from my case file. I don't know if it's just me, but that strikes me as being a) rude and b) lazy.

Based on his 'review' of my history, he concluded that I should be diagnosed with "Emotionally Unstable Personality Disorder" aka "Borderline Personality Disorder". This is a serious diagnosis, and should not be thrown around lightly. What scares me most, is that not only is this completely and totally WRONG  but the level of stigma within the mental health system, hell the NHS as a whole, attached to this diagnosis means that I would be effectively black-listed for the rest of my adult life.

My CPN broke the news to me during our session last week and I could feel myself being taken over by the 'bad' part of me that belongs to my paternal lineage (in other words, dissociating) .... It took all my energy to stay in control and she could see how scared and upset I was. She agreed with me that there is stigma and while she doesn't 'buy into' the misconceptions surrounding people with the condition, she knows it exists and frequently comes up against problems when advocating for other patients.

So. I asked for a meeting with her and the psychiatrist to discuss things. Thankfully this request was accepted and I will finally meet my consultant psychiatrist on 8th May. Needless to say I will be going armed to the teeth with why I know he his wrong and what I think could potentially be the problem. I love that I am at a university with a medical school. The library has everything I need!

So. Why is he wrong? Let's look at the diagnostic criteria for Emotionally Unstable Personality Disorder (DSM-IV-TR) via mind.org.uk :

The criterion states that you must meet 5 and the symptoms have a significant impact on your day-to-day living:
  • you have emotions that are up and down (for example, feeling confident one day and feeling despair another), with feelings of emptiness and often anger - my MOODS are up and down, but they are not transient or changing daily. I get angry when something pisses me off. I don't feel empty, quite the opposite! I do not experience emotions 'intensely' and can remain in control.
  • you find it difficult to make and maintain relationships - let's see, I've been with my current boyfriend almost 5 years, and we've been friends since 1999. I've made friends at university and have maintained the relationships, which I value so very much. I've made blogger friends too!! No arguments. No drama.
  • you have an unstable sense of identity, such as thinking differently about yourself depending on who you are with - erm, no..... just, no. That doesn't make sense to me.
  • you take risks or do things without thinking about the consequences - only when feeling 'high', generally manifests in excessive spending or piercings. I'm not a 'risk taker' per se.
  • you harm yourself or think about harming yourself (for example, cutting yourself or overdosing) - yes, and it is very scary to me as I have no reason to self-harm. Those thoughts do not feel like my own and I wish it would go away. I have not self-harmed in almost 2 years.
  • you fear being abandoned or rejected or being alone - nope. I'm dealing with my issues that stem from my previous relationship - being physically/emotionally abused again - and I only have issues with being alone in my house because it's so big!
  • you sometimes believe in things that are not real or true (called delusions) or see or hear things that are not really there (called hallucinations). Yes. I have since the age of about 7/8.
Ok. So we have a weak 4 here. Let's look at the Rethink website and their list of criteria, as it's worded slightly differently:
  • Extreme reactions to abandonment, whether real or perceived - Nope!
  • A pattern of unstable and intense personal relationships with others - Nope!
  • Unstable self-image or sense of self - Nope!
  • Impulsivity in at least two areas that are potentially self-damaging (for example, spending, sex, substance abuse, reckless driving, binge eating) - spending. I have been sober since 28th June 2012. I don't drive and don't binge and/or purge.
  • Recurring suicidal behaviour, gestures, threats, or self-harming - nope.
  • Long lasting feelings of emptiness - nope.
  • Inappropriate, intense anger or difficulty controlling anger (for example, frequent displays of temper, constant anger, recurrent physical fights) - nope. I can control myself.
  • Intense, highly changeable moods - My moods change, but it is  absolutely not daily.
  • Stress related paranoid thoughts - maybe?
All five must be severe for you to get a BPD diagnosis.
Swing and a miss, Mr. Psychiatrist. Once I get a copy of the DSM-V I will update again but I think we know that it's not going to match my symptoms.... at all.

It is very important to speak up if you disagree with your doctor. Talk to Mind and get an advocate. I'm considering that as an option myself. Also, it is your legal right to see your medical records. You need to apply in writing to the primary care trust. My application is in process now. I know that the only way this could have happened is if my notes are vastly inaccurate. It's not something I'm surprised about given where I was being treated before.

I know people with this condition. I know what it looks like. This isn't denial. It's just flat out wrong. Simple as that. I can't self-diagnose, but in the back of my mind I really wonder if I've inherited bipolar disorder of some description. I bet Mr. Psychiatrist hasn't even looked at my family history. The fact I respond to medication and function a hell of a lot better once the dose is right pretty much rules out personality disorder. It's not my fault it stopped bloody working!

Once I have seen my file I can go to the library and compile a strong medical argument against his lazy theory/impression of me. I will fight this to the end of time if I have to.

Samantha Nicholls. Powered by Blogger.

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