UPDATE: Since writing the below, I arrived at Mum’s (still my official home address) to find a letter from the local trust offering me a psychiatric appointment this Friday! Obviously this is good news. I owe one to Lovely GP. What a sweetheart. But of course my nervousness and catastrophising has already started :-/
Anyway, here is the usual rant. Obviously I am now hopeful that my self-diagnosis can be trumped by that of a shrink, but here it is anyhow.
In the absence of a psychiatrist, and given the reluctance of other healthcare professionals to come up with an adequate diagnosis of my condition(s), I have been perusing the internet in an attempt to do it myself.
Question One: Am I ‘Just’ Depressed and ‘Just’ Anxious?
My visceral reaction to this question is a resounding ‘no’. I am not saying I do not think I am anxious and depressed; clearly I am. But is it more than ‘just’ those things, which are hideous enough in themselves? I will not repeat myself by listing the additional symptoms to which I refer, but if you have missed them somewhere in the ether try looking here, here, here, here and to some extent here.
Given some of these manifestations of madness, I will move on to…
Question Two: Am I Psychotic?
There is quite a comprehensive, if slightly patronising, analysis of the symptoms of psychosis on the NHS’s website. Let’s take it one by one:
Kind of. They would be relatively mild, and are possibly due entirely to insomnia, but they do exist. See here, for example. I also commonly see patterns on things on which there are not patterns – walls, for instance. I do sometimes feel physical sensations that are not caused by anything physical. The example the NHS website gives is feeling an insect crawling over you. I wouldn’t say that, exactly; the sensations tend to be more nebulous. Again, though, they do exist in some shape or form, on an occasional basis. I would say that by and large these hallucinatory episodes occur most frequently when I am really depressed, manic (whether positive or negative) or anxious.
Again, kind of. I don’t think I am permanently deluded, but I am usually pretty paranoid and I don’t many trust people at all. My lack of trust and belief that almost all people will fuck me over is overwhelming at times. Even A, the most cynical of cynics, thinks I am extreme in my distrustful misanthropy. Anyway, I have been known to experience some more demonstrable delusions, such as the (albeit very temporary) belief that the iPod was psychic. I am horrified by that at present, but it seemed real at the time.
As far as ‘delusions of grandeur’ go, well not really. As is evident throughout this entire blog, I am a narcissistic freak, but I don’t actually think I am of particular importance in this world (even though I do think I’m owed something and am superior to many). Presumably the narcissism is a cover-up for my real insecurity and self-hatred. Interestingly, the mental fantasy in which I sometimes live sees me as someone much above my station. However, I don’t believe it’s actually real. Yet…
- Confusion of Thought
Oh yes. Racing, disordered and random thoughts are normal for me, and I am almost constantly confused. Do I outwardly manifest this? Not always of course, but it does happen – with disturbing regularity these days. Quite a bit of it has been discussed on previous links I’ve posted on this entry and in the blog in general.
- Lack of Self-Insight
Well…obviously not all the time., otherwise I couldn’t sit here and analyse all this rubbish. I am trying to work out if I genuinely don’t realise I am mad when I am mad. I’m not sure. I think possibly I think it is normal and real, but only for seconds. Generally I do think my deep distrust of people and my intense fear of abandonment are normal. I’m sitting here typing this, accepting rationally that they are not remotely normal, but no amount of logical persuasion will convince my mind to agree with that.
In conclusion to the psychotic question, I would contend that I am not completely psychotic, at this stage anyway. I think that much is obvious. Although the NHS article doesn’t allude to whether or not a permanent state of the above is required to diagnose psychosis, it is my understanding that the lack of self-awareness thing in particular is certainly a required criterion. Can anyone confirm or refute this?
Nevertheless, I do think it is strongly evident from the foregoing that I have at least some psychotic tendencies. They are internalised frequently, and manifested outwardly more often these days than I’d like. So…
Question Three: What the Fuck is it, Then?
That definitive source of truth and reliable information, Wikipedia, states on its article on psychosis that, according to the DSM, there are nine disorders in which psychosis is a significant symptom:
- Schizoaffective disorder
- Schizophreniform disorder
- Brief psychotic disorder
- Delusional disorder
- Shared psychotic disorder (Folie à deux)
- Substance-induced psychosis
- Psychosis due to a general medical condition
- Psychosis – Not otherwise specified
However, I am fairly certain that I do not have any of these. Indeed, as discussed above, I think I accept that whilst some of my tendencies are psychotic, little is completely so.
The article does state that a number of other mental illnesses can exhibit psychotic behaviour.
- Clinical Depression
Curiously, it does say on the aforementioned Wiki article that what it terms unipolar depression (clinical depression to you and me), the condition with which I was diagnosed all those years ago, can on occasion include psychosis. So it is therefore possible that I am talking out of my arse when I am offering the opinion that there must be something more wrong with me.
Nevertheless, I’m not convinced, especially given some of the manic episodes. So is it…
- Bipolar Disorder
In discussion with A recently, I voiced the view that given my some of my symptoms, I was likely to have something beyond ‘just’ depression and anxiety. A did not disagree, but did opine that I am unlikely to suffer from bipolar disorder, as my episodes of real, euphoric mania are fairly rare. Even having read the Wikipedia article on this, I still wasn’t sure whether it was strongly a possibility. Today, though, I stumbled upon this interesting article.
To paraphrase Dr Comeau, the author, simultaneous mania and depression can exist, the disordered thoughts thing can exist, narcissism can be prevalent and it is common to be easily distracted. When manic, you think you are brilliant. When depressed, which according to here is actually the much more common state in bipolar individuals (most people think the illness is characterised between swinging between mania and depression), obviously you feel worthless.
Impulsiveness, such as spending excessively on very little is apparently a common occurrence in bipolar depression (other similar impulses include sexual promiscuity, gambling etc). I have a mountain of debts…
So, sounds like me, no?
- Borderline Personality Disorder
This is an interesting possibility. Here are the main crteria as set out in the DSM for this illness. Of course, DSM provides the American standard, and as it happens, the British diagnosis of this varies slightly from the one therein. I’ll come back to that momentarily.
- Fear of abandonment – perhaps I don’t meet this criterion in terms of my actual actions like Wikipedia suggests; however, I certainly have the intense fear.
- Interpersonal relationships – they aren’t characterised by instability. However, I would be guilty at times of the idealisation and devaluation thing. Well, perhaps less of the idealisation, but I do tend to see things, and people for that matter, in very black and white terms. It doesn’t always apply, but it is a tendency of sorts.
- Identity disturbance – I certainly have the long-term problems with self-image. It’s very unstable; I go from thinking I’m fucking fabulous to absolutely profoundly detesting myself. Sense of self? Tricky, this one. I struggle with it at times, in the way it is outlined here. I obviously do think others think differently of me than I do, given my tendency to post-mortem every social situation in which I ever engage. Nevertheless, I wouldn’t frequently feel that I personally am struggling with my sense of self. But am I unconsciously doing so, if I feel worry about what others think?
- Impulsivity – binge eating, spending money I haven’t got.
- Self-injury / suicidal thinking – OK, so I have only self-harmed once recently, but I do fantasise about it daily and feel like doing it frequently. Plus my suicide ideation is really pretty severe. I think about it most of the day.
- Affective instability – well, I have the irritability and anxiety. Now my anxiety is a long-term problem, but I am not necessarily anxious all the time. I suppose a fit of anxiety would last a few hours, perhaps even a day or two if something is worrying me in particular, or for the duration of the event about which I am getting anxious.
- Chronic emptiness and worthlessness – oh yes.
- Inappropriate anger – oh yes. And it can be incredibly difficult to control.
- Paranoia etc – yeah. Occasional delusions as hitherto discussed. Definitely guilty of dissassociation, depersonalisation and derealisation.
Now, apparently the UK diagnostic material is slightly different. However, I can’t see any major difference, other than terminology. Once Mind have got over their whinging about the supposed controversy over personality disorders, they have produced a very informative (if dumbed-down) leaftlet on the disorder here. I note with interest that re: the paranoia issues, they also talk about the potential of a trance-like state. Affirmative to that too.
Furthermore, the Mind article references restlessness in addition to irritability and anxiety. Were they using my sometime self as their case study?
Apparently five of six of these symptoms need to be made before BPD will be diagnosed. I think I would be willing to say that I definitely have five of the aforementioned criteria, and pretty much all of the rest are arguably present.
Perhaps the most interesting thing about BPD for me is that it can exist co-morbidly. That is to say, it can be present alongside other mental illnesses, which – surprise surprise – can include both clinical and bipolar depression and anxiety disorders.
- Other Contenders
I also read recently of an illness that involved masking emotions and making out that you didn’t feel them, something of which I am eternally guilty (and no, it wasn’t pyschopathy). I recalled that this was called something like “Emotional (De)Regulation Disorder” but a quick Google search for that suggests that that is an alternative name for BPD.
Can anyone enlighten me as to this disorder’s name? Or was it a phantom memory? Have I been hallucinating again? I think I found reference to it when reading about Depersonalisation Disorder, but looking that up again I am not finding the link. Did I really imagine it?
If it was real, I’d be very grateful if someone could enlighten me. Cheers!
Here are a couple more contenders. I’m not going to go into them in any great detail as I don’t really think I have them, but I certainly have some of the symptoms contained within their diagnostic criteria.
- Avoidant Personality Disorder – I do experience some traits of this, especially of late (although it has been partly the case for many, many years). I do despise most engagement with other humans, mainly because I hate other humans and am scared and deeply distrustful of them. However, I am capable of some normal social intercourse.
- Depersonalisation Disorder – I do experience some quite strong depersonalisation (and derealisation) at times, whilst still retaining awareness that they are not reality. This could be caused by other illnesses, however.
- Narcissistic Personality Disorder – I initially thought that despite my evident narcissism, this was an unlikely contender – but now I’m not so sure. I do have a sense of entitlement, I do feel envious of others, I do preoccupy myself with fantasies of success, I do think I am worthy of contact only with other brains, I do display arrogant and haughty attitudes, I completely lack empathy in most cases. Fuck! Fuck! That’s six out a possible nine symptoms (and at least one of the others is arguable). Five is required to diagnose NPD, under the DSM anyway. Shit! The Wiki artcle further opines that NPD can be related to shame. Does this tie in with my underlying self-confidence and self-hate issues? Is the narcissism trying to cover them? Furthermore, according to here, co-morbidity in NPD is common with other personality disorders, including BPD. Intriguingly this article says that NPD is often misdiagnosed as bipolar disorder.
- So Which Do I Have?
Well, obviously since I’m no psychiatrist or even psychologist, it’s impossible to be certain. I am sure of this: I do suffer from severe depression and anxiety. That is a given.
As to what else is controlling my mind, my reaction when I typed the majority of this post yesterday was that I also seemed to have strong indicators of BPD and bipolar disorder. I still agree about BPD. I understand that in contemporary psychology, ‘borderline’ refers to being on the border of psychosis, and actually experiencing psychotic episodes at times of significant stress. I do believe this applies to me.
But having now analysed NPD, and seeing that it is often misdiagnosed as bipolar, I am less sure of the likelihood of bipolar in conjunction with BPD. It could well be depression, anxiety, BPD and NPD! I don’t like this at all. The NPD bit is especially troubling as apparently it isn’t easy to treat. Fortunately in my case, if I do have it, it would probably be secondary to other conditions, which can be treated (or, perhaps more accurately, managed) through medications and psychotherapy. On the other hand, it could still be bipolar disorder, as narcissistic tendencies can be a product of that illness too. There is so much and it is all so confusing.
Question Four: Why Are You Trying to Diagnose Yourself, You Dumb Broad?
I’m sick and tired of mental health specialists not taking me seriously. Psychiatrists don’t want to know me and the psychologist, whilst admittedly not qualified to give diagnoses, has chosen to not answer my questions about what is wrong with me in a direct and forthright fashion.
I can appreciate that in many ways researching and writing all this is a bad idea. I know nothing of psychiatry bar what I read online, and my knowledge of psychology is pretty rudimentary as well. So I can go online and get what could potentially be unreliable information, so then I could be sitting here saying, “oh look, you have a, b, and c, isn’t that nice.” However, I may finally see a shrink and knowing my luck, (s)he will say diagnose something completely different to the “diagnoses” I’ve made here, and then I’ll be really pissed off with myself and feel even more confused and worthless than ever.
But I’m just so fed up. I want to know what is wrong with me. I feel so bewildered and lost about all of this. I want answers, and if no one else will give them to me, then I feel like I have to give them to myself. I have considered the possibility of consulting a private psychiatrist, but I can’t afford it. I have no money. In fact, I have less than no money because I have a sea of debts. This is all because I am mental, in whatever amorphous and nefarious fashion, and cannot hold down a fucking job.
Question Five: Yawn. Is This Ridiculously Long, Self-Indulgent Post Ever Going to End?