These are the criteria, at least five of which are required to be met, in order to be diagnosed with borderline personality disorder. Apologies if this is too much of an echo of my year-old post called ‘BPD vs C-PTSD‘ – but there’s method in the madness, I promise
But what is that method?
I realised something last night, when I commented on Frankie’s blog, The Sunshine Diaries. I was saying to Frankie (who has both schizophrenia and BPD, the former being an illness that she is managing well, the latter being something she still struggles with at times) that I had felt so much better lately, showing that (contrary to a lot of uninformed but sadly popular opinion) there is hope for people with the disorder. As I typed, the following words seemed to roll of my fingers
I’m not sure I meet the required five criteria any more and if so, only just.
I hit the ‘reply’ button largely without thinking…then I realised what I had said, and the possibly enormity of it. Could that possibly be true? Honestly, literally true? That I might no longer meet the criteria for BPD? Really?! Surely not!
Well – this is not official in any way, but stilll…as it turns out; yes, it could be true. I no longer meet the diagnostic criteria for BPD!
*does a happy dance*
Let’s examine it one by one.
[BPD is a]… pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-injuring behaviour covered in Criterion Five). Me? NO. I’m not even that anxious in terms of abandonment issues any more, never mind going to extreme measures to avoid it. I don’t suppose I ever really went out of my way to prevent rejection, other than to make the complaint against the Trust about the end of matters with C – but really, that was more about morality and rights within the system than it was about me and him per se (not that that wasn’t part of it, admittedly. It just wasn’t the whole story).
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation. Me? NO, and this has never been true. I have had issues with splitting in fairness (although this is increasingly less true as time goes on), but it’s very rarely been the case in the context of my close relationships. A and I will have been together for eight years this month. My two best friends from school are still my two best friends. Aside from the normal ups and downs any lengthy connections go through, all of these relationships have been pretty stable.
- Identity disturbance: markedly and persistently unstable self-image or sense of self. Me? NO. Not significantly more than anyone else anyway, I think. In the last few months my self-perceptions have been stable, or at least consistent with an ongoing mood. When severely depressed, I don’t like myself – who does?! When I’m feeling euthymic – as I think I am at present – I am reasonably content with myself. So yeah, it changes occasionally – but it’s not some sort of yo-yo disparity at all.
- Impulsivity in at least two areas that are potentially self-damaging (eg. promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). (Note: Do not include suicidal or self-injuring behavior covered in Criterion Five). Me? MAYBE. The binge eating thing still applies, though in fairness that’s only really gone out of control since I started taking such a high dosage of Seroquel. Even if we can assume that it is a BPD symptom, is there (at least) a second such trait? It’s hard to say. I used to do a lot of stupid shit when I was driving, like seriously exceeding the speed limit. In the past few months, I’ve actually noticed myself being exceedingly boring whilst ensconced behind the wheel. I haven’t even gone beyond 60mph on the motorway in the last few months. *zzzzzzzz* Oh, and - assuming we’re talking in terms of consent (*coughs*), then I’m about as far from promiscuous as you can get without being one of those no-sex-before-marriage people. Yeah. I should vote Conservative.
- Recurrent suicidal behaviour, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself. Me? YES. Not threats and gestures; I’ve actually never been guilty of that. And I haven’t attempted suicide in well over a year, though I have seriously toyed with the idea since. Suicidal ideation is still a very big part of my life, and I can’t see it ever going away. However, it’s about degrees; right now, it’s fairly low by the standards to which I am used. As for self-harm, I’m perennially guilty of the whole ‘interfering with scabs and picking at self’ thing, and I do self-injure with my old friend the scalpel from time to time. 18 months ago, though, I was doing that at least once a week. I find it hard to average out its frequency in terms of today, but it would be less than once a month anyway – perhaps not as often even as that.
- Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days). Me? YES, but also NO – not in terms of the specific criteria detailed here. The DSM says that people with BPD have reactive moods, and that said moods last a few hours or days, and only ‘rarely’ longer. This is not me at all. My mood ‘episodes’ last for weeks, quite often months actually, and – in an opposite to the DSM criteria – only rarely last for shorter periods than these. In this way, any affective ‘instability’ is much more consistent with major depressive disorder and/or an anxiety-related difficulty.
- Chronic feelings of emptiness. Me? NO. No! I don’t feel empty at all. One can feel hugely depressed, anxious, traumatised or whatever without feeling empty. I have all those issues and more, but no – no emptiness. Not any more.
- Inappropriate anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights). Me? NO. I rant and rave on this blog all the time, but as I discussed somewhere else (I can’t be arsed looking for the link, sorry), that’s often because I’m really pretty submissive in ‘real life’. I have occasional tiffs with my mother and with A, but – shock! horror! – that happens in such relationships. Big wow! All that said, my types of ire can alternate – but even when it’s internally explosive, my old skills at acting allow me to behave, mostly, in a measured fashion. I am not constantly angry, and the one, solitary physical fight I’ve ever been in was when I was being bullied at school and had no choice but to defend myself.
- Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms. Me? YES. This is still the main criterion that applies to me, though things are a lot less severe in this regard than they used to be. They could also be explained by other illnesses with which I am diagnosed, but I accept that they could certainly still be BPD ‘traits’ too. NewVCB has told me on a couple of occasions that, in her observations, there are two main strands of people with BPD: you have one bracket of folks who are (to use her phrase) “classically emotionally unstable”, then another who tend more towards dissociation and psychosis (which is much more in keeping with Stern’s original observation of the phenomenon, ie. that it was on the ‘borderline’ between psychosis and neurosis).
So! There you go. I have two of the main symptoms, and a couple of others remain arguably applicable. That’s probably still enough to see me considered to have ‘borderline traits’, but by the definition of the full-blown disorder, I can no longer have its ‘complete’ version.
It’s weird to write this, you know: in a way, it even feels uncomfortable. Waaaaaay back just after I started writing Confessions, I debated the issue of whether or not if, if given the option, I would flick the fabled switch to bring me to sanity. I said that I wouldn’t, and I still hold to that largely. Yet here I am, effectively devoid of an entire set of insane-ish personality characteristics that seemed such a normal part of my apparently abnormal life for so long. Someone once accused me of being obsessed with the diagnosis, which I don’t think I ever was; I did, however, embrace it in many ways – in terms of learning how to be able to manage it, of interacting with others in similar boats, of advocating and trying to fight that ridiculous stigma that permeates it.
I am not ashamed to have been diagnosed with borderline personality disorder; the stigma is unfair, and the histrionic, manipulative stereotypes are blown out of all proportion and are in no way representative of the majority of people that have the illness. You can’t base everything on what you see in an A and E department on a Saturday night, and if you’re stupid enough to think that you can, then you’re not worthy of further words on the subject from me – aside from screw you.
So no, I’m not ashamed, but at the same time, I’m relieved that it’s seemingly no longer with me too. The diagnosis will never leave my medical notes so it’s not about that aspect of things; no, it’s about progress. If I can no longer be diagnosed with BPD, then I have moved forward considerably – and, maybe, returning to work is not a million miles down the road. That is still my ultimate benchmark of ‘wellness’ and ‘recovery’.
All that said, perhaps oddly I still meet the criteria for the similar psychiatric problem of complex post-traumatic stress disorder. I won’t bother to go through the whole thing with it like I did with BPD, but perhaps the reason that it could still be applied is that it puts more emphasis on dissociation than the BPD definition does, or that some of the more specific sub-criteria are applicable to me in a way that the BPD symptomatology is not. Since NewVCB first told me that I “couldn’t not have” complex PTSD, I’ve tried to embrace that diagnosis much more than borderline – not because I was ashamed of the latter, as I’ve noted, but because it seemed politic, wise and even affirming to acknowledge the trauma partly associated with my illnesses.
Furthermore, it’s evident that I still have major depressive disorder, (social?) anxiety, psychotic and dissociative episodes (potentially part of C-PTSD or a BPD trait, but possibly independent thereof too), plus arguable issues with agoraphobia, panic disorder, yadda yadda. But still. It’s progress. I’ll never be rid of everything. I don’t believe that for a second, as well you know, good readers. But if I can manage some of it, eliminate other bits – then maybe I can go back to work and stop wasting my life like this.
How did we get here, this point of non-borderline-ness? Intense, in-depth therapy, with a competent, vaguely integrative (but non-behavioural!), caring and demanding therapist. Someone with whom you’re comfortable – but not obsessed. Someone who cares about you and not targets or looking good to his or her colleagues. Someone who asks a lot of you but is willing to give a lot back in return.
However, therapy is only one part of the equation. I have to say that Quetiapine and, in its higher dose, Venlafaxine, have both worked wonders. It pisses me off that NICE strongly recommend against the use on medication in BPD – the right combination, under the supervision of a good psychiatrist, has made my life better. Simple as, end of. I don’t think therapy would have improved things so much on its own – not in less than six months, anyway. And would I have been able to even have undertaken such intensive work without the relative stability the medication gave me in the first place? Probably not.
In fact, although I think therapy with Paul has been incredibly useful (and will continue to be), the timing of my positivity* is consistent with starting to take the higher dose of Venlafaxine. Placebo? Given that I formally thought it was a useless pile of wank before and had no expectations of it, higher dose or otherwise, whatsoever? Placebo my fucking arse.
* Well. There we go, readers. I’m bored with the newfound positivity of this blog. This is not me, is it? I mean – don’t get me wrong – life is still shite and everything…but it’s a little less shite. Tolerable. Acceptable and passable. This is new and different, and is less bollocks than it is normally. That’s good, but I feel like I’m becoming some sort of saccharine fucking cherub here, and that makes me want to vomit all over this screen.
As I said to my CPN yesterday (blog on her tomorrow, I hope), it’s all going to go tits up again before long. This is probably a calm before a gargantuan cunt of a storm.
Random rant to prove I still can: the human race is an out-of-control fucking virus of much disgusting-ness and David Cameron and friends are cunts who need to have their smug, wanky faces beaten in by ASBO yobs. And, whilst I wish both concerned parties well, who in the name of all that is HOrwell (geddit?! Holy Orwell! HOrwell?!!!1!!!1!!11! No? Sigh ) gives a damn about the Royal Wedding? And this fucking post has taken me about three hours, not because the content is so amazingly refined – it certainly isn’t – but because WordPress is shit. gah. I feel sorry for WordPress now; I didn’t mean that, I’m sorry. I do actually love Wordperss, but honestly – they really, truly, honestly need to revise the user’s ability to create bullet points and so on. This has been eminently frustrating to format.
Bla. Blafuck. Fuckblah. Fuck. FUCK! FUCK!
There’s more to say and more to rant about, but I have a more general update planned for tomorrow so it’ll go there.
Isn’t that class, and isn’t it a brilliant idea? I love tai’s creativity, both in her art and in her prose, and feel very privileged to have been part of this project – so thank you, tai, very much indeed!
‘Night everybody. x