Firstly, you may or may not have noticed that I’ve been away from the blog for a little while. Since I last posted I have applied to jobs, I became a waitress in a busy and demanding pub, I quit the waitress job, had a short skiing break and finally arrived at another job interview (for tomorrow..AHH!). I think it’s fair to say that I’ve been busy.
I finally came to the realisation that to stop the pressure building up around my ‘comeback’ post, I just had to start writing, here and now, no more excuses! So here we are, I’m ripping the plaster off and writing a post. Its not going to be the most interesting, I’m not sure if it even has a point, but I’m glad I finally got around to writing it.
I have learnt many things about blog writing and about myself since January, when I started. The moment my daily views and followers started to increase, it became harder and harder to decide what to write about and it took longer and longer to finish the post. I felt put off, and very self aware while writing. What lesson did I learn? Similarly to the general rule about how frequently you should step on the scale; don’t look at the statistics more than once a week.
One of my most productivity deflating characteristics is what I would describe as “cascading” ideas. It might be a dyslexic thing, a borderline thing or maybe even a Annabel thing. I have about 20 half finished or half started ideas on a single word document. By the time I’ve started working on one idea, another seemingly brilliant one pops into my head allowing me to abandon the first. Discipline and acknowledging the fact that not all my ideas are pure gold dust, essentially not allowing myself to get carried away down a tangent will hopefully improve my productivity and reduce the amount of time it takes to write a post.
I hope that changing jobs to one that’s a little less time heavy will allow me to focus more on my campaigning and writing, as it is something that I really enjoy.
Please stick with me, in spite of my little hiatus! I appreciate your support.
Hello everyone! As you may have read a couple of posts ago, I emailed my MP Theresa May about the Mental Health Taskforce. I received a reply from her office and thought I would share the message with you.
“Dear Ms Swatman,
Thank you for contacting Theresa about the independent Mental Health Taskforce. She appreciates your concerns about mental health services.
I hope that you will be pleased to learn that the Prime Minister has recently announced a new approach to mental health based on recommendations from the Taskforce. Thousands of people with mental health conditions will be supported to find or return to work, meaning they have the opportunity to get on in life. The Government plans to deliver true equality between mental and physical health for the first time. An extra £1 billion a year is being provided by this Government for mental health care to make sure that it gets the attention it needs. This will support one million more people with mental health problems to access high quality care that they are not getting today.
Action will be taken to treat potentially debilitating mental health conditions early on through improved access to care. The Prime Minister has also met with business leaders to highlight the need for a shift in attitude to people with mental health conditions in the workplace and to agree new workplace standards. The Government is implementing the first-ever mental health access and waiting time standards. This means 75 per cent of people referred for talking therapies to treat common mental health problems such as depression and anxiety will start their treatment within 6 weeks, and 95 per cent within 18 weeks. Patients experiencing psychosis for the first time must be treated within two weeks. Please be assured that the Government has a vision of a 7-day mental health service where people will get the care they need, when they need it, and will help to prevent mental illness developing in the first place.
Thank you very much again for taking the time to contact Theresa about this important issue.
I think it is so incredibly promising to hear that the government is making steps to improve the quality of mental health care in the UK in order to bring it up the the physical health standards. Although the aims for waiting times are really great, I believe we can be and we should be more ambitious. With all mental health conditions, a 6 week wait for treatment, although shorter than the waiting times many people are currently experiencing, is a long time. People don’t seek help the moment they suspect something is wrong. Usually, there is a period of pushing everything under the carpet. Many people I know and have talked to didn’t go to the doctor until they were desperate. When your mind is in absolute crisis, waiting 6 weeks before treatment could feel like torture.
Finally I am encouraged by the generally improving attitude in the UK about mental illness, and the greater understanding around what is needed and what can be done. However, through personal experience I know that if you walk into the emergency department and tell them that you are suicidal or in crisis, it feels as if there is nothing that they are able to do, or even that there is nothing that they are willing to do. As a society we should be more ambitious.
Thank you for reading, please ask your own MP about what they are planning to do to help people struggling with mental illness in their constituency.
Have a quick google; the types of people you’ll meet in university halls. Every single one of these lists will include a reference to the mysterious housemate that is spotted in person as infrequently as a major astrological event. They could be called The Ghost, The Loner, literally anything under the sun. What’s more, this language is replicated and encouraged within the halls of residence itself. People love to gossip and wander about the girl or boy who never leaves their room, label them weird.
It is only natural to stop trying to include someone you barely know if they keep turning you down, but consider this;
They really want to join you for that drink or a movie, they imagined the same picture perfect university experience as you. It is likely that they are afflicted with social anxiety.
I was ‘The Invisible One’ in my second halls of residence. To begin with, when I met the other flats in the hallway I would receive casual invites to join them whenever I wanted. No matter how much I wanted to meet them and develop relationships that would make my university experience more enjoyable, I didn’t feel able to do so. I would become increasingly anxious even just thinking about knocking on their door. As the semester and year moved on, they understandably stopped asking. Why should they bother if I clearly didn’t want to join them? My anxiety got worse, and eventually I had to build myself up to even step out of my door, just incase I bumped into somebody.
I was in the unusual situation of moving into my studio flat late, so not only did I live entirely on my own, but by the time I moved in everyone else had already met and established friendships. If I wasn’t a person who suffered from varying degrees of social anxiety then it would have been okay. I would have put in the little extra effort required due to my unusual circumstances. However, I couldn’t. There were many times I wished that someone in my block would have an experience of anxiety, personally or through friends and family. I wished that they would have kept inviting me for just one week longer.
My message to anyone at university and living in halls is if you hear about the notorious flat 12B resident who never leaves, take a moment when nobody else is in the hall to knock on the door and talk to them one-to-one. Worst result for you, turns out they are happy in their own company and want to focus on studying. Best result, you have helped a interesting and valuable person integrate into university and massively increased the chance that when you knock on their door again to invite them out, they will be able to say yes. So please, ask one more time than feels comfortable to you, I guarantee they will appreciate it.
I have just read the Mental Health Taskforce published February this year in the UK. If you live in the UK, and care about the quality of mental health services then I urge you to take a look at the Taskforce and email your MP urging them to make mental health a priority.
To Theresa May,
My name is Annabel Swatman and I have a mental health condition called borderline personality disorder. I was displaying symptoms of my condition years before I was eventually diagnosed at age 18. As a 18 year old girl I had high hopes and expectations for my future; I was heading to university to study, with plans to graduate in 3 years and continue on to medical school. Instead, I have spent the past 3 years in and out of hospitals and emergency rooms, dropped out of university and with it dropped my plans for an academic future.
I have learnt through my involvement with the mental health services that there is simply not enough support available for people like me, and the support that is available is not as good as it needs to be. For example; after a crisis I experienced while studying in Newcastle, my GP referred me to the local CMHT (community mental health team). 3 months later, after no contact from CMHT and after struggling to cope on my own, I booked another appointment to see my GP and was informed that as I was no longer in crisis the wait for an appointment would be long, and when I eventually got an appointment there was no guarantee that they would offer any therapy, treatment, or support. I was devastated.
When I first came to the attention of the mental health services I was 18 and had made an attempt on my life. The hospital mistakenly referred me to the CAMHS (child and adolescent mental health services) who were unable to offer me support or treatment as I was 18 years old. This caused a delay to my access of a suitable assessment and to treatment. With the crisis team in my area unavailable for long periods of time over the christmas holidays and no understanding of my then undiagnosed condition or support for how to cope with it, I was left stranded with only a very stressed and concerned family to helplessly watch their daughter disappear. Inevitably, my condition worsened and I made a second attempt on my life. At this time the NHS were unable to offer me the treatment I so clearly needed, and felt content with giving me a list of numbers to call in a crisis. I am extremely lucky that my family were able to get me treatment in the private sector. Without the treatment my family were forced to pay for, I am not sure where I would be today.
The shockingly long amount of time it took for the mental health services to take notice and offer help, meant that I went so deep into my mental illness, it took months to climb out. I had to put my life on hold, which has had a knock on effect with all aspects of my life. If I had been assessed the first time I was taken to the emergency department for suicidal behaviour, and received the preventative treatment then and there, I believe I would be graduating from university this year with good prospects for the future. My parents wouldn’t have had to spend their own money in order to get the treatment their daughter needed. I would not have spent 6 months of my life as a patient in a psychiatric hospital.
I am asking for you to help transform the mental health services, for your constituents who up until now have been putting up with a lesser standard of health care, simply because their illness is mental rather than physical.
I have just read the Mental Health Taskforce, as I am sure you have too.
The Taskforce has so many brilliant recommendations that people in power can use transform the mental health services, that you can use to transform the mental health services in your constituency, for people like me.
I want good mental health support to be a local priority. As my MP, you have a role to play in ensuring the Taskforce recommendations become a reality in our area. I am asking you to:
• Write to the Prime Minister. Ask how he will be implementing the Mental Health Taskforce recommendations for Government, and what governance arrangements will be put in place to support the delivery of this strategy.
• Help raise awareness in Parliament by asking questions about the recommendations, or lead a Westminster Hall debate.
• Speak with our local NHS and CCG leaders. Ask how they will be implementing the recommendations on a local level.
• Read Mind’s Parliamentary briefing on the key recommendations of the Taskforce.
I hope that this is just the starting point, and that mental health in your constituency is a priority, as physical health has always been.
I look forward to hearing your plans for supporting the Taskforce recommendations.
With best wishes,
10 Changes the Taskforce wants to see happen by 2020
If you don’t have time to read the whole document right now, here’s a handy summary taken from Mind;
One million extra people provided with support for their mental health problem.
10 per cent fewer people take their own lives and everyone in a mental health crisis gets the right care, at the right time, in the right place, seven days a week and 24 hours a day.
People’s mental health and physical health are treated equally – including people with severe mental health problems, pregnant women and new mums, and children and young people.
All children and young people get the right mental health support, when and where they need it.
Clear access and waiting time standards for mental health are in place so you know when you will get treatment.
More people have access to the right talking therapy.
Fewer people are sent miles away from home for mental health care – ultimately no one will have to travel for quality care.
People who fall out of work due to their mental health are provided with personalised, effective and voluntary support to help them back to work.
People who have had the worst experiences of accessing good quality mental health care, particularly people from Black and Minority Ethnic communities, get the help they need.
Public attitudes to mental health have improved by a further 5 per cent.
Mind and mental health advocates here in the UK aren’t asking for much, and they have provided the government MPs with guidelines, recommendations and resources to help them achieve these goals. (If you’re interested you can take a look at the Mind parliamentary briefing here).
On the Mind website, there is an option to send your MP an email like I did asking them to prioritise mental health. I used the template offered but wanted to add my own personal story as well.
The debate of nature versus nurture has been prevalent throughout psychological research since the concept of heritability was first understood. When you first try to understand BPD, one of the questions you’ll likely be asking your doctor, or google, is why? What has caused the personality disorder to manifest?
The answer you’re given is usually a combination of two; your genes have determined that you will have BPD since you were born, or there have been factors in your life and childhood that caused or allowed the disorder to develop as you grew. Even with my minimal scientific background, I don’t entirely understand what this means, and in particular what this means for me. Was I born with BPD?
Psychologists have tried to answer these questions by studying families where a family member has BPD, to see whether members of the same family, with shared genes, are likely to share the disorder. If more than one member of the same family was diagnosed with BPD or showed BPD like traits, this could suggest a degree of heritability. However, members of the same family tend to grow up in a very similar environment, meaning that the BPD traits could have been recreated by a similar familial environment rather than inherited.
Neuroscientists and neuropsychologists have also attempted to find out to what extent genes and biology play a role in the development of BPD. Impulsive aggression is a symptom of many cluster B personality disorders, including BPD. It manifests in people with BPD through self harm, and impulsive and aggressive acts against yourself. Scientists have found that there is a relationship between the serotonergic system in the brain, and impulsive aggression. Essentially, many people with cluster B personality disorders have low serotonin levels in the brain. A chemical difference like this could predispose someone to experience mental illness and BPD later in life. This discovery was also important because it has lead to the use of medications to help manage the symptoms of BPD such as selective serotonin re-uptake inhibitors. you can read more about my experience with this medication here.
Neuroimaging has shown that the brain of someone with BPD is significantly different to the brain of a neurotypical healthy person. These differences could be produced by either the genetic or environmental causes of BPD, because our brain has the ability to change based on how we use it. If we have learned to use our brain ‘the BPD way’ then through plasticity, aspects of our brain change in response to the way we use it. Through researching for this post, I have discovered that there is too much to talk about when comparing the brain images of healthy and borderline subjects here, so I will devote a new post to this topic in the future.
Although I feel much better informed about the known biological and genetic causes of borderline personality disorder, I am finding the information hard to relate to on a personal level. I have no family members who have been diagnosed with BPD or even experience the characteristic symptoms or behaviours on a lesser level. This makes me question whether I inherited the disorder from my parents at all. Additionally, I have found serotonin based medication fairly unhelpful. Although this doesn’t mean I don’t have low levels of serotonin, as there are many different medications available and I have only tried one of them.
It is well known among the psychiatric community that many people who are diagnosed with BPD share the same or similar negative childhood experiences. These experiences are so incredibly prevalent, it is unlikely to be coincidental.
The ‘nurture’ argument states that people will develop BPD because negative experiences have taught the child to develop maladaptive behaviours as coping skills, which are used in place of emotion regulation because the child has not been provided with the opportunity to learn this skill.
I am hesitant to create a list of childhood environments and experiences that contribute to the development of BPD, because I know how varied and individual the experiences leading to BPD are. Mind, a mental illness charity provides a simple list of reasons why a child may not gain enough experience of healthy emotions and relationships. Living with an unreliable parent, for example a parent with an addiction problem, could cause a child to develop the belief that they are unimportant, and that everyone will eventually abandon them. When this belief grows into adulthood, it could manifest in symptoms of BPD such as an extreme fear of abandonment or self harm.
Personally, I find the environmental causes of BPD easier to understand, the path from cause to result is easy to visualise and fairly simple to follow. However, I am not able to pin point an area in my childhood where I may have been made more susceptible to develop BPD. Like many children I was bullied in primary school, and my parents went through a divorce. However, the bullying was dealt with and ended when I moved schools, and the divorce was nothing special and finished while I was still young. I was not neglected or abused as a child. I had a reasonably happy childhood, and wouldn’t change any part of it. However, I do have BPD. I can understand how if I was genetically predisposed to be sensitive to the triggers of BPD, unhealthy lessons about emotions and relationships that I was exposed to in my childhood could have accumulated to affect my emotional development and behaviour in adult life.
If you feel a particular way about whether your BPD was more influenced by genetics or your environment I would be really interested to know, please get in touch!
I was really struggling to find a way to describe the experience of my first day at the priory retrospectively. I found it not only hard to remember the facts, but also remembering how I felt at the time was incredibly difficult. I couldn’t convey the experience truly through my normal style, so I decided to write it as if it was an ongoing inner monologue from 2013. You can read this article here. The process of writing it and the feedback I have received made it a therapeutic and cleansing experience, enhancing my connection to and understanding of my younger self.
I stayed at the Priory Hospital for 2 weeks. During this time I explored some of the therapy groups, beginning to recognise the same people day after day. There were many staff members that I encountered daily, the majority were not in my favour. I have to emphasise that I hated the staff and the therapists because of where I was standing mentally and emotionally. I later discovered that they are all caring, kind and supportive people who are brilliant in their fields of work. One staff-patient confrontation sticks in my mind. Months before, my family members had booked a trip to the theatre. For some reason, I believed that I would be and should be allowed to go even if it was only two days after my admission. Numerous emotionally heated conversations culminated in a one-to-one meeting with the ward manager. He told me I would not be allowed to leave the ward, and I replied with nothing less than raw, unfiltered anger and disgust. It was so bad that I wasn’t able to properly look at him for the rest of this or any of my other visits.
I remember having an influx of visitors, almost every day. They bought chocolate and clothes and anything else they imagined would make my experience better. I feel like both parties in these meetings were ignoring and denying the blatant fact of where I was and why. Jokes were made (mostly by me), I would dismiss the importance of everything that was happening there. Although I was grateful for the company and the distraction, this probably wasn’t the best line of attack for two weeks in a psychiatric hospital, and maybe contributed to my lack of immersion in the therapy offered. During my second admission a while later, I put some boundaries on who could visit and how often.
I met my doctor after my first weekend; Dr Woolley. I wasn’t entirely sure what to make of him, a middle aged man with facial expressions and a demeanour like an awkward teen boy, but with marks of his age on his skin. He had a way of talking and looking at me like he was observing a dangerous animal, but with fascination rather than fear. At the time it is likely I was misinterpreting interest and concern. We talked with, and without my mother. I sat up straight with my hands neatly folded in my lap, nodded and smiled where appropriate and answered all questions with a considered and clean cut response. During my time in therapy I frequently confused observations about my detached demeanour and apparent logic based ideology as complements. I distinctly remember a point in one of our early meetings when Dr Woolley said something along the lines of ‘you appear rigidly rational’, my instinctive response was to politely say ‘thank you’ and smile, returning my gaze to my hands. This moment stuck with me because I found his response intriguing; he was quiet, looking invasively at me, amusement visible on his face. He asked why I assumed it was a compliment, I don’t remember my response.
I spent a lot of time watching Breaking Bad and reading the books family members had brought from my bedside, but at least 2 times a day I was expected to attend group therapy. Group therapy at The Priory involved sitting in a cold and slightly damp room, with paint or wallpaper peeling from the wall. Chairs were placed in a circle around the edge of the room, just the normal plastic chairs usually found at schools. Most of the rooms had a flip-chart whiteboard in one of the corners, rarely used, with the same old scribbles never wiped or cleaned away. There were rules for the groups, such as no leaving once the session had started, no talking over people and no hot drinks. Mostly the same people would talk each session, possibly the most confident or veteran patients in the hospital. It sometimes felt like you had to search really hard for something to share on topic, just in case they picked on you and thought you weren’t cooperating, when actually you couldn’t think of an example to share. During this first admission I found group therapy boring and pointless, and usually too early in the morning to fit in with my sleep schedule.
As I was admitted the Friday after boxing day, I spent New Years as an inpatient. New years eve was a strange event to experience in hospital. I did not want to leave my room and ‘celebrate’ with the other patients in the common room, despite the repeated invitations and coaxing from staff members. Not because I thought myself better than they were, I wanted to be on my own, I suppose to allow myself to forget where I was, but also out of some misguided protest. Speaking to friends on New Years, happy and drunk from the parties I should have been at, was the only memorable experience from that night. The few friends who knew the truth about where I was showed a great deal of love and patience by speaking to me that night. I was bored, angry and frustrated, and coming to terms with the fact that I would simply have to drop out of university. I stayed up late into the early hours of the morning, reading books, magazines and listening to music. I didn’t want to sleep, in hindsight the symbol of waking up in a psychiatric hospital on New Years Day was probably too much to handle.
Two weeks after my arrival at the Priory, my doctor and I had agreed about my withdrawal from university and my discharge from the hospital. The plan was to continue as a day patient, I was to be under the hospital care during week days in order to undergo therapy. I left that day still detached and in denial, remaining a day patient for 5 weeks before my second admission.
There are many aspects to our lives that we are embarrassed about. It takes a lot of courage to open up to someone, so if you happen to be this lucky person please don’t judge how we feel or our behaviour. If there is something you don’t understand, say that you are here and that you support us. You can research what you were told later to find out how you can best be supportive. The same goes for if you accidentally find information out, there should be no difference to how you behave. Finally, when in a group situation don’t join in with gossip or negative talk about BPD behaviours. You could be causing someone unknown in this group to feel intense pain.
Moderate Your Vocabulary
Although we don’t want you to be too precious around us, there are some things that can bring up horrible feelings and experiences. Repeatedly describing someone as crazy in a negative way, saying things such as “she really needs to get some help” makes me in particular feel ashamed and awkward. I personally don’t like it when people call themselves fat or skinny in front of me, or talk about the health quality of food that I am about to eat. I understand that everyone has their own insecurities that are completely unrelated to their opinion of me, but it still triggers unhelpful feelings and emotions. There are other obvious things that people can say that can affect someone with BPD more than an average person, for example jokes or comments around sexual violence and trauma. If in doubt try to be a little sensitive, and ask the person if anything you say is triggering.
Don’t Take It Personally
My friends all know and hopefully understand that I am not the most reliable person. If we have made plans, and I cancelled last minute, there are literally hundreds of reasons why. Anxiety, depression, and particularly violent mood swings sometimes make the prospect of leaving the house terrifying, for reasons that are hard to explain, sometimes something as seemingly silly as finding a mark on the outfit I planned last night. We are also a group of people known for snapping and being blunt with people, all I can say here is please don’t take it personally. I know it can be horrible to experience the rough side of someones bad mood, but if you can, try to ask us whether we are mad at you or being affected by something else in our lives. Simply put, it can be hard to be friends with someone with borderline personality disorder, but know that we understand this fact and we’re trying our best. I appreciate all the friends that have stuck by me, I know that it hasn’t been easy!
Listen and Don’t Steal
There have been a number of occasions where I opened up to somebody by speaking to them about something difficult, and thought that they were listening and understanding. However, down the line I noticed that they had listened to my problems and not let them go since. I don’t mean by checking that I’m alright the day after I told you I was struggling. These tend to be the kind of people that are excited by the prospect of drama. Once the conversation about my problem has ended, some people try to own the pain I have just opened up about, leading me to feel guilty and responsible for them. I don’t think that this is helpful for either party, it would be better to tell me that you don’t feel up to talking at this time, and then change the subject! If its going to cause long term problems and drama, please take a step back.
Be Upfront and Honest
This is true for friendships with average minded people too! People with BPD are often incredibly sensitive to interpersonal cues, in a way they can be paranoid. Taking any steps to hide things from them rather than manage the conflict you foresee, can make the situation worse. Feelings of deception and paranoia is often a strong trigger that is particularly hard to identify, and therefore to self manage. I would ask that you are sensitively upfront and honest about a situation which you fear would affect me, and trust me to be able to deal with it.
Think About the Situation
Some situations are more sensitive to triggers than others. I personally need to keep this in mind when planning to meet someone or go somewhere, but it would be helpful if my friends also did the same. For example, it is very easy to get someone talking after a few drinks and you may feel more confident to ask questions with a bit of a buzz. However, talking about a dark period in your life while drunk is not fun, and for someone with BPD can be very triggering. Furthermore, if your friend struggles with social anxiety and you’re planning on going to a busy event, you could ask if theres anything you could do to make it easier for them.
Its lovely to be told that you look nice, a compliment is supposed to make the receiver feel cared for and appreciated. For me and other people with body image issues, specific comments around weight make me feel uncomfortable and ashamed. This applies to all people but when making positive comments about someone, try to think about how you want them to feel and use the right words to achieve this. There are many other ways to compliment someone other than to say that they look slim.
Avoid the Egg Shells
Or rather, don’t avoid the egg shells! We’re your friend too and we don’t want to you molly coddle us. We can cope with a lot, and we do cope with a lot. Please don’t feel like you have to not be you when we hang out, because its you we became friends with. Exercise sensitivity and we’ll be able to carry on our friendship as normal, we’ll do the same!
Look After Yourselves
Finally, we know that being the supportive and patient friend that you are can take a lot out of you. We don’t want to drag you down with us, we promise, so make sure you have your own support network if you need to talk. We also understand that you need time away from our intense relationships, and this is fine, just let us know that you’re still going to be around, and more importantly if you’re coming back! You should always put yourself first, and look after yourself as well as you look after us. If your own health is at risk because of our relationship, talk about it. I’m not holding anyone physically or emotionally hostage, and I want the best for all my friends just as most want the best for me.
Eating disorders and disordered eating are some of the many co-morbid diseases with BPD. According to this website about BPD approximately 25% of individuals with anorexia nervosa are also suffering from the symptoms of BPD.
I have used the term disordered eating to refer to unhealthy eating patterns, beliefs and emotions around food that have not resulted in a diagnosis.
I have been unhappy about my body and my overall appearance for as long as I can remember. From the age of 5 I thought I was fat and ugly. I used to sit in the bath as a 8 or 9 year old girl, pinch the fat and skin from around my stomach and my thighs, and imagine slicing it off with a sharp knife.Although I was wildly uncomfortable with my appearance and by body, I didn’t make the connection between food, hunger, and weight fluctuation until a little later. In secondary school I knew that I needed to ‘simply’ exercise more and eat less, but I was too embarrassed to try in P.E. or jog outside. The thought of people seeing me exercise filled me with fear. I imagined that people would look at me and think ‘haha look at the fatty run’. To get around this, I used to exercise in my room in the evening. Jumping jacks and sit-ups, never too intensively and not usually for more than a hour.
I wasn’t ever more than a little chubby, but I felt absolutely huge, and thought that this was the worst thing in the world to be. I believed that if I lost weight everything in my life would fall into place; that I would find making friends easier, that my teachers would take me more seriously, that my family wouldn’t think of me as a joke. I didn’t realise at the time that my thinking was massively distorted. My weight started fluctuating, I never lost that much and it never stayed off for long. I started skipping lunch and going to the gym, obsessing about food 24/7. I tried cutting out dairy and wheat, dairy lasting the longest (which is surprising because I love cheese).
In the Summer after GCSEs I travelled to Tanzania to get some work experience in a hospital there. I felt a surge in my confidence, I was around people that had never met me before and I was doing great. I started smoking, and convinced myself that the food was disgusting. I would fill my plate with, at most half of what everyone else was eating, and then pick at it until they were finished. It was hot and we were often hungover in the morning. I felt light headed and almost fainted more than a few times during the day. Im not sure whether I actually lost weight while I was there, but I had learned how to restrict my diet, and got the ‘taste’ for hunger pangs.
My new food philosophy didn’t last, I was eating normally again soon after arriving home. The difference was that now, when I would hate myself after eating something bad, or when looking in the mirror, I was able to think back to when I wasn’t being ‘a pig’ and when I felt great about myself. My diets and behaviour didn’t really escalate into disordered eating until after the summer holidays. I was starting sixth form at a new school, it wasn’t long before I started trying to restrict my food intake again. I got myself stuck into a cycle where I would try not to eat for as long as I could, mess up, binge or eat the food that I had been withholding from myself, purge, then feel so crap about myself it would all start again. I started keeping a food journal and documenting everything that I had eaten that day. It started out with fairly healthy goals, such as 1500 cals or less. I wasn’t able to weigh myself but I used clothes to measure my progress. I began reducing the calories that I was allowed, and spent every evening doing the maths of how long it would take for me to lose so many pounds if I ate so much each day. I would throw up my dinner so that I was able to keep my calories under the more and more restrictive allowance. I believe that by doing this I lost a little weight, but nothing excessive.
Half-way through year 12 I went on a ski trip, which was fairly out of character because I didn’t know how to ski and only one of my close friends was also going. It was another one of those situations where you could get away without eating very much and exercising all day. My eating patterns aroused the suspicion of the 3 girls I was sharing a room with. I can see how my odd behaviour would annoy them to no end. I look back on this trip fondly, as its where I learnt to ski and I had fun with my friends.
For the next half of the year I had moments where I was losing weight to my satisfaction. I was managing to reach my weight and clothes goals, and getting away with eating under 400 calories each day, sometimes nothing. I was binging less frequently and going to the gym fairly regularly. The only time I really purged was when I had to eat with people, or something that I didn’t feel comfortable eating. I knew that it was wrong to do, that it was rude and antisocial, especially as people started noticing. I would start to get incredibly anxious about even the thought of food, and would write mantras and phrases in my diary reprimanding myself for giving in to food. I would use my friends and my social life to get away without eating, by not eating much while out I could lie to my parents at home.
I remember at one point during the summer between year 12 and year 13 when my aunt and my mum confronted me about my bulimic behaviour. My mum said something along the lines of ‘you’re not bulimic are you, you know better than that’ and frequently (unsubtly) checked my knuckles for scars. My aunt said something like ‘you’re not spreading pesto on toast and then throwing up are you?’, I said no. I got more secretive and better at hiding my behaviour, they never brought it up again. I was stuck in a cycle of feeling happy about my progress and hating my body. Comments from family members about my body or my weight were never welcome, even if positive. I began to hate other people who talked about diet or food or weight or bodies, especially while eating. My heart would pound and my face would blush if someone said a food I was supposed to eat was ‘naughty’ or ‘bad’. I managed to lose a little for year 13 leavers ball, but not enough.
When I moved to university I had the freedom to eat whatever I wanted. I began to lose weight by eating tiny portions or not at all, but quickly began purging again. I was getting more and more unwell, staying up late at night to binge and purge. It got to the point that everything I ate had to be purged. I was too scared to do a food shop so I ended up eating the weirdest things, such as raw oats.
Since then I have been through stages that last anything from a week to months. My weight doesn’t often move above or below two numbers, no matter what my behaviour is. The common denominator for all my eating habits is poor body image. I don’t believe I’ll ever be able to not want to lose weight. In a way I am lucky that I cannot stick to the same routine for more than 2 weeks, this way I never get really unwell due to diet. My battle with body image and self esteem, and to be honest, weight goes on.
If you think you, or another person is showing signs of disordered eating, please speak up in a calm and understanding manner. It is incredibly important not to be judgemental, and not to ambush the person. You could send them retreating further into their developing illness, and make it harder for them to end the damaging cycle before it takes over their lives. People with disordered eating need support and help, and in particular they need to be taken seriously. It is often a sign of other underlying problems, and problems that they could face in the future. Just because someone struggling with food is not underweight, or even if they are overweight, doesn’t make their problems any less serious.
When I was first admitted to hospital I frequently refused the offer of medication. I believed that there was nothing medically wrong with me, and the only way I could prove that I was not unwell was if I wasn’t taking meds. I eventually folded to the necessity of sleeping pills, mainly because sleeping in hospital is not easy. I also began taking a benzodiazepam, simply because I could. My experience with medication has been very mixed and incredibly stop-start. For varying periods of time I have taken all 4 of the medications I talk about below (actually a low number for many people with mental illness), as well as different combinations. I have learnt that (for me) sometimes medication can help, but also sometimes its okay to take a break and re-stock. In the past I have decided to take these drugs in order to make the people around me more comfortable, in the hope that they would find me more agreeable if I was medicated, and in some cases sedated. However, I am happy with who I am. I can manage mood swings and can enjoy the variation in my personality and even sometimes mood.
Lorazepam is a benzodiazepam normally prescribed to patients with anxiety or sleep problems. It is also used as a muscle relaxant in hospitals when somebody experiences a seizure. Gamma-Aminobutyric acid (GABA) is a chemical neurotransmitter in the brain. Its role in the central nervous system (CNS) is to reduce excitability of the neurons, which leads to a reduced CNS response. When your CNS response is reduced, your heart rate slows down and your blood pressure lowers, essentially you relax. Lorazepam blocks the breakdown of GABA to that the concentration of this calming chemical increases, and that you can feel the relaxed effect. Once you have taken lorazepam, you can feel the effects very quickly. I found this drug incredibly helpful, to stop or reduce the effects of a panic attack or situational anxiety quickly and easily. However, after taking it for 4 or 5 months, I began to accidentally overdose when also drinking alcohol. My dose was increasing, and as alcohol is also a CNS depressant this mixture caused some problems for me.
Zopiclone is the sleeping pill my doctor first prescribed when I was an impatient to help me get to sleep. It didn’t knock me out, in fact they were shocked that I didn’t sleep for about two hours after taking my first dose. Zopiclone boosts the effectiveness of the chemical GABA by attaching to the receptor sites in the brain where it normally works. Although the package clearly says that you shouldn’t take this medication for more than 2 weeks at a time, I was taking it for about 8 months. It was the last thing I decided to stop taking but I don’t necessarily think that it was helpful. Unfortunately they prescribed it to ensure that I would sleep through the night in hospital, however I didn’t suffer from a sleep disorder before. Once you’ve started taking sleeping pills, its really hard to sleep without them. I wouldn’t recommend this medication for the treatment of BPD unless you also have insomnia.
Citalopram is a type of anti-depressant called a selective serotonin re-uptake inhibitor. This means that the removal of serotonin from your brain is reduced, increasing the concentration of serotonin. Serotonin helps to regulate mood, appetite and sleep, and is used as an antidepressant as it brings about feelings of wellbeing and happiness. I was first prescribed citalopram upon my second admission to hospital. It had become apparent that I could no longer put off the use of medication, therefore my doctor and I agreed that an antidepressant would be the least invasive and could really help my depression. I have taken it for short periods of time since then, but I don’t really notice much of an effect. It might increase my general happiness and reduce my impulsivity, but not enough to notice on myself. I might talk to my doctor about trying a new anti-depressant.
Quetiapine is an atypical antipsychotic medication. It is usually prescribed as a mood stabiliser for people with bipolar or mania, or as an antipsychotic for people with psychosis. However, there has been a lot of research recently about the effectiveness of quetiapine for the management of BPD symptoms, and it looks promising. Quetiapine works by blocking dopamine receptors in the brain, reducing the effect. Dopamine is involved with motivation, emotions, behaviour and perceptions. The reduction of dopamine in my brain caused me to feel overly tired and uninterested in activities. It also lead me to gain weight (a common side effect) which I did not enjoy. The sedative effect helped to stabilise my mood and keep me stable, but having stopped taking it now, I believe that for me and my disorder, quetiapine is not the right drug.
I have taken some information from wikipedia and some from the website headmeds which I really recommend for information about medication and illnesses.
I wake up from a long deep slumber, I’ve been sleeping in a large comfortable double bed. I’m not at home because my room is only home to a childlike single. The room I’m in is similar to a medium starred hotel room, the kind I imagine that business men and women crash into after a long day of city work. It has a desk and an ensuite, and a beautiful large window. Theres not a feel of ‘ikea’ about the furniture, so it must be a nice place. I didn’t sleep well, and feel quite drowsy. Frequent interruptions from the staff disturbed me at regular 30 minute intervals. I soon learned that this inevitable annoyance was less invasive if I slept with my face uncovered by the blankets and facing the door. This way had the downside of the hallway light hitting my face every time the door opened, but at least the stranger night staff felt no need to gently peel the cover away from my face, and peer their own right against mine. I did consider whether I would rather have a pulse monitor on, at least then the rhythmic beeping would announce my ‘aliveness’ for me, and I might be disturbed slightly less. However, this is not a hotel, or even a hospital with heart rate monitors. I am sitting in a private psychiatric hospital called ‘The Priory’.
Evidently, I have slept passed breakfast, but this causes me no disappointment. I am thankful that the nurses allowed me to sleep in as I have very little motivation to leave the bed, let alone the room. I faintly remember being roused in the morning at the change of shift, to ask what I would like for breakfast. I replied nothing, I wanted them to stop waking me up and disturbing me. Beside me, rather disturbingly on the bedside table furthest from the door, is a tray. There is a banana, an apple and a pastry. I don’t remember anyone bringing this. It feels violating that anybody and everybody can walk into my bedroom. I make a point to remember where I am and try to forget the idea and the comfort of personal privacy.
I am nervous to go to the bathroom, as I haven’t yet checked whether there is a lock on the inside. I also must time my shower perfectly. Based what I learned about the staff behaviour last night, I doubt anyone would think twice about barging in while I am in the shower, and I am not sure whether a verbal affirmation would convince them that I am, indeed still alive.
I walk back into my room and change as quickly as a pubescent high school student in the filthy crowded P.E. changing room. I wish people would knock. I make my bed. I don’t eat the food, but contemplate what I am supposed to do with it, would the mystery room service person return to take it back? I am not smoking at the moment, currently I cannot remember what drove me to stop as there is nothing I wouldn’t do for a cigarette right now.
The day is passing slowly, nothing eventful occurs. I am beginning to recognise the faces that pop through my door, there appears to be a repeating pattern. A few of them make half hearted attempts to rouse me out of the door, to meet the other patients. I have no interest in doing so, I would not know how to behave around them. I am not depressed, I am disgruntled at being here. A nurse comes in to visit me and have a little chat. Ive been having a lot of those over the past couple of days. He’s a middle aged man, with a face that I cant read. His lips are slightly too large for his mouth and it affects his London accent more than mildly. Im straining to understand the questions, but he seems friendly if not a bit patronising. The conversation is inconsequential. My doctor is not working this weekend and nothing about my treatment and care can be changed until he returns. I am not allowed to leave for any reason.
There is nothing to do here, I have spoken to my mum, or she came to visit. There really is no difference. I could get my books out and start revising, but i’m not in the right mind set. I’m agitated and stressed, this would all be a lot easier from home. Lunch has come and gone, I snuck downstairs and picked at a salad. I sat on my own and exuded no signal of wanting the people around me to join. Dinner is going a similar way. The food hall has such a mixture of smells it’s making me feel unwell, like all the bright and beautiful colours mixing together to form sludge. Nobody stays here for dinner unless they are inpatients. There is a long table opposite me, reserved for the eating disorder patients. Its empty, but I am here early. There are small bundles of people who appear to know each other, some are talking and some are simply using other peoples company to guard themselves from prying eyes and loneliness. Its not busy here, and mostly women. There are a few people who visibly appear unwell, through the pain on their faces and the outfits they have managed to put on, but mostly the people here appear like I do. Entirely normal.
Theres a television in my room that I am looking forward to getting back to, so I eat my meal quickly with my head down and make my way back to Upper Court, my ward. In order to get inside I have the press a button on the intercom, and wait while it makes the most grating and inconceivably annoying noise. Eventually the noise will stop and I will step inside, turn up the stairs and then into the first door on the right. My room. I am lucky that I don’t have to walk past the nurses station, or any other door in order to get back, I do not want to talk to anybody. Not today.