Theresa Mays office replied…

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.

Best wishes”

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.

Borderline Bella xxx

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Invisibility and University Halls

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.

Thank you for reading

Borderline Bella xx

To Theresa May.. regarding the Mental Health Taskforce

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,
Annabel Swatman

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;

  1. One million extra people provided with support for their mental health problem.
  2. 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.
  3. 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.
  4. All children and young people get the right mental health support, when and where they need it.
  5. Clear access and waiting time standards for mental health are in place so you know when you will get treatment.
  6. More people have access to the right talking therapy.
  7. Fewer people are sent miles away from home for mental health care – ultimately no one will have to travel for quality care.
  8. 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.
  9. 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.
  10. 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.

 

Thank you for reading,

Borderline Bella xxx

BPD; Was I born this way?

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!

Thank you for reading,
Borderline Bella xxx

How to be Friends with a Borderline (like me!)

Be Non-Judgemental

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.

Compliment Kindly

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.

Thank you for reading,

Borderline Bella xx

 

Body Image and the Borderline

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.

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Me and My sister on holiday age 9 (I think)

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.

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Me on my 16th birthday

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).

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Me at 16, spending the summer after GCSEs volunteering in Tanzania

 

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.

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Me at 17, at the end of a restrictive week. I was pale and tired, but hadn’t lost very much weight.

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.

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Me at 17, probably at my highest weight immediately after exams.

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.

Thank you for reading
Borderline Bella

My BPD Medication

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

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

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

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

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.

Borderline Bella

Mental Health Crisis

If you have experience of mental illness then you are probably aware of the charity Mind, they found that “only 14 per cent of people in crisis got all the help and support they needed.” Which is horrific. Try to imagine what would happen if for only 24 hours only 14% of people in a physical health crisis got all the help and support that they needed. It shouldn’t be any different. Mind is involved in an ongoing campaign to better crisis services and the overall treatment of people with mental illness. I will include a link to this campaign website if you are interested.

What is a mental health crisis and when does it become a crisis?

I would describe a mental health crisis as a moment no matter how fleeting when someone feels they have lost control of their mind and their mental illness. It could be triggered by an external stressor event, or medication changes or simply a worsening of a current illness that requires more care. Most of the time, you or your loved ones will be able to make the decision as to whether you are in crisis and whether you need help. For example, if you are afraid that you will self-harm and you don’t want to this would be a crisis, but each case will be personal. The danger or self-harm is not a crisis for everyone, depending on the amount of harm you are likely to cause and the frame of mind you are in at the time. Other experiences that may occur alongside a mental health crisis are psychosis, extreme anxiety or panic attacks, mania, paranoia, and feeling suicidal. When people with an existing mental health condition experience crisis it is likely that their symptoms will become more determined and persistent. If you are afraid that you will hurt yourself or someone else, or lose control of reality then this is a valid crisis and you deserve to have more support and to be helped through this.

I personally keep two lists on my person, they are written very simply as if a child will be reading them to ensure that whatever frame of mind I am in, I have the best chance to help myself through. One list is for when i’m feeling agitated, usually anxious and when I cannot relax. Oddly enough, when I am in this state I know that I am more likely to suddenly decide to attempt suicide, more so than when I’m feeling extremely low. This is when I am most impulsive and least likely to be thinking rationally. From experience I know that if I can use up some energy and distract myself I will calm down within 2 hours. My list is a numbered list, 1-10. I rate how ‘bad’ I’m feeling and start at that number, doing the exercise on the list and if that doesn’t work I move to the next one. It starts with simple activities like 10 mins of intense exercise or intensively cleaning the room, activities that I can channel my energy and obsession into that are satisfying to complete. As the list increases I tell myself to contact certain people who I know can help, and finally number 10 means I have to allow someone else to look after me by going to the emergency department or calling the crisis team. My low mood list is very similar, except it includes calming activities that allow my mind to switch of, such as colouring and taking a shower.

I really recommend that you write your own lists, it really helps to think through and plan for those moments because when you are in the middle of them, its extremely hard to think straight and know what you should do.

Who can help you in a crisis and who can’t?

When you’re experiencing a mental health crisis there are a number of options you have to reach out for support, you can pick the right one for you depending on pervious experience and how serious you feel your crisis is. Its always personal, and it is always as serious as you say it is.

The first options are phone services such as the samaritans (116 123). You might have local services that are available to you, it is a good idea to look these up and make a note of them or save them in your phone so they are easy to access. You could also call the crisis team for your area, if you haven’t been referred or if you don’t know the number of the team in your area you could call the non-emergency hospital line (111) and ask them. The crisis team are usually very good, they will talk to you on the phone and can advise you how to best keep you safe. They could also come and visit you where you are. It all depends on what you feel you need. If you tell the crisis team that you have self harmed seriously or taken something however, they will want you to go to the hospital and have the ability to send an ambulance. If your crisis is during working hours you could call your local GP and tell them that you are in crisis and would like an emergency appointment, they should try to fit you in that day but this wont always be the case, unfortunately. The last option of professionals that I will cover is going to the emergency department. This is not always the best option and in my experience can make things worse. I will cover more about emergency departments and mental health crisis support later in this post.

I find that it is helpful to have written out a ‘script’ for the possibly scenarios where you might be asking for help. This makes it less scary for me to do, especially if its over the phone. It also means that you wont miss out any crucial information.

Another route to support that you could consider is friends and family, however you should pick the people that will be able to help you, rather than be unhelpful or even unkind. Through experience I have learned not to elicit the help of people who are impatient, unkind, dramatic, weak, naive and people who don’t trust me. This final point is important because if you want to talk things through you might be going into the deepest darkest corners of your mind, however we all know when we are done and we are ready to let it go and move on. When a person doesn’t trust you they could end up making the situation worse by not believing you when you say you are ready to move on. Some people will feel comfortable to contact their therapist, some won’t. Some people will want to contact their family as I do, however some people don’t and this is all okay. Everyones inner circle is personal and you shouldn’t feel like you have to go to someone in crisis when you don’t feel comfortable doing so, just because they told you that you should.

The emergency department

The emergency department is an awful place to be, it usually involves a wait of above 3 hours surrounded by people while also being ignored. However, in some cases the care that can be provided by a hospital is the best thing for you, outlined by the number of times you read on the internet ‘go to the ED’ if you are feeling suicidal ect. but it might not be the best equipped place to provide you care.

Pros;

  • There are doctors that can assess you mentally and physically and they can refer you to other services that can help.
  • You are in a controlled environment, which may make you feel safer.
  • You might get a bed in a hospital and psychiatric treatment.
  • You might be listened to and cared for.

Cons;

  • You will be sitting alone for a long period of time.
  • Unless you have a physical injury, a ‘plan’, a suicide note or you have already taken actions to harm yourself. I have no experience of mania or psychosis but I imagine that it is the same, unless you are in acute and what they define as serious danger they will not treat you.
  • It is unlikely that there will be a bed available.
  • It is likely they will simply hand you a phone and tell you to talk to the crisis team (I’d advise you to always call the crisis team before you decide to go to the hospital, so that you don’t have your time wasted).

The emergency department – what will happen if you go?

To begin with this depends on your route there. If you have called an ambulance you will be assessed by the paramedics and then probably taken to wait in the ED for a psychiatric assessment, but not always. If you walk in to the ED, then the first person you will talk to is the receptionist. You will have to tell the receptionist why you are there, including your physical and mental symptoms. They will probably ask you to talk to the nurse at the end of the desk, who will then tell you to give your information including your address to the front desk. The next bit is tedious, your name is added to a list of people, and unless you have serious physical trauma, you will be lowest priority because of how mental health crisis are treated in hospitals. This means a wait of possibly 3-4 hours. It gets tricky here, because if you have told the front desk that you are suicidal or in danger to yourself, and if you get bored or frustrated or simply tired of the long wait, and you walk out, they have the right to send the police to collect you and bring you back to the hospital. Simply put, be sure that you want to be there, and that you have the time and ability to see it through. If you decide to leave the emergency room, make sure you let the receptionist know.

Once your name is called, in my experiences the first thing any doctor will tend to is a physical problem. They will usually take blood tests, and will treat you depending on what you have told them. Most of my experiences involve overdoses, which leads to someone checking your heart, sometimes you are put on a drip and sometimes you are observed. It all depends on the results of your blood tests.

If you don’t also have a physical reason to be in the emergency room, in my experience they don’t treat you seriously. In my times in EDs I have spoken to a handful of nice doctors, but ultimately none of them had any power to help me. The fact that I had asked for help before hurting myself, the fact that I hadn’t written a note, the fact that I couldn’t describe a definitive ‘plan’ meant they dismissed my struggle and sent me home. This is after a phone conversation with the crisis team. My most recent experience in the ED was awful.

I waited 4 hours, only to be dismissed as not in crisis. They handed me a phone with the crisis team on the other end and as the conversation progressed I began to feel less suicidal and more angry, for me this is not a good transition. They were not taking me seriously and had wasted my time. I was discharged. Then the doctor came back and asked if he could take some blood to test, I obliged. However, then he said the results would be ready in about 2 hours and that I should wait back in the main area. I was fuming and refused to wait on the grounds that I knew that I hadn’t taken anything and in my opinion the results were intended to put the doctors at rest, not me. The doctor got impatient and less sympathetic, he told me I could go but he wasn’t happy about it and he would call the police if there was anything abnormal in the results. This was supposed to scare me, and if I was intending on committing suicide, or if I had taken something, he basically just warned me not to go home. I could have gone anywhere.

Personally I feel that the care you receive in emergency departments is the best that they can manage at the time. Sometimes you will receive a psychiatric assessment, sometime you won’t. Sometimes you will leave feeling safer and happier, sometimes you will feel angry and belittled. I would never advise someone in crisis not to go to the hospital, I would just like to make sure that everyone is prepared for what will happen when they arrive.

All of my opinions and advise comes directly from my personal experiences. Everyones experiences will be different. If you feel like I have missed something, or miss-represented something about the crisis experience please let me know. For this post I will add in any notes I am given as I feel that is is an incredibly important topic.

Thank you for reading!

Heres the link to Minds campaign, its an interesting read; http://www.mind.org.uk/news-campaigns/campaigns/crisis-care/about-the-campaign/?ctaId=http://www.mind.org.uk/news-campaigns/campaigns/crisis-care/crisis-care-slices/we-need-excellent-crisis-care/

Borderline Bella xxx

Anxiety’s a B*tch!

Hello everyone!

Sorry for the delay with this post, I’ve been busy learning to ski bumps and haven’t had a moment to type! I’ve also been struggling with what this post should be. I don’t want to only write ‘my story’ as that could become a little self-gratifying, and its not really a joy to write most of the time. I’ll get back to it, but its the kind of story you have to be in the right frame of mind to write.

I was standing on the button lift pondering anxiety this morning. For some reason, no matter how fast I progress on skis, no matter what terrain I learn to ski with minimal fear, I find myself getting really worked up about that button lift. It could be because it’s always the first thing we do on skis in the morning, but I wouldn’t be too happy about the suggestion of using it at the end of the day either. I decided that for some not too rational reason this lift was making me anxious, and decided to write my next post about anxiety.

I have a fair bit of experience with anxiety, that feeling when your thoughts outrun your head and even your inner monologue ceases to make any sense. I’ve had times when I’ve been willing by body to calm down, because I’m certain people around me can see the fear, and will wonder what’s wrong with me. If you don’t believe you’ve experienced anxiety, I assure you that you’re wrong. Its the uncomfortable feeling where your body is certain that you’re in danger and acts appropriately, the nerves you feel before a test, the fear of going to tell someone you’re sorry. My anxiety is no different to this, it’s certainly not stronger or any more persistent. Maybe its a bit easier to set off than the average person but that’s hard to judge. I am lucky that I don’t live with persistent unchanging anxiety, Its caused more by the situation.

Luckily for the moment, the most I have to worry about is that dammed button lift, and I can deal with that. My previous living arrangement was prime for festering anxiety, with people fearful of me and treating me like a stick of charged dynamite, people lying to me and going behind my back to talk about me, about ‘the problem’. It was horrible, and probably, hopefully the closest I’ll ever come to persistent unchanging anxiety.

To help me cope my doctor prescribed me Diazepam. I had asked for Lorazepam as this is what I had used before, but I wasn’t too sure about the difference and I didn’t want to appear like I was looking for drugs. In my experience, Lorazepam is a very instant release, you take it and you sit, and then 10 mins later you magically realise that you feel fabulous! You don’t immediately attribute it to the pill. Diazepam wasn’t such an instant release, but it definitely lasted longer which was useful in my situation. These drugs are helpful for when you are too exhausted to use your meditative and mindful coping strategies, but in my experience they become counterproductive if you begin to rely on them to get through the day.

For the time being, anxiety is not a problem for me. When you surround yourself with people who understand and care, it’s easier to forgive yourself for being you. When your friends understand, they wont moan and roll their eyes when you ask for excessive details about the event you’re going to, who will be there and what the ‘plan’ is, half the anxiety is gone because there’s no fear of judgement or frustration. Everyone needs a little more support sometimes, even for the small things such as going to the shops, it’s always real to the person experiencing it and therefore should never be mocked.

I feel like I could end every one of my posts about my experiences with a statement of how grateful I am to the people around me, I will try not to because It will get a little repetitive, but it is true. I am lucky to have such a supportive network of people around me.

Thank you for reading and wish me luck for the button lift tomorrow morning! I will try to post the next segment of ‘my story’ on the 2nd Feb so keep an eye out.

Borderline Bella xx

My borderline personality

What is BPD?

BPD stands for borderline personality disorder, sometimes referred to as emotionally unstable personality disorder. Everyone with BPD will have their own individual experiences with the symptoms, I’m going to talk about my specific experiences below. It is generally agreed that someone can be diagnosed if they have at least 5 of the following symptoms;

  • Fear of abandonment, presumed or otherwise
  • Unstable, changing relationships (generally easy to make friends but hard to keep them)
  • Impulsive or self-damaging behaviours, which can include drinking, drug use, unsafe sex and binge eating.
  • Unstable self image, struggles with identity and sense of self
  • Suicidal behaviour or self-injury
  • Varied or random mood swings
  • Constant feelings of worthlessness or sadness, sometimes described as emptiness
  • Problems with anger, sometimes culminating in physical acts of aggression
  • Stress related paranoia or loss of contact with reality

My BPD

If I was to go down that list and tick off the relevant symptoms I would tick 8, leaving the anger issues. However, I don’t think this list helps a non-sufferer to understand what the disorder really is.

Describing my own experiences without simply replicating this list is proving harder than I thought it would be. I wrote “define your BPD” in my notebook, but I am now realising that I should have given this some more thought.

I’m going to start with a point on the list; the unstable sense of self. Lots of people with and without mental illnesses will notice that they change aspects of their self according to the context they are in and the people that are around them. For example if you work in an office and your colleagues know you as ‘the tidy one’, you might experience some difficulty if you encountered them alongside your college friends that know you as ‘the wild one’. These two groups of people have interpreted your behaviour and other cues to form an impression of you in two entirely different contexts, shaping their impression of you. As a result, your behaviour will have changed slightly to fit into what they expect based on their impression. Encountering these two groups together might cause you to feel uncomfortable and unsure how to act, and possibly anxious as a result. I probably don’t have two people in my life that experience the exact same person. The uncomfortable feeling I just described is something that shapes every aspect of my life. 

In order to reduce anxiety before I meet someone new, or someone important, I find myself deciding what impression I want the person to form before hand, and then manipulating my behaviour and appearance to ensure that they form the impression I approve of. My wardrobe would confuse anybody, its almost like my character costume box.

Furthermore, because I like to categorise people and find relationships much easier when a person can be cleanly and easily described, I willingly pick up labels. I can promote certain aspects of my personality, in a way exaggerating them, so that people can feel like they know me well. When people feel like they know you, they don’t search deeper or notice the inconsistencies.

I’ve talked a lot about my experience with ‘the self concept’ because I feel it is the most important point on the list. Mood swings and the other emotional issues probably have their roots in an individuals biology and are therefore less interesting to me, however the behavioural issues feel as if they are caused or at least affected by the unstable self image.

Impulsive and reckless behaviour can be a mechanism to find stability. A lot of behaviours that would be considered reckless come with person labels; the party girl, the bad driver, the promiscuous person, the adrenaline junkie ect. Behaving in extremes makes your sense of self feel more stable, because their are fewer contradictions between the idea in your head and the behaviour you’re displaying. 

Finally, I find relationships extremely hard to manage. The friends that I have held for more than a year all have at least one thing in common, they are consistent and clear cut. They are also patient and strong. When people are consistent in the way they treat me, I can be consistent in my responses. When people behave towards me in a way that doesn’t match the way they think about me, I notice. This leads to me being unsure about what category to keep the person in, friend ie good or non-friend ie bad. When someone treats me like a friend but gives signs that they feel differently I experience a fair amount of distress. I am not certain why this is, however I am grateful to the friends that have stuck by me through problems and changes and whatever chaos I’ve thrown up, rather than take on an aspect of my personality and run with it.

I’ve tried to explain my experience with BPD in a way that anyone could understand, however the ideas are complicated and confused in my head, and therefore I imagine that this post might not make too much sense. Trying to understand yourself is a challenge, especially when you are a ‘complicated’ person, and I am still working on it. Based on the difficulty I faced when sitting down to write this post, I still have a lot of work to do. I might set myself this challenge again in a years time, and see what I write differently and what I write the same.

Thank you for reading,

BorderlineBella xxx