Do you think I have borderline?

*WARNING: MAMMOTH POST AHEAD - Please just read bold bits or even just the last bit if you want - it was still cathartic for me to write regardless of whether anyone reads it all*

EDIT: Oops, I have bolded most of it :/ Oh well, I'm not good at editing my writing as I'm scared of it then being misinterpreted or not adequately explained - so just read whatever, if possible, I would most appreciate it.

Now before anyone jumps in and says 'Don't go trying to diagnose yourself, see a psychiatrist' - my answer to this is that one psychiatrist has told me 'If you still have this presentation of symptoms when you are 28, then you will have Borderline personality disorder' (I don't know why 28 is a magic number when I am already over 18 so within the range for it to be diagnosed if it was that anyway). Another psychiatrist has said (literally) 'That's crap, you definitely don't have a personality disorder. If you had borderline you'd be a bitch and would have done things like pretending to overdose etc'. Yeah, so in conclusion one of them must be completely wrong, I'm just trying to figure out which one.

I think it gets to the point where the patient has to start believing in their own gut instinct in order to protect themselves from being wrongly treated for something they haven't got, which can make the disorder they have got, worse. I think this whole 'a psychiatrist always knows best' is a bit naive. After seeing enough psychiatrists you realise that this isn't a scientific field, noone agrees, so you may as well make your own conclusions as best you can by taking the views of the psychiatrist into consideration but researching and discussing with others who have similar experiences as well. The other psychiatrist I saw when I was younger said 'it's definitely Anorexia, but the rage isn't part of the eating disorder - I don't know what that is'. At first they labelled me as a badly behaved child who had just been brought up wrong, but they soon realised that wasn't my usual personality at all, and admitted this.

The problem with treating me as though I have got borderline, if I haven't, is that even if things like DBT could work, the assumptions they refuse to let go of once you are in the system for personality disorders I find very destructive. For example, when we keep putting in complaints about the fact I have had no one-to-one support from the NHS for nearly two years, they tell me I am attention seeking = borderline. When two years ago I had a short span of CBT before they gave up, the therapist would cancel the sessions so often that I'm not sure I ever had more than two sessions in a row. Because people with borderline tend to fear abandonment and tend to take it personally and think it is because they are a bad person if someone has to cancel on them every once in a while, me expressing that I didn't feel safe with such an eratic therapy schedule was classed again as 'borderline'. What annoys me even more is that the sessions weren't even at the same time every week. And the therapist never organised the next session before she saw me, and would go off for ten minutes at the end of each session to find the diary (who knows why it always took so long).

Anyway, the POINT is that ANY MENTALLY WELL PERSON would be annoyed if someone was so unprofessional as to swap meetings around ALL OF THE TIME like that. Plus I was ALLWAYS prompt to the session, and ALLWAYS waiting for her (When they chucked me out and we forced them to give a reason they had the cheek to say that it was because I obviously didn't have the motivation to get better.) Despite the therapist beforehand writing down in a letter that I had always done all the homework she set me to perfection (or as close as I could get to it).

I am going off topic...

When I go to assessments now (all of which have failed to agree to give me treatment so far - I feel like it's a f*&*king interview for a scholarship or something), the person looks through all these notes about how I am an attention seeking, argumentative, over-protected brat who refuses to take responsibility and has a fear of independance (I refused to admit I was still suffering from an eating disorder for 5 years for fear of people taking away my independance - I would have thought finally having the courage to admit I needed help WAS taking responsibility?! Apparently not). But back to the point again: The assessment person allways says things like 'you have problems with trust don't you?' in that really patronising 'it's okay to tell me the truth' voice. They insist that I have massive issues with the people in my life cancelling plans etc, and when I tell them the truth and say actually I think I handle relationships pretty damn well considering the restrictions of my eating disorder, they raise their eyebrows and they state that word 'denial'.

It is very hard for me to acknowledge that there are good things about myself. However nomatter how much I put myself down, I know deep down that my friends are telling me the truth when they say that I am an easy person to get along with. I am not knocking people with borderline, as I know they cannot help the way their behaviour makes them very hard for others to deal with. I have friends who I think do have that fear of abandonment, as when I can't meet up with them for a while because I am busy they think it's because I don't like them any more and then I feel a bit manipulated into neglecting myself or others in order to spend time with them when it is not at all convenient for me.

I put my foot down now because I know I cannot maintain the relationship if I let them make me resent them for being so demanding of my time. I deal with the potential resulting anger in them that this can cause, but so far this approach has worked and I have allways sorted things out with a friend in the end by explaining to them why I have to do this. I understand that they don't mean to manipulate me, so I am patient, and I have stood by people when the rest of their friends have got sick of them and left, because when they tell me to '###$ off' because they are angry due to what they are going through, I don't take it personally.

When a friend doesn't talk to me for even a year, but I can see they're doing okay on facebook, then one day they come back and say 'I'm so sorry I lost track of time and I haven't been there for you', I can sincerely say 'it's fine, that's life, it gets in the way sometimes.', and it doesn't bother me, because I do trust my close friends and I know that just because they vanish for a year, it doesn't mean they've forgotten me forever. I know they will come back.

Does THIS sound like someone who has 'love/hate' relationships and who 'makes frantic efforts to avoid real or imagined abandonment?'

I am not a violent person by nature and I do not set out to cause arguments or lash out at anyone. The only exception to this is the crucial problem here; my rage episodes. I refer them to an episode as they are not like normal anger. My normal reaction to anger is to cry, to shout at the the most. However when these rages occur it is as though I have been pocessed, and the emotion that feels even stronger than the anger, is fear. These times terrify me. I lose all sense of time, I never know whether the rage has lasted minutes or hours. The main target is myself; if there is a solid wall nearby I will bang my arms and skull on that uncontrollably. I feel the pain and yet it doesn't feel real, it feels like a nightmare but i can't wake up. If there are no solid walls near I go for the nearest solid object; I have destroyed several phones, smashed dishes and glasses, thrown displays of bottles (luckily plastic) to the floor in shops, bitten myself until I bleed, and bitten a nurse at one point as he got in the way of me biting myself. All this I mostly only remember fully from the aftermath; seeing the destruction around me and feeling the horror at what I have done and what I could have done. My mum has been hit when she got in the way, and I am so scared of doing someone, myself or someone else's property, a car or something, some serious damage one day. I am terrified to learn to drive; what if this happened while I was at a steering wheel? I could kill someone. I have to sit in the back of the car most of the time when my mum picks me up to drive me home from uni, as I cannot risk that happening while I am in the front of the car.

SO: The main question I wanted to ask was - does anyone know whether 'instability of interpersonal relationships' is required for borderline? Most sites mention this part as though it is a central part of the disorder, but the below criteria suggests that any 5 or more criterion met would indicate borderline. However even if the latter is the case, I am still not convinced that a decent argument could be made for my case being Borderline, as even the potential 5 that I could have, are a bit 'iffy', 'on the border'... haha. Also - can anyone explain what number 3 means?

'BPD is manifested by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:


1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5). - NO

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting." - NO

3. Identity disturbance: markedly and persistently unstable self-image or sense of self - Don't know what this means?

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5). - Only bingeing and self-harm, so not including self mutilation - NO

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. - Recurrent self mutilation but none of the others, but it says, OR so YES

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). - YES

7. Chronic feelings of emptiness. - YES

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). - When it happens, VERY intense and destructive, but doesn't happen often so - questionable whether it happens enough to qualify?

9. Transient, stress-related paranoid ideation or severe dissociative symptoms - NO'

xxx

P.s. Sorry for the 'bitch' comment - I am just quoting what the psychiatrist said not what I personally think of people with Borderline, so please don't throw anything at me or smash my windows! (I have just been reading the 'you know you're BPD when...' thread and although they are amusing, the way me making fun of my own eating disorder is amusing, to lighten the pain a bit, I cannot relate to any of them I have read so far, so that is another suggestion that I don't have it) x

Hi Alba,

I can't really give you any definite answers myself - I am not sure anyone on here could - so I will just give you my thoughts based on what you've said.

I'm not an expert on this disorder as I was only diagnosed a few months back and even though I've been suffering with the symptoms for a very long time, I am still getting to grips with the whole thing. However, it does sound like you've had some bad luck when it comes to psychiatrists. I haven't seen that many - I usually left it to GPs who never bothered to refer me to a psychiatrist because they put my problems down to depression and gave me drugs that never worked. The first psychiatrist I saw didn't pick up on anything else apart from depression. Maybe that was because he didn't ask the right questions or maybe he just wasn't that good at his job, I don't know. But the best advice I can give in this area is that if you don't agree with what they've said ask to see someone else. I don't believe that your age has anything to do with it. A lot of the information says a personality disorder usually manifests in early adulthood but I haven't heard that there's any specific age and also, I had symptoms when I was much younger and not an adult yet. I don't see why it should manifest in adulthood, but it's probably got something to do with the fact that our real personalities show through about then. You are constantly changing as you grow up so it's probably hard for professionals to tell whether it's just a phase or an actual psychological disorder. Either way, I think they should still be offering you counselling of some sort as you clearly have some problems, right? Unfortunately I just don't think you can self diagnose when it comes to this kind of thing and you can't tell them what treatment to give you - they will only treat you base on your diagnosis.

For me, when I was diagnosed recently I read up on BPD to see if I identified with the symptoms and I did so I was happy to accept treatment for BPD. You don't have to have all the symptoms, but you don't seem convinced that you have BPD so I think the best thing to do is ask for another opinion.

I honestly can't comment on how normal people would feel or react to situations like being cancelled on, but I know that people with BPD have a lot more difficulty dealing with those situations. I don't know you well enough to be able to comment on anything definitely, but people with BPD do tend to feel like they're being patronised even when they're not, so that's something to take into account. And I guess you would know yourself better in relationships than anyone, but I can't say whether or not you are in denial.

I know that I definitely could not handle someone not talking to me for a year - I would not bother with them again and would take it far too personally. However, if they tried hard enough then I might forgive them. But if they lost touch with me again, even for a few months, that would be it. It tends to depend on how I feel at the time. But it's usually people I've trusted the most that I can't forgive. So that's one way we differ, but I don't think you can draw any real conclusions from that and I'm afraid I can't answer your question on whether instability in relationships is required to be BPD. I think only someone qualified could answer that - someone who specialises in BPD.

As for what the 3rd characteristic means, I understand it to mean that you have periods of not really knowing who you are because you seem to change depending on who you are with. I know I am different with different people and I've often not known who I am or what my purpose is and why I'm here at all. I've not known my own personality and it's brought me to tears.

With regards to the impulsivity I would say that you could say yes if you've been prone to unprotected sex with people, been very impulsive with something you wanted to buy...I often see something and feel I want it NOW and it takes a lot of convincing to get me to stop and think before I buy it. Doesn't always work, but I am very impulsive that way and if I were left to my own devices I'd be a lot worse.

Anyway, I hope that's helped even a little and I hope you finally get to where you need to be. Good luck.

The current DSM means that you need to have 5 out of the 9 symptoms of BPD. The main symptom in diagnosing BPD, is Black and White thinking/Splitting.

If you think you have an issue with Black and White thinking/Splitting, then you could have BPD, but I very much doubt it. You don't seem "emotionally unstable" enough to have BPD.

Are you young? Maybe you're going through hormone changes?

You seem to have an issue with abandonment and emotion, but just not "borderline", so to speak.

You say you don't split or anything, so I don't think BPD is the right diagnosis for you. I'm no professional though.

deethebee - Thankyou so much for such a detailed reply and for sharing your experiences with me. I agree about the whole age thing – that it probably is to do with the personality not yet being fully formed as a child so they are careful not to diagnose too early.

Can I ask, do you live in the UK? Since my original post was actually even longer than the one I posted, I had edited parts out; one part being that describing the other psychiatrists I have seen. 2 were just hopeless, one saying he couldn't refer me anywhere as he didn't specialise in eating disorders and the ED service had refused to treat me any longer than 18 sessions (when I left that service my self harm was the worse it has ever been –they said they couldn’t treat me because I had ‘more than just an eating disorder’ whatever that means). Another one was the second opinion that we sought, which was extremely hard to get (My mum has had to reduce her work to one day a week over the past 2 years in order to have the time to fight for my treatment, the amount of letters and phonecalls she has made and the emotional burden this puts on her, dealing with me but also dealing with be verbal abuse fired at her by the NHS when they are challenged.) I am now back at university because I couldn't deal with being trapped at home any longer and for my family to hear my crying day after day just made my guilt worse. They can get on with their lives better now, and at uni, although people on the corridor hear me, as long as I don't get close to any of them they don't have to feel responsible for me. I am failing though, and extremely lonely. I often cannot even sit through 30 minutes of a lecture because I have to binge, and I often don't sleep because of my bingeing too, despite sleep medication.

Anyway, that second opinion was around 18 months ago now and he wrote down that he recommended CAT or psychodynamic therapy for me, but that has still not happened. My mum still keeps complaining (if I get on the phone to them I end up smashing it or myself). I have a punch bag at home but again, the screaming and crying when I use that gets to my brother as he is in the room above the garage where it is. I am failing at uni, and if it wasn't for my parents I would probably be on the streets by now resorting to theft or bins to binge, as when I do have a job I blow all of my money and more on binge food. However the criteria for BPD specifically states that the 'at least two' impulsive behaviours must not include self harm, so it seems the impulsive bingeing is not borderline behaviour. I am not an impulsive person otherwise; before my bingeing started as a result of trying to recover from Anorexia, I was very good at saving my money. I don't buy clothes or new phones etc unless they literally have holes in or stop working.

The psychiatrist who made the bitch comment was one we spent 250 pounds on to see privately, as the NHS weren't doing anything. My parents have also spent thousands on private therapy for me over the last few years, as we were that desperate, but the guilt of this I fear is counter-productive to my recovery, so it is hard. Also, practically my parents cannot continue to pay for this indefinitely without going bankrupt.

The NHS have tried to give me DBT for personality disorder but they were just group sessions, therefore anything that is brought up in the group that I need to discuss with someone, I can’t. Group sessions I think could help alongside one to one, but not as a replacement. They banned me from going because I kept having to leave the room when I felt a rage coming on. They said this wasn’t following the rules and wasn’t fair on the others in the group, but it was extremely hard for me to take responsibility and walk out calmly to calm down, so I just feel like everything I do is wrong. I know from personal experience that it is very distressing to witness someone screaming , crying and having to be restrained, especially when you are suffering from a mental illness yourself and are already on the edge. So no matter what the DBT therapists said, I still do not believe I was in the wrong to try to protect the group from that. Others in the group had to walk out sometimes and I didn’t feel that was unfair to the rest of us.

I have seen some counselers, but without the specialist knowledge in eating disorders and the specialist training to deal with that (if eating disorders didn't need a specialist, then there would be no specialist field), they tend to create more problems that they solve as the understanding simply isn't there. I think counselers are more there to listen, whereas I have now talked so much that I need someone to provide some extremely in-depth discussion and analysis on why I do the things I do and how that can be changed.

I know noone here can really help me, but I just wanted to ask for opinions from people who suffer from this so that I can get a better idea as to whether, if I was offered treatment within a personality disorder service again, perhaps inpatient as they don’t seem to do more intense treatment than just group round here (which the NHS seem to be heading towards), whether that would be wise for me to accept or not xxx

Lia_Interrupted wrote:The current DSM means that you need to have 5 out of the 9 symptoms of BPD. The main symptom in diagnosing BPD, is Black and White thinking/Splitting.

If you think you have an issue with Black and White thinking/Splitting, then you could have BPD, but I very much doubt it. You don't seem "emotionally unstable" enough to have BPD.

Are you young? Maybe you're going through hormone changes?

You seem to have an issue with abandonment and emotion, but just not "borderline", so to speak.

You say you don't split or anything, so I don't think BPD is the right diagnosis for you. I'm no professional though.

Thankyou for this clarification of the DSM criteria. This may sound like a silly question but what exactly is black and white thinking/ splitting? My mum has said maybe I have that, as I work to extremes regarding work and exercise, going overboard or doing nothing. However I don't think this is due to black and white thinking, I feel like it more resembles a compulsion. This is bizarre but in a way I feel I perhaps don't think in black and white terms ENOUGH. Like, I see things from so many different angles, so many people's potential points of view, that I drive myself mad with analysis. But I may have my definition of black and white thinking wrong... ?

When you said I do seem to have an issue with abandonment - which bit where you referring to, and in what way? This isn't a defensive question, I am just curious. I do not believe I do but if someone can give me a good argument as to why they think I do, then I will listen. I guess what you mean when saying that you suspect it is not borderline, is 'are the abandonment/emotional issues etc extreme enough and far enough away from the norm to be part of a personality disorder?' ? And also, being repeatedly abandoned by the people you thought were meant to be help you, of course is going to make me less trusting of other people within that field (there have been other incidents I didn't mention but I won't go on). However I argue this is not an irrational fear, therefore it is not a disordered fear. I do not extend this fear to people outside of the health service, for example within the education system, noone has let me down.

I am 21, however my puberty was delayed due to weight loss so whether it is hormonal I do not know (I started puberty at 12 then it stopped until I was 17). I was diagnosed with Anorexia when I was 12, and it was when I was 13 that the rages started, and they got worse to the point of occurring almost every meal time and countless other times throughout the day when I was inpatient for 6 months. Since developing eating habits at the other end of the spectrum, the rages have returned. Which leads me to believe that this has to be linked to the eating disorder, and that the eating disorder underlies the rages. However the professionals in the ED service which discharged me think it is the other way around and they told me to come back once the rages have been treated. If it is the eating disorder which underlies all of this though, the emotional distress of dealing with an eating disorder, then they will be waiting a very long time :/

Thankyou for your response xxx

Hi Alba

My apologies, I have only read the bolded stuff, but thanks for doing that. My head starts spinning when I see heaps of text.

As Lia said, diagnosis is based on having at least 5 of the 9- so people can end up with all different sorts of combinations- some have all of them. The identity disturbance is not really knowing what your "identity" is- not knowing who you are, or what you think or feel or need or want, and when you do think you know, that idea quickly changes to something else. The black and white/splitting is viewing things as all good or all bad with no grey in-between.

I have a number of the symptoms, and could tick most of them off, but my therapist has said that some of them aren't strong enough for me to be diagnosed BPD- doesn't mean they're not there and that he's dismissing them though. So I have a diagnosis of BPD traits, (along with Avoidant PD actually).

The abandonment thing is where we take someone saying something like "I can't talk to you now" as "they don't want to deal with me anymore and they don't want me...." So some people might make threats or hurt themselves to stop the other person from leaving them.

It is being recommended that I have DBT to help me deal with some of my behaviours even though I don't have a full diagnosis of BPD. I've never made a suicide attempt, though I'm frequently suicidal, and I'm generally quite pleasant towards people, but inside I'm raging. So being a b*tch isn't one of the criteria- some people let everything out and don't hold back, raging etc, while other people do all that internally, and appear to function relatively normally to those around them (those that don't know them well anyway).

The reason they say it's not to be diagnosed until adulthood is that many of the symptoms, like the moods, and sometimes risky behaviour (though not as extreme as what we are going through) are a normal part of adolescence and puberty, so unless it's really clear to them before you turn 18 and the symptoms have been there for over a year, they hold off on a diagnosis until you're over 18. It's taken a very long time for me to reach my current diagnosis (we're talking at least 5 years, but I've had issues for about 11 years), which I have only been told about in the past week, and it has been made by my psychologist (who is qualified to do so) rather than the psychiatrist I last saw (who said something completely different). But I trust my psychologist's diagnosis because he's been seeing me for so long and has been observing my behaviours long enough to understand what is going on, and that I definitely don't fit the last psychiatrist's diagnosis.

Hang in there, I completely understand your frustration with health systems, and I hope you can get the answers and the help you need from them.

Black and white thinking is splitting someone black and hating them, or white and idealising them and love them.

For example, if a friend hasn't replied to a text straight away, you might feel that they should have replied straight away, and not a day later, and then you split them black, stop talking to them, hate them, etc.

Does that make sense? It's basically having no grey area. You either love something/someone, or you hate it/them.

What you explained, is basically compulsions, yes.

lilyfairy - Thankyou, your response is really helpful. I am sorry for the fact that the boldness was most of it! Lol. I have trouble deciding which is the most important stuff, but I too struggle when faced with masses of text so I know it is more likely for people to be able to read it if it is shorter... :/ I therefore really appreciate you taking the time to read it anyway.

According to your description, which sounds very accurate, I don't think I have identity disturbance or black and white thinking. One psychiatrist mentioned the 'borderline traits' thing to me, which I struggle to understand because I would have thought the whole point of having the criteria was so that you either have it, or you don't. Like, how can someone half have it? I may be completely wrong here though, just wondered what you thought about that? I think it's hard because so many of the healthy population could also have 'traits' of a personality disorder, therefore I feel like there mustn't really be anything wrong with me if it is just traits. People wonder why I am looking for my problems to be diagnosed as something, but I think it is because I question whether I am ill at all, or whether I do these things because I am simply a bad person. A diagnosis would lift the guilt a bit and also: how can you treat something when you don't know what you're treating?

It was interesting to hear about the fact that the raging etc doesn't neccesarily have to happen outwardly. I wondered about that - how some people can function in jobs etc for years when they have Borderline and noone ever suspects they have a mental illness unless as you say, they get close/start living with them. I also see what you mean about the erratic behaviour perhaps being merely teen rebellion, if you are still a teenager.

I am sorry to hear it took you so long to get the right diagnosis - I have read about this happening a lot with Borderline, and at the other extreme I have heard of many being diagnosed with it when really they have Bipolar. It baffles me how so-called intelligent professionals can get things so wrong, so often. I know mental illness is very complicated, but if they don't understand the difference between them after years of education then we're stuffed. x

3. Identity disturbance: markedly and persistently unstable self-image or sense of self -[b] Don't know what this means?

There was a joke about this on another thread. Here goes. I'll paraphrase.

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You listen to your lawyer-friend talk about his day at work and you are convinced this is what you are meant to do too. So you run to the bookstore and buy everything you need to study for the screening exam.

On your way home, your nurse-friend phones you and begins to tell you about her day at work. Before you arrive to your flat you are convinced this is the job you are destined to do too. You turn the car around and head back to the bookstore where you purchase everything you need to study for the screening exam.

As you look at the bill, you decide book dealers make a lot of money indeed! Owning a bookstore MUST be what you are meant to do.

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The above is an extreme example of a identity crisis. People with an unstable self-image or sense of self might change their perception of who they are from month to month, day to day even. Another example of this is a true story of mine. Back when I was a teen, I pretended to be gay, even though I had no such inclinations. I dressed as a boy (I am female) and socialized with the gay community.

Another true story. I enrolled in college and declared a major in Forensic Pathology. Then I changed major to Music, then Nursing, and finally Psychology. When I was in grade school I couldnt decide if I was a prep, a jock, a punk, or a goth. I had so many different styles it was difficult to keep up with all of my personas.

These are all examples of an identity crisis however, to meet the criteria for BPD this behavior has to be consistant. In other words a single identity crisis is probably normal whereas a string of them is a symptom.