Borderline Personality Disorder Diagnosis

Borderline Personality Disorder, or BPD, is a personality disorder which effects the way the sufferer interacts with others, the way they think, and their beliefs. It can be grouped in to four unique subtypes, but a BPD sufferer can have one, several, or none of these. I have personally been diagnosed with two of the formal subtypes: Self-destructive BPD and Impulsive BPD, but feel personally that I exhibit symptoms of all four.

Subtypes in Detail

• Discouraged BPD — Someone with Discouraged BPD feels that no matter what, they are not good enough. As a result, they often withdraw from social activities and people in their life, believing they are not good enough and unworthy of the attention.
• Petulant BPD — A person with Petulant BPD will typically act out, usually by hurting themselves physically or emotionally in an attempt to get their needs met. They have an intense fear of abandonment and an inability to express their needs conventionally.
• Self-Destructive BPD — I can tell you about this first hand, but the medical criteria for this includes a deep sense of self-loathing, feeling that no one cares, and frequent self-harm as well as (usually) a co-occuring diagnosis of depression.
• Impulsive BPD — I'll give you my personal account of living with Impulsive BPD, but medically it involves difficulties processing emotions which often results in violence (due to lack of impulse control) either toward themself or others, as well as a desperate urge to be "approved of" by peers.

More on the four Subtypes here.

So, how on earth did I end up diagnosing myself correctly and have a psychiatrist agree with me? Well, it's quite simple really. I had spent months unable to control my impulses, usually resulting in scaring my mother with my sudden rage at the slightest thing, as well as attempting to kill myself every time something went wrong. It came to a head while I was unfortunately alone, and thankfully my mum came to my rescue and got me an emergency appointment at my local psychiatric clinic. I wanted to know why my first urge whenever I felt the slightest pain or anger was to end my life, and I did a lot of in-depth Googling before ending up on a BPD page. I went through the nine criteria UK psychiatrists are bound to follow when diagnosing the condition, (with four or five required to be met to diagnose it) and found I fit seven of them.

I spent the days before the appointment composing a letter for my assesor, outlining how I fit these criteria and giving examples of it — my inability to process negative emotions without at least self-harm, my sudden switching from joyous to the depths of despair and back again, my transformation to someone my mum "does not recognise" when my Impulsive BPD takes over and I become violent. It all fit, and I wanted them to take my concerns seriously.

My assessor, Nicole, was a wonderful mental health nurse and said she had never had a patient so well-prepared with a self-diagnosis before. I'm not really surprised, I put plenty of time into that letter and I was certain of my conclusion — and that she agreed with me, but it would be up to my now-psychiatrist Dr. Weldon to make a formal diagnosis.

In the appointment with Dr. Weldon, he read through my letter and asked me plenty of questions before coming to the conclusion that yes, I do have BPD, specifically Impulsive and Self-Destructive BPD.

I was beyond relieved, because not only did I finally have answers about why I could try to kill myself and then be laughing in the Accident & Emergency department of my local hospital hours later, I had actually been listened to. Doctors and nurses must be told multiple times a day by patients that they've self-diagnosed based off of one Google search and won't accept it when they're wrong — so I was prepared to stand my ground if Dr. Weldon told me I was wrong, but he saw the work I had put into my personal diagnosis and gave my opinion a fair hearing.

Now that I'm diagnosed, I've been referred for a special type of therapy not widely available on the NHS — Cognitive Analytical Therapy, CAT for short, which is an in-depth and logical analysis of why you react to things in certain ways and what past events may have shaped you to develop BPD. People who have experienced parental issues, social isolation, or traumatic events in their childhood are more likely to develop BPD later in life, for example. Unfortunately, with it being a less regularly used therapy, it's a longer wait to see the therapist than I would like, but I'm willing to wait it out and ready to dive in head first when I finally get my first appointment.

The CAT therapist will also be making some medication changes for me, and I've been given some options by Dr. Weldon to consider while I wait — he wants the CAT therapist to have final say on what the changes are — but the options are limited. Unfortunately there is no one tablet to help every aspect of BPD, but various drugs used for other mental health conditions can be used to lessen or pacify some symptoms. Anti-psychotics, unlicensed for BPD use in the UK, have been recommended by him, but with the side-effect risks they carry I'm hesitant to try them unless I absolutely have to. His second recommendation was mood stabilisers, like lithium for example. Knowing a family member has taken lithium in the past for a different condition I feel more secure about the idea of taking it, so I think that's going to be my first choice as long as the CAT therapist gives it the go-ahead.

But what am I doing to manage all of these horrible symptoms in the meantime? I have no medical support to speak of until I get that first appointment, so I'm basically flying solo on how I handle the worst aspects of my BPD... however, I'm doing it pretty well for someone only recently diagnosed. My mum agrees, but she's kind of biased.

Once I feel the rage, the pure unfiltered anger rising within me, regardless of what has caused it, (trying to understand a bus timetable but not being able to has to be the most ridiculous trigger so far) I simply remove myself from the situation. Part of learning to live with BPD is teaching the sufferer to learn to step back from their actions and think them over properly. I'm not great at doing this on the fly so far, so I basically just stop doing whatever has set it off... it's not ideal, because it means I can't do a lot of things myself once I know they'll trigger my Impulsive BPD, but it's a step in the right direction. I have learned where my limit is and more importantly, when to remove myself from the cause to stop the rage from progressing into violence, as it has in the past. The "bus timetable incident" for example caused me to rip up my favourite books, destroying some of my prized possessions in an indirect episode of self-harm. I knew that hurting my books was hurting myself, and that's what I did.

My mum secretly taped them all back together for me after she had calmed me down and when I saw that she had done that for me I was moved to tears. After all, part of BPD is feeling unworthy of positive attention and actions, and she had just done something so kind for me that I still feel like I owe her for doing it... even though she would ever expect me to.

There are times when the urge to kill myself comes out of nowhere, completely unexpected, and when this happens at the minute there's little I can do myself to talk myself out of it, so my family all have Diazepam (muscle relaxant) tablets on their person to administer and bring me down to a calm state of mind again. Again, it's really not ideal when I can have these episodes more than once a week, but it's all we can do until I'm getting the right help for my condition.

I want to highlight that if you think you have BPD, don't self diagnose without the support of a medical professional. Part of my letter included that I felt I strongly identified with BPD symptoms, but that if they thought I didn't have it, I was open to other ideas as long as the impulse and self-destructive behaviours were addressed. You have to be open minded, because a professional psychiatrist is the only one who can make a formal diagnosis of a personality disorder and get you the correct help; it would do nothing for you to assume you've got it and then use it as an excuse for behaving badly, because that's just finding the easy way out of problems you caused. My family, but my mum in particular, is very understanding about why I'll react to things in certain ways and why they have to sometimes approach things differently with me... but they're understanding of it because I've been formally diagnosed, I'm waiting for professional help, and in the meantime they can see I'm really trying to set myself boundaries.

You may feel you have BPD because you can identify with some of the things I've experienced as a person who is diagnosed with it, but psychiatrists always look at the "big picture," meaning that they want to see if you display BPD specific behaviours in more than one area of your life, on a regular basis, and whether or not it affects your life as a whole. You may take your concerns to a psychiatrist and be told you don't have it, and feel a little lost without a medical reason for why you are the way you are — I know I felt lost when I was saying and doing things I didn't want to and couldn't explain to anyone, myself included , but as long as you're willing to hear them out if they have other explanations for your concerns, it'll be okay, because you'll get the help you need for whatever your condition or conditions happen to be.

Being diagnosed has given me a sense of security that there are things that can be done about the parts of me that worry me, and even if you're scared of what a doctor will say if you take your worries to them, the sense of safety from being able to read about what you're going through and learning how to handle it is worth building up the courage to go and be assessed by a professional, whatever the outcome.