It is four years since I was diagnosed as having a borderline
personality disorder. I was 23 and seeing a consultant psychiatrist
for the first time. Having entered the mental health system at the
age of 17 I had only ever been treated for anorexia. But the
consultant thought there was more to my problems.
No one told me what my diagnosis was. I met the consultant’s
senior house officer (SHO) in accident and emergency. She had
assessed me following self-harm and said she was doing a
psychotherapy course and could take me on as a client. I felt
special – she had chosen me. When I started seeing her she
mentioned her tutor’s name and a day centre that I could attend and
I looked both up on the internet. I discovered that the SHO was on
a course on treating severe personality disorders. I dropped out of
the therapy since I felt that the doctors had not been open with
me. I did not want to be used as a case study.
I also opted out of seeing the consultant who diagnosed me
because he was dismissive. I felt that the label personality
disorder meant I was defective.
Now I can see that I do meet some but not all of the criteria
for borderline personality disorder (BPD). I had been going
downhill since my mid-teens with anorexia and a secret habit of
scratching my arms with a disposable razor. I hate people leaving
me since I can feel abandoned. As an in-patient I used to think it
was because of me that my keyworker went on holiday. Discharge
would cause me to feel rejected.
I also have a sense of inner emptiness which I think is because
I don’t have sufficient good memories – only ones of being unwell.
However, I don’t get angry, have mood swings or display impulsive
behaviour which are said to be features of BPD. Instead of treating
me for BPD my community psychiatric nurse says that I have reactive
depression. My diagnosis was revoked once when I was more stable
but the consultant changed it back to BPD when I started
self-harming again. Some of the BPD symptoms have improved as I’ve
got older and worked with my CPN.
The gold standard treatment for BPD is a therapeutic community
regime. But having been in a residential project run along these
principles I would not consider this option. Talking about negative
emotions five days a week felt like too much analysis. Although
many therapeutic communities have good results and are run by
highly skilled professionals I think my time is better spent on my
Yesterday was my care programme approach meeting. The same
consultant who gave me the BPD diagnosis heard of my achievements
direct from me. He seemed pleased. He has been respectful and a
good listener, and has taken positive risks with me when I have
seen him in emergencies, reviews and for hospital admissions. I am
glad that those treating me see me as more than a patient with BPD
and have high hopes for me.
Alex Williams uses mental health services and is a