Sudden borderline relapse after twelve years - please help

[Relapsecrisis]

I really didn't think I would be writing this message and be in this situation. I'd be really grateful if anyone can respond. I've name changed for obvious reasons. Apologies for the length of this post.

I had a diagnosis of borderline personality disorder when I was about twenty. It's something that I loathe and hate having on my medical records. However, I can accept that the diagnosis was accurate and my behaviour and moods at the time were classic textbook symptoms (cutting, suicide attempts, overdoses, ever-shifting moods, fear of abandonment etc).

I was hospitalised twice at the time (one week each time) when I was extremely suicidal. The last stay I had, something clicked, they put me on Prozac, I stopped self-harming, stopped the overdosing and whilst I've battled on and off with depression of varying degrees for the last twelve years, things have been relatively stable (got degree, got post-grad degree, sorted profession, have good career, bought house, got married, got divorced, never self-harmed, no more suicide attempts, no more idealising people).

I'm now mid-thirties. And suddenly seem to have relapsed and I don't understand why. My long-term relationship broke down four months ago and DP moved out. It was a mutual decision and we'd been unhappy for months. I had anticipated a sense of relief and freedom when the relationship ended, but instead, wholly unexpectedly, I was absolutely devastated. Total grief and everything fell apart. I was deeply suicidal for about a month, went onto anti-depressants, moved out of the acutely suicidal phase and suddenly appear to have veered off back into classic BPD territory.

I started self-harming again in January (after twelve years of not cutting). Not as regularly as I used to, but my arm is fucked. My moods are spiralling daily, from suicidal to ok and back again. My sleep is awful (I'm taking sleeping tablets regularly so haven't slept normally in months). I can't eat and have lost two stone in four months. I've become emotionally fixated and dependent on a married male friend and seem to be pushing all boundaries with him. I can't seem to focus on any long-term life goals (I had lots - they now all seem utterly irrelevant). Everything seems meaningless. DD is suffering (she was tiny when I was last like this. She's now much older and hasn't seen me ill like this before).

I'm acutely suicidal. Yesterday and today especially. Have been researching various methods in depth. I don't want to engage with any mental health services because frankly, I don't see what they can do. I don't want to become bound up in being someone with a label and going through the cycle of being in and out of hospital and being a professional patient. I thought I would never be in this situation again. I'm mortified and utterly at sea. I don't want to take an overdose and exacerbate the situation. I don't want to manipulate things. I don't want to self-harm and make things worse. I just want to be dead.

The only thing I can think that might have contributed towards this (and I may be clutching at straws) is the medication I'm on. I'm taking lofepramine (I can't take SSRIs any more for various reasons) and it's one I've not taken before. I don't know if it can somehow trigger a BPD relapse, or if this is something that is unrelated. Or maybe it's having no natural sleep for 4 months (and a lack of REM sleep owing to the sleeping pills).

I have been googling to try and find answers and there are none. How have I suddenly relapsed and become like this when I had so many years of things going well? This is supposed to be something that you grow out of - not something that re-emerges in your mid-thirties.

I don't know who to talk to or how to get back to where I was.

If anyone has any insight or any pearls of wisdom I'd be extremely grateful.

[AgainstTheGlock]

I'm a few months down the line from you. The breakup was my trigger and it's triggered all those abandonment issues in me.

My life is a mess - I thought all of this was behind me, instead I find myself falling further and further down the rabbit hole.

[Relapsecrisis]

So sorry - AgainstTheGlock. But I guess it's marginally reassuring that I'm not the only one completely taken aback by all of this.

I keep reading about relapse rates in a 10 year period online. There's nothing about relapses after ten years.

Have you had anything to do with any mental health services? Does anyone have any suggestions? I'm adamant that I do not want to engage with any kind of mental health team and I'm reluctant to see my GP as I don't want more crap on my medical records. I just can't see what anyone can do to help. And I know that ultimately, it's somehow down to me to pull myself back up again and sort things out. But I'm just utterly bewildered as to how this has happened after so many years.

It's like I'm fifteen again and it was bad enough the first time. I'm carrying a razor blade with me all the time. I'm cutting in the loos at work. I'm googling fatality rates from various medication overdoses. This is all stuff that I never thought I would be involved with again. It's fucking hideous.

Do you have children? How are they coping?

[AgainstTheGlock]

I can't get any help from mental health services - they can't dose me up with medication and they can't fob me off with a regular counsellor - and I can't get access to a clinical psychologist.

What I really need to do is sink $$ into private therapy (at least Google has moved on in the last decade and it's easier than ever to find someone private).

I'm not sure we can just haul ourselves back out from the pit - although a psychiatrist I saw a few months ago did tell me I was a "clever girl" and told me to read the royal psychiatrist's website and he was sure I'd figure it out.

Although if I could... I probably wouldn't have been sat in his office with bandaged arms.

I have my "game face" on for my kids, they know I get sad and tired and they know I had an accident and hurt my arm (ambulance in middle of night). I don't want them to have to grow up with the mental mother though - but I'll be damned if I know what else to do right now.

[Relapsecrisis]

DD knew I used to have issues and had been hospitalised when she was tiny. Neither she nor I expected that we'd be facing this situation where her mother has totally lost the plot and she's trying to process it all (she's a teenager so it's pretty hard on her to try and deal with this).

I feel like I've exhausted the patience of my long-suffering friends. My therapist is very nice but has no background in BPD (I was seeing her before my relationship broke down, primarily to talk about the relationship problems I was having).

I just need to get back to "normal" and how things used to be. As each month goes on and as I get more fucked up, it seems harder and more out of reach to be able to sort things out.

And I'm just so shocked by being in this position. I cannot believe I'm back to how I used to be.

Sorry you're suffering through all of this too. It's really shit.

[willowcatkin111]

I am in my first 'phase' of borderline at well over 40 so not just something you get when younger. I have excellent crisis/home treatment team help, but longer term has been sporadic. I am hopeful about my latest care coordinator though.
I have teenage dc (13 & 14) too and they are coping fine - I have hidden nothing from them, and they have researched bpd so have some idea what it is all about. They have both been here when the police turn up to stop me SH or because I have gone AWOL and understand it is the bpd and not me. Both are really great at understanding when I need space or a rest. Both have said that the scariest thing would be not knowing what is happening.
You will probably find that mental health services have moved on a lot for bpd in 12 years - it is now seen as treatable and if you are lucky you may have DBT in your area. Do consider asking your GP to refer you to secondary services.

[Relapsecrisis]

What triggered your BPD willow? I'm glad your children are coping ok.

I'm so, so reluctant to engage with anyone from mental health services. To me, it just confirms the relapse, confirms how fucked up I am and I'm desperately trying to keep out of the revolving door I used to experience with crisis team/A&E/psychiatrist/mental health ward when I was younger. I don't know that I can necessarily avoid it, being how things are at the moment, but it's such a slippery slope. I hate the stigma associated with personality disorders and the contempt I used to be treated with 12 years ago. I know things may have changed, but it seems that so many people consider this is something within my control and that I can somehow snap out of it.

DBT is something to consider, though. I just really didn't think I needed intensive therapy anymore. I thought everything had gone away, that I'd dealt with it all and that it was in the past.

I'm so tired of this. It's been months. I'm a bit calmer this evening, thank god. The relentless agitation and despair have receded. Long may it last.

[AgainstTheGlock]

Having spoken to other people on this board since my relapse it seems the care you may or may not receive is very patchy and very much a postcode lottery. I get sweet FA, others get great help.

I too am very much the wrong side of 40 and was happy to have filed "all of this" away in the files of misspent youth.

I am now at a point of pointedly not asking for help. Went to see the GP (locum) on friday to beg for help - his opening line was, and allow me to paraphrase; why the fuck are you living here then if you know there's no help?

Self-medication with wine & diazepam.

[Relapsecrisis]

If I could get hold of diazepam I would take it by the fistful. I've exhausted my codeine supply and alcohol makes me increasingly suicidal so it's risky.

The only respite I get at the moment is the sleeping tablets (zopiclone) which I bought online.

[willowcatkin111]

I agree it is very much a postcode lottery. Bigger cities seem to have the best but actually getting on their books takes forever.
When I am in the 'what's the point' phase people try to convince me that I deserve help, even if there is not much available, and they are doing more stuff all the time.
I think you need to think of your dd and seek help for her sake. OK if you seek and there is none then at least you have tried.
Also they do try not to hospitalise now if at all possible and especially for bpd so you will hopefully get crisis / home treatment help.
glock your locum gp sounds as helpful as the job centre 'work coach' who told me I should move to where there are jobs!
Not sure what set mine off - depression diagnosis 15 years ago, and up and down since but it was only last year I got into the suicidal roller coaster, and had the full psychological assessment in hospital

[AgainstTheGlock]

Oh I would very much like to move to an area which has excellent MH services. Trouble is I'm caught between a rock and a hard place. Moving house can be "trying" - right now, getting to the shop for me is "trying". Pulling 5k out of my arse, uprooting the family and moving hundreds of miles is "quite hard".

What I'd really like is a smorgasbord of psychiatric drugs which will give me the energy and will to get this shit moving so I can help myself to help myself!

[Relapsecrisis]

Spoke to GP this morning. Explained situation and that BPD symptoms suddenly back with a vengeance. Said about rapidity of mood shifts and how suicidal I'm getting. Answer - up the dosage of lofepramine and review in two weeks .

I understand in a way - what on earth can the GP really do? I just wish they could give me a bunch of medication to calm things down and knock me out. But they can't.

[msrisotto]

Have you looked at the NICE guidance for BPD treatment? I wonder if you could have a conversation with your GP about their long term treatment plan for you, because medication is not it.

[msrisotto]

You don't necessarily need long term treatment so maybe that is what they are trying first, but yeah, medication isn't the only (or most appropriate) treatment.

[msrisotto]

If you want a book recommendation, The Dialectcal Behaviour Therapy Skills Workbook is very good. DBT is designed specifically for managing BPD symptoms, you can look through it via the link there.

[Relapsecrisis]

I hadn't, no. Thank you for the link.

To be fair, at the time I went to the GP in November, it wasn't that the BPD symptoms had come back, it was that I was in utter and total grief that DP had left and I was so depressed and distraught that I was a very real suicide risk. I wasn't self-harming, or cycling through moods, or anything else. I was just trying to not throw myself under a lorry. Which is why they gave me the anti-depressants.

It's only been since January that all the BDP stuff has kicked off again.

I had thought all of this was behind me, that I was 'cured'. That I didn't need care plans, intervention, community mental health teams or anything else. I don't want any of that. I hate the stigma. I just want to wake up again and be "normal" and feel like I used to. When I had plans, a stable life, things interested me, I had long-term goals, I had fun. All of that has suddenly fallen away and I don't know how to get it back.

I might look into doing DBT privately and see how much it will cost.

[msrisotto]

Sorry, I feel like I bombarded you with stuff there. You can and you will get back to that place. You sound really proactive and motivated, you've got a really good shot of getting through this. Take care of yourself.

[FrumpleMum]

I second msrisotto, The Dialectical Behaviour Therapy Skills Workbook is really good. Also good is the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. Marsha Linehan is the "inventor" of DBT, and also has lived experience of BPD herself.

If you want a type of therapy that deals more with the issues underlying the symptoms, as well as coping with they symptoms themselves, then Reinventing Your Life by Jeff Young and Janet Klosko also excellent. It uses Schema Therapy, which was originally devised by Jeff Young for treating BPD, and has now been expanded to treat most other personality disorders too. It is a longer therapy than DBT.

Just thought these might be useful for you to know about if you don't want to get involved with local MH services.

[AgainstTheGlock]

I do kind of understand the book recommendations (I have those books myself) - but isn't it bit "physician, heal thyself"? If I were in any sort of state to be able to cure myself, I wouldn't be in this position.

Right now I need a little more help. :(

[Relapsecrisis]

Thank you for book recommendation. I will order a copy and take it from there.

[msrisotto]

AgainstTheGlock Sure, I understand where you're coming from. I think we need to attack the problem from many different angles though. Medication might be a part of it, but it's not the one and only answer. Especially as there isn't effective medication for BPD. Plus if there isn't an abundance of services, it is at least something. No one is saying that this is THE answer, but if it helps a little bit, that's a good thing. Sorry you're feeling shit though, I know if you could snap out of it you would and there are no easy answers.

[Relapsecrisis]

Have read preview of book and it looks really helpful. At least it has practical suggestions and anecdotes. Have ordered it and it's on its way.

Thank you again.

[Kelsoooo]

Have they tried you on mood stabilisers? I know that without mine, my BPD relapses pretty quickly. Even with all my coping mechanisms.

I'm probably teaching you to suck eggs, but have you tried Mindfulness?

I take quetiapine and mirtazapine for my BPD, which actually, is miraculous in its help after 12 years of varying anti-depressants (Tri-Cyclic, SSRI, SSNRI etc)

I always think of BPD as a cancer like state, I'm in remission now...but I know it can, and probably will,come back with a vengeance.

I'd advocate finding a MDT therapist and trying mood stabilisers?

[Relapsecrisis]

I was on an assortment of medication back when I was 20/21, including olanzapine, trazodone and various SSRIs. None of which really made a blind bit of difference. I don't remember being given a mood stabiliser, but it was so long ago and I've blocked so much of that time period out, that they may well have done.

I was on mirtazapine in the past, for depression, and came off it within weeks owing to the weight gain (8 lbs in two weeks IIRC).

Mood stabilisers, if they worked, would be brilliant if it stopped me from spiralling between normal (ish) and acutely suicidal within hours. For example, today has gone from ok (when I woke up), to increasingly anxious and agitated (to about 10am), then to ok (now). Sunday was hideous (eight hours of crying and making plans for suicide), Monday morning also just as bad, then Monday afternoon and evening were ok again (got into my work, watched some TV, cooked dinner, hung out with DD). On the flip side, though, mood stabilisers seem very hardcore and the side effects look pretty nasty. And I would have to see a psychiatrist, which I don't really want to do.

I guess I always thought of my BPD as being historic, not something that was just in remission. I had twelve years of normality. I never thought I'd be like this again. Vowed I would never self-harm and said I'd always kill myself before ever getting involved with mental health services again. I just don't want to get into the cycle of it all again.

Mindfulness is something I haven't tried, but will look into. Thank you.

[Kelsoooo]

Ah see the weight gain stopped after 8 weeks for me, and I've lost it again now a year later... Might be worth thinking about?

And honestly, the quetiapine gave me instant relief. There was no waiting for it to kick in. It's only a low dose too.!50mg daily. It is worth considering I'd say. And I know it's horrible having to go to a psychiatrist, but honestly, it changed my life.
Before I had it, the mood swings were awful, I was a shell, exhausted and worn down. I wanted to die and then I felt like I could conquer the world.
Now, I'm cruising nicely. Despite a few major life changes in that time.

I also used to not sleep. I was taking Ucerax (antihistamine) to help me sleep, but like you say, I wasn't getting REM sleep. Hence the mirtazapine really, sedative effect. I'll be asleep within 30minutes of taking it, but it's sleep... Not a level of unconsciousness that sleeping tablets Gave me.

Mindfulness takes a while to understand and get into, but once you've figured it out.. It becomes second nature.

I can now go, okay I'm in a really angry mood right now and want to slam my head through that door, but that's ok, because this will pass and then I'll feel calm... Oh the water from the tap is nice and warm....it sounds like claptrap but seriously it's been amazing.

I've only been diagnosed a few years, but from 8 Ive been ill with it. Just took a while to get diagnosed. The last 2 years of my life have been..... Amazing really. That battle I always had, even when on antidepressants has gone..... So I'm always around for a chat if you need

[Relapsecrisis]

I've upped the lofepramine and feel like a zombie. Albeit a suicidally-agitated zombie. My therapist is concerned, my friends are texting daily to check I'm alive and I feel totally overwhelmed.

I don't want to be in this situation. I want to go back to the person I was for twelve years. I don't want my life to be reduced to staying safe, accessing "services", being referred, being a professional patient. I feel like a leper.

All my options just seem to be narrowing and I can't see why it's so hard to get through the day without thinking about cutting, overdosing or just dying. The thoughts just go round in circles. I just need to get up, go to work, come home, go to bed and repeat and not do anything more than that. It's just so fucking difficult.