Gp appointment borderline personality disorder

[piffar]

Hi

I have posted quite a lot recently about my poor mental health.

I have had anxiety and depression since my very early childhood. I self harm, have uncontrollable fits of rage, feel empty, suicidal etc., I have shockingly low levels of self esteem and this has led to self sabotage in degrees I'm excelling in etc. I often find myself in places I have no recollection of getting to, extreme mood swings etc

Anyway I think I may have bpd. I've never responded to medication (antidepressants and propranolol) or CBT or counselling. I had an extremely anxious childhood, alcoholism and suicide highly prevalent in the family.

I'm obviously no expert so I don't know. I know it's easy to self diagnoswe on the Internet.

I've made a gp appointment today because my anxiety is horrendous. I keep thinking people are about to report me to authorities etc for no reason. My gp is extremely unhelpful though. He keeps parroting that I need to take antidepressants but I have and they don't work. I think he will dismiss me outright.

Aibu to ask for tips on how to approach this.

I am feeling so hopeless, is the only way to receive mh help though admission to a and e

Look up the DSM 5 criteria, copy it out and tick what symptoms you recognise - you’ll need 5. Equally look at the DSM 5 for PTSD and do the same

Think about what outcome you want from the appointment e.g. referral to specialist, change in medication etc. and don’t be afraid to ask directly.

Definitely a GP appointment and perhaps self refer to a specialist mental health counselling service. Where we live there is I Talk and Talking Change. GP's do not normally make the referal down here. The surgery will often have this advertised in their waiting area. It isn't generic counselling and is provided by Adult Mental Health Services. Everyone I have been involved with has always spoken very highly of this service (or equivalent) and have often been referred from them to alternative agencies if required. Good luck.

Some medications can take weeks to start working.
But it does sound like you need more help. Things might start to be sorted out better with a hospital stay.

I think you need to ask for a referral rather than a diagnosis - in my experience GPs won't diagnose something like BPD (and nor should they).

No a&e isn’t the only way, you just need to be clearish about what you want. Also have a look to see what services are available in your area and if any are self refer.
Hospital stays can be horrendous and to be avoided as much as possible. Thankfully locally we have a type of half way house that’s a lot better than hospital. Other areas have similar.
The gp isn’t a specialist in mh and will be going by the basics unless you ask. Through mh services others meds can be prescribed as well as diagnosis if relevant.

Oh and at first my diagnosis messed me up more.
Once I had therapy and learned more it was obvious that I’d always had these and no one gave a shit to mention anything.

Thank you for the help, I have a list of my symptoms next to the dsm 5 so I will use this to know what to say.

Over the last few years I have had anxiety eating disorder and depression and ocd diagnosed - for about 10 years.

I definitely do not have an eating disorder (I told the gp at this point that I made my self sick to help me cope)

I was referred by a uni psychologist in 2018 to a CMH, and needed the gp to make this referral. But he refused. He instead said I should self refer to iapt. I will be taking this referral letter with me.

I guess the referral is what I am after. I know there's something wrong with me and always has been. I don't have any hope of getting better with counselling or CBT. I have deeply entrenched believes etc.

I'm already panicking about the gp appointment

No, admission to A & E is not the only way to get help. In fact, if you present there, just claiming BPD, they will consider you to be manipulative and send you away after a quick chat with the Crisis team.

You need a referral to the CMHT by your GP. Only a psychiatrist can diagnose BPD; and even then you may not reach the criteria for proper treatment like DBT. DD was told that had she simply taken overdoses at home, which would not bother anybody else, she would not have got treatment. She only got treatment, because most of her suicidal behaviour was at railway stations involving station staff, the ordinary police, British Transport police, emergency stops of trains, being taken to A & E/S136 suite at the request of the police....

Antidepressants do nothing for her, except increase suicidal ideation imo.

don't have any hope of getting better with counselling or CBT

There are many different therapies around, counselling has different types to. CBT isn't recomended for BPD. We do an evidence based treatment for BPD called Mentalisation based therapy and DBT can treat it to, although I have no experience of this in our service. I work on an NHS Psychotherapy service and we take referrals from GPS.

I don't have much useful advice but I just wanted to offer, you know, unmumsnetty hugs. It's bad enough having a mental illness, but trying to negotiate your way through the system to get help is traumatising in itself and I have so much respect for your bravery in doing it.

@toomuchtooold thank you for your message. It definitely is a hard slog getting help - I'm even sitting here now thinking that I'm "playing the system", trying to find a way to convince them I'm not well!

@MontStMichel I'm sorry to hear your DD has had/is having such a distressing time, hoping you are both coping as far as possible

My previous counsellor suggested mentalisation based therapy or cognitive analytical therapy @LagunaBubbles but this is £90 per session where I live, so I couldnt do it

Thank you - she is much better now.

OP I don’t want to worry you but patients with BPD, or EUPD as they now call it are very poorly treated within the MH service. BPD/EUPD is kind of a dustbin diagnosis for anyone doctors consider to be ‘problematic,’ and a lot of CPNs and care coordinators won’t work with them.

The fact that you had a traumatic childhood suggests that what you are suffering from may not be BPD at all but much more likely CPTSD (Complex Post Traumatic Stress Disorder.) Unfortunately, despite a large body of research having been done on the subject, CPTSD is not well recognised in psychiatry and isn’t in the DSM. There have been many attempts to have it added but they have all failed. The DSM doesn’t have a great deal on trauma full stop, but CPTSD is more prevalent in women, so that fact might be a clue to it’s continued absence.

Anyway my point, before you go to your GP I’d strongly consider the above. A diagnosis of BPD/EUPD might not help you very much, it could probably hamper you for reasons already stated.Have a read around about CPTSD and see what you think. Approaching your GP with it might not get you far but you may be able to find a counsellor who specialises. It’s certainly worth a look around I’d say.

ITA with Whatis! I wrote the same post as her originally, but changed my mind! There seems to be a stigma around BPD, as if they are 2nd class citizens in mental and physical health! Everything they say is dismissed as being manipulative and attention seeking, when IME, it's a genuine attempt to get needs (for help) met!

DD regrets getting the diagnosis because it is a real hindrance in health services! I suspect it's because there is no quick fix - DBT takes a long time, and therefore it's a better use of resources to treat others, who improve quicker or save society money (like addicts, who can generate their own crime wave). She is also diagnosed with ADD, so it's difficult to know if the the BPD was misdiagnosed originally, or she has both, because symptoms overlap!

I have CPTSD and have fought against a diagnosis of EUPD hence I’ve sat with the DSM5 and highlighted I don’t meet the criteria but I do meet some of the crossover symptoms that PTSD has. I am going to be doing DBT for the next year and only then can I access the trauma therapy I need

It didn't go well.

A prescription for more antidepressants and sleeping tablets. Fought for a community mental health referral and did get one in the end. He said however that he won't be writing about my concerns for bpd

The gp said bpd didn't exist and is a loose term and i was "just depressed". He also said "sometimes we do stupid things" when referring to self harm and previous suicide.

He said "you don't strike me as someone with a personality disorder you can speak easily to me" and "you're making eye contact which suggests your not suicidal"

He didn't look at my list and cut me off half way through saying "these are all anxiety symptoms" and you're not schizophrenic. I didn't say I was!!!!

He said the best way to get the help he thought I needed was via psychiatric liaison in A&E.

Feeling deflated

The gp said bpd didn't exist and is a loose term and i was "just depressed". He also said "sometimes we do stupid things" when referring to self harm and previous suicide

Tbst is completely outrageous and not acceptable. Your GP sounds awful. It's also a shame you can't access MBT on tbe NHS. It's not a quick fix (18 months individual and group therapy once a week) but I've seen it really help people.

Your GP is a twat. Good luck with CMHT

Your GP was grossly unprofessional, poor you OP

He's entirely wrong, BPD is real and very recognised. And you were really brave to ask for help. I can only suggest trying another GP.

I second (third?) DBT if you can afford to seek private therapy. I also echo the point that often complex-PTSD can overlap/be misdiagnosed as BPD.

It's a great sign that you're so self aware, feel free to PM if you need to chat.

Your GP is a dick! Stay away from the DSM it just pathologies human suffering. BPD is a response to trauma. I would suggest a psychotherapist or a service that would help you explore that. People fight hard to get rid of that diagnosis once they have it. Where shouts are you? Do you have Facebook? Check out the "drop the disorder" group. Full of survivors, people currently struggling and professionals that can help.

Where abouts are you...not shouts!

Can you see another GP in your practice? I rarely see the partner who is actually my official GP.

I got a referral to the hospital psychiatry department by going in and saying that years of antidepressants have done bugger all and there's something else going on. I suspected I had ADD, listed all my symptoms, and quoted the Royal College of Psychiatrists advice on getting a diagnosis. I'm in Scotland if that makes any difference.

I got my diagnosis today - BPD with similar symptoms to ADD and some possible autistic traits. I'm a bit bemused at how I could get a diagnosis from a qualified psychiatrist who had discussed the case with the consultant for something that doesn't exist according to your GP.

Change the doctor you see, change practices if necessary; a helpful doctor is worth their weight in gold. Good luck and hugs.

I was diagnosed with bpd. I actually don’t think I am. I have two children with autism and adhd and I suspect it’s much more likely I have adhd. I know a lot of women especially end up being diagnosed with bpd when really it’s autism or adhd. Just a thought. I hope you get the help you need. Your GP sounds like a waste of space.

OP, so sorry you’re having a tough time and I admire you for persisting. I needed to persist (for a long time) and eventually got mentalisation therapy and DBT for diagnosed BPD. They’ve helped a lot. And yes, I can make eye contact and talk articulately even when I’m very ill! Please follow the referral if you have one now, and also find another GP - this one is unsympathetic and, more importantly, wrong. I wish you the very best.