Why do I feel offended at the idea of borderline personality?

[WordsAreNoUseAtAll]

I have bipolar, I know I do. It took me a while to get my head round it, but fair enough.

Now, apparently, without anybody telling me, my main diagnosis is borderline personality disorder.

WTF???

Up to now, every doctor has said bipolar. I'm on mood stabilisers, ffs. They very nearly started me on lithium until they decided I was not reliable enough and it can't be messed around.

I remember being told that there was a possibility of borderline personality, but my cpn told me before the meeting to just nod and agree with the doctor so that he would discharge me from hospital, so I did.

A couple of months later I had reason to see my GP about something and they said that there was no record of bipolar, only borderline personality.

All I can think of is that I asked about a possibility of aspergers or suchlike while I was in hospital (I do have a diagnosis of dyspraxia, but I think a lot of my childhood behaviour was classic aspergers and I just avoid school like situations now and stay at home instead) and maybe that got used as evidence?

Quite apart from getting this surprise diagnosis, I somehow am offended. Bipolar is separate from me, my personality IS me.

Help me sort out my feelings!

I should add, I have not seen any paperwork since hospital (6 months ago) and the last psych doctor I saw didn't have my notes. CPNs just tell me that I had it explained to me at the time, but I am almost certain that I didn't. DH was there and he doesn't remember it, but we both remember the cpn telling us to just nod and agree and that it would be easy to reverse anything once I was discharged (we thought she meant medication)

I think it feels more like a personal attack and failure than something like bipolar, doesn't it?

Do YOU think you have BPD? And will having that as a dx make a difference to your treatment?

A diagnosis of a personality disorder needs to be made very carefully for exactly the reason you describe- your personality is you. I think you are entitled to discuss this in great detail with whoever made the diagnosis to see how it was made. Ask for an appointment. Complain via PALS if you don't get anywhere.

As for cpns who tell you to just nod. Sorry. Speechless.

The doctor who I think made the diagnosis - like I say, as far as I understood it was just a note to be further investigated as a possibility - is the hospital doctor, and one of those "God complex" types - always 10 people in the room with him, turning up at random and getting annoyed if you are on leave or doing something, etc. He kept telling me how I should feel really grateful to have seen him four times in the eight days I was there (I spent most of the time trying to get him to let me out) but that he had taken a personal interest in me.

I have now changed cpn - the "just smile and nod" cpn was the good one. This new one is worse than useless.

I have applied for a look at my notes and am allowed to see them (although apparently they might be edited) but I'm nervous as I don't want to just find out more that will confuse me, plus it is just at the GP, so the records person might not know what one earth the notes mean.

I missed my last dr appointment because the cpn didn't bother to tell me about it. Or at least, I told her I had forgotten, she had a month to tell me, I kept trying to contact her, she finally got a message to me via my old cpn that it had already passed. Sigh.

I think it is kind of that I have accepted the bipolar - I have been doing some stuff with Rethink (ie for the charity, not as a service user) and blogging etc. I was given all the booklets, NICE guidelines etc in hospital, googled some basic journally things on it, etc, looked up stories and celebrities with it. Before hospital I knew I had it and so had been getting used to it.

Do I think I have it? I dunno.

<strong>A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:</strong>

    <strong>Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5</strong>

I'm not even sure what this means. I don't really have any friends that I see much, when I was in hospital I had just finished relate over DH kissing some other woman, but we had got over it - is that unusual?

    <strong>A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.</strong>

I suppose I have intense relationships, in that I have had two boyfriends, one of whom I was engaged to and was with from the age of 17 to 21, and then DH from the age of 21 to now (27). Me and DH argue, but mostly about the usual stuff - money, him going to the pub, me not doing the housework. Sometimes you like your husband, sometimes you are annoyed at them, right?

    <strong>Identity disturbance: markedly and persistently unstable self-image or sense of self.</strong>

Err...don't understand this either. I suppose I sometimes think I am still a teenager, and sometimes I feel old, but I would say I have a pretty strong sense of self, in that I never follow trends (mostly because they are stupid) and I dress...well, unusually. I very rarely do that disassociation thing, so I suppose that could count...

    <strong>Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5</strong>

Well, I've had my moments with this one, I must say. But they were in times of increased creativity, hyperactivity, less sleep...ie mania.

    <strong>Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.</strong>

Yeah, I do/have done that. Cut for most of my teens. First self harmed at the age of six. Haven't cut for years now though. Cutting was mostly because things felt too soft or weird, or there was too much noise etc (ie school) In hospital I kept banging my head against stuff, but it was frustration. I have had suicidal thoughts, some as part of hallucinations, some because I was grandiose or depressed.

    <strong>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).</strong>

Well, if what I thought was bipolar gets really bad it can start to change quickly over a day, but it is usually over weeks or months

    <strong>Chronic feelings of emptiness</strong>

If I'm depressed, probably. But no, it's more a heavyness than an emptiness.

    <strong>Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).</strong>

I am one of the least violent people ever. I am a wimp. I get annoyed, but not angry.

    <strong>Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms</strong>

Yeah, I get them. When manic.

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

That criteria is basically that it needs to have starte3d early, not have changed and not be due to anything else. Which doesn't help one way or the other.

So, no. I don't think I have borderline personality disorder.

I think I have an underlying issue along the lines of dyspraxia/aspergers syndrome, which would explain my many, many weird fears, sensory "things", social rubbishness, bad co ordination and so on. I actually have the dyspraxia diagnosis.

I think that my teenage emotional problems were brought on by bullying combined with being really, really not cut out for school.

I then think that, from that starting point and with a family history of my nana being "bad with her nerves" (ie she is sometimes really really energetic and sees angels, getting messages from god, and is sometimes really depressed - sound like any well known disorders?) having a very very traumatic birth of my first child was enough to tip me over into bipolar disorder.

I also think that, if my mental health people don't start communicating with me, I might have to become the angry person.

Or, in reality, I will sit here and mutter, then when they come round chat about really irrelevant things like the weather.

Sorry, that came across wrong, I was actually working my way through that then - I was "typing aloud" or whatever the phrase is.

You sound quite similar to me, OP. I have a note of borderline on my file, although I think it was suggested rather than fully assessed and diagnosed. Personally my own feeling is that I have Aspergers, although my psych disagrees. BPD is a very, very common misdiagnosis for those on the spectrum, especially women who have only been diagnosed as adults. It's a very controversial diagnosis as well, as it's often used to label problematic female patients.

The reason that I'm particularly convinced about my own AS (and probably dyspraxia too) is that my DS is on the spectrum and I've learned so much about it which chimes with my own experience. And also because there's a family history of it, and because many of the characteristics of bpd absolutely do not apply to me (the same ones as you - not angry, no emptiness, no fear of abandonment). I've also had psychotherapy which is supposed to work well for those with bpd, but is known to be ineffective for those on the spectrum...and it didn't work for me.

For me, I am requesting a referral to an AS specialist, but it's taking a long time to come through. If you think AS is the right diagnosis for you, I would recommend you ask for a referral to the right specialist in your area. It might be worth requesting records from your past as well (e.g. any clinics you went to, maybe schools) if there might be evidence that AS behaviour was present back then. Often for AS diagnosis in adults, they need to have someone corroborating what you say, e.g. a parent or partner.

Just a silly thought, but- BPD could stand for both BiPolarDisorder and Borderline PersonalityDisorder.... Is it possible the new doc glanced through your notes and saw the abbreviation and made the wrong assumption?

When someone presents with mood swings both borderline and bipolar have to be looked at. They looked at whether they thought I had borderline but settled on bipolar for now. In normal bipolar the difference is very easy to see as a person has large periods of normality and the a episode which is not triggered lasting months which is quite different to borderline. As is type 1 different as it is rare for pychosis to be present with borderline.

But borderline is very similar to someone with rapid cyling bipolar type 2 because both have extremely quick changes of mood. Their mood will change hour by hour. In fact my pychiatrist says even for someone qualified it can be hard to tell the difference between these two. But the main difference and what they mean by instability of emotions is someone with bipolar has the wrong chemical levels in their brain but someone with borderline has difficulty controling their emotions usually through trauma or poor role models. You can see the difference between the two as someone with bipolar just has the mood swings regardless of whether the mood is correct for the situation (e.g they canbe happy at a funeral of someone they loved) because chemicals control the mood swing, but someone with borderline reacts to situations and a negative comment can cause a downward spiral into depression very quickly.

Try not to worry about this my pychiatrist have suggested Bipolar borderline or scizophrenia at one time or another but they do this because they need to eliminate them and then they came back to what the two pychiatrists who first saw me said and at the moment the health professionals say I have bipolar but a cross over of scizophrenic symtoms but not enough to diagnose scizophrenia. Diagnosis take years try to be patient and be truthfull so they can eliminate the similar illnesses and find the one that fits your symtoms best. Also having borderline does not mean your personality is flawed just that you have trouble with emotions.