Bpd assessment

[Turnitupto11]

I self referred to the local mental health team and have had four telephone assessments now. The latest was today. They only concentrate on suicidal ideations. I told her I'd contacted them as I suspected bpd, she seemed surprised - despite me mentioning this in the previous assessments - then asked why I thought this. I told her about my symptoms (all of which are listed on the NHS website) and she said she didn't think I had bpd. She's referring me to the primary mental health team for short term support, probably counselling but they would look at my medication too, although unable to prescribe The reason I've had so many assessments was because I was told the team assessing would be able to offer long term support, so I feel let down. I know something isn't right. I've been taking antidepressants on and off for over 20 years but nothing improves. In truly to some of the crazy behaviour I mentioned she said she knows people who do that! I'm devastated that yet again I'm getting nowhere. I don't want to take up their precious resources for no reason, I just want some help, but it seems unless you kill yourself or are planning to kill someone else there is no help to be had

I've no idea what to do now, where to turn. I've emailed them with everything I wanted to tell her, my symptoms, because I struggle with phone calls and get confused and forget things. I doubt it'll help though.

In reply, not in truly!!

Your wish for long term support is valid, we should all get the help we need, but a BPD diagnosis will not get you that. Sadly, unless you're extremely unwell, there's very little mental health support at all.

A BPD diagnosis has a great deal of stigma around it, including from those working in mental health. Are you sure that's what you want?

Sorry, to be more constructive, do you know what help you are looking for? Are you able to afford private care?

Thanks for replying. I just want to know what's wrong really. I'm tired of feeling like this, of behaving the way I do. It makes relationships really difficult, my life really difficult. I suppose I'm hoping if they know what it is they will help me change things. I don't really care about stigma. I haven't been able to work for five years, that has sigma attached too, I've no contact with a lot of people I knew, due to how they feel about that. I'd just like to understand and maybe be able to do something about it.

@CorrBlimeyGG

Sorry, to be more constructive, do you know what help you are looking for? Are you able to afford private care?

No I can't afford private care.

You could look at DBT, that is seen as the best therapy for managing DBT? This is the recommended text.

www.amazon.co.uk/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1684034582/ref=pd_lpo_1?psc=1&pd_rd_i=1684034582&tag=mumsnetforu03-21

It's not going to be the same as working through it with a therapist, but it's a good starting point.

Mental health services are so overwhelmed that they're just fire fighting, as long as you're not actively suicidal then you can go on a waiting list or a low intensity service. It's not right, your needs are as valid as anyone else's, but sadly that's how had things have become.

• for managing BPD

Sorry, confusing my acronyms.

She was probably surprised because hardly anybody actively wants a BPD diagnosis; at least, not once they know what it means for their treatment by services. Of all the diagnoses you can be stuck with, it's one of the worst — sure, it comes with a slight chance you might be one of the few who get referred for long-term therapy (which isn't always as great as you'd hope), but most of the time it means you get refused treatment and accused of manipulation. Someone who's suicidal and diagnosed with depression may get crisis team intervention or hospitalisation if they're considered high enough risk. The same person with a diagnosis of BPD may instead be told that such treatment would only reinforce their manipulative suicidal behaviour, and that services will be taking a "positive risk-taking" approach instead (told to go away, allowed only a specific number of calls to the MH crisis line, etc.). This isn't what should happen, but it has for years, and despite lots of attempts at reform and guidelines and instructions (e.g. the "No Longer A Diagnosis Of Exclusion" report that came out about twenty years ago), and some deaths of people with BPD diagnoses who were treated with this approach, it still happens. In the past "BPD" has often seemed to be applied to patients punitively, or in order to signal to others that this is a problem patient. It's also been known as a "dustbin diagnosis", i.e. a diagnosis you use for any patient who doesn't seem to properly fit any other category. Additionally, many patient groups have historically identified the BPD diagnosis as being misogynistic or at least applied in the service of misogynistic and sexist values.

I really hate to put you off seeking care, especially if you have the difficulties that often result in a BPD diagnosis, but IMO that's probably why the nurse was surprised you were seeking that diagnosis.

Oh gods, what a wall of text. Sorry. Was adding bits and didn't realise how long it was getting.

@ClumpingBambooIsALie

She was probably surprised because hardly anybody actively wants a BPD diagnosis; at least, not once they know what it means for their treatment by services. Of all the diagnoses you can be stuck with, it's one of the worst — sure, it comes with a slight chance you might be one of the few who get referred for long-term therapy (which isn't always as great as you'd hope), but most of the time it means you get refused treatment and accused of manipulation. Someone who's suicidal and diagnosed with depression may get crisis team intervention or hospitalisation if they're considered high enough risk. The same person with a diagnosis of BPD may instead be told that such treatment would only reinforce their manipulative suicidal behaviour, and that services will be taking a "positive risk-taking" approach instead (told to go away, allowed only a specific number of calls to the MH crisis line, etc.). This isn't what should happen, but it has for years, and despite lots of attempts at reform and guidelines and instructions (e.g. the "No Longer A Diagnosis Of Exclusion" report that came out about twenty years ago), and some deaths of people with BPD diagnoses who were treated with this approach, it still happens. In the past "BPD" has often seemed to be applied to patients punitively, or in order to signal to others that this is a problem patient. It's also been known as a "dustbin diagnosis", i.e. a diagnosis you use for any patient who doesn't seem to properly fit any other category. Additionally, many patient groups have historically identified the BPD diagnosis as being misogynistic or at least applied in the service of misogynistic and sexist values.

I really hate to put you off seeking care, especially if you have the difficulties that often result in a BPD diagnosis, but IMO that's probably why the nurse was surprised you were seeking that diagnosis.

@CorrBlimeyGG

You could look at DBT, that is seen as the best therapy for managing DBT? This is the recommended text.

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It's not going to be the same as working through it with a therapist, but it's a good starting point.

Mental health services are so overwhelmed that they're just fire fighting, as long as you're not actively suicidal then you can go on a waiting list or a low intensity service. It's not right, your needs are as valid as anyone else's, but sadly that's how had things have become.

Thank you, I'll look for that.

The good news is that BPD-type difficulties are treatable, and also tend to lessen as you get older, unlike many other mental health diagnoses.

But one thing that services don't really seem to like is patients going in there with their own ideas about what might be wrong… it's possible that the best way to avoid a BPD diagnosis is by going in there and telling them that's what you think you have

The other thing to remember is that many of the people they see who have BPD diagnoses will have frequent and extreme symptoms, so if your difficulties are more subtle they might be reluctant to diagnose it.

Thank you. Tbh things seem to have got worse for me, I'm now mid 50s.

I understand what you're all saying and will give up now, as I'm clearly not going to get any help beyond antidepressants that aren't working.

Don't give up! In your position, I'd go for the short term primary care support, and if/when it becomes obvious to them that you need further input beyond what their service can provide, they can feed that back. Mental health services including primary care, secondary care and IAPT tend to start everybody off on the shorter, less intensive interventions, and escalate from there if necessary. At the shorter/less intensive levels, it won't matter so much what your diagnosis is.

Ok, thanks. I'll see what they offer me. They did say someone would be able to prescribe, although not a doctor, so not sure what that means but maybe they'll have some ideas regarding antidepressants that night help.

OP first off I’m so sorry this is happening. It’s not right. And it’s also insane and unacceptable that BPD remains so stigmatised WITHIN mental health services.

Tactically I am wondering if you would get further by suggesting you have CPTSD. Some people (not me though actually) consider it synonymous with BPD but awareness of it is relatively high and stigma maybe less. But I hate suggesting that too because things shouldn’t be this way.

I think you did a good thing in sending that email.

I’m so sorry this is happening.

Thank you. I did suggest ptsd but she was no longer interested at that point and didn't go into it. It's something I'll mention if the primary mental health team do contact me.

Is there a difference between cptsd and ptsd?

Yeah, PTSD is the one that used to be thought of as mostly happening to soldiers. Being really broadbrush about it, PTSD tends to happen after a single event or trauma that happened over short periods of time, and you get nightmares, flashbacks, and hypervigilance. CPTSD is a more recent construct and tends to be applied to people who have symptoms like those diagnosed as BPD, and the trauma is likely to have been long-standing (like childhood abuse) rather than a one-off (like a car crash). That's a really rough description of the differences, sorry.

Thank you, that's helpful.

I have bpd. I spent many years battling to get any kind of support being fobbed off saying that I have depression and anxiety which is true I do but there is so much going on. I was diagnosed 8 years ago now. I have meds, a psychiatrist and a cpn. There is help around for it and the stigma is lessening slowly. You don't have to tell people that you have bpd when you are diagnosed because I don't.

@fantasmasgoria1

I have bpd. I spent many years battling to get any kind of support being fobbed off saying that I have depression and anxiety which is true I do but there is so much going on. I was diagnosed 8 years ago now. I have meds, a psychiatrist and a cpn. There is help around for it and the stigma is lessening slowly. You don't have to tell people that you have bpd when you are diagnosed because I don't.

Thanks. Yes I wasn't planning on telling anyone. I just want to know what's wrong because I'm sure this is more than depression/anxiety. How did you finally manage to get a diagnosis?

I was admitted to hospital. About a year later I went to the gp and told him I thought I had bpd. He said yes you do you were diagnosed in hospital! I informed him that i was never personally told. At my first psychiatrist appointment he confirmed it again. Having a diagnosis can be negative but it can also be positive. It has enabled me to get medication for the symptoms of bpd and so on.

@Turnitupto11

Thank you. Tbh things seem to have got worse for me, I'm now mid 50s.

I understand what you're all saying and will give up now, as I'm clearly not going to get any help beyond antidepressants that aren't working.

A lot of women reporting a decline in their mental health during peri-menopause and beyond and consequently loads of women end up being prescribed anti depressants when they should/could be prescribed HRT.

It might be worth you having a look on the menopause section of this forum as there are loads of women posting over there about menopause and mental ill health.

Speaking from personal experience, I found my mental well-being went into decline in my late 40's and subsequently improved with HRT, dietary changes, practicing mindfulness and addressing my life long insomnia. I also had long term therapy following a diagnosis of C-PTSD (prolonged childhood abuse/very high ACE score).

Thanks. I'm on HRT but possibly the dose is too low. When I tried to discuss it with my gp he said at my age I should be thinking of coming off it at my age