BPD - Getting diagnosed (TW suicide ideations)

[DonkeySong]

Hi,

TW - brief mentions of suicidal thoughts.

NC for this one.

Been suffering with poor MH for as long as I can remember. Taken anti depressants for probably over 6 years in two forms, a few suicdal spells, with plans made on occasion and then just general prevaling thoughts for extended periods.

History of unstable relationships and suffice to say I've put previous, and most importantly current DP through hell and endless worry about it, as well as the associated problems poor MH brings to relationships.

I've been to my GP twice now and begged for a clinical diagnosis as I'm convinced I've got BPD but the bar for psychiatric services beyond CBT seems super high in my area. Been waiting for my ADHD referral for ages too.

Has anyone successfully got to see a clinical pyscatrist and what did you 'say' to your GP to obtain the illusive refferal?

I really don't want to end up back on the general counselling train again as I've (shamefully) not stuck with it and I don't think it fair I take a place in that queue again when I've not fully committed to their processes.

Thank you!

Hi OP, the NHS is struggling so much so your best option would be to have an appointment with a private psychiatrist if you can afford it. It would be £300-£400 for an initial consultation.

The gold standard treatment for BPD is DBT, and that is what you would probably be offered if diagnosed by the NHS. However, you can download workbooks etc, and work through a lot of DBT yourself without a diagnosis.
Personally, I would not be pursuing that specific diagnosis, as it carries a lot of stigma with it that will follow you around everywhere (speaking from experience).

Thank you. But does the diagnosis not help the person to understand what's behind some behaviours?

Surely there is more stigma attached with NPD which I'm lead to believe is what many people mistake BPD for?

Hi OP

Sorry you're having a difficult time.

It likely will not be that the GP is choosing not to refer you. In my area GPs cannot refer to CMHT for assessment/diagnosis. The referral will simply be rejected. Referrals are only accepted when a person's functioning is severely impacted by their symptoms and CMHT have moved away from seeing to diagnose and more towards symptom management in general.

There is a personality disorder service here that you can self-refer into (without needing a dx) however you will "only" be offered DBT based group work delivered by occupational therapists (I say "only" because 9/10 people I encounter who are offered this reject it because its group based and not delivered by a psychiatrist/psychologist). You will only get a care co-ordinator if your MH is so bad that are at risk of a long term hospital admission or if you are leaving hospital after a long term admission.

Obviously this will vary depending where you are but in general it is not easy to have a referral accepted by CMHT unless you are very unwell on a daily basis.

Your GP should be able to refer you into PCMHT who would work with you on a formulation for symptom management but they will not diagnose.

If diagnosis if your goal then private would be the only option really.

Thank you for the detailed reply. I appreciate what yourself and @AtDeathsDoor have stated private is probably the only way to get clinically diagnosed quickly.

Do you know if it's common for ADHD and BPD to occur together?

My worry is I'm just a vile person who's masquerading as struggling with MH. One therapist stated they suspected me to be narcissistic, then another said if I even contemplated me to be it's not the case. It's such a minefield.

Is there a reason you haven't tried sticking with counselling? Could your GP not offer CBT or you can have a look in your area, I self referred to one in a hospital near me years ago.

I think deep down I feel a bit like it's either too 'fluffy', or maybe I'm not committed to it. I don't know myself to be honest.

I've had two extremes of counselling, ones where they are super kind and almost excuse me for being a horror, or the other end when they say I'm an incurable narcissistic person.

Genuinely feel a broken human! Haha!

There is a huge overlap between BPD and ADHD and there can be a huge overlap between BPD and NPD.

When I was diagnosed with BPD (they called it EUPD) about 20 years ago aged as many years (after a series of crises around self harm, extreme moods, paranoia etc since my late teens) I wasn't even told to my face. I discovered it by accident, came across my notes when transferring from one mental health team to another. Apparently it was quite a common thing for that to happen because of the stigma. It took me another decade before I was eventually given two years of DBT on the NHS. I thank God for that.

Another thing I realised is that I had a lot of complex trauma (abuse of various kinds from parents and peers and others) and a lot of what is termed BPD is a manifestation of complex trauma. Turns out I fit the criteria for CPTSD as well!

I don't understand how NPD is stigmatized so much more when it seems both NPD and BPD are different but sometimes overlapping manifestations of complex trauma.

Its great to hear that you got the help you needed eventually, unfortunate and quite sad how you found out and what you had to deal with in your formative years.

The paranoia and mood swings are very relatable. However trauma and CPTSD is something that I struggle to associate with, I always associate trauma with something grave and serious, but I actually had a pretty normal upbringing.

I agree, the stigma is awful, everyone thinks if you have a disorder you're immediately a serial killer.

CBT is short term though. I was offered that back in the days they thought I was depressed or maybe slightly bipolar, but I wasn't able to engage. And it is short term. Once I was diagnosed with BPD, after another decade of bouncing round the MH system on and off, I was finally offered DBT, which is about 2 years and twice a week, group and individual work. It has been a game changer to be honest . I'm still alive and learning to cope. It hasn't been a quick process. I struggled at first accessing the skills and went back to them a few years later! This time I was ready (was having some help processing my childhood trauma) and began to work seriously at it.

What is needed is to build trust with a therapist, people with BPD often have issues around that, either attaching too quickly and idealising/devaluing the therapist, or take a while to trust, pushing away from them. My therapist was lovely but it took a long time before I could open up. I was still living with abusive parent at the time I started.

What a torrid time, but a heck of a result in the long term, I'm glad you got the diagnosis you needed eventually.

That's very relatable not being able to engage, I always thought I was just lazy.

Thanks so much @DonkeySong . I will say that sometimes trauma is more broadly defined than we often assume and chronic invalidation, emotional abandonment are often huge elements in BPD.

Regarding some counsellors thinking we are evil, for me it was some of the churches or Christian organisations I was involved with at the time (thankfully I am involved now in a lovely MH friendly church) and my own parents being quite fundamentalist, too. The exorcism attempts, being told "God showed me you have a narcissistic jezebel spirit", my meltdowns and self harm being dismissed as attention seeking and pride. It's a horrible feeling to be made to feel even more worthless and insecure than we were already.

I hope you find the help you need.

I was convinced I was suffering from BPD but I think it's actually more like complex PTSD.
I begged the GP to see a psychiatrist to try and be diagnosed. He gave me this one but he was a 'community' psych. And that he doesn't actually diagnose things? He also asked me unsettling questions about sexual abuse which freaked me out. The outcome was he recommended a high dose of pregabelin for my extreme anxiety.
There's no way I'm taking that. It totally zonks you out.
So I'm afraid my experience was not very good or helpful. I hope you can just press for a clinical psychiatrist appointment.

My doctor seems totally resistant. Always jusylt referral to CBT and then adjusting meds. Honestly very little works. I struggle to sleep properly and I'm chronically anxious.

I’d agree that BPD is a stigmatising diagnosis - and increasingly not one the NHS use anyway preferring Complex Emotional Needs. DBT is the standard offer and as a pp said there are excellent workbooks/online courses that could be helpful.

I was diagnosed with BPD after being taken to A&E by the police because I told them I wanted to kill myself. I saw an emergency psychologist and got the most help I've ever received. However since then it's been one round of group therapy and then nothing but increasing my meds. I get no support at all.
A Diagnosis isn't going to bring more help unfortunately in fact it seems that most don't want to deal with me.

In our area you can access DBT via an online group without a diagnosis

Psychiatrists are in very short supply compared to therapists and doing a one off diagnostic appointment is not considered a good use of this resource vs using the psychiatrist for medication responsive conditions which is their main skill set.

Therefore in our area you would be offered the online DBT group but there would be very little chance of you seeing a psychiatrist for that diagnosis. I guess does it matter so much that someone official states it? If you think it fits and is helpful for you then you can just look up strategies etc that would help with BPD/ EUPD and try those out as there is nothing to lose by doing that.

I doubt you are lazy but struggling with a debilitating emotional issue, whatever your diagnosis does turn out to be. It's not your fault at all. Don't let others try to put that shame on you, it doesn't belong there. I know, easier said than done.

@ThePure Facebook does have some groups for DBT skills run by practitioners or those service users or former service users who have long term experience in utilising the skills themselves. I helped moderate a brilliant one. I loved it . Sadly the lady who runs it and is trained as a practitioner as well as being a former BPD patient (in the US) messaged all is admins and mods just a few days ago to say she is archiving the group for a few months as she is going through some severe physical health issues. It has been a brilliant group and hopefully won't be closed for long. That said most of us who use this kind of group have been or are going through some kind of face to face DBT already, and the group is more a top up than a main source of support. We can't deal with crisis care, it's an international FB group, if someone is distressed to the point they can't utilise their skills and need to be seen by a doctor we always encourage them to reach out to the or nearest hospital or crisis team if applicable. Of course for members of the group who are based in Britain or unable to afford private getting into on going long term help can be a huge challenge, and even crisis help is limited on the NHS, units have few beds.

@BloodandGlitter I'm so sorry. The stigma is horrendous and it should be getting better after all these decades since BPD was recognised (in the 30s) and Marsha Lineman creating DBT (1980s) but it still remains. It stinks.

That's really interesting that there is online DBT self help

I meant that the NHS in our area run an online DBT group course that you can be referred to for free with no need of an official diagnosis. There's an initial 1:1 online assessment and if it's felt you would benefit you are referred into the group.

It would not provide any face to face or crisis support and does not have a psychiatrist or medication advice it is straight up a DBT service but it's a helpful offer for people who otherwise would not get a service.

I think that's really weird. A psychiatrist is a psychiatrist as in a medically qualified specialist in mental health and I am not aware of a distinction between a community and a clinical psychiatrist.

In many areas you first get referred to a mental health nurse or possibly another qualified practitioner like a mental health social worker or OT and they will screen and signpost but cannot diagnose. Might that have been who you saw? Were they a community psychiatric nurse? Nurses usually don't diagnose but any medically qualified psychiatrist can do.

This sounds a brilliant idea. I wish it could be rolled out to all NHS trusts because it's hard for many people to get secondary services these days because they are so underfunded. I found back in the 2010s and 20teens IAPT/LIFT psychology services weren't able to deal with complex issues like BPD and complex PTSD. I had a period of time about a year after finishing DBT with the NHS that I was struggling badly again because trauma triggers were getting more intense again. The secondary services just said to GP "we've done all we can for Bonzo, there is nothing left." So was referred to IAPT only to be told they couldn't deal with me. I was admitted also struggling with an ED and religious OCD which was affecting me using the skills as my OCD kept saying I was going to hell unless I saw a Christian counsellor and that didn't help, they didn't know how to deal with me. I'm so glad I ended up some years down the line (2018) seeing a private therapist at a trauma organisation in Bath who told me if I was working with him and uncovering the past I needed to make sure I was on top of the skills . I got Marshas book again, the skills manual and started applying myself . By this time the religious issues had improved massively and I was ready to get back to using the skills. I have had a few blips but I'm ever moving forward . I am stabilising and the happiest I've been in my life. I now am away from my parents which helps so much!

I think the general suggestion here is, that of I feel I have BPD to self DBT via Internet or books as an NHS referral is unlikely, and even if I did get one, it'd be a short term thing.

As many have stated CPTSD is also a possibility so I guess a 'normal' counsellor can help unpick those things?

If you get DBT it would be 2 years at least. Maybe with a few months after if needed (that's what I needed and got) but CBT would be a few weeks (12 usually).

You can see a non DBT therapist but would be wise to check that they have some dealings with childhood trauma or stressful childhood relationships and/or events. What is usually advised is DBT first to help you emotionally regulate and manage impulsive or self damaging behaviour better or DBT alongside trauma therapy. Because it's tough going through the past and reliving or looking at things.

Other options for BPD might be schema therapy, Acceptance and commitment therapy or mentalisation based therapy. I've also heard of art and drama therapy being used for BPD, but I'm not sure any of these are usually offered on NHS. I think for art therapy, drama therapy et c some charities or private therapists could do it. I myself have no experience of schema, ACT or MBT therapy, might be worth a Google but I'm guessing you may need to go private.

All the best with your journey.