Personality Disorders

I am pissed off. I was reading a book earlier and it annoyed me, enough that I felt I needed to blog about it. The book is 'Bedside Stories - Confessions of a Junior Doctor', by Michael Foxton, and it is a good book. It is basically a Junior Doctor's account of his first 2 years working as a Doctor. I found him likeable, and the book was funny, parts of it very funny. I would recommend it if you like that kind of book. However, what pissed me off was his attitude towards personality disorders. Fairly on in the book there was a reference to PDs, which I thought seemed quite negative, but it was brief and I just kind of ignored it. Then later on there was another one, but again I was able to gloss over it. This one I wasn't able to gloss over. He was working in Psychiatry, and was risk assessing a girl who was presenting in A&E as suicidal.

'It's a blatant personality disorder, a world full of frustration, untreatable, incessant, lifelong maladaptive, manipulative, anxiety inducing nightmare punters from hell. I just don't get them. I think that's because nobody does.

Right then, don't hold back - let's hear what you really think about personality disorders shall we? What really got me about that quote was how accusing he sounds. A 'blatant personality disorder'. Sounds like it could be rephrased as 'Blatant attention seeking'. So what if someone has a personality disorder? Personality disorders are valid mental illnesses. Patients with a Borderline Personality Disorder make up about 20% of inpatient admissions, and approximately 10% of people with a BPD diagnosis commit suicide. I really genuinely do appreciate that some personality disorder presentations must be frustrating for staff. I know people with personality disorder diagnoses who frequently attend A&E having taken a few painkillers, or having self harmed superficially, and I understand that A&E staff must get frustrated with this. But people doing this ARE still ill, and I think the fact they are needing to do that implies that they probably need more, or different, support to that which they are currently receiving. And finally, not everyone with a personality disorder is the manipulative attention seeker that he is making out.

Turning up at A&E when you are feeling strongly suicidal is really not an easy thing to do. For a start, you feel very divided about going full stop - after all, you are suicidal. But sometimes you can just manage that last grasp for help before you fall totally off the edge. And then you come across staff who clearly have the sort of attitude expressed above, and it just succeeds in making you feel worse about yourself. Michael Foxton's attitude towards people with Depression is very different. He seems sympathetic and understanding. So why the change when someone has a personality disorder diagnosis? It really makes me angry when I hear of professionals with this type of attitude. It is unhelpful and distressing, and I think probably still far too common.

Oh, and at the end of his House Officer training years, Michael Foxton became a Psychiatrist. Comforting, huh?

I hate titles

So, the stopping gaining that I referred to last week hasn't happened unfortunately. Another 2lbs have been added. Nice one. I have been trying hard. I even forced myself to go to both my ballet classes this week, which ok, is only 2 hours exercise, but you would think it would be better than none right? Clearly wrong. 3 BMI points in 6 months. Not on. 2 clothes sizes. None of my normal trousers fit anymore. I got really upset a couple of days ago as I got out some trousers to wear that I haven't worn for a while, as when I was at a lower weight they were too big for me, so I thought they would fit now. I couldn't do them up. Every time I have to get dressed I end up crying because nothing fits, and I feel so enormous.

Last night I decided I hated the world, as it is clearly conspiring to make me fat. This included, but was not limited to, Dr E, Dr O, L, N and my parents. Everyone I come into contact with basically. I decided it was mostly Dr E's fault for taking me off my meds, which has only managed to make me fat and more depressed. I have less hatred today, probably because I was actually half a pound less this morning, but I am still not happy with Dr E. And actually, I was talking to a friend the other day, and it reminded me about my last appointment with Dr E, which I had forgotten about.

Before I went in she said she had a medical student with her and was that ok. I don't have a problem with students - they have to learn, so I said that was fine. I regretted that afterwards. Dr E was asking me the same sort of questions as usual, but every time I said something that she didn't agree with, she gave her med student a look. A kind of 'Did you hear that?' look. Or a smirk. Or a semi eye roll. Things that made me feel about 5, and very patronised. And that to be honest, I thought were pretty unprofessional. I don't usually have a problem with Dr E. As psychiatrists go, she is probably my 2nd favourite of all of those I have seen. But not that appointment. If she has a med student with her again I will not have them sitting in on my appointment, which I kind of feel bad about, because the med student didn't do anything wrong, but I really disliked the way that appointment made me feel, because of the way that Dr E was with them. Unfortunately it doesn't seem like it is just me that feels like that. My friend also sees Dr E, and has also had a med student in one of her appointments and said that the same thing happened with her, or that if her CPN goes to her appointments with her then Dr E will do the same thing with the CPN that she did with the med student. Surely she should be more professional than that? If she doesn't agree with what I am saying, fine, but she doesn't need to show it in a way that will make me feel bad about myself. It can be hard enough for people with mental health problems to talk to Consultant Psychiatrists anyway - we all know who has the power in that relationship, plus it is hard talking honestly to anyone that you only see for 20 minutes once a month, or once every 3 or 6 months. We don't need the consultant to make it even more difficult by their attitude. I was supposed to see Dr E this week, but I had to cancel as I couldn't get there, so am waiting for a new appointment to come through, and am hoping it is more successful than the above.

I saw Dr O today. I get the impression she maybe doesn't really 'get' eating disorders/weight issues. I told her that since I last saw her I had gained half a stone. Firstly she didn't believe me and wanted to weigh me. She looked utterly baffled by my slightly hysterical refusal to be weighed. And told me about a patient she had seen earlier in the week who had weighed 180 kilos. Apparently the scales had protested and they had both ended up laughing a lot about it all. She assured me that I didn't weigh that much, and I wouldn't break her scales. She then said she thought I was gaining weight on purpose (!!) so that they would prescribe the Tryptophan again. I said that I am certainly not gaining weight on purpose, and that I end up crying most days when I weigh myself. Her solution was to stop weighing myself and get rid of the scales.... So anyway, I am now thinking she possibly isn't too hot with EDs. Although reading this makes it sound like she is a really shit Doctor, and she isn't, and I do like her. She just seems to come out with some slightly odd statements.

My sleep is still very bad. I have given up watching the Olympics, but I am still awake all night. I got to sleep about half 6 this morning. Actually, I should probably have tried to get some sleeping tablets. Although they never actually help me sleep, so it probably wouldn't have been worth it. At the moment I don't really have any motivation to try and sort out my sleep anyway. Or anything else for that matter.

So.....

I haven't written anything for a while. Don't really seem to have much to say at the moment. I am feeling quite flat/numb most of the time. I am still really unhappy with my weight and struggling on that front. I ordered some weight loss tablets earlier. Nothing drastic or dangerous - just some herbal ones from a health shop. Figured I would try those before I went for the Ephedra. So I have ordered some Hoodia, just to try and curb my appetite. If they don't work I will order some Ephedra. I feel so enormous. I do know logically that I am not fat - if BMI 20 - 25 is healthy (I say if because so many BMI guides say 18.5 - 25, but Doctors and health people always say 20, and I believe that it is officially 20 for Caucasians) then I am at the low end of that, but it is a big increase from my BMI of 17.5 in September. Even in the last 3 or 4 weeks I have gained about 6lbs, which is a lot. And actually it is those 6lbs that have made the difference between me feeling ok in my clothes, and not wanting to get dressed because everything is so tight, so I am going to focus on losing that first, before I think about long term. But I need to stop gaining first!

I was supposed to be seeing L today, but she was off sick, and she is on leave next week, so that isn't too good. I haven't seen her since tuesday of last week, so that is a week and a half ago already, and it will be another week and a half before I see her, so it will be 3 weeks between appointments, which is really hard when I am used to seeing her every week. I do get annoyed with myself for being so dependant on people. That is the trouble with therapy, and getting so attached. It does make it really difficult when I have to miss a week for any reason, and even 1 week to the next feels like a long time. It isn't only down to attachment - it is partly because it can be such a relief to have the chance to talk about everything and just get it all out, and it is the only time I even come close to doing that. So it is really difficult when that hour and a half disappears an hour before. I don't blame L at all, it isn't her fault she is ill - it is just unfortunate, and it is difficult when you have expected a session and then don't get it, and also unfortunate that she isn't there next week. I am seeing N next week, on tuesday, so at least that is something. She had this week off, so I haven't seen anyone at all next week. I was due to be seeing Dr E next week as well, but I have had to cancel as I can't get there when my mum is at work, so I am waiting to hear when that will be rearranged for. And I am seeing Dr O on friday, but that is just a little chat really.

My sleep is very bad still. At the moment I can use the Olympics as an excuse to an extent (did anybody see the Women's Skeleton tonight? So exciting!), but I am sleeping until 3 or 4 in the afternoon, which even I admit is not terribly good. When I spoke to L the other day she said we really need to work on improving that. For some reason the day scares me a bit. I think it is partly because when things are really bad I don't like being awake in the day, as I know that I have the whole day on my own and it feels really unsafe, and also psychologically the day feels shorter if I wake up later - I know it isn't, but if I wake up in the afternoon then I can tell myself the day is nearly over, whereas if I wake up in the morning the day feels painfully long. Also, if I don't wake up until the afternoon there is less time left for eating... But I do accept I need to improve my sleep, even if it goes back to waking up at 12 or so, that would be a vast improvement. There is just so much I need to work on, it all feels a bit overwhelming.

Golden Gate bridge

So I just saw this article and am a little unsure about the whole thing. If someone is determined enough to jump off the Golden Gate Bridge they must be pretty strongly suicidal, and so if they know that isn't going to work they will probably just do something else. I think I agree with the view that the article says some people hold - that $50million could be better spent on MH services. Or I might just be pissed off because I have always liked the idea of jumping off the Golden Gate bridge.

Improvement?

I am watching the Winter Olympics. I am not sure why really. Quite like watching the people fall over, but I know nothing about any of the Winter sports, although I do a fairly good line in pretending to be knowledgable about the figure skating thanks to avidly watching Dancing on Ice and being a dancer. I like watching Dancing on Ice and saying 'What hideous lines - look at those arms!', or 'Oh dear, what a horrible leg line in that spiral (except I call it an arabesque because I am a dancer, and therefore calling it a spiral makes no sense to me - spiral implies turning, not sticking your leg in the air!) - they really need to work on their turnout' and then feeling clever when one of the judges says the same thing. I am watching the bumpy skiing at the moment. What a random sport?! That's the thing with the Winter Olympics, they just seem to make up loads of sports. The Summer Olympics do it to an extent - Beach Volleyball anyone?! But not like the Winter Olympics.

Right, enough waffling about sports I know nothing about. I am actually doing a bit better than I have been the last few weeks. I still feel like shit, and am still thinking about suicide a lot of the time, but I am not finding the thoughts nearly so overwhelming on the whole. They are still there, but for some reason I can tolerate them at the moment, I don't feel compelled to act on them. Sure, I would still like to - I still don't want to be alive, but I am not hideously desperate at the moment in the same way that I was. What bothers me now is that I should be feeling positive about this - I am doing a bit better. I can tolerate having the TV on, I have been able to read a bit - generally I am finding it easier to distract myself, and my concentration is a bit better. But even though I am feeling better, I still want to die. It isn't even fear of things getting worse - even if I knew things would never get any worse than this, I would still want to die. I suppose to be fair to myself things are still pretty shit - I still have no motivation to do anything, sleep is bad, concentration is bad (although improved), body image is atrocious, anxiety is bad. I would say my mood rating has moved from maybe 0 to 2 on average (on a scale of 1 to 10 - 10 being able to get out the house, get some enjoyment from things, have motivation etc etc, rather than being 'happy'). But it is a massive relief - even if I am still not feeling able to get out of bed much, and certainly not wanting to dress or leave the house, I am not hiding under my covers crying and hyperventilating and desperately trying to fight the urges to kill myself. And that will do for now.

Unfortunately my body image and weight issues are the worst they have been for a while. Or rather I perceive it as being the worst - from a disordered point of view I was worse in the summer when I was bordering on an Anorexic weight and severely restricting my intake. But to me this is worse because I feel enormous - I am 17lbs heavier than I was in August, and that is incredibly difficult to deal with, plus a lot of the weight gain has been very recent - in the last month I have gained about 5lbs, and the thing that scares me is that it is showing no signs of stopping; if anything I am gaining faster. I know that this is my fault - that I am eating too much, the wrong foods etc etc, but I just don't seem able to stop myself. When my mood is very low I either restrict severely, or comfort eat and gain weight, and sometimes get into a pattern of purging. In the summer things were bad, and I restricted and lost weight, and although I am sure that MH professionals would judge my eating as being much worse then than now (I am actually eating a fairly 'normal' diet, if somewhat carb/sugar heavy, and at random times, but calorie wise it is pretty reasonable), for me this is just horrific - stepping on the scales does literally make me want to kill myself, as does catching sight of my body in the mirror, or measuring myself, which I made the mistake of doing the other day. I just don't know what to do about it. I know it isn't a great idea health wise, but I have been looking at buying weight loss tablets online, and am seriously considering it. I desperately need something to curb my appetite so that I can get back in control of my eating, I don't actually care if it affects my physical health. Even though I am doing a bit better depression wise, I still feel completely out of control of things, and I still desperately want to get something back, and eating really does seem the only thing possible.

Mostly weight

Today has been quite difficult. I wrote this last night

'I thought the other day that even though I feel like shit, maybe I should keep going a bit longer. Maybe I should give myself a bit more time to see if things improve. Then I saw my weight this morning, and it completely changed my mind. I need to kill myself before I get any fatter. Nothing is right. I hate that I have tried so so hard this week, it has just been a nonstop battle with my head, and what do I get in return? Weight gain, to make me feel even more shit about myself, and more suicidal. And I know it is my fault for being such a disgusting, greedy cow, which makes it even worse. But I just can’t stop eating.

I will have to get dressed tomorrow to go and see L and I just feel so ashamed of myself. I feel like everyone will be staring at me because they will see how fat I have got. I hate myself for being so disgusting and greedy.

I have had no energy lately. Even worse than usual. I don’t know what is wrong with me. I wake up, and even if I have slept reasonably well and for a decent length of time, I just feel absolutely exhausted. My limbs feel like they weigh a tonne each, moving them takes real effort. And I just want to sleep all the time. But then when I try to sleep I can’t because of my head. It just feels like everything is wrong with me. I don’t know what I was thinking with my let’s give it a bit longer thing. I just didn’t want to hurt people, and I still don’t, but I am really not meant to be alive. I am just like a shell. I am already dead inside'

I couldn't sleep last night, and I had to get up this morning at a reasonable time as I was seeing L at 11, and only ended up with about 4 hours sleep, so that hasn't helped with the exhaustion. Then this morning I had gained another pound. I didn't actually want to go and see L, which is unusual for me, but I just felt so disgusting and ashamed of myself. Plus I just really don't feel like I trust anyone at the moment, I don't know why. I wore a skirt in the deluded hope that people wouldn't be able to see my size as clearly as if I was in trousers, but I don't think it helped. Then the first thing I thought when I saw her was how thin she looked, she looked really tiny today, and that made me feel even worse about myself. I think partly because of this, and partly because of not feeling very trusting at the moment, I just clammed up at the beginning of the appointment. I got quite upset, and I couldn't think properly which upset me more. I did start to open up more as it went on, but now I feel frustrated with myself as I feel like I didn't make the best use of the time I had, and I am not seeing her until friday next week as she is on a course at the beginning of the week. We talked quite a lot about my weight and body image as it is definitely affecting my mood a lot at the moment.

I have to get dressed again tomorrow as I am seeing N. The problem with this is that I see N to get me out the house, and I don't want to leave the house, I feel too ashamed of myself and I don't want to sit somewhere public where people can see me. I very much doubt I will go to ballet tomorrow night either, as I just can't face people seeing my body like this. I am fully aware of the irony of skipping the only exercise that I get because I feel too fat, but pink tights just aren't going to be helpful when I am hating my body this much already.

Weight

My weight has gone up again. I can't fucking deal with this. I know I need to eat less, but I don't seem able to. I am going to restart writing down everything I eat, maybe that will make a difference. I am not going to ballet tonight - there is no bloody way I am getting in a leotard and tights looking like this. I need to lose weight, fast. I want my bloody tryptophan back. I need some fucking control over something.

Update

Finding it hard to concentrate enough to write, so I will do bullet points.

- Purged twice so far this week. This is good that it is better than last week, but bad as I hadn't done it at all for months before last week. And I am wanting to do it more and more often - the only thing that stops me most of the time is my parents being around, and not wanting them to know what I am doing.

- My weight is definitely an issue at the moment. Although I try not to let it, it does impact on my mood for sure, and I have 'rules' around it that I make before I step on the scales in the morning, like if I weigh less than X I am not allowed to kill myself, if I weigh less than X I have to go to ballet, etc etc. I am not getting dressed at the moment unless I absolutely have to, because clothes make me feel too uncomfortable. I can't deal with them feeling tighter than I am used to, so I just stay in my PJs.

- Despite all the issues with weight I said above, I don't seem to be able to stop eating. I know it is comfort eating, and it really isn't helping matters, because obviously I am not losing weight, which is about the only thing that might make me feel more in control of things. I hate the doctors for not giving me the Tryptophan. Rationally I suppose I can understand why they wouldn't, but I feel like it would help me with my depression if I could get my eating a bit under control.

- My mood has been very, very low. I have been having very strong suicidal thoughts the whole time, and it has been incredibly difficult to not act on them. Diazepam has helped me enormously. There is no way that I would have got through the night I last posted without it. It doesn't take the feelings away, but it does take the edge off, and 2 managed to calm me down enough that I could sleep, which was by far the safest thing for me to do.

- L and I are both thinking that perhaps anti depressants do help me after all. Probably only a very tiny bit, as I still have very bad patches when on them, and have still attempted suicide when taking them etc, but right now things are the worst they have ever been, and this is the first time in 6 years that I haven't been on anti depressants. She is going to speak to Dr E about restarting them, which I kind of have mixed feelings about, but if they can stop things from getting this bad I will take them, even if they only help by half a percent.

- Being included in TWIM on this week made me feel good. I wasn't expecting it when I went to read it, as I had basically just written moany crap this week. It always means a lot to be included in TWIM, because it was Mental Nurse that got me into the world of mental health blogging, and I never expected to see myself on there when I started blogging. May only be a small thing, but I can see so little positive at the moment that I really need to grasp hold of the little things.

Help

I feel so horrible and desperate. I can't even explain how I feel, and I certainly don't know why. I just don't know what to do with myself. I can't keep going like this.

My day

I saw L today. I am so grateful to have such a supportive and caring CPN. If there were more people like her working in the NHS then Mental Health services would be so much better. I have never had another care coordinator who I have felt able to trust to such an extent, and who I have believed genuinely cares about what happens to me and is actually committed to helping me. I am obviously very attached to her, but I think she knows that and knows how to deal with it (and me!).

I am struggling a lot. Very strong suicidal thoughts, which to be honest I do feel like I will act on at some point soon. It sounds stupid but my weight and eating issues are contributing to this, although obviously that isn't the only thing by any means. A couple of weeks ago I mentioned that I had lost a couple of pounds, basically from feeling too crap to move. Unfortunately that has now swung into comfort eating, which is the other thing that can happen to my eating when my depression is bad. Consequently not only have I gained the 2 pounds that I lost, but I have gained more on top of that. I have just weighed myself (yes I know it is 3AM and that is a stupid time to be awake, let alone weigh myself) and nearly burst into tears as my weight is just going up and up and I feel so bloody out of control of that too now, on top of all the feelings and thoughts that I can't control. Plus I have some documentary on TV that just showed a clip of You're The One That I Want from Grease, and Olivia Newton John looked so skinny that I found it really triggering, and I am not usually triggered easily like that. It was just weighing myself and seeing my weight so high, followed by seeing that. It just really set me off.

I don't know what to do with myself. I just can't cope with all these feelings, it is too overwhelming. I really am desperate.

Stuff

Things have been hard. Not really sure what to say. Still struggling enormously with the suicidal thoughts. Been frantically planning again. Seeing L tomorrow afternoon.

Eating isn't good. Purged again the other day, which made it 3 times last week, which having not done it for months and months was not good. Getting fatter and fatter. My baggy jeans were really quite tight when I put them on today. Felt hideous. Hate myself for being so weak. Even though I knew my weight before that, having clothes feeling tight like that made me feel even worse, so I don't think I am going to get dressed anymore until I lose a few lbs at least. It made me feel too horrible. Generally I don't have to leave the house too often, so I don't get dressed much anyway, but I will just make sure I stay in even more - can't deal with that. Feel hungry the whole time. It makes me so angry. I wish my body would just understand that I desperately need some control over something, and I really can't control my thoughts, so it has to be food. I hate the doctors for refusing the give me the Tryptophan. I don't give a shit if it is off label - eating like this and my weight being like this is just adding to the depression and suicidal thoughts, so I don't see that prescribing a fucking amino acid to me could be such a bad thing, even if it is bloody off label. Hate everyone and everything.