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PhoenixFlower

Possible Bpd But Psychiatrist Reluctant To Diagnose....

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Hi everyone, I am always reading this site but it's rare that I'm brave enough to post on here haha, I will try to be more active. I'm really needing advice and opinions from people who have been there or know what it's like, so here's my story and I'd really appreciate some input if someone has the time, thank you :)

Today I went for a second psychiatric assessment. I was extremely nervous as so far I've not exactly received much help and I'm constantly being told how my symptoms aren't 'severe' enough for certain diagnoses. The psychiatrist I saw today was the same guy I saw last time who I have no faith in and do not trust - last time I saw him I told him my dad had recently died, yet 15 mins later he asked if my dad was around. Then today he asked me some of the same questions as last time until I told him I'd seen him before and he then decided to actually check his notes and he tried to apologize :/

I strongly believe I have Borderline Personality Disorder. Everything I read about it fits exactly how I am and have been for a very long time. I told the doctor that I believed I may it, so after our conversation he went to get a second opinion. When the second doctor spoke to me she said I have all the traits of BPD, yet she told me I don't have it :/ I am so confused as to how from a brief explanation of what I'd said in the last hour she could possibly come to that conclusion? It's not like I had time to explain my whole life in an hour or so and surely something as serious as a mental illness and possible personality disorder should be studied over several meetings, not after a brief conversation with a doctor who didn't listen to me. She also implied she didn't want to give me the diagnosis as I am only 22 and it will affect my future job prospects. I have now been told to try Quetiapine (Seroquel) and to slowly come off the Venlafaxine I am currently on. I strongly believe she is wrong in what she said and I also think it is wrong to not give me the right answers out of fear I'll be judged. I have spent the last two years trying to find answers and a possible diagnosis so you can imagine my frustration at constantly being passed on without any real diagnosis.

I just want to know what your take is on this and what are the next steps you recommend I should take?

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Hey there,

That is quite an interesting story. It's a shame that there are professionals out there who don't belong in the field. I've had my share of therapists who have done the exact same things you mentioned: forgetting details (even important ones), repeating questions (not for clarification, but for lack of memory), and reading off handouts rather than speaking from knowledge. Unfortunately, they exist; it is just a trial and error situation until you find a psychologist/psychiatrist who works for you individually.

Secondly, your concern with a diagnosis and possible BPD. You're correct in thinking that your health is more important than any stigma that may affect your employment and future. I believe that if your symptoms were serious enough, there would be no question of this. Here is my impression based on what you said, as the psychologist may be reluctant for multiple reasons: BPD is a personality disorder, meaning it lies on a continuum, ranging from very mild to an intense severity of symptoms. Everyone will fit into at least one personality disorder, as the criteria are both vague and specific. So this could be the reason you are so adamant about BPD. But more importantly, in my opinion, is the desire to have a clear diagnosis. Thanks to insurance companies and HMO's, many professionals are forced to make a diagnosis, treat, and send the patients on their way. But there is a legitimate reason why many psychiatrists hesitate to do so. A simple diagnosis can affect psychotherapy and the way in which you are viewed. It is a perceptual set - you see what you want to see or what you believe you will see. Once a diagnosis is made, every little symptom that verifies it will be seen, and all other possibilities will be neglected, diminishing the possibility of finding the true problem you may be having. Since you did not list your symptoms, I do not have an opinion regarding a diagnosis. If i were you, I would try to keep an open mind and keep track, on paper, of every symptom that arises. And when I say 'every', i mean it; do your best to be an impartial observer, avoiding your own opinions and keeping track of even the minute symptoms.

As far as the Seroquel goes, I have been taking it for quite a while. If you do get better, it still will not lead to a clear diagnosis. It is prescribed for manic episodes of manic-depression and schizophrenia-like symptoms, but also as an adjunct treatment for major depressive disorder. Since you did not mention any other medication, I am assuming the goal is to target your positive symptoms, rather than the negative. I hope it works out for you.

So taking not of everything, I would continue to search for a psychologist you like, and keep track of all the symptoms you may suffer from. Do not get caught up with the diagnosis, as this is not an exact science. The DSM does a lovely job (sarcastic) setting strict criteria on ilnesses, but they typically venture away from reality. Diagnosing too early in the therapy process could eliminate all possibility of finding the correct one, which would benefit no one. Thanks for sharing your story, and I look forward to hearing more.

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Personally I'm not surprised by your experience in the least (please take into consideration my mood though which is poor whilst writing this post). I have been to pdrs and have always found them worse than useless. I think it may be less to do with the drs themselves and more to do with the structure of the NHS and the cost implications etc (I am all for the NHS in general, i just think the mental health department is really under-funded!). But yes, been in that position where I've actually been told that I seem like a 'good, sensible girl' and it has been implied that they're not been bothered that i'm cutting up my arms up as long as I'm not causing trouble/e,g, make them liable. It hurts that invalidation.

Will you be having another appt with the pdr? If so write down a list of questions that you have re: diagnosis and make them answer every one of them. If they won't or that is your last appt, go to your GP and get him/her to explain the rational of the pdr. As I say, whether this will *help* and you'll get definitive answers is a different matter, but at least you'll go in there fully prepared and know it is them unable to answer not you being flummoxed!

I'm not entirely sure I'd be happy taking seroquel without knowing the reason for the switch...I hope that was explained to you.

Tbh I'm not sure of the implications of having a bpd diagnosis in the UK re: jobs although I'm sure any diagnosed mental health condition can't be a positive in this stigmatized culture we live in! I would ask about general treatment plans if the pdr has already suggested you have all the traits of the personality disorder and I would ask about therapy in general as you are likely to have more luck with a weekly therapist than a one off pdr. Also build a relationship up with your dr as they can be an unbelievable advocate on your behalf within the medical world.

Let us know what happens next.

ps - sorry if i'm too cynical in this post.

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Probably going to a new doctor and telling her or him your past experience with your old doctor may help things get on a little bit better from the start. There are some bad psychiatrists out there, but there are also some really good ones too. I would try to find one that you feel is better suited to your needs.

Best of luck,

Kat

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Hey there,

That is quite an interesting story. It's a shame that there are professionals out there who don't belong in the field. I've had my share of therapists who have done the exact same things you mentioned: forgetting details (even important ones), repeating questions (not for clarification, but for lack of memory), and reading off handouts rather than speaking from knowledge. Unfortunately, they exist; it is just a trial and error situation until you find a psychologist/psychiatrist who works for you individually.

Secondly, your concern with a diagnosis and possible BPD. You're correct in thinking that your health is more important than any stigma that may affect your employment and future. I believe that if your symptoms were serious enough, there would be no question of this. Here is my impression based on what you said, as the psychologist may be reluctant for multiple reasons: BPD is a personality disorder, meaning it lies on a continuum, ranging from very mild to an intense severity of symptoms. Everyone will fit into at least one personality disorder, as the criteria are both vague and specific. So this could be the reason you are so adamant about BPD. But more importantly, in my opinion, is the desire to have a clear diagnosis. Thanks to insurance companies and HMO's, many professionals are forced to make a diagnosis, treat, and send the patients on their way. But there is a legitimate reason why many psychiatrists hesitate to do so. A simple diagnosis can affect psychotherapy and the way in which you are viewed. It is a perceptual set - you see what you want to see or what you believe you will see. Once a diagnosis is made, every little symptom that verifies it will be seen, and all other possibilities will be neglected, diminishing the possibility of finding the true problem you may be having. Since you did not list your symptoms, I do not have an opinion regarding a diagnosis. If i were you, I would try to keep an open mind and keep track, on paper, of every symptom that arises. And when I say 'every', i mean it; do your best to be an impartial observer, avoiding your own opinions and keeping track of even the minute symptoms.

As far as the Seroquel goes, I have been taking it for quite a while. If you do get better, it still will not lead to a clear diagnosis. It is prescribed for manic episodes of manic-depression and schizophrenia-like symptoms, but also as an adjunct treatment for major depressive disorder. Since you did not mention any other medication, I am assuming the goal is to target your positive symptoms, rather than the negative. I hope it works out for you.

So taking not of everything, I would continue to search for a psychologist you like, and keep track of all the symptoms you may suffer from. Do not get caught up with the diagnosis, as this is not an exact science. The DSM does a lovely job (sarcastic) setting strict criteria on ilnesses, but they typically venture away from reality. Diagnosing too early in the therapy process could eliminate all possibility of finding the correct one, which would benefit no one. Thanks for sharing your story, and I look forward to hearing more.

I will take your advice and try to note down every time something happens which I feel shows I have BPD. The way I am most of the time literally matches every piece of diagnositc criteria that I've read about for BPD apart from my anger isn't as high as some - I'm irritable and snap at times, but on the odd occasion I get angry it's usually fairly just and not erratic. I suffer from many relationship problems - usually something I see that isn't there, trust issues, abandonment issues, valuing someone highly then the next day being paranoid about their motives and seeing their flaws or how they've 'wronged' me, black and white thinking, low self-image, rapid mood swings throughout the day (ranging from very low, to hyper, to irritable, to 'normal' etc.), impulsivity concerning buying things and drinking (though the drinking to excess is usually when I'm feeling really down), a history of self-harm, suicidal thoughts when very low or if I feel out of control (usually after a break up or falling out with someone I care about). That's just a brief summary of how I am and why I believe I have BPD.

It feels really odd talking so matter-of-fact about all of this, but they say it's easier to talk to 'strangers' on the internet, which I believe to be true :)

I didn't necessarily want a diagnosis then and there, as otherwise I'd have been doubting them as a professional. I feel they need more time to get a clearer picture on my mental state. It just frustrated me being told I have all the traits but she felt she was able to say I don't have it - this still does not make sense to me... but I feel too strongly about this to just accept the word of one doctor.

Anyways, I am rambling slightly. Thank you for your response, I appreciate it and will take on board what you have said :)

Personally I'm not surprised by your experience in the least (please take into consideration my mood though which is poor whilst writing this post). I have been to pdrs and have always found them worse than useless. I think it may be less to do with the drs themselves and more to do with the structure of the NHS and the cost implications etc (I am all for the NHS in general, i just think the mental health department is really under-funded!). But yes, been in that position where I've actually been told that I seem like a 'good, sensible girl' and it has been implied that they're not been bothered that i'm cutting up my arms up as long as I'm not causing trouble/e,g, make them liable. It hurts that invalidation.

Will you be having another appt with the pdr? If so write down a list of questions that you have re: diagnosis and make them answer every one of them. If they won't or that is your last appt, go to your GP and get him/her to explain the rational of the pdr. As I say, whether this will *help* and you'll get definitive answers is a different matter, but at least you'll go in there fully prepared and know it is them unable to answer not you being flummoxed!

I'm not entirely sure I'd be happy taking seroquel without knowing the reason for the switch...I hope that was explained to you.

Tbh I'm not sure of the implications of having a bpd diagnosis in the UK re: jobs although I'm sure any diagnosed mental health condition can't be a positive in this stigmatized culture we live in! I would ask about general treatment plans if the pdr has already suggested you have all the traits of the personality disorder and I would ask about therapy in general as you are likely to have more luck with a weekly therapist than a one off pdr. Also build a relationship up with your dr as they can be an unbelievable advocate on your behalf within the medical world.

Let us know what happens next.

ps - sorry if i'm too cynical in this post.

From my experience so far I do not have faith in the doctors anymore - I've received little to no help in my opinion and I'm growing tired of the lack of understanding.

I will be seeing the psychiatrist again in 6-8 weeks so they can see how I'm doing, or that's what I was told anyways. I will try to think of what else I want to know, but right now I do not trust him or his answers, nor do I trust the second psychiatrist I briefly saw.

I was told to try Seroquel to help my rapid mood swings and to see if it would help. I will be picking the prescription up today and I'm still feeling very unsure about taking it. I won't be taking it until after the weekend as I don't want to be too tired for certain events this weekend, plus I've just got a new puppy within the last week and I'm the main carer for her - I really don't want to be too tired to look after her at times as she's my responsibility :/

Thank you for your reply. Oh and you didn't come across as cynical at all btw :)

Probably going to a new doctor and telling her or him your past experience with your old doctor may help things get on a little bit better from the start. There are some bad psychiatrists out there, but there are also some really good ones too. I would try to find one that you feel is better suited to your needs.

Best of luck,

Kat

Yeah I'm going to ask the GP today if there's anywhere else I can be referred to. If not, then I might ask my psychiatrist if there's anyone else I can see. I know I'm just having bad luck right now and that there are better psychiatrists out there, but I think we all know what it's like to feel a hopeless over something for a while.

Thanks for your reply Kat.

Edited by PhoenixFlower

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Hi PheonixFlower I think it is actually positive not to be given a label. I believe that the psychiatrists are trying to say 'yeah you have the symptoms - which can be treated and we won't label you as it may affect you in the future.'

Knowing where you are and how you feel is more important that being given a label. You can now start working on the symptoms and learning to live in a happier place.

I hope that my comments have not caused offense.

Girly

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Hi PheonixFlower I think it is actually positive not to be given a label. I believe that the psychiatrists are trying to say 'yeah you have the symptoms - which can be treated and we won't label you as it may affect you in the future.'

Knowing where you are and how you feel is more important that being given a label. You can now start working on the symptoms and learning to live in a happier place.

I hope that my comments have not caused offense.

Girly

I do see your point :) I guess I was just really hoping to get a proper diagnosis for once, but overall it's not really needed as long as I'm receiving help and learning to live with it so I can get on with my life.

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Were you hoping for a name, a label to put to it so you knew what you were dealing with? Maybe you just wanted to find people like you? You are both right, the labels can mess things up and so long as the symptoms are treated you shall (hopefully) get happier.

Edited by falseflag

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