Discharge, again

So, I've been discharged from CMHT again. I'm not sure if I feel ready, but the way my CPN spoke, I get the feeling that they just don't have the resources to do anything else for me. There was the option of a Distress Tolerance group, but my Support Worker had already covered most of it, so my CPN didn't think I'd get any more benefit from it.

I'm not left completely empty handed however. I will get a care plan in the post (so at least I'll have an idea as to what to do if feeling unwell) and I've been signposted to the Cruse Bereavement Counselling service (for the abortion) and a domestic violence charity (for my abusive relationship, see I'm a Survivor)

I still feel weird, and lonely, and lost, but I don't think I'm quite as unwell as I was when referred to CMHT. I'm writing this on a day where I feel numb though, so who knows!

When having a personality disorder that mainly manifests as extreme mood swings, I find it really hard to tell whether I'm getting more ill or if I'm having a bad hour/day/week. My moods often change so quickly, I can be feeling extremely low at one point, agitated and paranoid the next, and hyper the next. This means that I can appear fine when I'm not. I can appear happy in an appointment, and then can feel very unwell when I get home.

Going back to the subject of signposting, I'm currently building up the courage to ring these places to see what sort of help I can get. I have some events coming up quite soon, and bringing myself back to these traumatic times may be risky, so maybe I should wait until at least some of these events have passed? It may be that there's a waiting list for help though, so do I get the ball rolling now?

How have you felt after discharge? Did you feel it was too soon, or did it turn out to be the right thing for you? Please comment below.

My Favourite Person

This blog post has been inspired by this article on The Mighty.

A Favourite Person (or FP) is someone you absolutely love, to an extreme extent. They really are your favourite person and you place responsibility of your happiness onto them. They can make you feel on top of the world, or in the deepest pit; depending on whether they are paying attention to you or not.

Looking back on past relationships, friendships etc, I can think of one particular person who became my FP. Let's call him M. M and I met while I was studying, and had a close friendship from the off. I was in an abusive relationship at the time, and M was always there for me. I confided in him a lot and the worse my relationship became, the stronger my friendship with M was. We continued talking after university and when single, we'd flirt as well. I always felt so grateful for how much he'd been there for me. We started flirting more, and even started talking about dating. I wasn't sure at first, but then the more we talked, the more attracted to him I became. I started to put him on a pedestal, and relied on him to talk to me constantly, and be there for me constantly. At first, it didn't seem a problem. I felt like I was his favourite person too.

But then he started dating others and I resented that. I really thought he was the best person ever, and that I was the only one he wanted to be with. I fell for him and saw him as The One. If we talked, everything was great, he was the best person ever and I loved him more than anything in the world. If we didn't talk for a day, or didn't talk much, I resented him and at times, I hated him. I felt so hurt and betrayed by him. I got very jealous of women he dated. I resented the closeness they had because I thought it should be me and him. I wasn't a very nice person to be honest.

He did mess with my feelings. I'm not denying that. He made me think we'd have a relationship soon, then next thing I know, he was in a relationship with somebody else. He should've told me. I wouldn't have liked it, but in time I'd accept it. But the way I was with him, the way I placed that responsibility of my happiness on him, wasn't healthy. We'd have big arguments because of it.

I ended our friendship when I found out he'd got engaged, and not bothered to tell me. It would've been nice for him to tell me this big news, especially as we were such close friends, but I think I made a bigger thing out of it than I should've. I saw it as the ultimate betrayal, and ended up blocking him for it.

Nowadays, I worry about getting another Favourite Person. I know I ask for reassurance constantly, and think someone hates me if they don't reply to me or start conversations with me. Whether it be with friendships or romantic/sexual relationships, when I love, I love extremely deeply. I have to be careful of that, and it has affected forming relationships.

Resources

1. What Having a Favourite Person Means to someone with Borderline Personality Disorder: https://themighty.com/2016/10/what-its-like-to-have-a-favorite-person-when-you-live-with-borderline/?utm_source=Mental%20Health&utm_medium=Email&utm_campaign=BPD%20Newsletter%20#4%20December%205,%202017

After CMHT Discharge

On 26th June, I was discharged from the Community Mental Health Team (CMHT). I was told I'd be sent my care plan in the post, so I'd know what to do depending on how well/ill I feel. At the time, I was having a fairly ok day and, although I felt anxious about being discharged, I accepted it and thought that maybe this was a good time for me to try coping just with self help and my support network of friends and family.

It was about 4 weeks before I eventually received my care plan, and in that time I was feeling more unwell, and really needed to be reminded of what to do. I rang the mental health team, to ask for my care plan, and also with the hope of being able to talk about how I'd been feeling. The line was bad unfortunately, and there was a lot of background noise. I had to repeat myself a lot, and couldn't face talking through how I felt in the end.

When my care plan arrived, I had a look through it and saw that there'd been some errors. On the front page was the Summary/Formulation of Need. It said:

Amy has been seen in primary care, however did not complete her therapy. There has been a history of bullying in school and emotional distress after a traumatic life decision. Amy feels that she has a diagnosis of Borderline Personality Disorder after comparing her symptoms to others and would like an OPA with a consultant psychiatrist in order to obtain a formal diagnosis. She is currently not working due to chronic pain caused by ME and hypermobility. She has agreed to have a short piece of work in regards to self compassion and anxiety management prior to her discharge from services.

26/6/17: Discharged from CMHT to continue her recovery independently in the community

As you may know, I have been formally diagnosed with Emotionally Unstable Personality Disorder (also known as Borderline Personality Disorder), but this was not confirmed in the Summary/Formulation of Need. When talking about my chronic pain conditions, it's written that I have ME and hypermobility. I actually have Fibromyalgia and Joint Hypermobility Syndrome.

The next page gives information on how I will be cared for in the community. In this, it mentions my GP is to provide future care and support. It also mentions my mental health medication (Aripriprazole 10mg and Sertraline 200mg) and that I can self refer to primary care if I need more support with anxiety.

The last few pages advise on what I would notice and what I should do when feeling relatively well (this is coded as GREEN), when I'm feeling that things are building up (AMBER) and when I am at crisis point (RED).

For GREEN, I would notice that I'm feeling more loved, less anxious, more motivated and impulsive etc. While I feel like this, I should continue with distraction techniques, self refer to Primary care if I feel able to tackle anxiety issues, and remind myself of positive comments I've received.

For AMBER, I would notice that I'm feeling low, that there's no point to anything, I'm being more argumentative, panicking, and having urges to self harm. While I feel like this, I should contact CMHT or out of hours and try to use coping strategies.

For RED, I would notice that I am having suicidal thoughts, dissociating a lot, becoming paranoid and isolating myself. While I feel like this I should contact CMHT and I may be reallocated to CPN and/or have an emergency OPA or medication review.

Although this care plan sounds pretty comprehensive, I've been finding it hard to concentrate on it and follow the advice. I've been feeling that I am between the Amber and Red stages, so should really contact CMHT but I'm put off by my experience when calling to ask for my care plan. I'm wondering about whether there's any point to asking for help from them. My mental health conditions are ongoing and what I need is ongoing care from mental health services. I remember my CPN saying that, due to funding cuts, they were only able to offer short term help. Should I call anyway? Will I be able to talk to someone or will there be lots of background noise again? I may need to talk about some difficult/private things and I worry others will hear me.

What I really want/need is ongoing contact with a CPN (preferably the one I was with before). It takes me a while to really open up and let go. I can sound positive if I don't know the person I'm talking to. I find it hard to really say how bad things are, so I may seem ok. Unfortunately, it looks as if I wouldn't be able to get a CPN on more than a short term basis.

I've been trying to use my support network as well; most of them being online. Thanks to social media algorithms, however, the status' etc that I post aren't always seen. I had a time very recently when I was feeling particularly low/paranoid/panicky and posted a status basically asking for friends to check in on me and notice when I'm spiralling. The first time I posted it, no one commented. I posted it again, and one person commented. Although I was of course grateful for one person noticing, I felt upset and angry that no one else had. I felt that surely out of 80ish friends, more would notice. I thought I was being ignored, or that I'd been muted/unfollowed by people I thought cared about me. I felt so awful and I guess I was getting to the RED stage of my care plan. I was too engulfed in my own horrible thoughts/feelings though, so could not motivate myself to read it and follow it.

The next day, I decided to take a break to see if anyone would notice I wasn't online. That only lasted a couple of days because I was so desperate to talk to friends, so no one noticed.

A few days after, I posted another status and was surprised to get a fair amount of comments of support. It definitely made me feel a bit better, although I knew that I still wasn't feeling well. Since then, I've had times where I'm numb, times when I'm emotional, and times where I have self harmed and felt suicidal. These feelings have been changing so rapidly though, I haven't been sure of what I should do. What if I feel really ill and decide to ring CMHT, but then I sound ok when I get through to them? What if they decide I should just rely on myself and then I'm left feeling awful again? Having rapidly changing moods is so hard when it comes to accessing help. Just because I may seem ok at one point (and may be feeling ok/numb as well) doesn't mean I'll feel like that for the rest of the day even!

The self compassion work did help me a bit, and I started to feel less paranoid if a friend didn't reply to me. I could consider that maybe they were just busy or not feeling well enough to talk. A support worker helped me with self compassion. Having that support from her did help me feel a bit better, but now it's not there, I've been feeling awful, alone, and paranoid about friends again.

The distraction techniques help as long as I'm not too unwell. I find it hard to catch myself before I get too ill though. My motivation to use the distraction techniques tends to be quite low as well.

I feel useless when it comes to looking after myself!

What Dissociation Feels Like to Me

This is something I vlogged about a couple of days ago (see below). I've been wondering what to blog/vlog about recently, and a friend suggested I write/speak about Dissociation and how I would describe my experience of it.

(source: https://www.youtube.com/watch?v=2zsYBghCOVc)

According to the Merriam-Webster website, dissociation is "the separation of whole segments of the personality (as in multiple personality disorder) or of discrete mental processes (as in the schizophrenias (sic)) from the mainstream of consciousness or of behaviour"¹

You do not have to have schizophrenia or multiple personality disorder to experience dissociation, as it is "one way the mind copes with too much stress, such as during a traumatic event"². Anyone can have short experiences of dissociation, but it is when it becomes long term that a dissociative disorder may be considered. 

The kinds of things you can experience when you dissociate may include:

• " having gaps in your life where you can't remember anything that happened
• feeling as though the world around you is unreal
• feeling as though you are watching yourself in a film or looking at yourself from the outside
• feeling as if you are just observing your emotions
• your identity shifting and changing" ³

There are many other things you can experience, as part of dissociation, so no two people will experience this in exactly the same way. As shown on the Mind website, there are clinical terms for each type of dissociative symptom (for example, derealisation) also. 

For me, dissociation is a symptom of the disorder I have; Borderline Personality Disorder ⁴. The kinds of things I experience include feeling as if I'm not real, or the world around me isn't real. I can also feel as if I'm watching myself speaking or moving, and I do not feel completely in control. I may feel disconnected from my emotions, or I may start panicking (usually because of not feeling in control). Sometimes, I will look in the mirror and not recognise the person looking back at me. 

I dissociate quite often, and it can be very hard to "ground" myself. Grounding ⁵ is "a technique that helps keep someone in the present. They help reorient a person to the here-and-now and in reality". There are various techniques for grounding yourself, and they usually involve focusing on stimulating your five senses. One particular example ⁶ asks you to try the following: 

"Look around you. Identify and name:

5 things you see

4 things you feel

3 things you hear

2 things you smell

1 thing you taste "

Of course different techniques will work for different people.Have you found any techniques particularly helpful, if you experience dissociation? Please comment below. 

Resources

¹ https://www.merriam-webster.com/dictionary/dissociation

² and ³ https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/#.WVtwcYgrKM8

⁴ https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/#.WVty8IgrKM9

⁵ http://www.peirsac.org/peirsacui/er/educational_resources10.pdf

⁶ https://uk.pinterest.com/pin/38632509284472245/

Validation

A lot has happened since my last post about mental health . I've had two Community Psychiatric Nurse appointments; to discuss my main problems and where to start with treatment. I've also had a very thorough assessment with a Trainee Psychiatrist, and a Consultant Psychiatrist.

First CPN Appointment - 

My vlog below explains how my first CPN appointment went but to summarise; I was asked similar questions to those at my initial Community Mental Health Team assessment. I was also asked how I'd been since my assessment, and my main reasons for asking for help from the Secondary Care team. I explained how my last therapy session had gone (see My Mental Health Timeline and my vlog A Referral to CMHT for more details), the kind of help I felt I needed (beyond therapy) and the fact that I thought I might have Borderline Personality Disorder.

Once the CPN had asked all the questions she needed to, she gave me her impression of what support she believed would be best for me. At first she wondered whether Cognitive Behavioural Therapy, at Primary Care level, would be more suitable. After I explained more about my needs, however, she decided that some short term therapy for specific problems may be what I need at the moment. She also said that she would get a Consultant Psychiatrist appointment for me, to review diagnoses and medication.




Second CPN Appointment

My second CPN appointment was carried out at home. She asked how I'd been since the last appointment; to which I answered "a bit all over the place again". We went over my responses to questions about my main issues now, any relevant information from the past and any significant events in my life that may have led to my problems now. She asked me to explain my mood swings, how often I have them, how extreme they are, whether anything triggered them and how I coped with them. We went over the medication I took, and whether it helped me at all. Finally, she asked me some more specific BPD-based questions (relationships, mood swings, impulses, feelings of numbness etc). She concluded by suggesting I do some Self Compassion work with her and a support worker. She felt that this would be a stepping stone for me. I will be meeting the support worker (and CPN) on 11th April for this. I also have another CPN appointmen on 24th April, so will let you know how these went.


Psychiatrist Appointment

 A couple of days after my CPN appointment, I had a psychiatrist appointment. I saw a trainee psychiatrist for this, and was asked a lot of questions to cover a whole variety of mental health problems. As well as questions about depression, and various anxiety disorders, I was also asked about my experiences with paranoia, delusions, hallucinations, mania, impulses, and any instances of aggression. The amount of questions asked were exhausting and overwhelming, but I was glad that I was given an opportunity to talk about the kinds of symptoms I had that didn't just fit anxiety and depression. It helped me to remember the things I needed to talk about too, and I honestly don't think I forgot to mention anything! I have had a hallucination and some delusions before, although these aren't regular occurrences at all. I do get mild hypomania sometimes too, and have had impulsive behaviour (although these don't tend to go further than urges now).

The psychiatrist took lots of notes on what I'd mentioned (even things I weren't sure had happened often/severely enough to be relevant) and also asked about my request for a BPD assessment. After asking questions, more specific to the Borderline Personality Disorder diagnostic criteria, she discussed my responses with the consultant psychiatrist. He came into the room, and asked me more questions (to be absolutely sure, I guess) and then confirmed I had Emotionally Unstable Personality Disorder (aka Borderline Personality Disorder)

The consultant also discussed medication with me. He felt that I should stay on the Sertraline 200mg as it helped a bit, and suited me. In order to help balance my moods, he also prescribed the anti-psychotic Aripriprazole. I'm to take that at 5mg per day for a week, then 10mg per day.

Overall, I'm really pleased with the support I'm getting from the mental health team so far. I was so nervous about opening up about the diagnosis I thought I had, and what help I felt I needed. It was a bad start with the therapist, so I wasn't holding out much hope, but I'm glad I didn't give up! As well as support, as this blog post title says, I've felt validation.