What Influences Me? : Counselling Session 4

(mention of cancer, suicide method, and death)

At the start of this session, I wasn't sure what to talk about. Not much had happened, mental health-wise, in the last week.

I was still thinking about my old school-friend, who died recently. Although I knew we'd drifted apart, I still blamed myself for not making enough effort. I miss her to be honest. She was a good person.

I'd also had a GP appointment recently, where I was told to taper off my pain medication (Tramadol, slow release) as well as stop my anti-sickness medication. I have struggled with my pain, since lessening my dose of Tramadol, and I'm trying to live with it, but it is affecting my functioning. I want to function better but I can't keep pushing myself to my absolute limits.

As well as this, I'd had some pains around my stomach, hips, and back. The pains were like cramps and were getting to the point where I was doubled over and sweating. The GP seemed concerned about this, and suggested I might have an ovarian cyst. This played on my mind, and I got a bit of a shock when I was handed the blood form and found they were testing for cancer (I reckon ovarian cancer, but I'm not sure if they test for antibodies or something like that.) They say it's around 1 in 2 people who get cancer now, and my parents haven't had it so far, so maybe I won't be so lucky? I'm trying not to think this way, but I can't help worrying this may be a possibility. Even if it's not cancer, any kind of problems with my ovaries makes me scared that my fertility would be affected.

I'm nearly 30 and running out of time where my fertility is at its optimum levels. I feel as if I am running out of time to meet someone, get married, and have children. Life seems to pass by so quickly, and with the death of my friend, it seems to be getting shorter and shorter.

The counsellor seemed very sad that I was thinking this way. She asked me why I thought I wouldn't meet someone.

I said that I just don't see myself having that life, and I'm scared that nothing will change unless I change parts of myself. But how? Where do I start?

I became upset as I told her that I never felt as if I was "enough". With romantic relationships specifically, I always felt as if I was second best, last choice, or just completely unimportant, so I felt like that about myself. I wanted to feel loved, attractive, and respected. She asked me why I felt this was so important?

I said that I wanted to make some sort of difference in the world. I wanted to feel as if my life was worth something, that I was worth something. I don't want to leave this world without doing some good. She also asked me if there were people I looked up to, who had made these kinds of differences in the world. I told her that I had some friends who were very vocal about mental health, and did their best to write in order to tell the truth about mental health services these days, as well as raising awareness and breaking down stigma. They wrote for online magazines and newspapers. They had thousands of followers. I'm not too bothered about having lots of followers, but I do want my opinion to be heard, respected, and understood. I want my words to mean something to someone. I want to do something good, however I can. I wish I had the confidence to do this. I feel I'm wasting my life otherwise.

I admitted that I had done some good. I've been over the phone/text/twitter to someone who was taking an overdose. I have talked someone out of killing themself. According to some friends, my blogging has helped them, and I've helped them by being there for them when they needed it most. I just felt like I could do more, make more of a difference. Even here, I feel like I'm not doing enough, and that I myself am not enough.

After this, my counsellor suggested doing an exercise. She did suggest talking about the future, but I refused, as I was feeling so scared and down about it, that I couldn't bring myself to focus on it right now. Instead, we did more identity work.

She gave me a sheet of paper, and asked me to put myself in the middle. I drew a stick man, and wrote "me" above it. My art skills aren't great...

She then asked me to write the traits I thought I had, around the figure of myself. I struggled a bit, but managed to put things such as "stubborn, determined, wanting to control things, perfectionist, kind, friendly, a good friend, ambitious, impressionable".

We spoke about the traits I had, and I told her that control was a big part of my personality. I'm diagnosed with OCD, although I believe my symptoms are quite mild now, but I am still a real perfectionist who hates to be out of control. We also talked about my stubbornness. My counsellor asked why I thought I was stubborn. I struggled to explain, and couldn't give any specific examples, but I did tell her that when I set my mind to something, I would usually do it. I would listen to advice from others, but it was ultimately me who would make the decision.

Possibly contradictory to the stubbornness, I also felt that I was quite impressionable. If I looked up to someone, I would try to take on parts of their personality. I would also follow their advice. In the past, I would do whatever someone wanted me to do, without question. Maybe I was worried about the consequences, if I did question them? I have a feeling this is how the bullying started anyway.

Lastly, the counsellor asked me to write down people who gave or influenced these personality traits in me. I won't say specific names, but these included friends, parents, and grandparents. I could link certain things to certain people. I also found myself digressing when I talked about some of them. One was a friend of mine who hasn't spoken to me in a long time. He was someone I had a lot of history with, and still thought about recently. I believed I got my determination and ambition from him, at least in some way. I resented how he hadn't been there for me for ages, when I really needed him. I wish we hadn't complicated our friendship, but at the same time, I still have thoughts about being with him again. I wish I could switch off those feelings, but I had a dream about him recently that brought it all back. I hate how influential my dreams are.

My counsellor and I discussed how it is interesting that people can pass certain traits onto people, without intending to. It certainly made me wonder just how impressionable I am.

There was only a few minutes left of the session by that time. My counsellor summed it all up, and said that she felt I was very lonely, unsure of myself, not really feeling like myself anymore. I want to go back to how things were with some friends, and my own traits (confidence, feeling attractive etc). I doubt myself and dread the future. She asked me what I'd like to do between sessions, in order to make some sort of change in myself. I asked what I could do, but she wanted me to come up with my own suggestions, as this wasn't rigidly structured (like CBT). Eventually, she said journalling would be useful for me. I could put what's important to me, the traits I have/inherit, how I'm feeling etc.

This session brought up a lot of difficult things that I have to face. I cried as I explained how lonely I'd been feeling. It's played on my mind ever since, so found it hard to put everything down on paper.

I will probably post about how the journalling is going, so might have posts every few days. It depends on how I feel. If I don't, then the next post will be about my next ENT appointment, where I undergo Vestibular tests for dizziness and balance problems. After that, I will post about my next counselling session.

CBT for Anxiety Session 3 - Facing my Fears

I had my latest CBT session on Monday, last week. On that day, as well as the stress and worry about my Nan, I'd had a shock after finding out a close friend of mine was transphobic. This seemed very out of character for him, but the post he had supported was so obviously abusive that I had no option but to block him.

Losing friends in any way is very distressing for me. I may dissociate or panic, my mood will plummet and the whole thing will play on my mind for at least a few days afterwards. Needless to say, I was on the verge of a panic attack whilst on my way to therapy. I was looking forward to therapy, however, as I really needed to vent how I was feeling.

Therapy itself went very well. Surprisingly, I didn't cry (although I was pretty close!). We talked about losing friends, as well as my Nan and her declining health. I found my therapist quite validating. She understood why I felt the way I did, and was reassuring as well

After all that, we moved onto the main reason I wanted CBT; to get out of the house more. We talked through the topic of Panic, and discussed the booklet she had asked me to print off. I'd filled in the activities I was asked to complete. I'd mentioned my symptoms of OCD as well. She wanted to know more, and whether it was still a problem for me.

I'm sure I've written about my OCD before, but cannot find the post right now. I may edit and add the link if/when I find it, but for now I will describe the obsessions and compulsions I have.

The first time I started having symptoms of OCD, I was about 13. I was being verbally/psychologically bullied badly and was looking for something/someone to help. I didn't talk to friends about it, as one had spoken to the bullies (in a well meaning but misguided way) and this had made it worse. Teachers didn't help either; arranging a meeting where I'd have to speak out in front of the bullies which of course meant I didn't have the courage to say much.

At the time, I and a few friends had started to dabble in Paganism. It was on a very superficial level, so I couldn't explain what it is to you in detail. We learnt blessings and prayers though, and I thought that saying these blessings/prayers may help to protect me from the bullies. It eventually got to a point where I "had" to start them at exactly midnight, and had to repeat them three times every night. If I had a bad day the next day, rather than blaming the bullies, I blamed myself for not saying the prayers/blessings in the "correct" way. I also carried things (which I saw as lucky charms) in certain pockets of my blazers. I would panic if I could not find these things straight away and I would hold them throughout the day for reassurance.

Once I left school and the bullying stopped, these compulsions stopped. Later on, I started to get an overactive bladder and this really heightened my anxiety and need for control. I would "go" at least 4 times and each time, I had to wipe 10 times. I would count to 10 each time. This would lessen my anxiety slightly but for the rest of the day, needing the toilet would be at the forefront of my mind.

My compulsions are much less, since I've been on Sertraline and since I've taken Vesicare for my overactive bladder. I don't spend as much time in the toilet, so I don't see these symptoms as a real problem now. Other than this, I do some things in three's but I don't think they are done strictly enough to be called compulsions.

I explained all of this to the therapist and she was reassured that I don't really fit the criteria for OCD any more. I can't tell you how relieved I am that these obsessions and compulsions don't have so much control over me anymore!

Anyway, onto my other anxiety problems, e.g. getting out of the house. At the moment, my limit is to occasionally walk from my house to the local shop, and do a small shop by myself. I have gone from being on the verge of/having a panic attack to just feeling moderately anxious. I'd say this is progress! I do want to be able to travel further by myself though. My therapist gave me a worksheet with a table to fill with distressing situations. For my homework, I had to list the distressing situations I wanted to work on. I'd have to rank them from most to least distressing, as well as rating them from 0-10 (0 being "no distress" and 10 being "extremely distressing"). I have listed as many situations as I can for now, and I will write them below:

1. Do some volunteer work (10/10)
2. Go to a Slimming World group with mum (9/10)
3. Take a train somewhere, alone (9/10)
4. Take a bus into town, alone (9/10)
5. Take a taxi into town, alone (8/10)
6. Take a bus, with mum (8/10)
7. Take a taxi to therapy, alone (7/10)
8. Take a taxi with mum (4/10)
9. Walk to the shop, alone (3/10)

There are various reasons why each of these is very distressing or not so distressing. It depends on factors such as, how familiar the destination is, how busy the destination is, how busy the mode of transport is, how long the journey is likely to be, how easy it is to get out of the situation etc. For example, walking to the shop alone doesn't cause too much anxiety now as I know the journey and the destination well, I tend to know how busy the shop is at certain times, I know how busy the journey there is likely to be, and I know I can escape the situation whenever I like, without anyone noticing. On the other hand, going to a Slimming World group means going to a destination I don't know well, with a big group of people I don't know, I may be required to speak up, I'm expected to last the duration of the session, and getting out of the situation early wouldn't go unnoticed. 

I am so fed up of being controlled by my mental health however. I want to be able to face my fears and get to a point where I realise nothing terrible is likely to happen. With the help and encouragement from my therapist, I hope to at least tackle some of these distressing tasks.

Wish me luck!

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.

"Not really disabled"

The other day, George Freeman (Theresa May's Policy Chief) gave some very insulting and trivialising comments about anxiety disorders. You'll find the details in this article . It seems he believes that those with anxiety disorders are "not really disabled". Apparently all we do is sit at home; taking pills.

After a lot of (very much deserved!) criticism, he responded with a feeble non-apology; where he expressed "regret" that people were offended. Now I do understand that he has had an anxiety disorder in the past & I would never invalidate his experience of that. I do think, however, he needs to educate himself on various anxiety disorders. He may then learn that the symptoms can vary in severity, are complex, and can be very debilitating.

Disability is officially defined in the Equality Act 2010 as this:

"A person (P) has a disability if-

(a) P has a physical or mental impairment, and
(b) the impairment has a substantial and long-term adverse effect on P's ability to carry out normal day-to-day activities."

I cannot speak for everyone with an anxiety disorder/s, but here are the ones that I have and how they affect me.

Agoraphobia

I get very anxious about leaving the house; especially if there are people outside. To travel anywhere, I rely on my dad driving me. I get far too anxious to take public transport, and can't even take a taxi on my own. I can't manage group situations where I have to stay in the room/it'd be considered rude to leave suddenly (such as a class or meeting) and have to be near the toilet or exit if I'm in a restaurant/cafe etc.

Last time I managed to take a train by myself (years ago), I had panic attacks and had to wait for a later train than the one I'd planned to take. I felt very nauseous, dizzy, shaky and sweaty for the entire journey. Once I arrived at my destination, I was physically and emotionally exhausted. I found it very hard to focus, and when I had to change trains, I ended up lost for an hour and almost in tears at the train station. It's a good job the friend I was meeting was a patient one! In order to get home, I had to get my dad to pick me up (the journey takes over an hour by car).

Obsessive Compulsive Disorder

I've had OCD since childhood, and have tried hard to hide my compulsions. On a bad day, it stops me from leaving the house. It makes me irritable, snappy, and has caused arguments in the past. I take much longer to do things than I should, and am often late for appointments because I've had to complete compulsions, or repeat them until I am "reassured" enough to leave the house. This condition makes me feel trapped and, when I did work, it caused me to miss meetings and compromised my performance at work.


Generalised Anxiety Disorder

I don't react well to changes in plans. I need to know what to expect, Usually, my anxiety flares up in response to things, but I do find that I can randomly panic and not know what has set it off. I get panicky about hypothetical situations, and cannot just wait to deal with a certain situation when it occurs. I tend to think 10 steps ahead of myself, and think of the worst case scenario. I will dwell on potential problems; even more so if I cannot think of a solution.

I find I get very paranoid as well, and I worry a lot about people's opinions of me. I worry about losing friends and look for cues that they may be annoyed at me or drifting away. I also am constantly asking for reassurance.

Phone Phobia

Recently, my phobia of this has lessened and I can now cope with making some phone calls. I still find that I get very nervous when receiving phone calls though, and most of the time I will leave it to go to voicemail. I worry about not knowing the answers to questions I may be asked on the phone. I also worry about not having details like reference numbers ready when needed. I often mishear things and get very anxious (panicky even) if I have to keep asking the other person to repeat themselves. When I worked, I had customers react angrily over the phone because of this. I would avoid answering the phone in the workplace, and have been told off by my manager. I think this contributed to decisions not to carry on my temporary contract too.

I cannot think of a job where you are not expected to use a phone, leave the house, go to meetings, cope with changes, be punctual, have good attendance or be timely with tasks. Even without my other mental health and physical health problems, I highly doubt I could manage work of any kind.

So yes, George Freeman, I may sit at home and take pills but there's so much more to anxiety than that, and yes I am "really disabled".

    

Spinning Plates

I was trying to think of a half-decent title for this blog post, and "Spinning Plates" was all that really came to mind. I needed a title that described how I felt when it came to dealing with physical health problems, as well as mental health problems. I've mentioned my diagnoses before, but I'll state them here and hopefully I can explain how managing these conditions feels a lot like "spinning plates".

Fibromyalgia: I've had this since 2010 and sometimes I feel I've accepted it, sometimes I get extremely frustrated, upset, and angry at how much it limits what I can do/how often I can do it. I'm so used to pushing myself that I find it very hard to stop and pace before I cause my symptoms to flare up. Sometimes I deliberately go too far, because I find physical pain a little easier to cope with than mental pain. When I do pace, the internalised ableism kicks in, and I feel as if I'm being lazy, not making the most of the day etc. I know that pacing myself is a good thing to do, and resting is still productive as it means I am looking after myself. I just wish I could feel less guilty about it!

Hypermobility Syndrome: I'm not entirely sure when it became Joint Hypermobility Syndrome, but I know I've been hypermobile all my life. As I learn more about it, I realise how mindful I have to be when it comes to using my joints. I have multiple subluxations every day, and sometimes I have dislocations too. Having doctors finally believe me (after a physio actually seeing and hearing a joint dislocate!) has helped a little, but doesn't take away the frustration with working around limitations and not getting much support for it.

Depression: Looking after yourself is so so important anyway, let alone when you are dealing with multiple illnesses & disabilities! I really do try, but Depression zaps my energy (what's left of it, thanks to Fibro and JHS anyway!). I struggle with motivation as well. Emotionally, the most basic sounding tasks can feel like trying to climb a mountain. On my bad depression days, I barely do a thing, and then I hate myself for being "lazy". If it isn't too bad on particular days, but my physical health problems are, I then get frustrated with myself for physically not being able to do things that might help my mood a little (e.g. making a nice snack, doing some cross stitch, meeting a friend).

Generalized Anxiety Disorder: When anxiety gets severe, it can limit you so much. I could be having a day with slightly less physical pain, or even less fatigue. On this day, I may want to make the most of this by maybe having a walk, or at least getting out of the house (even if just into the garden). Anxiety can have a real hold on me however, and often it becomes a panic attack (which then makes the physical pain, fatigue etc worse!). As much as I want to be able to do stuff, I just can't. It's as if invisible arms are squeezing me tightly, the room has become unbearably hot, my head is pounding, the room is spinning, and I can't focus on anything else. I know these things are down to anxiety and panic, and that they will lessen in time, but it does not stop me from feeling them so intensely.

Agoraphobia: The symptoms I get with Agoraphobia are very much the same as with GAD, but they are of course more about situations (such as being out of the house, being in a busy place, not being able to get out of somewhere quickly or easily). If it is quiet, having a short walk can help lessen my depressive symptoms temporarily. I want to be able to do this as much as my health allows, but the agoraphobia holds me back. Even if I manage to force myself outside, if it is bad enough, I will not feel better. I will spend the whole time on the edge of a panic attack and that will be my energy gone for the day.

Obsessive Compulsive Disorder: This can affect my ability to get out of the house and cope with daily things. The meds I'm on do help calm down my OCD related anxiety a little, but on a bad day I could struggle just as much as I did before I was on the meds. Again, this holds me back and stops me from being able to make the most of low pain/fatigue days.

I hope this makes sense. There's a lot of similarities with each condition, and of course I know that mental health and physical health often overlap. For me, it feels as if they clash too! I'm trying to manage my struggles with things like anxiety with going outside and guilt from not going outside, when it occurs on a day my physical symptoms aren't too bad. On the less anxious days, I want to do more to help myself, but physical symptoms limit how much I can help myself on bad physical health days!

I guess it's about moderation and, yes, Pacing. If anyone has any tips on getting that balance right, or even if you don't and you need to vent to someone who understands, leave a comment below!

Thank you for reading.

Let's try this again: Part two

(TW: Mentions of suicide, self-harm, and abortion)

On Wednesday, I had my phone assessment with the Primary Care Mental Health team. I was really nervous on the day, and was watching the clock. The more I waited, the more nervous I got, and the more shaky I was when the call finally came. In order to prepare for my assessment, I'd gathered together all my paperwork from previous assessments and appointments. I wanted to be as prepared as possible so that I wouldn't miss anything out during the assessment. I completely overwhelmed myself, however.

Although I was extremely anxious when answering the phone, I was very glad to have the opportunity to be assessed again and talk through the things I'd been struggling with. The therapist began the assessment by asking me what sort of problems had brought me to contact mental health services this time. I found it hard to know where to start. I had so much going on in my head that I don't think I made much sense at first. I tried to prioritise the main things that I needed help with; which included how easily overwhelmed I was getting, things from the past that needed addressing, how my anxiety seemed to be worse, and the recent breakdown I had. I told him that I'd been through CBT a few times in the past and found that it didn't help much. I said that it didn't seem to fit my problems, as I wasn't able to talk about certain things in the past that affected how I am now. The therapist said that there were different types of CBT, and some did consider the past when attempting to help with the problems that the person has right now. He told me not to completely shut myself off from the idea of CBT. I reluctantly said that I would keep an open mind, but that other therapies that have been suggested to me by my last therapist and my psychiatrist were EMDR and Psychodynamic therapy. This therapist said to me that there were other therapies we could consider if I found that CBT still wasn't working for me. One therapy he mentioned was a person-centred one. He gave a brief description of what that therapy entailed, and said that this would include going through things in the past and discussing how they affected how I see the world now. I said that this sounded like the type of therapy that may suit me a little more.

He wanted to know how long I'd had symptoms of Anxiety, Depression, and OCD. He also wanted to know the obsessions and compulsions I had now and in the past. Although I was diagnosed as an adult, I'd realised that I'd had symptoms pretty much since the start of primary school. He asked (sensitively of course) what I thought had led to this. Although I struggled a lot, and was in tears for most of it, I just about managed to tell him about the bullying, and the termination I had during my first year of university. He was very patient, understanding, and non-judgmental. He gave me time to talk about what I needed to, and was kind when my mind would go blank & it took me a while to remember what I wanted to say. After this, he gave me a brief analysis of what he thought were my main things that I needed help with.

Next came the necessary, but frustrating part of the assessment; the questionnaires. He admitted that he hated them too. I guess they have to quantify some things, to see how severely a client is affected by their mental health problems. It's just such a restrictive set of questionnaires/ I may meet the criteria for Anxiety and Depression, but if there are any other mental health problems, that could be identified by asking other questions, I don't have that access to those questions.

I may have described these questionnaires before, but the first one I had was the PHQ-9 . This is to test for Depression, and the severity of it. For each question, there is a score between 0 and 3. 0 means "not at all" and 3 means "nearly every day". When responding, you focus on how often you've been experiencing (the things stated in the question) in the last two weeks.

For this questionnaire, you have a score out of 27. My score was 24; which places me in the severe category. The therapist also had to assess my risk of attempting suicide. I told him that although I frequently had thoughts, and sometimes strong urges, I'm unlikely to actively plan or carry them out because of my cat and my parents. I forgot to mention about my regular self-harming, but I guess this is something I can talk about during therapy sessions.

The second questionnaire was the GAD-7 . This tests for Generalised Anxiety Disorder and the severity of it. Similarly to the PHQ-9, there is a score between 0 and 3 for each question. Again, 0 means "not at all" and 3 means "nearly every day", and you are asked to consider how you've felt in the last two weeks.

For this questionnaire, you have a score out of 21. My score was 18; which places me in the severe category.

The third questionnaire focused on phobias. For each types of phobias described, you give a score between 0 and 8 to state to what extent you would avoid various situations because of it. A lot of my fears involve loss of control; for example, losing control of my bladder in a public place, having a panic attack etc. 0 means you wouldn't avoid the situation, 8 means you would always avoid that situation based on the phobias mentioned.

Once these had been completed, the therapist discussed with me what the next steps would be. He said that he believed I should give CBT another go, at least to tackle my symptoms of OCD. He did say that I could have person-centred therapy instead, if I still find the CBT unhelpful. I reluctantly agreed to this. At least I can have access to other therapies, instead of it being CBT or nothing. He said the wait is likely to be around 10 weeks, as the waiting list is long. I knew to expect this anyway. Before we ended the call, he made sure that I knew who to contact if I do become actively suicidal. These were the Out of Hours team, and Samaritans.

 I do feel a little more hopeful about this mental health team, but we'll have to see how therapy goes. 

Let's try this again.

After months and months of avoiding mental health services, and one GP appointment that I got too ill to follow up, I'm finally asking for help again.

It's been a mixture of reasons really. Fibromyalgia flare ups, helping my parents through various things, feeling I don't deserve help, and being too anxious to use the phone (you have to ring up and self refer to the Primary Care team).

It took a breakdown in front of my mum to push me to ask for help. It was mum who got in touch with the GP and then the mental health team to get me to stop avoiding this. I've been getting close to crisis point recently so of course it's important I get some sort of support. I've bottled up so much (and 'coping' by self harming) because I didn't want to worry my parents and I didn't want to bring any attention to myself. I knew it wasn't a healthy thing to do, but I felt that I had to do it.

After a very nervous wait, I had a callback from the Primary Care mental health team earlier today. I was shaking the whole time, but managed to give them the details they needed (contact details, diagnoses, previous therapies, demographic questions etc). They asked if I was suicidal/had plans too, and gave me some helpline numbers. I don't know if I'll manage to ring if I'm in crisis (it's scary enough even on good days!) but at least I know who to contact.

So, the next step is a phone assessment this Wednesday. It's been a while since I've had a mental health assessment, so I'm glad it'll happen even if I'm really nervous about it being over the phone. The person on the phone today was really friendly and patient with me though, and I hope the person I speak with next is the same.

My next post should be much sooner than usual, and a lot longer than this one! I'll be talking about the assessment and what the next step will be.

I hate my skin.

TW: This post includes details of self harm. Please take care reading it. 

I pick my skin. A lot. Several times a day. I've done it at least since my teens, but it has got a lot worse in the past year or so. I absolutely hate my skin at the moment and even though it's mainly because of my picking, It also give me the severe urge to carry on picking. I've been trying to think of why I do it, what my triggers are etc. I tend to do it much more when I'm stressed, anxious, or very depressed. This can be to distract myself from the thing/s I'm stressed about, or can be as a form of punishment if I've been too anxious or depressed to do something. I also find that if I see a flaw (a spot, bit of dry skin etc) I just *have* to sort it out. I will do this for hours on end; as if I'm in some sort of trance. It's like an itch that gets worse, the more I leave it. I cannot concentrate on anything else, and all I can think of is "fixing" that flaw. Of course, it rarely helps my skin. Quite the opposite in fact. The more I pick, the worse it gets, and I have marks that I don't think are ever going to go away.

It's got to a point where I don't just use my fingers, I use pins as well. I've come to realise that this has become a form of self harm. Although it hasn't required medical treatment, I've caused myself to bleed a fair amount, and have needed to use plasters. Small parts of my body have reduced/no feeling now as well. 

I've admitted (some of) this to my parents, and think it has worried them. I try to conceal the wounds and make excuses for why I've been out of the room for so long. It is something I guess I feel ashamed of, but the more I hate myself for it, the more I do it!

I've been trying very very hard to reduce how often I do this and have so far managed up to a day with no picking. I just about managed yesterday, and I'm trying to make it two days without picking. It is so difficult, because I'm having to try to ignore those intrusive thoughts and urges. I'm trying to find ways to distract myself, by keeping myself as busy as I can. This of course isn't helping my physical health, but sometimes I have to compromise in order to help my mental health a bit. 

A while back, I bought one of those fidget toys. It was some little wooden blocks strung together with elasticated string. You could make different shapes by twisting and moving the blocks. Unfortunately, I found it didn't really help. It kept my hands busy for a bit, but it just wasn't the same. I wasn't "fixing" anything, just adjusting it. 

I've tried adult colouring books too. It helps a little, and can be a good distraction sometimes, but it doesn't require much focus so doesn't really help keep my mind off intrusive thoughts and urges. 

In order to calm my skin down a little, I've used ice cubes on the worst marks. Although it took some of the redness away, I ended up using this as a way to harm myself; by holding the icecubes on my skin until the pain was too hard to bear. 

At the moment, I'm using cross stitch to distract myself and keep my hands busy. I struggle with concentration, but on my not-so-bad days, I can focus on this and push those picking urges back a little. I game a lot as well; casual gaming when I can't concentrate for too long. 

I'm feeling so restless right now, but I'm trying to hold it together and not give in. Can I make it to two days without picking? Wish me luck, I need it!

So, what now?

Since I moved house (end of last year!) I've been avoiding sorting out referrals; mainly mental health ones. There are various reasons for this, such as the exhaustion from the move,  and other things taking priority, but I've been avoiding delving into all my mental health problems.

I've made some progress on my own, but I keep going back to square one, and I need some proper support. As you may know I did have a psychiatrist, and was due to see her soon. Her secretary said she would call back to arrange a home visit so I could then be transferred to the mental health team in the area I live now. It all sounded very simple and at the time I felt relieved. After weeks of no reply from secretary or psychiatrist, I chased them up and they'd now decided that I would have to just go to my GP and get referred to the mental health team where I live now. There would be no appointment for a meds review or to transfer me.

I felt as if I'd been forgotten about. To be honest, I've felt like that a lot of times with mental health services. I'm sort of left to my own devices, with no continuous support (even though I have frequent suicidal thoughts and self harm regularly). I could've been a real risk to myself, and no one would've known.

Anyway, I have approached my GP about referral to my local mental health services. I told her that the whole thing had been really confusing and I didn't know if I'd be getting the therapy that had been suggested. Unfortunately the GP didn't know much about different therapies, so she upped my Sertraline dose; based on the fact that my Depression score was still high (21 I think?). It turns out that I can self refer to the primary mental healthcare team; who will then refer me to the appropriate service. I have a feeling they'll just try and get me to go through CBT all over again. If they do, I'm very tempted to tell them to forget it. That may be the depression talking, but I'm so fed up of getting so far, being built up with promises of various services, and then it all being taken away.

I may have mentioned this before, but I've been really confused about what my actual "official" diagnoses are. My GP showed me a letter from my medical notes (possibly the psychiatrist one?) and I noticed it said Moderate Depression, Anxiety, & Agoraphobia. The contents of the letter mentioned "symptoms of OCD" too. I didn't get chance to see more of the letter than that, but it kind of annoyed me that I'd been told one thing (i.e. the psych agreeing that I do have OCD) and another thing had been written down. It makes me wonder if other things I've been told, haven't made their way into my notes either? For example, the two therapies that were suggested to me (EMDR, & Psychodynamic therapy). I really want to get a copy of my medical records, but keep forgetting to ask. I just want things cleared up! I feel as if I'm being kept out of the loop so to speak. It reminds me of the time I'd been under the impression I had an M.E. diagnosis, but my notes said "Anxiety Disorder".

Back to the point; self referral. I have to ring up to self refer, so it's going to take more time for me to build up the courage for that. It's taken long enough for me to be completely honest and open with mental health staff, so it feels as if I'm back to square one!

Have you found yourself very lost with mental health services, and whether things suggested to you (diagnoses, therapies etc) were actually written down in your medical notes? I'd be very interested to hear how similar my experience is to others'.

Yay!

This is a very short post, to point you towards a blog post I recently wrote for a website. "The Secret Illness" shares people's experiences of Obsessive Compulsive Disorder. These submissions really show the various forms OCD can take, and how complicated it can be. This is the first time I've been asked to write something for a website, so I'm very excited about it!

Here you go: http://thesecretillness.com/2015/11/02/amy-25-west-midlands-uk/