Interpersonal Therapy (Take Two) - Session 4

As with other sessions, I had to fill in my PHQ9 etc and my Symptom Review. I scored quite highly on the Depression and Anxiety questionnaires particularly, but this was mainly for reasons related to my physical health. For about 5 months now, I have been having some awful stomach and bowel problems. I am already diagnosed with Irritable Bowel Syndrome (IBS), but what I have been experiencing is out of the ordinary for me. Waiting for test results had me worrying about all sorts of possible diagnoses, including Bowel Cancer. (I will talk about this in full in the next blog post). 

My 5 most powerful symptoms this week are as below:

• Anxiety: This was mainly about some blood test results that had just come through to my Gastroenterologist. The secretary would not tell me the results, and said I would get a letter and a phone appointment to discuss them. This set off my Anxiety, as I worried there might be very bad news. I spent the week waiting for the results and hearing nothing back, which only made me worry more.

• Wake early in the morning: I have had disturbed sleep through worrying about various things. I'm scared of missing calls or post, in case it is some news about my physical health problems. I have been extremely fatigued, but I have been forcing myself to get up if I haven't naturally woken early anyway. 

• Can't concentrate: I was hoping to do more "antidepressant activities" such as playing musical instruments and singing. I have not been able to focus on doing that, or watching full television programmes. This is because worrying and fixating on my test results has given me a sort of mental "tunnel vision" where I can't see anything aside from the problem at hand, in front of me. 

• Sadness: I feel extremely negative about my results. I am sure that I will be given bad, worrying news and will suddenly have something huge to deal with. The constant anxiety is draining any positivity from me too. I have been trying not to be too negative, as I know that has an impact on others, but I can't seem to help myself out of this hole. 

• Can't get going: I feel far too tired and distracted to do much, and getting started with things such as blogging, housework etc, has become a really difficult task. I have been worried that friends wouldn't understand why I'm so fixated on my current health problems. My To Do list has been getting bigger and bigger. I have been really stressed out, which has exacerbated physical symptoms and made it physically harder to get things started. I particularly notice my Vestibular Migraines have returned with a vengeance, and my Fibromyalgia/Hypermobility pain is worse.

Alongside talking through my Symptom Review, this session was mainly about my support network; i.e. friends, family members etc that I felt close to for various reasons. My homework, leading up to this session, was to draw a social map of people in my life, using increasing circles (with me in the middle) to plot how close I felt each person was to me. I also had to think about why I felt they were so close, how they help me, the roles they play in my life etc. 

I won't say who featured in these circles, as I don't think it is fair to list my favourites in case friends see this. I'm sure the ones who are close to me know they're close anyway. I will use numbers instead of names.

Persons 1-6 are very close to me for different reasons:

Person 1: They have been a support to me all my life; but especially since I turned 18. They provide emotional support, as well as some practical support. I feel I can tell them almost anything and I feel they can tell me almost anything too. There is a lot of trust in this relationship. We both have mental health problems, so have an understanding when one or both of us is depressed. We advise each other and aren't afraid to help out when needed. 

Person 2: This person has also been a support all my life. They do not understand mental health quite as well as Person 1, but they will listen to what I feel comfortable telling them. They are also brilliant with practical help, such as lifts to appointments and sitting with me for assessments/appointments when allowed to. I feel like they are on my side and I try to help them out too.

Person 3: I've known this person since the start of university and I'm not sure if they know this but I see them as my rock. They have been there for me through some of my darkest moments, including the traumatic abortion and the abusive relationship I had. I have had times where I have been afraid of losing them to other people, but they have never given me reason to doubt our friendship. They wouldn't agree, but I feel I owe them everything. This person gives me practical, as well as emotional support, and I can tell them anything that is on my mind without fear of them taking it personally.

Person 4: I became friends with this person from out of the blue. I met them in a club when I was 18. I thought they were part of my friendship group, as they happened to be sitting near us, but years later found they didn't know each other! We hit it off straight away. We have had our differences, and don't talk every day, but I know we have each other's back. This person has seen my disaster of a love life and is not afraid to be honest about it! I respect them for that and I give as good as I get.

Person 5: I met this person online many years ago, and we have met in person a few times. We support each other a lot, especially emotionally. We talk nearly every day and know a lot about each other's mental health, for example. We are very honest with each other and seem to know when the other one needs extra help. They have seen me through some very dark moments too, and I really appreciate their support, honesty, and ability to keep my feet on solid ground.

Person 6: I also met this person at university, while I was with my abusive ex. We have got on well for many years, despite some falling out times. They showed so much support during my abusive relationship especially, and they noticed things that many others didn't. I could confide in them and they would turn up at any time for a good chat, watching a funny TV show, and the best of hugs. We may not be able to meet up much now, but I still feel we are close and have each other's back. 

I talked through most of this with my therapist, and told her I felt I was lucky to have such a large and solid support network. Not everyone has this, and I can't understand why I'm still so paranoid about friends when I feel so supported by the above people especially. Alongside these, I have other close friends, but I worry more that I might lose them. It may not be that I get as much reassurance, although that is neither of our faults. It just shows how different friendships can be. My therapist found this interesting, although she could understand where I was coming from. She sympathised with my worries about my test results too, and said that if anything changed and an appointment clashed with the next therapy session, then to email or phone her as soon as I knew. 

The next session would be about going through all the information I'd given her about my most recent, and some of my past Depressive episodes, as well as my support network, recent events, triggers, interests etc. These would be summarised and she would read them out to me so I could agree with them, amend anything that wasn't quite right etc. We would then move onto the next phase of therapy; where we use skills to improve my symptoms of Depression and my social skills. My homework this time was just to complete the PHQ9 etc questionnaires, and the Symptom Review.  

Resources

Irritable Bowel Syndrome: https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

Gastroenterology: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/gastroenterology

Am I "Triggered"?: Amy's Mystery Illness: https://www.amysmysteryillness.co.uk/2014/03/am-i-triggered.html

I'm a Survivor: Amy's Mystery Illness: https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

Interpersonal Therapy (Take Two) Session 3

(TRIGGER WARNING: Mentions of Suicide, Self Harm, and Childhood Bullying)

 This session, we were to speak about previous depressive episodes, in order to create a "timeline" of events and declines in my mental health. We were also going to start to draw up a diagram of my key relationships (family, friends, any romantic partners etc).

In the week leading up to this session, I had a lot of times where I felt quite on edge and irritable. I do tend to have a hatred of sound sometimes, usually when I'm overwhelmed. It tends to be more sounds of people's voices rather than inanimate objects (the washing machine, music etc). The technical term for this is Misophonia, although I am not actually diagnosed with this. I find sounds of voices can instil anxiety in me, or even rage. I go into a fight or flight mode, where I want to either escape the sounds or yell at them in order to hopefully make them stop.

We did the usual PHQ9, GAD etc questionnaires in which I scored more severely for Depression than Generalised Anxiety (which makes me a good fit for this type of therapy, as it is specifically for Depression). We also went through my Symptom Review; where I picked out 5 most prominent symptoms for me in that past week.

As explained above, irritability was one of the main symptoms of my Depression in that week. I explained examples of conversations that had set me off, and how I reacted. I told my therapist about how I find it hard to process information when there is more than one voice speaking at the same time as well. It does either make me very anxious, or very angry, and people don't tend to understand that.

As well as irritability, I found the following symptoms had been either very strong or very frequent recently:

• Always tired: I believe this could be a mixture of fatigue due to mental health problems, as well as the fatigue I experience with my Fibromyalgia. The weather tends to make my Fibro flare up too. Either way, I struggled with my energy levels and felt relieved on any occasion I could get into bed and nap. I found it hard to do much else really.

• Think other people don't like me: I think I've mentioned this before, but I find it difficult to reassure myself that my friends still like me. I look for clues that they are drifting away from me, or simply don't like me anymore. It could range from someone cutting off contact online (unfriending on Facebook for instance) to something as silly as not being one of the friends tagged in a post I can relate to. I keep having recurring dreams about a friend who cut contact with me around 8 years ago. In the dream, I am asking her why but never getting a clear answer. I believe some of this paranoia around friends stems from the times I was bullied. Part of the tactics they used were to pretend to be my friend, then leave me out of things. It made it hard to trust who was my real friend, and whether they actually liked me

• Down on myself: My homework for this session was to play some music on one of my instruments, or to sing. It was supposed to be an "antidepressant activity" that I could enjoy and feel a sense of achievement from. When I struggled to do this more than once or twice in a week, I felt very down on myself. I enjoyed it when I did do it, even though I was quite rusty, but I was very self critical afterwards. When I didn't do it, I felt guilty, as if I was letting myself and my therapist down by not trying hard enough to ease my Depression.

• Worrying: Although my Generalised Anxiety score on the GAD questionnaire was lower than my Depression score on the PHQ, I still found I worried a lot about things in that week. Various things got to me, and I was apprehensive about when I would get my Gastroenterology appointment through, when I would get my PIP decision, would my therapist be annoyed at me for not doing my homework "enough" etc.

I explained all these things to my therapist; trying not to go off topic too much, and having her guide me back on topic when I did. She also reassured me that she was glad I'd at least tried to do my music practice, and that my struggle to get going with it was something that needed addressing. 

We then went onto the topic of a Depression timeline. This is a recollection of past depressive episodes, what caused/triggered them, how you felt at the time, how you noticed you were depressed, and what happened. I find it hard to split my Depression into clear cut episodes, as it mostly feels quite constant, but I tried my best to recall times it had flared up and the symptoms I noticed first.

My most recent episode started about 4 or 5 months ago and coincided with my stomach and bowel issues. (I will do a separate post about my Gastroenterology journey soon). I had been experiencing pains and severe constipation that was making me miserable. Alongside this, family disputes had come to light, and I finally decided to get help when I had a sort of public breakdown on social media. The symptoms I noticed that made me think my Depression was flaring up, were lack of appetite and sleep problems. I usually sleep fairly well (for a chronically ill person!) and my appetite is usually moderate-large. Waking up in the night many more times, and not feeling like eating had become disturbing symptoms for me. 

The episode before this, I don't remember very clearly. It may have been about a year ago; involving losing a few friends. My Depressive episodes are very interpersonal (hence why I feel optimistic about this type of therapy!) and disputes, anxieties, lack of contact etc can set them off quite badly. I deeply fear rejection, and I constantly seek reassurance. My emotions can feel very unstable too, especially when it feels like things around me are falling apart. I suppose I noticed the start of this episode, when I began to feel out of control with my emotions, and I started tweeting a lot about losing friends. 

I struggled to recall details about previous episodes, and tried to explain how I mostly remember episodes from years ago, when I was suicidal. My therapist then asked if I remembered my first ever Depressive episode.

I was about 13, in my most hated year of Secondary School; year 8. I remember I had strong suicidal feelings, due to the constant bullying I experienced. I confided in a friend, who broke my trust and told the bullies about my urge to attempt suicide and why. They ganged up on me, and I could not trust anyone with my deepest darkest secrets for a while after that. It also helped shape my ideas about people; whether I could trust them, how I expect them to react, how I always felt inferior to them etc. I never sought help for my mental health at that age, partly because I didn't know it was available. There was a school nurse, but you had to be physically unwell to see her. I just didn't feel I had anyone to talk to and my only outlet was to self harm. This is when I started, and it carried on for many years, whilst I was being bullied. I didn't know a lot about Depression at the time, but I knew it wasn't "normal" to feel suicidal or to want to harm myself. I also knew I felt desperately low, and motivation went out of the window. I strongly believe it was music that saved me. I engaged in extra curricular activities, such as junior, then senior band and choir. None of my bullies were in those groups, and I enjoyed music so much that it became my saviour. 

After we had gone through all this, there was only a bit of time left in the session. We were yet to go onto my key relationships. My therapist briefly explained this task, and how it would be presented on paper. I was to use my time before session 4 to have a go at starting the task, and we would go through it properly in this next session.

So far, I think my therapy sessions are going well. I have wanted to explain about various traumas in my life (as they still need addressing) but my therapist hesitates to let me, as this type of therapy doesn't deal with that. I will have to stay on topic and hope that what I can talk about, and address, helps my Depression in the long run. 

Resources

What Is Misophonia?: https://www.webmd.com/mental-health/what-is-misophonia#1

Fight or Flight Response: https://www.psychologytools.com/resource/fight-or-flight-response/

Patient Health Questionnaire 9: https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

GAD 7 Anxiety Test Questionnaire: https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7

Fibromyalgia - NHS: https://www.nhs.uk/conditions/fibromyalgia/

Interpersonal Therapy (Take two) Session 2

(TRIGGER WARNING: Mention of past trauma, and an abusive relationship)

Leading up to session 2 of Interpersonal Therapy, I thought I would have to talk about past trauma and previous episodes of Depression. I spent the past week ruminating over this, feeling much worse by the time session 2 came around. I even had a horribly triggering dream; the night before therapy. It involved confronting my abusive ex about everything he'd done, and him denying everything. His friends, and some of my ex friends didn't believe me either. It made me feel so invalidated and unsafe. I woke up paranoid, and unable to do much. It took a while to get out of bed, as I wanted to stay away from everyone. I just felt that no one around me was a safe person (even though the people I live with, my parents and my cat, are extremely safe). 

Even before this dream, I spent the week depressed most days and unable to motivate myself to do much. I tried to do enjoyable things; activities my therapist refer to as "anti-depressant". The one thing I could get myself to do was play casual games. I found this had become more of a habit than something enjoyable though. It distracted me from awful thoughts and feelings, but it didn't do anything to lift my mood as such. 

As it turned out, session 2 of IPT was mostly about my most recent depressive episode. At first, we went through the PHQ, GAD etc questionnaires (to assess and quantify levels of depression, anxiety, and daily functioning/lifestyle), then we went on to the symptom review. I will list below the 5 most prominent symptoms for me:

1. No motivation - I had to go back to past trauma to explain how it linked to my feelings now. I felt stuck in one place. Memories of the past seemed to hold me back. I guess I was triggered by thoughts of past trauma, and they held me in one place when I ruminated on them. I felt like I couldn't move on, especially as I anticipated talking about my past yet again. I know I need to address things, but I'd really rather avoid them.

2. No energy - The energy that constantly worrying about the past takes is exhausting. Thinking about what I need to talk about takes all my energy as well. I think we forget that just thinking can take its toll on our energy levels. Even if all we're doing is sitting and remembering, we are still exerting ourselves. A phrase I used to describe my frame of mind is that I felt the weight of the world on my shoulders.

3. Feel guilty -  I am taking a long time to do things, because of the symptoms of my depression. I am slowed down, and motivation levels are low. Because of this, I may take ages in the shower, planning things, getting dressed, cooking etc. I feel guilty because people may have to wait for me, or wait to use the bathroom. The way I behave has an impact on others, it doesn't happen in a vacuum. I also worry that my problems have an impact on others; such as my frame of mind, my feelings, the way I talk etc. I also assume that my mood has an impact on others. I suppose I'm an empath because of the way a room's atmosphere or a person's mood affects me. I understand other's emotions a lot too. I'm like a sponge to be honest! Not everyone is like that though, and I have to remember that me being sad won't always bring others down. I'm allowed to feel how I feel without guilt!

4. Think other people don't like me - I read into everything! I look for clues that someone doesn't like me, or is drifting away from me. I talk about it on Twitter, because I want that reassurance even though deep down I know it won't help me in the long run. I need to reassure myself and trust others. My lack of trust, my paranoia, and the things I type, I feel are pushing people away. This is a big big part of why I decided to try Interpersonal Therapy. As I said in Session 1 , it involves addressing problems in relationships, role changes, disputes etc. Part of my Borderline Personality Disorder symptoms involves being terrified of rejection and abandonment. I do things to avoid that rejection or maintain that friendship, even if it has turned toxic. In the past, I have begged bullies to stay "friends" with me, so I don't end up alone.

5. Can't make decisions - Due to lack of energy and motivation, I have been finding it do hard to come to a decision about simple things, such as what to eat, what to do to entertain myself etc. It takes me ages to decide, I talk myself out of it, or I spend so long thinking about it, or flicking between activities etc, that there is simply no time left to actually engage in the activity. Alongside this, my concentration levels have been low, so I haven't been able to focus on things, or I worry that I won't be able to focus on or enjoy something. I may have mentioned this before, but the thought of being bored/not enjoying something becomes unbearable rather than slightly disappointing. I think it is part of the extreme mood swings and emotions I get, especially with BPD.  

After going through the symptom review, my therapist noted that I take on so much pressure from assumptions about other people's thoughts about me, how my moods/behaviour impacts others and so on. It's no wonder I have no energy! She then asked about my most recent depressive episode.

I explained to her that I believe it started during lockdown, about 4 months ago when my physical gastro symptoms developed. I have experienced chronic constipation, moderate/severe abdominal pain, appetite changes, bloating, and bloody mucus in my stools. Because of all these symptoms, I started off fed up, then my appetite changed even more, and I noticed something wasn't right when my sleep changed. I would wake up many times in the night (not just because of pain) and I would be deep in thought for a while before I could settle down to sleep again. I would get more tired, much earlier, and therefore would wake up much earlier. I usually take a nap halfway through the day, to try and replenish my energy slightly (it never fully replenishes, due to the nature of my chronic physical conditions such as Fibromyalgia). I found recently that I needed more and more, or longer and longer naps however, and I was desperate to sleep all the time!

My moods were low anyway, but I wasn't sure how low exactly until it affected my sleep first of all. 

As well as having physical gastro symptoms which frustrated and worried me, I had conflicts with some family members I used to be close to. I won't go into details, but it involved some nastiness that I wouldn't tolerate. Trying to make the peace didn't work, and because I saw certain people in a different light, it affected how I expected others to be and therefore affected my moods further. My support circle seemed to be getting smaller and smaller.

Another thing that kept this particular depressive episode going, was my worries about pushing friends away. I wrote some fairly bitter things on social media, that didn't go down well. What I was looking for was support and reassurance, but quite understandably, it was misinterpreted and now I worry that others are drifting away from me, or beginning to see me in the way I see myself (i.e. as some kind of horrible monster who craves attention constantly).

I told my therapist that I do tend to be extremely self critical, and it's something I'm trying to work on, but not getting very far with. She said that I am very critical of myself and conflicts with relationships seem to be a big part of this latest depressive episode, but she would explore other reasons too. Conflicts in relationships need to be addressed first though.

We finally moved on to antidepressant activities. The gaming needed to be put to one side really, as it served no real purpose other than as a slight distraction. She asked me what else I enjoyed doing, and I mentioned my musical side. I play flute, guitar, and keyboard. I also enjoy singing and writing lyrics. Apparently, when I said this to her, my tone of voice became much brighter and happier sounding. She set me "homework" to do more musical things, then tell her how it went in the next session. 

Again, time went on very quickly, and we had been speaking for over an hour, so we had to leave it there. Next session is 1pm on 18th Jan. 

Resources

Interpersonal Therapy for Depression: https://www.healthline.com/health/depression/interpersonal-therapy#how-ipt-works

Amy's Mystery Illness: "I'm a Survivor": https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

PHQ 9 Score Interpretation: https://www.efficacy.org.uk/therapy/phq-9-and-gad-7/

Amy's Mystery Illness: Interpersonal Therapy (Take two) Session 1: https://www.amysmysteryillness.co.uk/2021/01/interpersonal-therapy-take-two-session-1.html

About BPD: Mind: https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/about-bpd/

Interpersonal Therapy (Take Two) Session 1

(TRIGGER WARNING: Mentions of Self Harm and Suicidal Feelings)

 After a major Depression and mood swings relapse, and encouraging words from loved ones, I decided to ask for help again. Initially, I thought I just needed my medication/dose changing but when calling Access/Crisis team, I was told I would probably benefit from therapy again, and my GP should be able to review my mental health medication. I reluctantly called Primary Care/IAPT to book an assessment and see what therapies were available (thinking they would just put me onto CBT again) but luckily was assessed by a wellbeing practitioner who realised that I had been through CBT many a time; resulting in some help for my anxiety disorders, but no improvement of my depressive episodes. The Primary Care team decided that I would be a good fit for Interpersonal Therapy instead. 

Interpersonal Therapy is intended as a treatment specifically for Depression (whether as a condition in itself or a part of another diagnosis) and focuses on how relationships can have a significant impact on our mental health. It could be things such as role changes (becoming a parent, carer, taking on a new job to name some examples), a loss or bereavement, arguments within relationships of any kind, or a major life event. This type of therapy aims to look at these factors and help the client to build up skills around them in order to improve their symptoms of Depression. There are 16 sessions to this type of therapy. The first 4 aim to get a picture of how Depression manifests for the client specifically, the middle 8 sessions aim to help build up skills to help improve symptoms, and the last 4 aim to conclude the therapy and get the client ready to continue practising those skills once therapy has ended. 

I had a few sessions of Interpersonal Therapy with someone prior to my diagnosis of Borderline Personality Disorder. I was very unwell at the time, however, and due to some things my therapist said as well, the therapeutic relationship broke down and I was unable to continue. I am looking forward to going through the process of this therapy with a different therapist though. 

My initial phone call with the new therapist went very well. I felt she was easy to talk to, and listened well to my problems. We decided that my diagnoses, symptoms, and issues would be a good fit for this type of therapy, and I was happy to go ahead. 

Before the first appointment, I had the PHQ/GAD/Phobia etc questionnaires to fill in, as well as a therapy agreement, consent for my therapist to record our appointments (she is a trainee IPT therapist, so her supervisor needs to monitor the sessions), and a symptom review sheet. 

The Symptom Review worksheet is a grid containing many different possible symptoms of Depression. My task was to tick each symptom I felt had been a problem within the last week, then pick 5 that specifically needed addressing. I did tick a lot of the symptoms, and found it hard to pick just 5. I put a star next to the most pressing symptoms, but through talking to my therapist in our first session, I found that each of those branched out into the other ones, were very similar in the way they manifested, or were linked quite closely together. What looked like a simple task, became a more complex one, the more I tried to explain each of the symptoms!

I felt like I was rambling throughout the conversation, and I worried that the therapist would not be able to organise what I'd said into cohesive notes. I should've had more faith though, she was very helpful and understanding. She would bring me back on topic when needed and would focus on the symptoms that seemed to bother me most. Between us, we decided that I was struggling with the following issues most in the past week:

• Irritability - I would find conversations and too much noise overwhelming, with led to a type of sensory overload which resulted in irritability. I may not always have made this apparent to the person/people I'm around, but I coped with it by turning on myself and either punishing myself (self harm) or isolating myself (going in my room). Generally, this is something I do if conversations online become too overwhelming or difficult. It's as if I'm suffering an emotional pain and I either want to escape it or turn it into a pain that I find easier to deal with. 

• Always tired - I experience extreme fatigue, due to my physical health problems, but I know that Depression plays a big part too. I find this symptom links in with lack of motivation and lack of energy (other symptoms on the symptom review sheet). This week especially, I have found I am constantly exhausted and want to stay in bed for longer and longer. I know that this is partly due to the Depression because my moods affect my levels of energy, and the worse I feel, the more sleep I need. Unfortunately, although sleep can have a positive effect on mood, oversleeping can have the opposite effect. I felt as if I hadn't achieved much at all in my week, I saw myself as lazy, and I worried others would see me as lazy too. 

• Mood swings - These are problems I have experienced a lot recently, which is why I think my mood stabilizers (Aripiprazole) have stopped working. I feel things in the extremes, to a point where I can feel as if I can't cope or I am out of control. The extremes weren't as bad as they could have been this week, but they were bad enough for it to be a problem. I didn't get the hypomanic emotions this time, but I did swing from considerably depressed and down, to irritable/angry, tearful, anxious, and even numb. I explained the numbness further, as my therapist said that it wasn't written down as a particular depressive symptom (which I found interesting, as a lot of people I know with Depression do feel numb quite a lot!). It's something I hadn't realised in myself until I connected with others with similar conditions and symptoms. When numb, my self awareness of how ill I am tends to decrease, and I'm not sure how to respond to the question "How are you?" because I simply don't know. When numb, I can dissociate too, although not always. I explained how I experience dissociation, to my therapist. She found that interesting too. We discussed how some of my symptoms had become coping mechanisms, as my numbness and dissociation can occur after days/events/conversations that I had found overwhelming. Again, it was a matter of extremes. I either felt too much, or not enough. 

• Feel worthless - I am often very self critical, although this is something I am trying to work on. I try to say more positive things about myself these days, but I do worry about coming across as arrogant, or just being wrong. When I'm not able/don't have the motivation to do much in my day, then I feel worthless and pointless as a person. This can lead to the suicidal feelings, as, in order to feel like I should be on this earth, I want to feel I have some sort of purpose, I am doing something to improve myself, or I'm doing some good for other people. It's a bit of a chicken and egg situation, as if I feel worthless, I lack motivation, but if I lack motivation and therefore don't do much, I feel worthless. I'm never sure which started first, but it seems endless! 

• Bored - As a symptom, this seems like a very mild one, but boredom can be unbearable for me. When I lack motivation and are not doing much, obviously I get bored. I have things I could do, but the thought of being disappointed if I do not enjoy them, or struggle to progress with them, can be very hard to deal with. Being bored can lead to becoming frustrated, angry at myself, extremely low and self critical, and even lead to suicidal feelings if I feel everything is going wrong. Doing something I enjoy (seeing a friend, not possible at the moment of course! Playing a musical instrument, cross stitch, a TV show etc) can lift my mood, but overthinking the possible result (not enjoying it) can make me talk myself out of even starting. I can usually push past this worry and do the activity anyway, but when very low, any disappointment feels like a big risk. 

As you can imagine, going through the symptom review took up most of the time in the therapy session. I was very apologetic and nervous throughout, but my therapist tried to put me at ease by saying she could understand what I was saying/what I meant, and she felt she had learnt a lot about me that day. She confirmed that, going on the questionnaires and what I had told her, I was still suffering from moderate to severe Depression. Apparently this type of therapy expects a diagnosis to be made and for Depression to be the main problem that needs addressing in order to go ahead. I know labels aren't useful for everyone but I like to have a name to put to the problems I experience, so I know what I am dealing with and what is likely to be helpful for me. 

She then told me what the other sessions would cover (possible past trauma/events, key relationships, arguments, role transitions etc) and asked me to complete the PHQ etc questionnaires and symptom review for next session as well. 

This concluded the session, and after checking there was nothing else I needed to discuss, we booked in for the same time next Monday. 

Resources

Interpersonal Therapy for Depression: https://www.healthline.com/health/depression/interpersonal-therapy#how-ipt-works

About BPD: Mind: https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/about-bpd/

PHQ 9 Score Interpretation: https://www.efficacy.org.uk/therapy/phq-9-and-gad-7/

Therapy Agreements: https://www.umcpt.co.uk/questionnaires/therapy-agreements/#:~:text=A%20Therapy%20Agreement%20is%20a,abide%20by%20throughout%20your%20sessions.

The Connection between Chronic Illness and Self Esteem

 (TRIGGER WARNING: Internalised fatphobia, body image, weight, mental illness, medication)

I've rarely had high self esteem, thanks to years of bullying, but my self esteem has taken such a knock since I've had chronic illnesses.

Throughout my treatment of chronic physical and mental illness, I have been on various medications, some of which have caused considerable weight gain. I try so hard to be body positive but I don't feel like me anymore and I'm desperate to get back some of my old self. I worry that others will think I've given up taking care of myself even though a combination of meds with weight gain side effects, inability to exercise sufficiently, and comfort/stress eating due to depression and anxiety, have led to significant weight gain and body change. I follow body positive people on Instagram in order to help with the disordered thinking I have about weight and diet. I read anti-diet books too. I think any change (not just weight gain) can have a serious effect on a person's self esteem. In my experience, in the past I have been known as the "skinny one", so I suppose, wrongly, I have made it part of my identity. I have liked being called things like "pixie", "petite" etc and when I don't see myself that way anymore, I feel very disappointed, at a loss, as if I've lost part of my identity and need to take on a whole new one which I don't particularly like. I know that this counts as fatphobia and I try so hard to reject those awful thoughts.

My balance problems and chronic pain, that come with Fibromyalgia and Hypermobility Syndrome, have changed the way I walk. I am a bit wobbly, I walk with my feet turned in (as much as I try not to), sometimes I limp. I have been stared at and mocked for this, and so my self esteem has taken a hit. I try not to let it bother me, but if I notice someone is staring, I am extremely aware of my manner of walking.

I often need to go to the toilet, due to Irritable Bowel Syndrome, Overactive Bladder Syndrome, and some bowel/stomach problems that are yet undiagnosed. If I'm particularly bad, I have to cancel plans last minute. Even if my friends are very understanding and compassionate, friends in the past haven't been and this has affected my self esteem too. I feel like a flaky, disappointing inconvenience, rather than a valuable friend. I feel all I do is annoy people and let them down. I know I cannot help this, because I would not do this if it weren't for my physical and mental illnesses, but it does not stop me from feeling this way.

Bladder and bowel issues can be (although they needn't be!) embarrassing and seen as a bit disgusting. I find I refer to them as "TMI problems" and try to describe them as delicately as possible to friends or people in Facebook groups. A lot of people have problems like this though, and a problem with bladder or bowel is nothing to be ashamed of! I do worry about it affecting my dating prospects though, although I would not want to be with a partner who was immature and easily disgusted by my health issues!

Part of mental health is self esteem, but mental health problems in themselves can have a severe impact upon self esteem. (Are you with me?). I'll explain. Anxiety can hold back so many things a person may want to accomplish for example. This could be taking on a dream job, travelling, or maybe even just meeting a friend for coffee. When someone has to cancel plans like these, or when they feel panicky whilst doing them, it can have a real knock-on effect. They can be frustrated with themselves for cancelling or acting in a "not normal" way. They may worry that others will pick up on the anxiety or the fact that they have cancelled multiple plans, and may treat them differently. I've certainly lost friends due to the way I've acted! These were friends I had felt quite close to as well. It does make you feel very low about yourself, as if there is something fundamentally wrong with you. 

Carrying on the mental health conversation, when very depressed we may push people away and isolate, maybe because we don't see a point in talking, maybe because we feel we are not worthy of friendship, maybe because we feel overwhelmed. There are many reasons why someone may isolate. The consequences of this could be losing friends, friends acting differently, friends not reaching in to persuade you to talk. Of course there could be many reasons why a friend might act differently that doesn't necessarily mean they see you as any less of a friend to them. When very depressed though, personally, I will perceive any change in their behaviour as a direct reflection on me and my personality. I may isolate, but I still want friends to reach in and try to contact me. If they don't, I feel that maybe they weren't that close to me after all and "of course" that's my fault for acting the way I do. I feel I can't help how I act though, so I believe I can't do anything about it. And therefore, self esteem = rock bottom. 

I'm constantly told by friends to not care what people think. I'm OK and I don't need to change for anyone. This is easier said than done though, especially when chronic physical and mental illness have ripped away my sense of self and confidence. I have a lot of paperwork from past CBT sessions, to do with negative thinking, all or nothing thinking etc. When very depressed, I don't see the point in looking through them. I also don't feel I deserve to have high self esteem. I think we all deserve to feel good about ourselves if we are good to others though. We beat ourselves up far too often, and usually for very small (although not to us) reasons.

I hope, in time and with practise, we will get that self confidence back.

What knocks your self esteem? Have you found ways of building yourself back up? Comment below!

My Experiences with Borderline Personality Disorder

(Disclaimer: The information given here is mainly about my own experiences of Borderline Personality Disorder. The ways I act, react and feel are not necessarily universal to all people with BPD and this should not be used as medical advice or a replacement for formal assessment. If you feel you have any symptoms such as mine, and especially if you have been self harming or suicidal, I urge you to contact your GP as soon as you can. Please let someone know how you feel. You deserve to get help.)

(TRIGGER WARNING: Mentions of Poor mental health treatment, Stigma against BPD, Self harm, Suicide, Alcohol and Sexual behaviour)

It was World Mental Health Day a few days ago. A day where I always feel the obligation, as a person with multiple mental illnesses, to do something such as write a blog post. I try to vary the specific subjects such as talking about one of my illnesses, how I cope with various ones, and/or the importance of awareness days, as well as supporting people every day.

Unfortunately life got in the way this time (doesn't it always?!) and I didn't manage to write my blog post in time. Mental illness happens every day though, not just on awareness days, so any day is a good day to raise awareness, talk about the importance of support, reaching in as well as out, having appropriate services for anyone who needs them etc.

Today I want to talk about a mental health diagnosis I have that is often misunderstood and stigmatised; Borderline Personality Disorder (BPD). Let's start with the diagnostic criteria:

The following is found on the NHS website:

Assessment

Internationally recognised criteria are used to diagnose BPD. A diagnosis can usually be made if you answer "yes" to 5 or more of the following questions:

• Do you have an intense fear of being left alone, which causes you to act in ways that, on reflection, seem out of the ordinary or extreme, such as constantly phoning somebody (but not including self-harming or suicidal behaviour)?
• Do you have a pattern of intense and unstable relationships with other people that switch between thinking you love that person and they're wonderful to hating that person and thinking they're terrible?
• Do you ever feel you do not have a strong sense of your own self and are unclear about your self-image?
• Do you engage in impulsive activities in 2 areas that are potentially damaging, such as unsafe sex, drug misuse or reckless spending (but not including self-harming or suicidal behaviour)?
• Have you made repeated suicide threats or attempts in your past and engaged in self-harming?
• Do you have severe mood swings, such as feeling intensely depressed, anxious or irritable, which last from a few hours to a few days?
• Do you have long-term feelings of emptiness and loneliness?
• Do you have sudden and intense feelings of anger and aggression, and often find it difficult to control your anger?
• When you find yourself in stressful situations, do you have feelings of paranoia, or do you feel like you're disconnected from the world or from your own body, thoughts and behaviour?

As well as talking about what BPD is, how it is diagnosed and treated etc, I want to speak about my experience of living with it. I have had symptoms of BPD for as long as I can remember, but I have been formally diagnosed since 2017. I have various mental illnesses, whose symptoms overlap, but the ones I think I can attribute to Borderline Personality Disorder are explained below:

• I am terrified of being alone, as well as rejection. I have practically begged bullies to stay "friends" with me so that they wouldn't take away my real friends and leave me without anyone. I have constantly phoned a partner when they hadn't spoken to me for a few days, to find out why, in the hope I could convince them to not dump me. (It didn't work). I go through regular phases of reassurance seeking which I'm sure annoys my friends, no matter how kindly they respond. No matter how many times I try to get reassurance that my friends won't leave me however, I can never reassure myself. I go round in circles with this. I admit I have checked a partner's messages too,  to make sure they hadn't found someone else. I also wanted to find out what they "really" thought of me. What I found out upset me a lot, but honestly I should've just spoken to my partner. Communication is so important! There are probably more examples of seeking reassurance, avoiding rejection/perceived rejection etc but I think I've said enough on that subject.

• In the past, I have gone from relationship to relationship, with not much of a break between them. I just couldn't bear being alone and single. A lot of the relationships I've been in have been pretty intense and unstable; not always through my fault though. I have been in at least one definitely abusive relationship, and although I made mistakes myself, I would never blame myself for how they treated me. Other relationships have involved love, marriage, and children being mentioned very quickly; burning out almost as soon as they began. I have also mistaken having feelings for someone, for being deeply in love with them. I have made everything about them and believed we had a future, even when it is pretty clear they didn't feel anywhere near the same way. 

• I still don't know what kind of person I am. I can say that I believe I am kind, passionate, and determined, but even then, I doubt that. I always rely on other people to prove they know me, and to tell me what kind of person I am, what makes me "me", what I'm good at, what my trademark is etc. Any comments about my character, I feel deeply. Good and bad. I'm more likely to believe the bad ones of course, but that's not necessarily a BPD thing. My unstable sense of self can even get so rocky that I literally don't recognise my own reflection in the mirror. The person in the mirror could be anyone, but I do not feel they are me. I have days where I feel attractive, and days where I feel extremely ugly. Nothing has physically changed, only my moods. Again, not necessarily a BPD thing, but it's worth mentioning as a mental health thing. I would love to truly know who I am, and I often feel lost and not grounded because I don't know.

• As for impulsive activities, I do engage in some, but not as many as I used to. At university in particular, I would engage in risky sexual behaviour. The only way I can explain why, is to say that I had very low self esteem, I often felt alone and unwanted, and that one night with someone I barely knew would make me feel wanted, if only for a few minutes. I would always feel guilty and ashamed afterwards, but I try not to now. As well as this, I am prone to drinking impulsively. It is a coping mechanism and although I know it is unlikely to lift my mood when I am particularly depressed, it feels like a good idea at the time! I drank a lot in my later teens and 20's. It was something I'd do to celebrate, commiserate, destress, forget, or just cope. It was binge drinking and thankfully I don't do it nearly as much now. It didn't help and I could've damaged myself. Right now, I don't self harm much, but I do still do it impulsively. A bad day, a bad comment, a low mood, a stressed mood, agitation, too many thought, too many mood swings. It doesn't take much. These are some of the most potentially dangerous impulses I have/had, but there are others that would take all day to talk about. 

•   I am suicidal. I'd say passively nowadays (thanks to good antidepressants and mood stabilizers), but I have had plans, and almost-attempts in the past. I have made "threats" too, although I do not like the term. It feeds into the stigma (which I will explain below). As in the previous post, I self harm occasionally too (it used to be every day though). 

• I used to have very severe mood swings, but thanks, again, to mood stabilizers, these are not so bad now. These mood swings can go on for hours, days, maybe even a week. They are very hard to cope with and when my moods are particularly high, I am scared about the comedown. Sometimes I can very rapidly go from deeply depressed, to anxious, angry, and hyper, then back down again. Sometimes I feel all these at once. For me, that is the worst and is often when I will feel more suicidal or self harm badly.

• I feel very lonely and empty on a regular basis. Most of the time, this is how I feel when I'm not having mood swings. When I feel empty, I find it hard to respond to the question "how are you?". Sometimes I even think I'm doing ok, when I'm really not. 

• I can feel intensely angry, but not very often. I act in rather than out too (punishing myself rather than lashing out at others). I can have kneejerk reactions to things but find it hard to express myself. Sometimes I will act without thinking but thankfully that has not involved me doing anything physical as a result. 

• In stressful situations I often dissociate. This involves feeling as if nothing is real. I might not feel as if I am in my own body, or even that I am real. It can last from a few minutes to a few hours. The stressful day, or moment can go by like a blur and I'm often not sure of what I said during that time. I may have lashed out verbally, or had a big panic attack, and I just don't remember the details. There are a couple of times I can think of. One time, I was on holiday with a partner. He was threatened by someone in a bar. I knew I was shouting and swearing at this person but I honestly cannot remember what I said. I burst into tears and was shaking afterwards. Another time, I was at a Work Programme induction, where I was taken into a group session without my prior knowledge. At the time I found group situations terrifying and extremely stressful. I know I spoke over the person leading the session, and apparently had a panic attack that was severe enough for me to be led out of the room. I know I spent the rest of the session signing some documents a work advisor put in front of me. I couldn't even tell you at the time what they were about though. I managed to sign them but I didn't read them and it was as if I was on autopilot. I often found Work Programme appointments very stressful and if I wasn't dissociating, I was paranoid. I used to believe any unfamiliar car or van outside my drive was a government official spying on me. If a stranger looked at me for a few seconds longer than "normal", I would believe they were spying on me too. I still find myself getting paranoid about various things, but I am a little better at calming myself down. I can ground myself a little more effectively too.

Treatment

I feel like all these symptoms are a lot to cope with. I have been at crisis point on multiple occasions and you'd be forgiven for thinking I had somewhere to turn when things become too much. Unfortunately, a common misconception about BPD is that people with it are too reliant on services, so mental health teams often discharge us before we are ready. It is very hard to convince someone you need help, especially when you are in a distressed state. It can look like over-reliance even when you truly need that help because you are in crisis. If you look at some of my previous posts, you will know that I have been assessed multiple times by the Access (Crisis) team and Community Mental Health team, and discharged straight after, or after a few sessions of help, even when I clearly wasn't ready. I believe it would take something drastic before I would have any intense help. Due to lack of funding and resources, however, I don't think I will ever get enough appropriate help.

According to NICE, therapy for BPD may include Dialectical Behaviour Therapy (DBT) if self harm is a particular issue. Brief psychological interventions (less than 3 months) are not recommended specifically for BPD either. Choice of therapy should be tailored to the individual's needs. In theory, this sounds promising, but as someone who was only ever offered a few months of CBT in Primary Care, and 4 sessions each of Distress Tolerance, and Self Compassion Therapy, in practice the needs of an individual with BPD are not always met. I think it mainly depends on how much knowledge your healthcare professionals have of this condition, and what sort of resources are actually available in your local Mental Health Team (be that Primary Care / IAPT or Community Mental Health Team/Secondary Care). 

Medication

In my experience, various mental health professionals have said that, with BPD, medication rarely helps and certainly isn't the be all and end all of treatment. It can help though, and does have a place in treatment. For me, Duloxetine helps the depressive moods I have, and Aripiprazole helps my mood swings. It allows me to get to a level of mental wellbeing where I am able to actually engage with therapy. Without medication, I would simply be too unstable and suicidal to accept any help. This might sound drastic too, but I do believe I would be dead without mental health medication.

Myths

There are various myths about people with Borderline Personality Disorder. A big one is that we are seen as manipulative. The truth though, is that we struggle to reassure ourselves that people actually want to spend time with us. We are scared of being rejected and sometimes we will do seemingly drastic things to gain that reassurance. 

We are seen as "threatening" self harm and suicide too. Actually, many of us are suicidal and do self harm but we do not do this/talk about this as a threat. We may in fact be asking for help and trying to be honest about how ill we are. People often misconstrue this though, especially when we have the BPD label. 

Also, we are said to be over-reliant on mental health services. That is not necessarily true though, and certainly isn't a particular symptom of BPD. We ask for help because we need that help. Mental illness is invisible too. Someone can seem fine on the outside, when they desperately need assistance. It can take presenting with physical injury for a mental illness to be taken seriously. Even then, the person may just be patched up in A&E then sent on their way with little to no aftercare. Last time I overdosed, I had to specifically ask to be seen by the Psychiatry Liaison team. I feel I've had to fight and almost beg for any scrap of help I've received. 

You can read about other myths here but I would advise avoiding this, or at least being careful not to overload yourself if you find these triggering at all. I am careful to only go on the myth-busting sites, rather than exposing myself to places with very upsetting misinformation. 

How Do I Cope?

I do have some unhealthy coping mechanisms, which I certainly wouldn't recommend, but I am learning healthy coping mechanisms too, and trying to replace the not-so-healthy ones.

For me, talking to trusted friends and family helps, but being in therapy can give me space to vent my feelings without judgment or fear of a loved one's reaction. It all depends what you feel ready for but in my experience, bottling it all up is a very bad idea

Having distractions can help with coping too. Gaming, cross stitch, going for a short walk (only when not in an unstable, suicidal place in my head though), studying short courses, reading, watching an episode of something or even a short Youtube video can help. I find I get overloaded very easily, and that can lead to major stress and self harm. I may manage a film, but when it seems too long or too involving, a few simple funny or cute Youtube videos will at least get me through some of the day.

If I'm particularly agitated, keeping my hands busy can help calm me down or at least channel some of my frustration. I am a lover of baking, and focusing on a task such as this, and creating something delicious can help me get through if not boost my mood even! The result is a tasty treat and the fact that I haven't punished myself for however many minutes or hours that particular bake takes.

When dissociating, I have learnt two things that sometimes help. 

                    1. Grounding. This involves doing simple things to reconnect myself with the outside world. It intends to remind me that the world around me, the people around me, and myself are real. It also brings me to the present time. One way of grounding myself involves focusing on one thing that stimulates each of my senses i.e. something I can see, something I can hear, something I can smell, something I can feel, and something I can taste. Even focusing on just some of these senses can ground me slightly.

                   2. Safe Place. I'm still learning and practising this one, as I find it hard to focus and take myself away from whatever stressful situation has triggered my dissociation. It involves imagining a pleasant, calm place that can either be real or something completely made up. An example could be a quiet, sandy beach. I imagine myself there at night, with no one around. Again, I can focus on my senses in order to make that place as real for me as possible. I may think about the taste of a fruity cocktail, the smell of the sea, the sound of the waves or the feel of a gentle breeze through my hair. Once I feel calmer, I can gently bring my awareness back to the present moment in the hopes that I will have stopped dissociating and feel more able to deal with the situation I am in, or simply walk away from it if that is possible. 

Conclusion

So, I am in no way a success story, and I'm definitely not looking for sympathy (well, maybe a bit if I'm having a bad day?). I simply wrote this blog post to let you know about how Borderline Personality Disorder feels for me, and how my experiences of it compare to the diagnostic criteria, recommended treatments etc. 

Resources

Diagnostic Criteria - https://www.nhs.uk/conditions/borderline-personality-disorder/diagnosis/

NICE guidelines for Borderline Personality Disorder - https://www.nice.org.uk/guidance/cg78/chapter/1-Guidance#general-principles-for-working-with-people-with-borderline-personality-disorder

MIND Dialectical Behaviour Therapy - https://www.mind.org.uk/information-support/drugs-and-treatments/talking-therapy-and-counselling/dialectical-behaviour-therapy-dbt/

MIND About CBT - https://www.mind.org.uk/information-support/drugs-and-treatments/cognitive-behavioural-therapy-cbt/about-cbt/

IAPT - https://www.nhs.uk/service-search/find-a-psychological-therapies-service/

Community Mental Health Teams - https://www.derbyshirehealthcareft.nhs.uk/services/mental-health-and-emotional-wellbeing/neighbourhood-community-support/cmht-adults-working-age

Five things people get wrong about BPD - https://www.sane.org/information-stories/the-sane-blog/mythbusters/five-things-people-get-wrong-about-bpd

If you feel you need to speak to someone, after reading this blog post, I am leaving some mental health links below. Please also comment below, if you know of any other links to inclusive mental health helplines.

Samaritans: https://www.samaritans.org/how-we-can-help/contact-samaritan/?gclid=CjwKCAjw5p_8BRBUEiwAPpJO61KYfF83b5CLcYslbI7Nz2_yJ-SwSqWHR31ZLgMF0nGpFFFqDv_VDRoCN9kQAvD_BwE

Mind: https://www.mind.org.uk/about-us/contact-us/

Stonewall: https://www.stonewall.org.uk/help-and-advice

(Please be aware that a lot of these links are for listening services. The people you speak to are unlikely to be allowed to advise you, and should not replace speaking to your GP, mental health professional, or even A&E if urgent. They do have a place in mental wellbeing however, and it can be helpful to hear a friendly, compassionate voice).

"Square Peg....Round Hole"

(TRIGGER WARNING: Medication, including dosage and overdose, mentions of self harm, suicide, trauma, hallucinations, domestic abuse, and abortion)

For many months, I've been on Citalopram for my Depression. The past month or so, I've been on 40mg (the highest dose). At first, I seemed to be doing well but, especially since trying to contact some charities to help me with my trauma from the abusive relationship I was in, I relapsed badly.

My suicidal thoughts have returned, I am being more impulsive with drinking, self harm, and taking small overdoses to help me sleep. I have not been sleeping well recently, I have had very graphic nightmares and flashbacks, and my appetite has been all over the place. Getting out of bed has been very difficult, as I am either very distressed or extremely low. Everything seems pointless.

I finally decided to speak to my GP on the phone the other day. I was due to have my mental health medication reviewed anyway, and I guess I was just expecting her to put me onto something else and book another review in a few weeks' time.

When she rang, she asked me how I'd been getting on with the higher dose of Citalopram, and how I'd been feeling recently. I explained everything, and I think I sounded quite panicky. She was very concerned, especially about the suicidal thoughts. She told me to ring the Community Mental Health Team, to see if they would see me. She also said that I would need them to refer me to a psychiatrist to see what other medication I could be put on.

I guess I didn't realise how bad things had become. I suppose I've been so used to having suicidal thoughts, but no real help for them, that I'd given up fighting for support (especially immediate support from crisis team/access team etc). I told her about my previous experiences with CMHT and how the last time I went to A&E after an overdose, I spoke to the Psychiatry Liaison Team who said that I wasn't ill in the "right way" for CMHT. My GP still insisted I rang them though, and got back to her with what they'd decided.

I was very panicky by the time I rang access/crisis team (you ring them to be triaged and referred to CMHT) but I spoke to a very nice, compassionate person. They listened to what I had to say, asked about my mental health medication (40mg Citalopram, 10mg Aripiprazole), asked me how I'd been feeling, and went through the risk assessment with me (suicidal thoughts, plans, self harm history, hallucinations etc). I also mentioned the trauma I had experienced from a medical abortion at 19 and an abusive relationship soon after. I told them I'd spoken to some LGBTQ charities to try and get support for the trauma. I'm bisexual and agender. I didn't expect to come out as agender to this person, but it sort of slipped out when I was explaining why I'd decided to contact LGBTQ charities instead of Women's Aid (the place I was signposted to by my last therapist). I was quite worried that I'd come out so suddenly. In the past, I had come out as agender to a therapist/nurse who then proceeded to deliberately call me a "lady" multiple times. This set off my gender dysphoria, and I didn't feel mental health services would understand me being non binary.

The person on the phone acknowledged my gender (although I'm not sure if they understood or believed me). They then asked about my daily functioning, and whether my symptoms had affected that. I told them about the nightmares, flashbacks, lack of sleep due to feeling unsafe, distressed, and having a lot on my mind. My appetite has been quite bad recently too. I've eaten, but I haven't been very interested in it. Again, everything feels pointless. I'm extremely stressed about the future too. I'm on ESA and PIP (sickness and disability benefits) and at the age of 30, I really want to move on with my life and rent a place of my own. I would have to get a job if I am to afford it though. I really do want to get a job, but I'm not sure how I would manage it physically or mentally. If I can't move on with my life though, do I want a life at all?

The person asked a few more questions then told me they would speak to one of their colleagues and get back to me with their decision at lunchtime. They called soon after lunch and told me that they want me to have a telephone appointment with a CPN (mental health nurse). We booked the appointment, then they told me that I should ring anytime if I need them urgently. I thanked them for their time and for how kind they'd been.

Since then, I've been looking forward to the appointment, in a way. It's at least a crumb of support from mental health services, and for me to be referred for assessment at least means they feel my symptoms are complex and serious enough. My previous experiences of being assessed then discharged are making me pessimistic about it though. I remember the A&E Psychiatry Liaison Team trying to explain to me why I never seemed to be taken on by CMHT. They described me as a "square peg" and CMHT as a "round hole". I didn't fully understand why that was the case though.

What makes me so different as to not being right for CMHT? I have a history of self harm and suicidal thoughts (plans even, sometimes). I've suffered multiple trauma. I have experienced hypomania on rare occasions. Very very rarely I have had visual hallucinations (usually after an antidepressant overdose). I do not have psychosis, so I understand why I wouldn't fit the criteria for some of the CMHT pathways, but there's at least one pathway that I think I do fit the description for.

The one pathway that seems to fit me is the one called the "Community Intervention Pathway". It says it "provides assessment and evidence based time limited interventions for people who have complex mental health difficulties that are significantly impacting on daily life. This would include mood disorders, anxiety disorders, trauma related conditions, and other severe emotional difficulties"

I have Depression, Generalised Anxiety Disorder, Obsessive Compulsive Disorder, Borderline Personality Disorder, and Post Traumatic Stress Disorder. These fit into various categories mentioned above and at least some of these affect my daily life significantly. I socialise rarely (especially since Covid of course), I am currently unable to work (although I want to try), my sleep and appetite are affected. I think some of my relationships with others have been affected too. I've certainly lost some friends anyway. Sometimes I freeze and dissociate, which can affect me for hours; as I'll be staring at whatever is in front of me. I'll be sort of "stuck", unable to take in conversation, or focus on anything else. When I'm very depressed or anxious, I cannot process anything that isn't to do with whatever is making me anxious or how I'm feeling when depressed.

I think my problems are complex and severe enough for intervention from Community Mental Health Team, and I know I need psychiatric input in order to sort out my medication. Past experience is making me worry that I will simply be discharged with no support whatsoever. People are telling me to be positive and "cross that bridge when I come to it". I don't want to get my hopes up though.

Resources

Amy's Mystery Illness blog: I'm a Survivor -  https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

Symptoms of PTSD: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#:~:text=A%20flashback%20is%20a%20vivid,events%20from%20start%20to%20finish.

Rethink: What is a Community Mental Health Team? https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/community-mental-health-team-cmht/

Amy's Mystery Illness blog: A Mental Health Nightmare - https://www.amysmysteryillness.co.uk/2019/08/a-mental-health-nightmare.html

Amy's Mystery Illness blog: Am I Triggered? - https://www.amysmysteryillness.co.uk/2014/03/am-i-triggered.html

Mind Charity: About hypomania and mania - https://www.mind.org.uk/information-support/types-of-mental-health-problems/hypomania-and-mania/about-hypomania-and-mania/#:~:text=What%20are%20hypomania%20and%20mania,period%20(usually%20a%20few%20days)

Mind Charity: About Psychosis - https://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/about-psychosis/

Mental Health Community Services: https://www.mpft.nhs.uk/services/mental-health-community-services

Dissociative Disorders: https://www.nhs.uk/conditions/dissociative-disorders/#:~:text=Dissociation%20is%20a%20way%20the,longer%20(weeks%20or%20months).