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Changing diagnosis. - May 11th 2012, 08:29 AM

So I've changed teams and it looks like the new team will be changing my diagnosis. I am not happy about this, for a number of reasons. I met my new doctor today and he seems to agree with what the doctor who saw me at hospital thought. Although the doctor who saw me at hospital only saw me once, for about 15 minutes.

They are changing my diagnosis to Borderline Personality Disorder.
Even though, from where I stand, I only fit a couple of the symptoms, not the 5 that must be met for a diagnosis according to the DSM-IV-TR. I brang this up with my new doctor, he said that a diagnosis can still be made if a person fits only a few of the symptoms.
So I'm pretty pissed about that, as you would be.

Also they're still going on about DBT. I've had people wanting me to do it for years but I refuse on principle, for starters it's group therapy, and also, I just don't want to do it so there's no point forcing me to do it.
They say they're not going to force me to do it but they are going to continue to "talk" to me about it.

So yeah. This royally sucks, I'm not borderline but I've magically got lumped with a doctor who thinks I am. Marvellous.
   
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Re: Changing diagnosis. - May 11th 2012, 10:43 AM

What are your main symptoms? Do you experience the mania/hypomania of Bipolar, instead of BPD? Or 'euphoric hypomania' which is more typical of BPD?

I think part of the problem is your case being handed over to different psychiatrists and/or psychologists.

What traits of BPD do you 'fit'/experience?

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Re: Changing diagnosis. - May 11th 2012, 11:13 AM

Traits I fit -
Impulsive/reckless behaviour
Self-harming behaviour
Suicidal behaviour.

Though it's important to note that I had a frontal lobe injury, so my levels of impulsivity are already much higher than normal as a result of that.
I started self-harming as a teenager initially as a way to cope with my frustration - a lot changed very quickly when I was about 13. None of it seemed positive at the time.
Generally my suicidal behaviour has been related to being depressed. Nobody takes 200 pills just out of the blue, or to get attention. They take them to DIE. Same with hanging oneself, same with parking a car with the lights out below a dip in the fast lane of the motorway.

The one time they put me on citalopram there was a massive increase in what people term "risky behaviour", so they took me off it. I was hospitalised for walking on the motorway, then for drinking a bottle of paracetamol (I found out later that the liquid doesn't act in the same way as the tablets, which is why I suffered no physical consequences aside from mild abdominal pain), then at one stage I was informal, there was an incident in hospital, and then I was kept there for a bit.
They also tried to put me in hospital at one stage, the lady who would have been the admitting psychiatrist seemed to think I was hypomanic, I was allowed to leave on the condition that I took olanzapine, and I had to take it with people watching me. They came to my house every night for nearly a month.

My old psychiatrist on more than one occasion threatened to hospitalise me for medication non-compliance.
I moved back to my Mum's place at their request because the other option was being put into shared care. I still wish they had allowed me to stay independent, I was generally coping a lot better in my own place.

I get depressed maybe 3 or 4 times a year, sometimes more, usually for between two to eight weeks. These times I tend to eat less, suffer from insomnia, use drugs more frequently (assuming I can source them), and self-harm more. I have never been on *just* and SSRI for longer than a fortnight, and the time I was on citalopram was enough to show them that it's not an appropriate medication for me.
I have times of increased enthusiasm and productivity where I tend to take on more tasks than usual and although I sleep well during these times I don't feel tired, I sleep merely because I run out of stuff to do or I get bored. One classic example of this was in 2009, where I was working two jobs, studying, and keeping my little unit that I had at the time spotlessly clean. I was accused of doing too much by family but it never came to the attention of the mental health services.
Last year just after I was taken off citalopram I did six months worth of planning for my squad mostly in one day. Although I never actually used the plans due to timetabling issues with apparatus in the club, they were nevertheless done and when my manager looked over them she thought they were good.
I also am likely to exercise more, talk like a demon - loudly and fast - and do things like go for random overnight drives to cities a few hours away.
These periods usually last one to two weeks, and are often followed by a low that is not as bad as being depressed nor as debilitating but is nevertheless much lower than a "normal" mood.

I also have long periods of "normal" mood, such as what I'm experiencing now, which can last anywhere between one week and six months. Currently I'm at three weeks of normal, and my therapist didn't know I was depressed before because I didn't tell her. She's still new and I'm still feeling it out.
During times of normal mood I still self-harm occasionally (it's a tough nut to crack) but generally am not noticeably unwell. I'm sleeping a lot at the moment but everyone is of the opinion that it's mostly because I really don't have much of a reason to get out of bed - I have no job and I'm not studying at the moment, so most of my day consists of computers, TV, wishing I had enough bus money to get to the gym (I'm considering changing to a gym that's actually in my township instead of the next one over), reading, and the usual showering, eating, etc. So there's not much mental stimulation at the moment. I am looking for work but my convictions and also pending convictions are holding me back - many employers will not consider a person with convictions.

The casual work I have has no work for me at the moment as it's their quiet season, but the manager is still pleased with me and my work broker has said that he said he'll contact me as soon as there is work.

I do not suffer from inappropriate rage, fear of abandonment, black and white thinking, or many of the other things that are related to BPD. The times I've been angry it's made perfect sense, for example, someone tries to put you in a locked ward, so you react. Someone arrests you, you react. Someone puts you in a hospital against your will, you react. My anger is mostly reactive, and at the times I really haven't thought things through. So yeah.

I'm just mad at this guy. Chances are if he keeps seeing me over the next year he'll see enough to change my diagnosis, but I'm awaiting the outcomes of two separate but nevertheless serious charges. I'm hoping to get community service and either supervision or home detention but jail is also on the cards. So he might not actually get to know me, but he might, and then he's likely to change what he thinks.

I'm just frustrated because I've been through this before, when I changed teams just before I turned 19 a psychiatrist then (patronising fat guy, seriously) wanted to put me as borderline - that time I simply stopped working with them.
This time even being in the services was accidental, I'd been out since I was 20 and it was only due to an overdose (non-serious, it was benzos, I took them because I was ridiculously tired and couldn't sleep but needed to sleep in order to get up at 3am the next day to continue with 12hr shifts of 5 - 5, ended up in hospital and lost the job, hospital psych referred me to the mental health services, didn't think they'd react so strongly, I honestly at the time thought it would just knock me out for the night) that I got referred into them. And for months, say, February until June, I just saw my key worker occasionally. Then I got depressed in June-July and referred to a psychiatrist and a psychologist . . . so yeah. Probably shouldn't even be in the services, and now I'm with the intensive team, who think I'm borderline.

As I said, fucking marvellous.
   
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Re: Changing diagnosis. - May 11th 2012, 11:29 AM

Whew, you've been through the mill!

I can see how diagnosing you in a finite way may be difficult though, as your symptoms seem to be a mix of some BPD traits and Bipolar. Perhaps BP II may be the most accurate 'fitting' diagnosis, although of course i'm not a psychiatrist.

Could you try to get transferred to a different team, who could refer you to a mood clinic? That may help to get a clearer diagnosis, or rule out potential Bipolar Disorder.


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Re: Changing diagnosis. - May 11th 2012, 11:31 AM

Also, Axis III as you've had damage to your frontal lobe, would be included in a final diagnosis, so an MRI might be helpful, also.


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Re: Changing diagnosis. - May 11th 2012, 11:49 AM

Last year I had both a CT scan and an MRI, both showed significant damage to the frontal lobe, to the degree that I was told it's really quite surprising that I'm functioning so highly. In other words, had they not known about the injury, they would not have guessed, but the amount of damage indicates that it should be sort of, well, obvious. But I'm not complaining, nobody wants to be impaired after all, and I think the fact that I maintained most of my functioning is something to be thankful for.

My diagnosis upon leaving my old team was Bipolar II, executive functioning difficulties, and borderline traits - a diagnosis which I totally and completely agreed with.

I did a neuropsychological assessment last year, which apparently used a Full-Scale WAIS-IV IQ and placed my functioning in the Superior range (95th percentile). There is a pre-injury estimate of all my functioning being in the Superior - Very Superior range however this test showed that in some areas my functioning is merely Average. This means that although it's a lot lower than expected, there's no actual impairment.
It was noted that I have "Attentional difficulties", "Planning difficulties", and "Difficulties with impulsivity and risky behaviour".
It says in the summary of the report (I was given a copy of the summary but not the full report) - "Jess presents with a complex mix of orbital-frontal brain damage, likely Bipolar II disorder, and psychological issues that has proven difficult to treat."

The report also suggests DBT, but as I said, people have been on at me about that for a while now.

The therapist who did the neuropsych was a senior neuropsychologist/clinical psychologist with the team I was with before and I worked with her for somewhere around 8 months, so she actually had a good idea of what was going on for me. It helped that I liked and trusted her because she seemed to click to how to get me to focus properly, something most therapists struggle with where I'm concerned.

As for a different team, what happened was I moved house, so I moved into the catchment of a different team, however that team refused to take me on the grounds that I'm too high-risk, so I was sent instead to ICT, who cover something like a 40km radius. The only way to change teams would be to move to a different city.

As for mood clinics, so far as I know, there aren't any available under the public health system in New Zealand. I will google it though.
   
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Re: Changing diagnosis. - May 11th 2012, 12:29 PM

I think the diagnosis you agree with sounds like the most accurate one.

I hope your new team can re-diagnose or treat you for that, you definitely need the support for a 'proper' diagnosis.

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Re: Changing diagnosis. - May 11th 2012, 01:21 PM

I looked up mood clinics, by the way, and I was right - there aren't any here.

It's one of the biggest frustrations of changing teams, you don't know them properly so they make assumptions. My psychologist actually asked me last week about my understanding of my diagnosis and I explained how I understood the Bipolar one to fit me. She seemed perfectly accepting of this and actually said at the time that as my doctor gets to know me it is likely that the Borderline diagnosis will change. It's just a pain in the arse that they changed it to that in the first place, it means more backwards and fowardsing and my file gets ever more extensive >.>

Anywho thanks for your replies. =]
   
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Re: Changing diagnosis. - May 11th 2012, 01:37 PM

Thought i'd add you anyhow, to contacts, as i definitely have BPD but my mood swings could potentially broach with BP II diagnoses, too.

Michy


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Re: Changing diagnosis. - May 11th 2012, 05:46 PM

Well, if they've been pushing the idea of DBT anyways, you may as well try it out if you can.

You've talked before about incidents of Hypomania, and if SSRIs are the trigger, then it's completely understandable that a diagnosis of Bipolar II makes sense. But, if the doctor you're seeing has decided to change it, not much else will tell them otherwise, unless you go into a Hypomanic/Manic episode. Perhaps doing DBT, which is supposed to help with BPD, will kind of "bring out" the Bipolar II traits, so the doctor can't deny them as easily..? It's worth a shot, since the DBT could prove beneficial during any Depressive episodes anyways, right?


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Re: Changing diagnosis. - May 12th 2012, 01:07 AM

I've done bits and pieces of DBT in individual therapy sessions and I get the gist of it, like I know how to apply mindfulness and I understand things I can do to help regulate my emotions and although my interpretation of "distress" is different to that of the therapy's, I also understand a lot of the distress tolerance stuff.

We didn't do anything on interpersonal relationships because I actually don't have any trouble there, when my old psychologist wanted me to do DBT she explained that it was mainly for the mindfulness and emotion regulation parts.

Thing is, I just don't like the idea of sitting in a group of strangers. Also I'm aware that I'll have to fill out diary cards, which I don't like doing, because then they pick up on the pattern of my mood quicker (e.g., see it going up or down) and are likely to suggest things like respite or medication. I'm actually kind of glad to not be on medication, it's one less complication. And I have a couple of times been moved from respite to hospital, and I really don't want that happening.

Over time it is likely that this new guy will witness a hypomanic episode, I had two in the latter half of last year, after all. It's really just a matter of wait and see.
   
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