Category Archives: Mental Health

Issues Surrounding Psychiatric Medication

Yesterday, Lydia of On The Borderline wrote an interesting piece on the stigma surrounding psychiatric medications and opioids for chronic pain. Today, I am going to add my own two cents to the conversation on meds.

Like Lydia says, many people, including patients, fear that psychiatric medications will change the person taking them, turning them into a zombie. I must say there is some truth to this. However, it’s hard to tell whether the medication is at fault or it’s the person’s illness. For example, as regular readers know, I spent a long time in a psychiatric hospital, including on a long-term care unit. Most people there have severee, treatment-resistant schizophrenia spectrum disorders. Most people who fall into this category were indeed heavily sedated and could be seen as “zombies”. However, the term “zombie” is a rather derogatory term for any human being, mentally ill or not.

When I started medication in 2007, I was indeed afraid of the antipsychotic I got prescribed turning me into a “zombie”. I was on a low dose of an atypical antipsychotic (which seem less sedative than classic antipsychotics) and it didn’t sedate me that much. It did keep me somewhat calmer than I was without medication, though I still felt pretty much as miserable.

This brings me to another issue that I touched upon in my comment on Lydia’s post: medications aren’t there for behavioral management. Okay, that may not be entirely true, in that severely aggressive people may benefit from medication for behavioral management if nothing else works. However, it’s a last resort and care must be taken to assess whether the patient actually feels better or they’re just too drugged up to make their feelings known. In this sense I, being a former long-term psychiatric hospital patient given medication for behavior control, have a different perspective to Lydia. She, after all, seemed to assume in her post that it’s stigma that keeps people from taking medications that could make them feel better.

Not that this didn’t happen in my own case, but in a different respect. I was taught in my years in inpatient psychiatric treatment, that medication is pure behavior control and how I felt didn’t matter. This not only got me to take medications I feel I didn’t need, but it also kept me from getting medications I did need. This is the case with my antidepressant. I was finally diagnosed with recurrent, moderate major depression in 2017 when I sought a second opinion on my diagnosis. I’ve probably been suffering depression off and on since at least age ten, but it was masked by my challenging behavior. Because I with good reason didn’t expect anyone to care about my mood if it wans’t bothering the staff, I was never treated for depression while in the hospital. Finally, earlier this year, I got a psychiatrist’s appointment to discuss my mood and was prescribed a higher dose of my antidepressant. (I had already been put on an antidepressant several years earlier, but don’t ask me why.) It seems to be working now.

Increase in My Antidepressant Dose: Is It Working?

Tomorrow, I will see my psychiatrist for a medication review. Last month, the dose of my citalopram, an SSRI antidepressant, was increased. Do I truly feel it helps?

When I started on the higher dose of citalopram, I had no idea what to expect. I’d originally been prescribed this medication in September of 2010 and had never had its effecacy evaluated. I seem to remember I was put on citalopram after the dose of my Abilify had been increased twice in a few months’ time and I was still very irritable. Abilify is an atypical antipsychotic commonly used for irritability and emotional dysregulation of all kinds. Citalopram is primarily used for depression and anxiety, but it can also help with emotional dysregulation, or so I seem to remember my psychiatrist having said.

Even before I started on my higher dose of citalopram, my mood started to lift a little, possibly because of anticipation. Once I started on the higher dose, my mood remained relatively good for a short time. Things were looking up in the day activities department, so that also helped.

One thing I have clearly been noticing, is that I’m more active. I have less need for sleep during the day. I am also a little more motivated and inspired to get things done. Though I obviously did’t complete the #AtoZChallenge, I did write far more regularly on this blog last month than i’d done in almost two years before.

Another positive that I’ve noticed is that I am more able to keep myself from engaging in self-destructive behavior. I do still have urges, but I’m more able to reach out for help first.

Though these are all very positive changes, I must say that if I’m truly honest, my depressed mood is still the same if not worse. Same for my irritability. I still experience this feeling as though a heavy weight is on my shoulders. I still get agitated very easily. I still experience suicidal thoughts.

Then again, these are most likely more symptoms of emotional regulation issues rather than major depression. Unfortunately, there’s no medication that targets these specifically. I won’t have my first appointment with my new treatment coordinator till the 17th, and I assume we won’t be diving back into dialetical behavior therapy right then. I try to use the skills I’m learning through self-help groups and apps, but it’s all rather hard.

Emotions: Dealing with Emotion Regulation Issues #AtoZChallenge

Welcome to day 5 in the #AtoZChallenge of random reflections. For my letter E post, I focus on emotions. In this post, I’ll explain what it is like living with emotion regulation issues and how dialectical behavior therapy helps. Both I and my treatment team prefer the term “emotion regulation difficulites” over “borderline personality disorder traits”, as my emotion regulation issues are likely in part due to my autism. Also, borderline personality disorder is very stigmatized. Now I know the solution to that is not to avoid the term, but I do feel I’m not the “classic” borderline.

First, I have difficulty understandign my own emotions. This is called alexithymia and is relatively common in autistic people. I can usually tell whether I’m feeling “good” or “bad”, but not whether “good” is joy or love or “bad” is anger, sadness, etc.

I feel “bad” far more often than I feel “good”. This may be because I suffer with depression too. I however tend not to express my depression as sadness. Rather, I express all “bad” feelings as irritability. Over the years, I have gotten slightly better at knowing when I’m genuinely angry and when it’s another feeling that I express as irritability.

In dialectical behavior therapy (DBT), the treatment I follow for my emotion regulation difficulties, we learn to counteract emotions by acting opposite to how the emotion “makes” us act. For example, one skill that I’m trying to practice is to half-smile, accepting the situation as it is even if I don’t like it. I initially thought that acting opposite to emotion was acting cheerful whenever a cheerful mood was expected. For example, I’d greet my husband enthusiastically when he’d come home even though I still felt like crap. Now I know that you’re not supposed to “fake it”, but that acting opposite from your initial impulse might help you achieve your goals. For exaple, if I feel like crap and want to stay in my room all the time, it may be more effective if I reach out to my husband instead.

Dialectical behavior therapy also teaches me about the misconceptions about emotions I may have. One of them is that some emotions are just stupid and shouldn’t be felt. Another is that emotions come up for no reason at all. In fact, emotions all happen for a reason and as such have value. Now that I write this, I realize this is the strongest argument against fake cheerfulness. It is important to acknowledge an emotion without judging it, but also without dwelling on it too much. Mindfulness, as such, is the first skill of DBT.

Succumb

I often feel like I want to succumb. Especially in the weeks after my first overdose last July, and again now, I find a form of peace and comfort in the thought that I could do it again. Note that I don’t want to die and the fact that apparently I could have died, makes these thoughts scary at the same time. I still envision myself coming out of a possible suicide attempt alive each time. It’s really hard to imagine anything else, as, you know, when I’m dead, there’s no longer me, so nothing to imagine for me. I mean, yes, I sometimes imagine what my funeral will be like, but the very fact that I can imagine it, means I’m alive.

I rationally know, these two times that I did something that could’ve cost me my life, that quite frankly there’s nothing positive about this. I mean, at the end of the day, each time, I still returned to my life as it was before my overdose. I didn’t even want to be taken to the psych unit and there was no need for it either.

How different were these events from my major crisis of 2007? At the time, I didn’t even take any actions that could’ve cost me my life – I just threatened suicide. However, I badly wanted, needed even, to escape the life I was in at the time. This was effective, as I went into the mental hospital and didn’t leave institutional life for almost a decade. Now I’m in the community again and it’s proving hard, but I must say, not as hard as I’d expected it to be. If things had gone as I expected them to, I would’ve been in chronic crisis mode. I’m not now. I don’t make any plans to end it all. Not that I did so back then, but I did run away from my home each day for a week before I finally crashed and threatened suicide.

I don’t know what makes my current thoughts that I can, if I want to, take my life any less serious than the thoughts I had back in 2007. After all, I did have these thoughts for several months following my crisis. Still, they feel less serious now. Is it because now, I don’t dramatically over-express them (unless this blog post counts)? Is it because, other than having these thoughts and being in a pretty depressed mood, I still go about my business as usual? Then again, I did most of the things I had to in 2007 too, up to taking an exam at university three days before being hospitalized.

I think honestly, the difference is that, back then, I was over-emotional, whereas now, I am under-emotional. Back then, I experienced and expressed quite intense emotions, whereas now, if anything at all, I feel numb.

I don’t know whether this is better or worse. I have a feeling that it is less serious, as I’m not emotionally dysregulated like I was back then. I don’t go about having public screaming and crying fits. I barely go about expressing myself at all, unless again this blog post counts. I don’t go about making suicide threats to random people. I don’t even know what I want to avoid or achieve anymore. As such, I don’t make any actual suicide plans, but I don’t know whether I care if I died right now either.

This post is linked up with The Daily Post’s prompt for today: sucuumb.

Self-Destructive

So #Write31Days didn’t work out, but not because I couldn’t be motivated to write. The reason was that, on Wednesday, I landed in crisis, took an overdose of medication and had to be taken to the hospital. I spent the night on the internal medicine ward and was medically cleared the following day. However, it took till around 5PM before I could see the consulting psychiatrist. She was a nice woman. I knew her nurse from the other time I’d taken an overdose last July. Nothing much has yet been decided, as the psychiatrist will speak to my CPN on Monday, but I was cleared to go home.

Today, I want to talk about harmful and self-destructive behavior as it happens in various mental disorders. Particularly, I want to relate it to what I assume are my current diagnoses: autism spectrum disorder and borderline personality disorder. Unlike what many people believe, the reasons for harmful behaviors are not either fully due to autism or fully due to BPD.

In autism, self-injury and aggression are common, but are seen as steretypical behaviors. For example, some autistics hit themselves as a form of self-stimulation. However, there is a common behaviorist phrase that says all behavior is communication. As such, autistics often also engage in self-injurious behavior to communicate pain, overload or frustration.

Here is where the lines between autism and BPD become blurry. After all, unlike what is commonly believed, borderlines don’t self-destruct “for attention” or “to manipulate”. Most self-harm to deal with strong emotions that they perceive as overwhelming. Whether these emotions come from within the person themself (as is often the case in BPD) or from external sources of frustration, may seem to be important, but it isn’t. A situation doesn’t make you self-destruct, after all. It’s each person’s choice, within the limits of their mind’s capacity at that particular point.

The reason I took an overdose on Wednesday, isn’t fully clear to me either. I do remember feeling sensorially overloaded with cold. I tried to warm up by going on the elliptical trainer. After all, I needed my exercise too, as I hadn’t worked out all week. I couldn’t find my sneakers or my sports clothes, so I tried for a bit to work out in my regular clohes, except for my vest. I was shivering though and this overloaded me even more. From that point, I don’t rmemeber much. I was feeling rather unreal, though I must’ve had some awareness of what I was doing, as I retrieved medications from various sources. Once the first pill bottle, which was the easiest to find, was down, I didn’t feel there was a way back.

So is this typical borderline behavior? Yes, in that it’s not stereotyped and was rather purposeful. It certainly wasn’t the stereotypical “cry for help” type of BPD behavior though. I didn’t want to call the out-of-hours GP and I had zero interest in being admitted to a mental hospital. I do think I need some more guidance, but not in the sense of somemone providing me emotional nurture.

In the sense of what caused it, it’s more autistic sensory overload and difficulty handling unexpected situations and frustrations. The help I requested when talking to the consulting psychiatrist was of such nature: I need some practical guidance on getting more structure in my day and dealing with unexpected situations. It may be my home support worker could provide this, or I may need my nurse from the assertive community treatment team for this. I also remember just now having discussed with my nurse a prescription phone call. This means that you can call (usually I think a max number of times a week or month) to a psych unit for support if you’re about to go into crisis. I will ask my CPN about this.

Psychiatric Diagnoses I’ve Been Given

I just checked out the “30 days of mental illness awareness” challenge and was inspired to write a timeline of my mental health. Then I realized I already wrote it in 2015. Another question in the 30-day challenge though is what you’re currently diagnosed with. Seriously, I don’t know what exactly my current diagnosis is. I know what the university hospital psychologist diagnosed me with, but I am not sure the psychiatrist at my current community treatment team agrees.

I’ve had a lot of diagnoses in the past. I’ve had even more suggested diagnoses that never made it into my file. Today, I will write a list of the diagnoses I’ve had. I will comment on them too.

1. Autism spectrum disorder. I was first diagnosed with this twice in 2007, then again in 2010. I lost my diagnosis in 2016 and was rediagnosed in 2017. This is the only diagnosis I’m pretty sure of that I agree with 100%. It’s the only diagnosis that I’ve been given through a proper evaluation (several, in fact).

2. Adjustment disorder. This was my diagnosis upon admission to the mental hospital in 2007. I didn’t meet the criteria for depression or any other serious mental health condition but needed care anyway. I was at the time fine with that diagnosis and think the crisis team psychiatrist who made it, did a pretty good job of assessing me.

3. Impulse control disorder NOS. I was never told why I got this diagnosis. I just found it on my treatment plan in May 2008. Probably, it was a replacement for the adjustment disorder, which you can only have for six months once the stressor that caused it goes away. I never agreed with this diagnosis and didn’t really take it all that seriously.

4. Dissociative identity disorder. This was diagnosed in November of 2010 and was probably the most controversial diagnosis I’ve ever had. I wasn’t properly assessed for it and my psychologist at the time took what I told her almost at face value. I never believed deep down that I met the full criteria for this. I mean, yes I do have alters and I do have pretty bad dissociative symptoms sometimes, but amnesia is the exception. I find this terribly hard to admit but I do have to acknowledge this diagnosis was in part based on (self-)suggestion. I do believe, like I said, that I have some dissociative symptoms.

5. Post-traumatic stress disorder. I got this diagnosis together with the DID. I don’t really know why. I mean, yes, I did (and still do) have some symptoms, but I’m not sure I have nough and I never reported more than I actually had. I did get some assessment for this. I do currently believe I definitely do have some PTSD symptoms, particularly complex PTSD symptoms. Then again, there is a lot of overlap with borderline personality disorder traits.

6. Borderline personality disorder. This was diagnosed in 2013 and replaced DID and PTSD. It was later “downgraded” to BPD traits. I do agree I have BPD traits, but I am more the quiet borderline type.

7. Dependent personality disorder. I was given this diagnosis in 2016. Never quite agreed with it, except in the sense that I could be led to believe I had every disorder that was ever suggested to me.

8. Depression. This was diagnosed in 2017 by the university hospital psychologist. I had previously been diagnosed with depressive disorder NOS, but that, according to my psychologist, was only because a diagnosis on axis I (anything other than a personality disorder) is required for treatment. I admit I was pretty badly depressed in the months that I had my assessment at the university hospital, but am not sure it was bad enough for a diagnosis. I mean, I didn’t meet the criteria in 2007, so how could I meet them in 2017? I’m assuming my current psychiatrist removed that diagnosis.

Just One Thing

Last week, I started a journal-style blog to explore my inner world. As usual, I didn’t write in it much at all, so I’m resorting back to this blog. The reason I wanted another blog is because of the derogatory comments I’ve gotten here regarding my dissociation. No, I don’t have a diagnosis of dissociative identity disorder anymore and no, I don’t claim to be DID. I do however have insiders, parts, alters or however you’d like to call them. I don’t care what people think of this, or at least, I try not to care. To reclaim myself and my experience, here I’m sharing a post I wrote last week.

Manyofus1980 from Therapy Bits posed an interesting question: if the world could understand just one thing about your mental health diagnosis, what would it be? In the post title, the question is about your “mental illness” rather than your “diagosis”. This is important to my answer, as my short answer is: my diagnosis does not dictate my experience.

I have had countless diagnoses over the years, some of which I agreed with and some of which I disputed. I don’t even know what my current diagnosis is according to my community treatment team. According to the university hospital where I got a second opinion last spring, it’s autism spectrum disorder, recurrent moderate depression and borderline personality disorder traits. Of this, I doubt the depression, because my default mood is low. Then again, I do seem to remember feeling much lower than low in the months that I had my assessment at this hospital. The thing is, I can’t usually connect my feelings from the past to the present if they’re very different.

We didn’t really go into my trauma experience, as my assessment was primarily focused on autism. However, the university hospital psychologist did recommend I get EMDR treatment for the negative experiences I had in the process of moving towards independence. I have not had a trauma-based diagnosis since 2013 and that’s fine by me. I don’t need a diagnosis to justify my experience.

I am who I am. We are who we are. We don’t fit in a diagnostic box, because, well, we’re we.

Sometimes, we feel upset that we don’t get recognition from our treatment team (as far as we know) for our traumatic and post-traumatic experiences. I had a lot of difficulty answering my psychiatrist’s questions about this during my intake interview. I mean, most of the trauma we endured, didn’t leave visible wounds. I know that dissociation can be caused by attachment issues, sometimes even too mild to create PTSD. However, there is still a common belief that only prolonged sexual or ritual abuse can create alter parts. I try not to care. We are we are we, so deal with it.

When Intense Emotions Take Over My Mind

Okay, this year’s #AtoZChallenge didn’t work out. I knew it would be tough writing about autism and related disorders when myself undergoing re-assessment for autism. It didn’t help that, from the E-mail I received on the day I posted my theme reveal, it became clear that I will not have an answer before the end of April. That wasn’t the reason I haven’t written at all since April 1 though. The real reason was my mental health.

Like I mentioned, I have been rather anxious and depressed lately. It however got extreme over the past two weeks. This likely isn’t a worsening of my depression as much as it is emotional dysregulation. That doesn’t make it less real though.

About two weeks ago, I started being more irritable and having more dark, death-related and suicidal thoughts than I had before. I had had almost-daily dark thoughts for a few months, but now they became more than daily. I also started making more concrete plans for a final step. Before then, there had been bizarre images in my head of how I’d die by crucifying myself over the staircase at home and such. These had appeared a bit laughable even to my twisted mind. Now, I started making plans and the before then bizarre-sounding thoughts didn’t seem that ridiculous anymore.

I wandered out of the house at home last week Saturday. Thankfully, my husband came back from where he’d been within aobut fifteen minutes and I was fine. Then on Sunday I had a very bad argument with my named nurse that ended in me melting down.

On Monday, I decided I’d stop taking my medication. I didn’t take my morning meds other than birth conrol and vitamin D (because I wanted to take birth control and couldn’t tell the two apart) on Tuesday. I spiraled out of control that same afternoon. This, for your information, can’t have been from withdrawal yet.

The reason I quit taking my medication was that I’d been having these dark thoughts for a while already and yet I felt I was too drugged up to express them. I don’t mean that I wanted to tell the world, like I’m doing now, but I wanted to be able to cry. And cry I did. I also felt like maybe, if I stopped taking my meds, I’d feel some kind of motivation again. I take a high dose of an antipsychotic, which admittedly the psychiatrist says can’t cause flat affect. I also take an antidepressant, but I’d forgotten why I’d been prescribed it (in 2010!) and it had never been reviewed.

Admittedly, there was also a part in me that wanted to signal to my staff that I wasn’t coping. That didn’t really work. My psychologist said that, if I wanted to be taken seriously about my mood, I needed to take my meds. Not that she’s ever taken me seriously about my mood, unless writing depression NOS into my diagnosis counts, which I don’t feel it does. She also told me that I sabotage the independent assessment if I don’t take my meds. I don’t like to admit it but that was one reason I started taking them again on Saturday. I hate to admit I give in to authoritarian manipulation, but I do.

on Wednesday, I started experiencing what I believe are brain zaps – a kind of weird dizzy spell caused by antidepressant withdrawal. I at first thought they were a side effect of a failed attempt at an overdose. They weren’t. By Friday, they occurred about every minute. I was then ready to start my antidepressant again, but wasn’t sure I could safely go back on it after five days. The nurses had to ask the on-duty doctor or some kind of head nurse or whoever and I didn’t get an answer till Saturday afternoon. Now I feel so stupid for havng bothered the nurses with this question on a week-end. I am glad for no more brain zaps though. I did also start back on the anitpsychotic. Not because I want to be on it, but because it seems I need to.

Since late Thursday evening, I’ve felt relatively well. I still experience anxiety and depression, but my emotions aren’t as out-of-control as they were before. Some things that helped were one nurse taking me on walks and allowing me to use her boxing equipment to blow off some steam. It sucks that I can’t do this at home.

#Depression: What It Feels Like to Me

I have had experience with low moods since I was a child. Nonetheless, until a few months ago, I was never diagnosed with depression. During the last round of diagnostic revisions, my psychologst decided to diagnose me with depressive disorder NOS along with dependent personality disorder and borderline personality disorder traits. I am not sure I agree and my psychologist admitted at first that it was more her needing to give me a diagnosis on axis I to warrant me staying in the institution than my actually needing treatment for this.

Today, Aspiecat described what depression is like for her. I could relate to some of these experiences, but nto others. I am going to describe what it’s like to be depressed for me.

Let me first say that low moods are my default. I am pretty sure that dysthymia, ie. chronic but mild depression, is a more useful diagnosis for me than depressive disorder NOS. Apparently though my psychologist doesn’t feel I meet the criteria for that. Really not remembering a prolonged time when I did not feel low makes me wonder whether I’m truly depressed or just pessimistic. I know that depression and optimism do not mutually exclude one another, but I tend to gravitate more towards the negative than the positive.

Then there is the state, as opposed to the trait, of being depressed. Like Aspiecat, I experience two forms of depression: the first in which I feel numb and inert and the second in which I mostly feel despair, sadness and often anger. The former tends to last longer and be harder to overcome. During this state, I sleep more than usual, eat irregularly but usually more than normal, am slower than usual and generally unmotivated. I don’t usually experience the extremest of dark thoughts in this state. Rather, I worry and feel a bit anxious. I may experience suicidal ideation during this state, though it’s rarer than when I’m in my state of despair. I am also less likely to act destructively, unless you count binge eating. When I do experience suicidal ideation in this state, it’s more of a logical, thought-based kind focused on self-hate rather than an active wish to die. I just can’t be arsed to care about life.

In the state of what Aspiecat refers to as meltdown, I, like her, experience all kinds of negative emotions. I think I may be somewhat alexithymic (unable to read my own emotions) too. I often express my emotions as anger when I’m in this state anyway, even though I think I experience many other emotions. I am more likely to experience suicidal thoughts and to engage in destructive behaviors in this state. I am usually agitated rather than slow.

Unlike Aspiecat, I prefer the state of despair to the state of numbness and inertia. There are several reasons for this, one of which may just be the fact that I’m currently numb and not liking it. Any emotion seems better than this state of inertia now. I however also feel that my despair is more actionable, because it tends to be more situational.

Other people also tend to understand my state of meltdown more than my state of inertia. They see me lying in bed all day as a choice, whereas when I’m in meltdown, they see my despair. They may not accept my agitation in this state, but at least they notice that I’m not doing well. My medication also tends to help with this state more than with numbness. I do take an antidepressant in addition to an antipsychotic, but I’m not so sure it helps with my low moods. The antipsychotic and maybe the antidepressant too do take the edge off of my agitation.

Unfortunately though, people see my state of despair as more needing treatment than my state of numbness. This may be because I don’t tend to respond well to psychotherapy and medication-wise, there is simply more to be done against agitation. I take a high dose of an antipsychotic on a daily basis. I also have a low-potency neuroleptic, an anti-anxiety benzodiazepine and a sleeping pill (also a benzo) as PRN medications. All of these can be seen as depressants. Like I said, I do take an antidepressant too, though in a low dose. I am not so sure it works, but then again it isn’t a great medication for the kind of atypical depression I experience. By this I mean that it isn’t shown to be too effective with depression that is characterized by inertia, eating and sleeping too much and general anhedonia (numbness). This kind of depression is particularly hard to treat.

Because other people are more bothered by my meltdowns than by my state of anhedonia, I also feel they tend to want me to be numb rather than agitated. I mean, of course they don’t actively want me to be numb, but they see it as less of a problem, because it causes little disruption to others. I go along with this and have never asked for more help, medication-wise or otherwise, with my inertia-based depression. I am not so sure that I should.

Diagnonsense, Oh Diagnonsense!

A few months ago, I wrote about my changing diagnosis. My autism diagnosis that’s been confirmed three times since 2007, was removed. That left me with just borderline personality disorder (BPD) as a diagnosis. If you thought I gracefully accepted this, you do not know me. I consulted with the patient liaison person at my institution, who recommended I seek a second opinion at another hospital. Now, three months on and we’re back at square one, and it’s not because an independent provider agreed with my psychologist.

On August 15, I talked to the patient liaison person, who on that same day E-mailed my psychologist asking her to make the necessary arrangements for me to get a second opinion. Instead, my psychologist told me she wanted to contact a psychiatrist at the brain injury unit first to inquire about the diagnosis of autism in people with brain injury. This doctor told her that indeed autism shouldn’t be diagnosed in people with brain injury, but the same is true of BPD. My psychologist would need to diagnose personality change due to a general medical conditon instead. I stupidly agreed with her changing my diagnosis herself rather than sending me to an independent psychiatrist or clinical psychologist.

My psychiatrist, who is the head clinician responsible for my care, however, disagreed with my psychologist’s diagnosis. My named nurse said they were throwing around all sorts of diagnoses at my treatment plan meeting last month. Eventually, my psychologist informed me they’d settled on dependent personality disorder, borderline personality disorder traits and a developmental disorder NOS. I hate the DPD label, but can see how I might have some of its features. I needed to see my treatment plan to see what they’d meant with developmental disorder NOS, which isn’t a diagnostic code in DSM-IV unless prefixed by “pervasive”. That would essentially mean autism. As it turned out, they hadn’t settled on this diagnosis, as the developmental disorder was gone.

Instead, I now have DPD, BPD traits and depressive disorder NOS. I asked my psychologist whether this was a coding typeo, but it wasn’t. Her explanation was that I may formally meet the criteria for this, but the main reason for the diagnosis is for insurance purposes. You see, I can’t be in the mental hospital without a diagnosis on axis I (anything that isn’t a personality disorder). A nurse even twisted my psychologist’s actions like she’d done me a favor.

Last week, when I found out my final diagnosis, I lost it pretty much and was considering checking myself out of the institution. My psychologist was called, because the nurses thought I said I was definitely leaving, which I can’t remember having said. My psychologist encouraged me to leave right then, which I refused. My husband instead came to pick me up thee nxt day for a night at home to have some distance.

Today, I spoke to the patient liaison person again. She was not happy at the fact that my psychologist had failed to cooperate with me in getting me a second opinion. This essentially means we’re back at where we started and I’m probably going to ask my psychologist to get me a second opinion again soon.