Just keep swimming!

Pretty good quote from Disney there.

When I last posted on here I thought I was coming out of a blip, and then said blip continued. I 100% thought I could positive think myself out of the hole. I don’t really recall what happened but it worked very temporarily, perhaps a day, and then things became worse again. I ended up in hospital a couple of more times, but only overnight…and then slept a lot in the day time. I mean positive thinking is vital and I 100% believe that what we think, we become. That being said mental illness and being low is not exactly the same as being negative, and positive thinking can only do so much. I think when you are at rock bottom, it takes more than positivity to help you, but once you are beginning to feel a little better, positivity can really help.

Things are better now though! I went through a couple of days at the weekend where I was looking after myself better, but I felt incredibly low, which is the usual process after a blip. It’s like you are letting go of the ways you have been coping, so it’s relatively “normal” to feel a bit rubbish and it’s a lot like when you have been physically ill and it takes a few days to get your energy back, but here we are!

I can’t say I am entirely sure how things have turned around. On Friday I was in A&E from about 3am-7am…but I was determined to still go to work, but then I fell asleep. I was so angry with myself when I woke up. I woke up 15 minutes before I was due at the hospital for an appointment that I was planning to go to on my lunch break. I had to practically run to the hospital and I was not exactly wide awake. The clinic was running an hour late, and I basically slept in the waiting room for another hour and then saw them. They asked a lot of questions and were worried about me, so they wanted me assessed by the crisis team but I managed to avoid it. I walked home in a daze and really disappointed in myself. I think sometimes you get to the point where you are drained, tired, and sick of letting yourself down. I spoke to the mental health team I am under for a planned phone call and I attempted to act “fine”…but the plastic surgeons, police and the university mental health team had all contacted them within a day so the “I’m fine” routine didn’t work. When I got home I rested all afternoon/evening, and my pain levels were so high that even with prescription painkillers, I was struggling. It helped me to keep safe because the idea of more pain was, to be honest, intolerable.

I am still on extra meds, plus the pain killers and antibiotics. Apparently it’s harder to get antibiotics these days but I swear I’m given them so often! It can’t be healthy!

I’ve been to work, and the gym for the last 3 days. On Monday I saw my MA supervisor, and I’ve also been super challenging myself with food. At home especially. I had been eating the same things every day for all meals including my evening meal, and then having set rules about lunch at work that I won’t go into, but I’ve had different meals every evening, eaten foods I haven’t eaten in a long time (cheese, avocado, salmon, cous cous, houmous, crisps and more), and also eaten different things at work. Every time I start panicking about it and my head wants to go back to eating the same old things I actually get really angry with the thoughts and I feel like, and excuse the swearing, “f**k you, you don’t get to dictate my life any more” and I love it when I am able to have this attitude.

I actually feel like my recovery from my eating disorder has had two stages; stage one was forced treatment as a child, stage two was actively choosing to “recover” as an adult, and I feel like I am entering a third stage where I am no longer accepting what I previously have. I’ve not been “ill” in terms of my anorexia for a few years, but I have been making a deliberate effort to keep my weight at or just below the target weight range eating disorder services set for me, doing as much cardio as possible, eating at certain times, eating the same foods, avoiding a lot of foods and other similar things…and I feel like I am beginning to challenge that.

If I gain more weight, who cares?! I’d rather be happy. Just because my current weight is what I need to be to be regarded as “healthy”, doesn’t mean it is my bodies healthy weight. I mean BMI isn’t the most reliable of measures, everyone’s weight/BMI varies, and a minimally healthy weight doesn’t have to be the end goal. A BMI of 20 is healthy, but so is a BMI of 21-24. I choose a little extra weight, happiness and being able to eat dessert any day! More than that, I choose being mentally healthy over spending my life restricting what I eat, not eating things I enjoy and having to put so much energy into not gaining weight. There are far better things to be putting so much effort into, and some food is good for your body, some food is good for your soul!! A healthy body is important, but so is a healthy mind.

I am a big believer in lifestyle changes for anyone who has weight related issues, rather than dieting. I am a big believer in body acceptance – body positivity is great, but actually you don’t have to love your body all of the time, but you can accept it and not criticise every aspect of your appearance. I despise the money making diet industry. I despise the guilt that so many women (and men), feel over their bodies and what they eat. I despise body shaming of any description albeit fat shaming, or thin shaming, and I absolutely hate that some people feel they have to adhere to certain standards. I hate that we are bombarded with messages such as ‘fat is bad’, ‘low calorie = healthy’, and ‘no pain, no gain’ – and I want to practice what I preach!

AMEN.

A Reminder of Why I Gained Weight

Sometimes I still catch myself looking back and wondering why I “let” myself gain 40lbs. Who does that? Who chooses to gain 40lbs? I feel like a failure. I cannot figure out why the hell I ever chose to do that. I regret it. But then I push those thoughts away and focus on the here and now.

Things have been slipping for months though. You see despite weight restoring I have never really “normalised” my eating; I still choose the lowest calorie sandwich in the supermarket, I still check the calories for restaurants and choose accordingly and I do not know the last time I chose something because I WANTED it. I avoid dessert unless I can “make up” for it, and I have a huge heap of food related rules. I do not eat things that my disorder stupidly labelled as “bad”; chocolate, burgers, sweets, white carbs, pasta, high fat foods (except peanut butter haha), crisps, non-diet versions of things you can get diet versions of, potatoes, milk, ice cream, chips…you can probably guess the kind of things. I eat the same breakfast, lunch and tea every day, and the same snacks, and the only variation I have managed to add in is different sandwiches at work so long as they are from the healthy living range, and different protein with my evening meal sometimes..but which is still limited to a few options.

I have been at my target weight of a BMI around 20 for a while now, but the food related rules have been plentiful. Eating out still scares me, Christmas still terrifies me although to a lesser extent…and I still often wish I could eat what the other people I am with are eating. I still avoid social situations involving food, I still long to eat certain things and I still feel like I deprive myself. And I convince myself it is ok because my weight is “fine.”

A year or two ago I started exercising again in the form of the gym. I have stuck to three times maximum mostly, with the occasional increase before reducing it back down. Three times is fine, I convince myself…while ignoring the thoughts I have. The panic at not being able to go because it is bank holiday, the panic that I might not fit in three times if I go home. The desire to go every day and the irritable mood I find myself in on my days off. The increased frequency of going an extra day. The obsessive thoughts about burning fat and building muscle.

It has gradually worsened. And in the last 6 months it has completely deteriorated. I had a few weeks where I was running three times, going to the gym three or four, and I ended up triggering an old injury and I felt suicidal. I know that sounds dramatic, but that is what happened. I have been weighing myself daily again, and when I was arrested and placed in a cell (don’t ask!), I was not bothered about the prospect of a criminal record so much as I was bothered about not being able to go to the gym; when I was released I rang my Mum crying that I could not go to the gym (it was too late) and that I was in so much pain I could barely even walk. (By the way I was not charged and I hadn’t committed a crime..it was mental health related and complicated – I will explain if anyone wants to know, but not on here!) I have been going to the gym extra days per week, doing a lot extra cardio and walking 10-20km every day, even if it means walking in the middle of the night.

I should have seen how bad things were getting but I wanted to ignore it. Or rather, because I am a healthy weight, I felt like I had to just act fine, pretend to be fine, get on with it. It was like I did not deserve to feel like I had a problem, and I know that the one person who really knows how things have been has been irritated with me for trying to pretend there is not a problem when it is blatantly obvious that there is, but the underlying issue has been the weight part. How can I need to cut down my exercise or eat more, or challenge my eating rules, when I am at a healthy weight?

But the thing is, being in that semi-recovered but still pretty damn disordered state leaves you not just miserable, but also very vulnerable to relapse, and while I feel like I only relapsed last weekend, it had been coming for a while. Last weekend I decided to lose weight. I was in bed when I made the decision and I planned to simply cut down a little on what I was eating, but then I got up the next morning and ate less than planned for breakfast, then skipped lunch and snacks, ate less than planned for tea, and skipped supper. I went to work without breakfast and had no lunch, I just ate a fiberone bar. Roll on to yesterday and I had a glass of unsweetened almond milk, some egg whites and veg…burnt 500 calories in the gym and 600 calories walking.

And guys, it worked. In 6 days I lost 6lbs. YAY WELL DONE NATALIE (not). How I feel reminds me of a quote by Marya Hornbacher:

“And when, after fifteen years of bingeing, barfing, starving, needles and tubes and terror and rage, and medical crises and personal failure and loss after loss – when, after all this, you are in your early twenties and staring down a vastly abbreviated life expectancy, and the eating disorder still takes up half your body, half your brain, with its invisible eroding force, when you have spent the majority of your life sick, when you do not yet know what it means to be ‘well,’ or ‘normal,’ when you doubt that those words even have meaning anymore, there are still no answers. You will die young, and you have no way to make sense of that fact.
You have this: You are thin.”

You are thin. And that is all you really have.

You are depressed, anxious, isolated, suicidal and empty. But you are thin. And at times your head convinces you this is what you want, especially at the start…but then one day it hits you. I remember a moment where it hit me in my last major relapse. It was 2011, I think. I was on an acute medical ward for refeeding in a general hospital. I took my first shower in the bathroom there and they had a full length mirror. I had been avoiding mirrors, and the sight of my own body reduced me to tears. I was thin, and that was all I was. I was nothing else. I was empty, and dying, and I cried. Usually I was pleased to lose weight, to be told I looked sick, to be wasting away…but it was like suddenly my eyes opened up to the reality, and I knew that this was not a life I could carry on living.

I remember looking at my body, seeing that I really was just skin and bones, and crying. I remember thinking “what have you done to yourself?” I remember having to crawl to get to bed because I could not walk at home, and as soon as I was in hospital, not being allowed to go anywhere except in a wheelchair. How can you be 19 years old and in this state for the third time?

 

 

So yes, I spent the last week losing weight as quickly as I could, taking diet pills that used to be prescription only on the NHS but were then banned for causing heart failure, and feeling moody as hell. I had a rubbish appointment with my mentor at uni. I have laid in bed making weight loss plans. I have worried about managing my degree and work, and doing pretty much anything. I have cancelled plans, avoided going home for my sisters birthday, and to be honest, been a wreck all while hiding what I was doing from everyone.

And then today I got up and I ate breakfast and I walked to Tesco and bought food, and I ate lunch and tea. I took the day off the gym, and after I had walked so far, I forced myself back home…and it was literally force. And I do not know how I have managed it. My stomach hurts. I have cried. I feel like I am about to gain a stone in the coming days and weeks, and I think I need to make the decision that a BMI over 20 is not the end of the world. That if I want to minimise the risk of relapse and stop living my life by so many damn food and exercise rules, I have to accept my body wants to be at a higher weight than eating disorder services told me to be.

Back to wondering why I ever let myself gain weight:

I did not gain weight because I wanted to gain weight. God if I had waited for that day, I would be in a grave by now. And that is the thing. An eating disorder is not a diet. There is no ‘end’. You just keep on going and I am one of those people who either eats nothing, or eats 3 meals and a snack every single day without failure. I am obsessive, and very rigid and that is how I go. There is no middle ground.

I have remembered why I gained weight.

  1. Social stuff! When I am losing weight and restricting I avoid people. I avoid family and friends and anything that might involve food. This is my biggest reason to eat; I am focusing on wanting energy for work and to help at an event on the 7th of June. I have arranged to see friends on both Monday and Tuesday, and my sister for the day after her birthday. This will be challenging, especially with food, but I know that being able to remind myself that eating = being able to spend time with the people I love will help me manage eating properly again. And I am not going to just try and return to where I was a few weeks ago…I want to start eating what I WANT and not trying to maintain a minimally “healthy” weight. I do not want to spend my life micro-managing my eating and weight.
  2. Because when I starve myself and become severely underweight I am an awful person. At my worst, as a teenager, I attacked my family, smashed windows while cooking, threw plates of food that my Mum was trying to force me to eat at her, and hid food in socks, pockets…anywhere. But beyond that…I was silent, empty, dead. I know if I relapsed I would sit with my mentor every week in silence, or talk and feel as rubbish and as guilty as I did yesterday. I do not want that life back. I do not want the life back where nothing is important except avoiding food and losing weight.
  3. I really, really, want to go back into treatment, and USE it. GET BETTER. If I go back there at the end of this year, two stone underweight, I will not be able to use it to get better. (It is not for eating disorders) I will struggle; I will struggle to talk because I will be a zombie. I will struggle with eating there. I will struggle to manage to physically cope with getting there and being there all day. Managing just to sit there in silence would be an achievement. I need to be better than that; I need to be able to make the most of it.

There a whole heap of other reasons; enjoying food, being warm, not wanting my osteoporosis to get worse, concentration, Christmas, energy…but those three are my main reasons.

It feels strange admitting what the last six months have been like, and what it has accumulated to in the last week. It feels scary to admit that I am not as “recovered” as I would like to think, or as I would like other people to think. It is hard to say that I have a lot of things I need to change, and possibly some weight to gain, when I am not really underweight and nobody can see that there is a problem.

But there is a problem. I do not care if you are under eating, or over exercising, or not; I am telling you that if you are psychologically obsessing over food, or have rules surrounding food and exercise that cause anxiety, make you depressed, and that dictate your life to you, you deserve more.

You deserve so much more. And I deserve so much more, and if I want to get anything from this week of hell, it is to get truly better for the first time ever, and make other people aware that being at a healthy weight does not mean you are “recovered”, or that you cannot gain more weight. And that being “fine” does not have to be the end. You are worthy of more than “fine” and I am here to tell you that just like me, you can fight for more. You can fight for more than just “fine” and for more than managing, and for more than having to follow your life with rules. I am here to tell you that being weight restored does not mean you cannot still be struggling, and does not mean you have to pretend to the rest of the world you are ok when inside you are still fighting a battle.

The Life Plan

My life plan right now is better known as the treatment plan. I’ve had a bit of a dilemma recently. I have a place at an assessment centre for a grad scheme. It was unexpected and it threw a spanner in the works. My plan was to fight to get back into the therapeutic community aka take time out, and then when I got onto the assessment centre I was thinking ‘Maybe I could just never go back to treatment and get “better” by just “getting on” with my life’. And it could work out. Treatment isn’t always the way to get better. Sometimes living life is. Maybe moving to London and doing a full-time grad scheme would help me get “better”.

However a draft email has been sat in my outlook account for the last week. A draft email stating that right now, due to health reasons, I can’t accept a grad scheme offer, therefore I need to pull out now. The reluctance to send it is the ‘But what if I actually got offered a place on the scheme? How can I turn that down?’ which is why I need to hit send. Because if I did get offered it, it would make my life even harder.

I had an “interim appointment” with the PD service today. A brief explanation if you don’t already know from my other posts is that in November I was, in short, chucked out of the therapeutic community (TC). I was “too unstable” and “too high risk”. I ended up on an acute psychiatric ward, and if you are deemed as being acutely unwell, you are not deemed ready for therapy. Since then I have just had an interim appointment in March.

Today a plan was made. My options were private, self-funded counselling which I was assessed for, and found for a VERY reasonable price; it’s with a charity, and they do student rates of £12 an hour! If you’ve ever looked into private counselling you’ll know you can pay £40-50 an hour minimum. So that was option 1, and would involve being discharged from the PD team with re-referral for the TC once ready and suitable (I’m not allowed back while people I was in treatment with last year are still there). Option 2 was to do a smaller, once weekly group for 6 months, starting in Jan with an interim appointment in May and fortnightly scheduled telephone support, then re-referral to the TC in July 2018. Option 3, which was the option I put forward, was to skip the once weekly group, have the interim appointment/phonecalls, and be re-referred to the TC as soon as I can be.

We are going with option 3! The downside is I won’t be having any formal support until that time comes, which should be November/December – but I will have an appointment in August, and fortnightly phone calls with my lead professional. They are going to work out the date they *think* should be the point at which I can go back into the TC process and let me know. I’m expecting it to be no later than December.

The TC process is a long one. You have to do a prep group first, on a Tuesday morning. If I started that in January, I’d expect to be finished in March/April. It took 4 months last time but I think this time I could be quicker. Then the actual TC is for one year. The TC is 3 days per week, with the occasional extra half day where you are expected to help run the prep group in blocks. Halfway (or 3/4 way) through the TC you join another group called Thrive, which would increase it further…Thrive is basically like the prep group, but it’s a post-therapy group…it’s preparing you for leaving the TC…and when you leave the TC after the one year, you continue going to thrive for either three or six months, I can’t remember. All in all you’re looking at 18-24months.

I am dreading it. The TC was the most exhausting, at times soul destroying, intense, sometimes toxic, environment I have ever been in. I found going there three days per week more exhausting than I would find a full-time job. All I wanted to do when I left each day was sleep. Weekends were spent recovering from the week.

The idea of going back terrifies me. It is by no means the easy option. It would actually be easier for me to try get on this grad scheme. I wouldn’t have to feel bad for not being in full-time employment. I wouldn’t feel like a failure because all of my friends are working and living their lives and going somewhere…and I am sat in a hospital. I wouldn’t have to turn down an amazing grad scheme. I wouldn’t have to worry about money. I wouldn’t have to go through intense therapy that is going to bring up some tough stuff; I am not a person who openly talks about stuff with people, so group therapy is really difficult for me. I am sat here right now thinking ‘oh f**ck what am I doing?!’.

But it’s the plan. And it is a good one. I can finish my current job because I will still be here in September, and honestly I was worried at the idea of having to leave the job early to move away for a grad scheme (grad schemes start in Sept) because I would honestly be absolutely gutted about it. People kept saying to me that I can’t not take a 1-2yr grad scheme because I want to finish the last month of a temporary contract and I was like UMMMM YES I CAN IF I CARE. So this works out soooo well for that. A grad scheme would also mean moving from Leicester at the start of Sept when my MA finishes on the 31st aka I would need to get my dissertation finished a month early which would be fun!

And how I am seeing this is…yes I am 25 this year and I thought I would be well into a career by now…but what is 1-2 years of my life if this treatment actually helps? Do I want a full time job where I am struggling and spending evenings and weekends in hospital or prison cells? Or do I want to focus on treatment, get myself sorted, and then focus on my career? In the long-term this could be the best decision I have made. I will be fully dedicating myself to treatment this time…rather than doing treatment plus university. This time I am going to give it everything. If I am taking a year or two out, I am going to make it worth it. While I do want to find part-time work, the part-time work will have to be second on my list of priorities.

So now I just need to work out how to get myself ready for returning so that I don’t get chucked out for a second time!

PLAN.

We also had some interesting conversations regarding diagnosis which I might write about another day, and it was raised that my exercise might be becoming excessive and/or obsessive and how to manage that.

A move towards targeted mental health awareness?

It’s mental health awareness week so it’s like I should post. I blog on mental health so not posting would be kind of weird…but then isn’t my whole blog raising awareness? It’s not really my goal to raise awareness for one week annually.

I’ve read some thought provoking stuff surrounding the use of mental health awareness events, which I imagine could apply to other awareness days and weeks too. The first was on Twitter; someone talking about being sick of talking about mental illness and not actually doing anything about it. Tonight I’ve seen a great illustration by rubyetc. I’m sure a lot of you have heard of her and I’ve included the illustration for you – you should check out her work if you’ve never seen her stuff before! Any way, this illustration is based on mental health awareness events being tedious. The illustration contains the comment “Yes I am very aware, thank you very much.”

And I get it. Sometimes I don’t want to hear, write, talk or anything to do with mental illness. Sometimes I hate awareness stuff and as a mental health blogger and as a person living with mental illness, you feel like you are not supposed to feel that way.

I guess the point is that some people are not aware, or not enough. I think awareness campaigns for particular areas of mental health are particularly important such as more misunderstood, often neglected disorders or issues such as addiction, personality disorders, and self-harm in adults. As for more common mental health problems like depression, anxiety and increasingly so with schizophrenia, people are more aware of the symptoms and more understanding than ever; but this doesn’t mean awareness isn’t necessary, but that a focus on specific areas – myths, misconceptions and how to help someone – is required.

When you have a mental illness it can definitely be a bit tedious though. Sometimes it feels like people touch on the subject because it’s awareness week, but not because it really means anything to them. But then how can anyone do in-depth work on EVERY SINGLE awareness event?

All of this has definitely led me to do some reflecting – how can I actually do something that makes a real difference? How can I reach the people that really need reaching? What areas of mental health really do need focusing on?

I feel particularly concerned with raising awareness of borderline personality disorder for obvious reasons; it’s something I’m diagnosed with, and you’re always going to care more about something that has impacted upon your life. But there are a number of things that have impacted upon my life, and this one still stands out to me as something to speak up about because it is such a highly misunderstood disorder which carries such awful stigma, and to be honest I’m not convinced that many people could tell me what BPD is if I stopped them and asked them.

My dream would be to educate professionals that come into contact with those with BPD who need better understanding to improve their ability to help. From personal experience this would be A&E staff and the police, but I am sure there are many more people who would benefit.

So I’m left thinking, can little old me do something about that? And what if I came face-to-face with the people who have seen me at my worst that I never thought I would have to face again? The thought of it is a bit sickening!

A weird thing happened a week or so ago. Two police officers that were involved in an incident with me a while ago did a random courtesy (if you like) call to my house. They called it a welfare check – you can imagine my panic when I opened the door and they said my name. I didn’t remember them because I really wasn’t in a state to even notice what they looked like so I was stood there having an internal panic; what have I done? I can’t remember doing anything?!

The first thing they said was “you look better” and it was weird to see them when I was feeling good and “well”. I think it was even stranger for them. It makes you realise the striking difference between how you are when you are managing, and how you are when you’re not. And I think it’s important for professionals to see that who you are when they see you, in that time of desperation and crisis, is not the person you truly are. I think it increases understanding that for the person to be in such a state, is to show that they truly need help because it’s outside of their ‘norm’. I imagine it is quite easy to see someone in a crisis and think that those moments define them, and I get that. I don’t think it is wrong of people to think that; but it doesn’t define them and it’s going to take people showing who they are beyond their label to change this.

A Shocking Fact About Mental Health

We all have it.

I know it doesn’t sound like a mindblowing fact, but apparently this is an issue. I recently saw, through a friend, a housing advertisement that said “we do not accept people with mental health”.

Now ignoring the fact that it sounds a hell of a lot like discrimination to me…I think they got their words confused because we all have mental health. Looks like this landlord doesn’t want a tenant!

Mental health does not mean mental illness. We all have mental health, just like we all have physical health, and it’s on a scale. We all have varying degrees of physical health, and this can worsen and improve at different times in our lives; it’s the same with mental health! You can have some issues with poor mental health without being mentally ill, without being in treatment and without y’know, seeing yourself as having an illness. Nobody is exempt from mental illness, or periods of poor mental health. Stress is a mental health issue, but being stressed isn’t an illness. We are so black and white when it comes to being mentally health and it’s a problem.

It’s recognising that we all have mental health that can lead us to being more understanding. People with mental health problems aren’t the ‘other’. They are me and you, your next door neighbour and your colleague from work. Rich, poor, black, white, lower class, upper class, heterosexual, homosexual, top of a business or right at the bottom…it does not matter. While there are higher risk groups for mental health problems and specifically for mental illnesses, they are just that, HIGHER risk; not the sole people at risk. Sure, if you’re born with stable parents, experience no trauma, have a good education, a great career and lots of supportive friends, yay because you are less likely to become severely mentally ill, but I hate to have to break this to you…mental illness does not discriminate, so it’s not all rainbows and butterflies.

Really I hope that if you don’t have a mental illness, you know that you still have mental health, and how you feel and cope is just as important. And if you do have a mental illness, I hope you know that even the people around you who don’t still have their dark times. I know it can feel like it’s just you, but it really isn’t, and the sooner we can all talk about our difficult times, the more acceptable it will become.

As for that landlord…using the wrong word was an accident, but it raises a significant issue with the way we think and talk.

(We’ll save the thoughts on not wanting a tenant with a mental health problem for another day!)

The Morning After the Night Before

I don’t drink. That’s right, not at all. A lot of people seem to struggle with the concept of not drinking at all and I’m pretty sure that says more about them, than me. I’ve had medical professionals be shocked because “people like me” usually drink and shouldn’t. When I say I don’t they have responded with “ok, but you shouldn’t drink at all if you can help it” like I don’t drink means I drink sometimes. Then there are the other times…taxi journeys where the driver brings up being a student in a city, and the night life. When I say I don’t go out they will usually go down the lines of “so you’re a pub girl”. No, not particularly. Next it’s “so do you just drink at home?”, followed by “a student that doesn’t drink, that’s odd!”.

It isn’t actually odd. I imagine many more students don’t drink that we would expect. My reasons for not drinking are complicated. I always say it is because of issues people in my life have had with alcohol and that it has put me off, but that would be a stretch of the truth. I want to say it is because when I first developed mental health problems at 14, I used to sneak alcohol out of my Mum’s vodka supply and take it to school in a water bottle and one time I went to a small party, got drunk, had a meltdown and locked myself in a bathroom, but again, the fact that drinking probably wouldn’t be good for me has very little to do with not actually drinking…just a lot to do with why it is probably a good thing. The honest reason is that it is a part of my eating disorder I have never overcome and really don’t feel a need to.

I didn’t go through the whole turning 18 and going out thing. I was at home starving myself to death, isolating myself from everyone and everything, and in my mind alcohol = a waste of calories. Why would I drink alcohol when I was only allowing myself 200 calories per day? Two vodkas and that would be all I could consume for the day. No thanks. And now I am “better” I challenge all of my disordered behaviours and thoughts, but with this one I just have no desire to. Take avoiding eating desserts. I have bundles of motivation to challenge that because you know, desserts are amazing and I genuinely want to be able to eat them. Hello cheesecake my long lost friend! But I’ve never enjoyed alcohol and it doesn’t interest me. I feel like I would be forcing myself to drink for the sake of drinking.

I do, however, know the feeling of the morning after the night before because having borderline personality disorder is great like that.

My mornings after the night before are filled with shame, embarrassment, and regret, and it is horrendous. Even months later the memories fill me with these emotions and when it is immediately after it quite literally makes me feel sick. I had one of these episodes this weekend. I won’t be going into the details because honestly, I am ashamed, and I really excelled myself this time. It went to a whole new level and the only thing I can think of to make myself feel better is ‘I won’t ever have to see the people involved again”. It has been a truly rock bottom moment and when it hit me what was going on and where I had led myself, I almost thought I was dreaming.

It is hard not to absolutely hate yourself for how you behave and feel at your worst. I feel like I want to rewind time and grab my own shoulders and give myself a good shake. WHAT ARE YOU DOING YOU FOOL?! Don’t be an idiot. Pull yourself together. Stop being so angry and take help.

However, there is a fine line between taking responsibility for your behaviour when you are mentally struggling, and blaming yourself to the point of hating yourself. While I absolutely believe I need to feel some degree of shame and regret in order to change, hating myself and over worrying about the way I was and the state others saw me in (aka what they were thinking of me) is not helpful; it makes me worse not better.

So after you have had a blip, a lapse, an episode or whatever else you want to call it, it is healthy to have some regrets and it’s a good thing to consider how you could have prevented yourself from getting to the stage of being out of control. BUT, if you blame yourself too much and are too hard on yourself, the guilt is going to eat you alive and you’re going to end up having another blip to cope with the guilt. Say your issue is drinking, and you get drunk and do something stupid and feel far too much guilt and self-blame…the risk is that you’re going to end up drinking again to manage that guilt. It’s counter-productive.

The line is fine and difficult to find, but it is a part of ‘recovery’ that you are going to have to keep working on because it is absolutely key to getting better. It’s all really about radical acceptance after these blips; you cannot change what has happened, and while you don’t have to be ok with what happened, you cannot punish yourself for it.

Learn. That is what you can do. Life is a series of lessons.

Borderline Personality Disorder and Emotional Dysregulation: Part One

There is a frequent debate about the term ‘Borderline Personality Disorder’ (BPD).

The term ‘borderline’ was coined in 1937 when it was believed that patients with the disorder were on the borderline between psychosis and neurosis. This is no longer seen as necessarily the case, and definitely not the case for everyone with the diagnosis, and today people prefer to call BPD ‘Emotionally Unstable Personality Disorder (EUPD).

I was actually asked which I prefer my diagnosis to be called, and I chose BPD. I know so many people hate this and choose EUPD, but being called ’emotionally unstable’, while probably accurate, just does not sit comfortably with me. To me, I think EUPD is a much more stigmatising label. ‘Emotionally unstable’ makes you sound, well, like an overly emotional mess and like someone to be avoided. It also sounds much more like one symptom of the disorder, albeit a major one, rather than a collective term for a set of symptoms. Ignoring that issue, I would prefer the term ‘Emotional Dysregulation Disorder’ which is occasionally used, but I actually think that BPD is more of an attachment disorder than anything else. There is a disorder called ‘Reactive Attachment Disorder’ but this is usually only diagnosed in children. I wonder what they think happens to these children when they hit 18? I think they probably, if their problems continue past that age, get diagnosed with BPD (which is usually only diagnosed in over 18’s).

That bothers me. Under 18 and I have an attachment disorder. Over 18 and I have a personality disorder, which is far more stigmatising.

Emotional instability, usually referred to as ’emotional dysregulation’ is a huge part of BPD. But this instability goes much further than emotions; it can be instability in a person’s sense of self/identity, and I think this can stem from being brought up in a very unstable environment. I think people would find out things about my childhood and call it pretty bad, and it was, sometimes. And sometimes it was not. Sometimes we were like any other family; happy and sad in “normal” ways. But things changed quickly and suddenly, usually without warning. I reckon growing up in that kind of environment, where you do not know what things are going to be like hour to hour, it makes you feel like nothing is safe, and that you do not know where you are going. One minute I had two solid, grounded parents and then in a blink of an eye one was back to abusing alcohol and the other was violent and would disappear off the face of the planet for a few days. There would be periods of stability in my Mum’s mental health, and then in the blink of an eye she would be carted off back to the psychiatric ward.

And to be honest, it felt normal. It was our normal. And when you live your life always ready for things to get worse, not knowing when it is going to happen, you become incredibly hypervigilant, and you develop ways of coping with it. Sometimes these coping mechanisms are unhealthy and dangerous, but regardless of that, they serve some kind of purpose. With regards to my anorexia and self-harm, I have often felt like those two things were always going to be there for me, that they were not going to abandon me, and so I clung onto them, sometimes with all my might, and other times just loosely, in case I needed them – never able to fully let go.

Education was my one positive coping mechanism, as I have wrote about before. School and college were always going to be there on a Monday morning at 9am. The supportive tutors, lecturers and support workers were always going to be there too. It was a safe haven, and especially during my time at school, it was the one place I did not have to pretend. This is quite different to some people’s experiences, where school is a place where they put on a mask, but for me school was where I could let myself feel my emotions and express them, and home was where I concealed everything. This was at times problematic as things would spill out uncontrollably. I would fall apart. But it was also needed at times. As I have become older I have gained a lot of control over this and while that seems like a good thing, it does mean that university tends to be a place I wear a mask to some extent – but I have a support worker within the university who I do not do this too. I guess it is more controlled now.

So, what is emotional dysregulation?

Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood) or mood swings.

This is something I have become increasingly aware of in myself over time. When I was in a child and adolescent psychiatric unit aged 15, I was diagnosed with cyclothymia, which is basically (and this is very simplified), a form of rapid cycling Bipolar disorder. This has never been mentioned again, and this is because while cyclothymia means that your moods change more frequently than found in typical Bipolar cases, my moods change much quicker than in cyclothymia, and approximately 50% of the time, in reaction to something happening around me.

It can be quite scary. Last Friday I ended up in A&E as I mentioned in my last post. I felt like I was at one of my worst points in a long time, and that was fair to say. Now, five days later, I am at one of my best points. It is a very unpredictable thing, that makes living difficult. I know that while I am feeling pretty good at this moment in time, in a few hours I could be laid in bed trying to sleep and having really negative, dangerous, thoughts and urges. While thoughts cannot hurt me, they can lead to me acting on them, which can hurt me. Learning to have these thoughts and feelings, these urges, and not act on them is one of the hardest parts of ‘recovery’.

When I am in the mindset of wanting to act on those thoughts, practically none of me can see any reason not to. I mean it varies; sometimes I can. Sometimes I can be very rational and recognise that feelings will pass, but other times the feelings are so intense and I lose grip of what I would call my “true self”, and there really is no talking me around when I am in that place.

I really want to end treatment and “get on with my life” as I keep saying. My support worker at university told me that while that would be very lovely for me to do, I need to think realistically about my ability to handle the responsibility of a full-time job right now. On my good days, I would be fantastic for a full-time job, but on my bad days, or during my rough patches, it would be a disaster. Right now, being a full-time student and working part-time is perfect for me. Work is absolutely perfect. I will admit I feel like I stumble my way through university. How I managed to get a degree, sometimes I really do not know. But it is manageable, and I am really lucky to have really accommodating lecturers. But in the working world, especially a full-time graduate scheme, this would be less likely to be the case which is why I am spending the next two days deciding whether it would be best to pull out of the graduate scheme assessment centre and focus on continuing with my treatment plan.

Does this mean someone with BPD can never have a full-time job? Of course not. I am sure thousands do. There are many extremely high-functioning people with BPD. BPD is often categorised into low functioning and high functioning (and I am pretty sure people can be a combination of the two). I think I am a combination of the two. Just the other day an A&E doctor told me he had never met someone with my diagnosis who was doing as well as I am, nor doing a masters. I reckon he would be surprised how many other people with BPD are doing high level qualifications, but that most of the people with BPD who find their ways into emergency departments are the ones who perhaps are not.

 

  • Low Functioning Borderline – The “Low Functioning” borderline is what most people think of when they are first introduced to the condition. Low functioning BPDs are a living train wreck. They have intense difficulties taking care of their basic needs, are constantly experiencing mood swings. They also have an extremely hard time managing any sort of relationship with another human being. Low Functioning BPDs are often hospitalized more than other BPD types, for the very reason that they can’t live productively without constant coaching and supervision. These patients are challenging for all but the most experienced psychiatrists. Unless otherwise treated, low functioning borderlines lead self destructive lives and attempt to manipulate those around them with desperate acts, including self harm (cutting, etc.).

(The comment regarding manipulation is not necessarily accurate. Often what appears like manipulation in BPD is just a person’s lack of ability to get their needs met, or express themselves, in a normal way – someone without BPD might need some extra support, and turn to a close friend and ask for it, whereas someone with BPD may struggle to recognise what they need and therefore find other ways to manage their feelings i.e. self-harm. Contrary to believing self-harm is a manipulative and attention seeking behaviour, self-harm is usually a very private, secretive thing – and any way, needing attention is not a bad thing. We all need attention.)

  • High Functioning Borderline – The High Functioning Borderline Personality shares many core aspects of the low functioning borderline personality, except for the fact that they can manage their lives, appear to be productive, and generally keep their relationships civil (even diplomatic in nature). High Functioning borderlines can appear to be normal, driven people one moment; then moody, inconsolable, and manipulative the next. Somehow, there is a mechanism within the minds of High Functioning Borderlines that allows them to lead somewhat “competent” lives, despite the fact that they are in a constant battle with BPD. High functioning BPDs are no better than low functioning: it’s basically the same face wearing a different mask.

 

 

These two “categories” are a bit too black and white for my liking. I am high functioning in terms of work and academically with my current workload. If I had a full-time job this would probably reduce. I am very low functioning in terms of mood swings, social functioning and self-destructive tendencies.

The thing about emotional dysregulation is, you can learn ways to manage it – and there are a huge number of ways that may or may not work for you personally, which I will discuss in a following blog (because I am on 1800 words and quite frankly that is ridiculous!)