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Dr John B
Dr John B, Psychologist
Category: Mental Health
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Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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Hello . I was discharged back to my Gp earlier this year

Resolved Question:

Hello .
I was discharged back to my Gp earlier this year with severe personality disorder but I do not know which one I come under.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr John B replied 1 year ago.

Hi,

I'm sorry to hear of the situation, it must be terrible to be away from your son. What were the symptoms/behaviours/difficulties considered to be representative of a PD (by whoever gave you a diagnosis)? Alternatively, what symptoms/behaviours/difficulties have been problematic for you over the years?

Customer: replied 1 year ago.

over the years I have found relationships difficult . I have reliving abuse in nightmares, panic attacks, problems concentrating, extreme mood swings where I break down into uncontrolled sobbing, permanently feel tired, weight loss , poor eating , suisidal thoughts , attemted overdoses, been in hospital four times and self harmed by burning my arms with matches and scrubbing out my vagina with a tooth brush . I was diagnosed by the therapist in Mental health that I was having therapy with whilst under the care of the mental health team. I still experience nightmares and panic attacks and poor concentration and the extreme tiredness and extreme mood swings . I have lost a lot of weight and i am self harming scrubbing out my vagina and using a loofa and exfoliating my body twice a day because i feel dirty . I am still on medication and over the years because of the impact of my traumas I suffer from migraine headaches . I cant cope with crowds and being in confined spaces . I find it difficult having relationships with men and i find it very hard to trust any one

Expert:  Dr John B replied 1 year ago.

Hi,

It sounds like things have been really difficult for you over the years. Based on what you have written I would presume that a diagnosis of Borderline Personality Disorder has been given. There are several pieces of information in your description that fit with the diagnosis

1) A history of trauma

2) Mood swings

3) Self harming

4) Poor eating

5) Suicidal thoúghts

6) Exhaustion

7) Difficulty maintaining stable relationships (particularly with the opposite sex)

Also, your description doesn't really suggest any of the other personality disorder categories.

Borderline Personality Disorder is one of the more common and this is probably because it seems to be something that can be triggered by assault (especially sexual abuse).

If you wish I can provide you with some more information on the disorder? Do you have any further questions given what I have written here?

Customer: replied 1 year ago.

On my discharge document to my Gp it states severe personality disorder that I have been diagnosed with Could you explain what this would mean and the symptoms related to this as i am confused and concerned as to how this may affect me with my case relating to my son.


Thank you.

Expert:  Dr John B replied 1 year ago.

I can understand how reading something like that would leave you feeling confused.

 

Symptoms do differ in severity from individual to individual so I would presume that by using the word 'severe' he is commenting that the problems present are more severe than mild. For example, in the case of self harming a clinician may consider self harming several times a week 'severe' and once a month 'mild'.

 

Has a specific type of PD been diagnosed or does it just say 'personality disorder'?

 

I can provide a more detailed description of Borderline PD but if it just says 'personality disorder' then the clinician is making a more general statement rather than a specific diagnosis.

 

In general 'Personality Disorders' refers to personality types and enduring behaviors associated with significant distress or disability, which appear to deviate from social expectations particularly in relating to other humans. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. These behavioral patterns are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations.

Customer: replied 1 year ago.

the Letter is actually signed off as Ms Griffin Has Personality Disorder (severe) . This is how it is written on my letter .

Expert:  Dr John B replied 1 year ago.

I must say that it is a pretty poor letter if they haven't even provided a specific diagnosis. Without a specific diagnosis they are not making any specific comment about symptoms, etiology (how it developed) or prognosis (what might happen in the future).

If I use a medical report analogy it would be like writing 'Ms Griffin has a stomach illness (severe)'.

I'm not a legal expert but I imagine it would be hard to use such a vague statement in any way at all in court.

Do you have any other questions or can I help you in any way further?

Customer: replied 1 year ago.

Do you suggest I contact mental health team I was treated by and ask them for a proper report for myself and my Gp and my therapist who is treating me at present ? And how do you suggest I deal with my mental health issues? Do you think I should still have support from the community mental health team ?


 

Expert:  Dr John B replied 1 year ago.

Yes you should certainly seek some clarification on the report as it sounds as though it is quite vague. I would imagine it would help your current GP & therapist if they have more information.

 

If I presume that what you are experiencing is Borderline PD (based on your earlier description) then I can certainly provide you with some advice on treatment. Yes you should still be receiving support if you want it...however this depends very much on what services they provide and under what circumstances. Unfortunately there are many people who need support but don't get it.

 

I'll post more detailed information on Borderline PD here:


Borderline Personality Disorder


Description


The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's emotions and feelings. Relationships and the person's emotion may often be characterized as being shallow.

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:



  • Frantic efforts to avoid real or imagined abandonment



  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation



  • Identity disturbance, such as a significant and persistent unstable self-image or sense of self

  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)



  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior



  • Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)



  • Chronic feelings of emptiness



  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)



  • Transient, stress-related paranoid thoughts or severe dissociative
    symptoms



As with all personality disorders, the person must be at least 18 years old before they can be diagnosed with it. Borderline personality disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that borderline personality disorder affects approximately 2 percent of the general population. Like most personality disorders, borderline personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.



Key Features in Detail


Frantic efforts to avoid real or imagined abandonment


The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.


Unstable and intense relationships


People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.



Identity disturbance


There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support.These individuals may show worse performance in unstructured work or school situations.


Treatment

 

The treatment generally regarded as the best approach to BPD is Dialectical Behavior Therapy (DBT). DBT is a system of therapy developed specifically to
treat persons with borderline personality disorder. DBT combines standard
cognitive-behavioral techniques for emotion regulation and reality-testing with
concepts of distress tolerance, acceptance, and mindful awareness largely
derived from Buddhist meditative practice. DBT is the first therapy that has
been experimentally demonstrated to be effective for treating BPD.


Start by taking a look at this excellent self-help program titled ‘Facing Your Feelings' here (it's completely free). It deals with one of the key areas of DBT - distress tolerance - and I find it to be a really helpful program when working with my own patients. There are also a number of books that can assist people to learn Dialectical skills at home. If you are interested in doing some further reading I can recommend both this book here and this book here .


I'll pause here and wait for any responses to what I have written so far.

Customer: replied 1 year ago.

This is very Helpful . I can relate to a majority of the information you have provided . I have not had DBT therapy . I Think that is something I should Look into and I will contact my Gp and discuss it with him and also contact mental health about the diagnosis. If I do have severe Personality disorder could you explain the symptoms and the disorder to me so I can have a better understanding please.

Expert:  Dr John B replied 1 year ago.

'Personality Disorder' is the category name for all the personality disorders and as such there aren't really any specific symptoms for the label. This is the problem with using that term as a diagnosis: it doesn't really say anything specific.

You can see that when a specific diagnosis is made (such as Borderline PD) then there is lots of information and understanding of specific symptoms. The problem we have here is that the term they have used is too vague to be particularly meaningful.

My suggestion at this point would be that you have an assessment for Borderline PD and get the diagnosis either confirmed or rejected. If it is confirmed then I would strongly encourage you to consider DBT as a therapeutic approach. You could discuss this possibility with your current therapist!

If you have further questions or would like me to clarify any part of what I have written please let me know. If not.....I wish you the best of luck!

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and 5 other Mental Health Specialists are ready to help you
Expert:  Dr John B replied 1 year ago.
Hi Tracey,

I hope you've made some progress with the confusing diagnosis. If I can be of further help, or if you ever have other questions in the future, please don't hesitate to contact me directly. You can do this by simply putting "For Dr John B" at the start of any question you post.

Regards,

John

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