Accepting The Label

This is genuinely one of the most difficult things I have ever written about because it’s the one label that I rip from my skin and pretend it isn’t there. I really struggle to accept it as my diagnosis because of the stigma and shame surrounding it. I have Personality Disorder NOS (Not Otherwise Specified) and it is incredibly difficult to live with.

I’ve not accepted the diagnosis before and always told myself that my diagnosis was wrong but reading through my Section papers made me realise that actually it is a problem and that realisation is heart-breaking. I guess I’m scared of who I am. I’ve never really talked about it before but some of the symptoms that come along with my personality disorder include:

  • Avoidance of everything that is uncomfortable. I avoid the scales at my eating disorder appointments, I avoid awkward or difficult conversations, confrontations, subjects I don’t want to talk about, social situations and so on.
  • Believing I am inadequate and worthless.
  • Low self-esteem.
  • Relationship difficulties. I have an intense fear of abandonment from those who are around me and I have intense positive emotions about them but this often leaves the other person feeling under pressure and strain and then it’s a self-fulfilling prophecy as real abandonment often happens.
  • Confusion over what happened, what was said and who was at fault.
  • Finding it difficult to trust others. I am always suspicious that people are trying to hurt me.
  • I feel that as relationships cause problems, I am better off alone.
  • Anxiety.
  • Acting impulsively, for example spending lots of money that I don’t have.
  • I have a lot of issues around anger.
  • Auditory hallucinations. I hear voices from time to time.
  • Self-harm and suicidal tendencies.
  • I feel dependent on other’s approvals and struggle if I do not get this.
  • I’m easily influenced by other people.
  • I’m very sensitive to any type of criticism.
  • A need for order and control.
  • Catastrophising hugely when small things go wrong.

I think my difficulty with accepting the diagnosis is that I feel I cannot control the personality disorder and I often feel like a bad person for the way I handle difficult situations. I fear that people will see me as a bad person if they know my diagnosis. I hate the term ‘Personality Disorder’ too, it’s like with an Eating Disorder the flaw is with eating, with a Mood Disorder the flaw is with the mood but with a Personality Disorder it is a flaw in personality, of who I am and who I was made to be. I want to be a good person but stigma and shame makes me feel as though this diagnosis makes me a bad person. I mean who would want to hang around with someone sensitive and dependent on others, someone with trust issues and relationship difficulties? It makes me fear that I will be alone forever or that I’ll hurt those I love by accident. Having a personality disorder makes me want to run away from myself but that’s not possible. I fear enduring another 50, 60 or even 70 years like this. That seems unbearable. I’m scared of who I am and what is wrong with me and I’m terrified that I may never be alright.

We’ve Got a Long Way To Go

Yesterday the Independent posted an article after Belgium doctors ruled that a 24 year old woman with depression has the right to die. I have no opinion on this article, on whether or not she should have the right to die because I have not lived her life and whilst I have my illness, I do not have hers. However what this article made me realise was just how far we have to go in terms of mental health stigma and discrimination.

These are some of the comments from the Facebook page along with my commentary:

“I am intrigued to know what kind of life lead to be so selfishly depressed. Deaths? Rape? Abuse? What exactly have you got to be so depressed about.”

Selfishly depressed? Have I missed something in this society? See I thought an illness you have no control over has nothing to do with your selfishness or selflessness. I know many people with depression, most of whom are incredibly selfless human beings. What have I got to be depressed about? Well the my neurotransmitter function is disrupted in my brain meaning that the transmission of serotonin fails to function and therefore the signal is disrupted.

“She should be grateful for life there’s a brain surgery op that turns off depression permanently via a small chip planted in the brain so she hasn’t tried every option I hope she donated her organs to give someone else the chance to live”

Are you her doctor or surgeon or have you had any access to her medical records? You do not know the options she has or has not tried or the options that would work for her specifically. Organ donation has nothing to do with this story. Her life is her life, she is not responsible for anyone with a physical illness.

“Bye then.”

Did you accidentally post this comment? You know when you’re texting and talking at the same time? Like maybe you were saying ‘Bye’ to your friend but typed it on this post by accident or maybe you’re incredibly ignorant and cruel.

“She sounds like an attention seeker.”

If I wanted attention, I probably wouldn’t try to die for it because as far as I am aware you don’t get attention once your life has ended. Mental illnesses are not easy to live with, nobody would choose to be unwell. If I go to bed with a migraine am I an attention seeker?

“She needs #yoga”

Oh yes the cure for all cancers, organ failures and blood borne viruses. Yoga. I’m on a waiting list for it now! Who needs medication and doctors and medical school, just stick to PE!! Erm…no!

“She’s 24…she hasn’t seen life yet. The best cure for her would be to visit a real third world country and see how people live through real hardship, forcing smiles on their impoverished faces.”

Cure? Or would it just make her feel even more guilty because no matter what she sees, whether it be hardship or freedom then she will still be poorly and still be stuck in a stigmatising and discriminating society that doesn’t want to be educated.

“To the woman who wants to end her life. Go join ISIS, they’ll give different ways you can end your life.”

I hope this is a joke…but then again I don’t. How inappropriate and disgusting especially only a week on from 30 Brits losing their life to terrorists. Why bring ISIS into this? What have the got to do with a woman’s mental health in Belgium?

“Send her to Syria, she will see the true depression and suffering…she will appreciate the life she has now…”

True depression? Hold on…I might be mistaken here but I thought that depression was an illness not an emotion. Sadness, heart break and devastation is what is happening in Syria but there are probably people with depression too and guess what? They would probably have depression had they been born and bred in Oxford because the issue is the brain chemistry. There is suffering in Syria but there is also suffering in the EU. Slavery, rape, trafficking, poverty and more so shall we not assume that she has an easy life? Last time I checked the only life you have lived was yours.

“She just needs a good old fashioned life check there’s people starving in Africa and they have to provide for there family’s yet she had an upbringing, grandparents who actually cared and loved her yet she wants to end her life she gets no sympathy from me ending your life is a cowards way out she should fight for what’s right and if she sat down and flipping snapped out of it then maybe she could find a resolve, a way out by helping others! This is a weird world we live in people but this is ridiculous!”

And breathe…There are also people with mental illness and clinical depression in Africa. Mental illness isn’t just for the developed countries because it isn’t a choice! Oh damn…that’s where I’ve been going wrong! All these years of illness, hospital and medication and I could have just sat down and snapped out of it. What a shame the doctors didn’t give me that advice….or maybe they have the education to know that isn’t how illness works. Got the flu and need to run a marathon? Oh just snap out of it! Okay then. Sorted. Why do we need doctors?

“Come to me lady I am sure I will remove ur depression and make u happiest girl in this world.”

Yes, that’s what her brain chemistry is missing, some egotistical, sexist and very single man. Depression cured.

“Shame she could not go to nepal or some other problem area and see how people handle disasters!  it would give her a new and much needed perspective”

This morning I was thinking, ‘Ahh how can I cure my chronic mental illness’ and then I thought, ‘Yes, new perspective, that’s what I need!’ Plane tickets to Nepal booked and hopefully this new perspective will cure my arthritis and asthma too. Who needs medication and medical professionals when you can see more trauma and devastation to cure you.

“Natural selection, why doesn’t she then.”

Whoa

“In latin american and in africa people gets killed every day for less than nothing…she wants to die? Pay the proper taxes so everybody really DONT CARE jump off a bridge”

I’m really struggling to jump on your wave length here. I’m not sure what taxes or any of this has to do with an individual’s health in Belgium. Little bit of advice for the future…Don’t tell people to jump off of bridges because one day it might be someone you know and you will wish you had been less closed-minded and more compassionate so that they had someone to talk to instead of ending their life through isolation and shame.

“Give her something real and external to be depressed about and she’ll soon want to live. North Korea or Saudi Arabia should make her realise things aren’t so bad.”

Is that how it works? Give a poorly person more trauma and sadness and they become happy? This feels a little bit like 2+2=5

“She needs to get married, have a family and trust she will as happy as Larry”

Ahh marriage! I haven’t tried that one yet…oh I won’t bother taking my medication today, I’ll just go and get engaged!! I wonder if marriage and a family cures post-natal depression too?!

“No! No! Go to Africa!”

Why would that be? Some new form of medication? Or maybe they are less discriminating that the Brits on Facebook? Who knows.

The problem is that these comments are happening every single day and I feel like a blind eye is turned. Would these comments be on a cancer story? Or a multiple sclerosis story? I doubt it and if they were then there would be many arguments starting. Nobody chooses to have depression and nobody wants to spend any length of time in a psychiatric hospital. We’ve got a long way to go. We have got many people to educate. It can be done. Attitudes towards racism and cancer and same sex marriage have changed and I have every belief that we can change these damaging attitudes too. Let’s dissolve stigma.

STOP

STOP

My psychologist handed me a few of these cards yesterday because I need them. There are times when I don’t think, I just react and then I end up making the situation worse whether that be because I’ve shouted back in an argument or because I’ve hurt myself or spent money I don’t have.

I’ve stuck these in a few places where I am likely to see them at a time when I need them. They are in my self-soothe box and next to my computer and I’m going to save the image onto my phone too.

I think STOP skills can help everyone but I feel it is important to put this on my blog because I think both people with mental health conditions and those caring for people with mental health conditions could benefit from this. Don’t just read it, write it down and put it where you will see it. If you struggle with binge eating stick it on the fridge, if you struggle with spending then put it in your purse. Put it somewhere that suits you.

Self-Soothe Boxes: Self-Harm Recovery

Something I really struggle with is self-harming and self-destructive behaviours. There are times where I feel really upset either because something has happened or because mental illness is dragging me down and I don’t know what to do with myself. I can’t concentrate on television as a distraction. Going for a walk feels like too much because I want to hide away from the world and not feel exposed and then I end up feeling kind of stuck because I don’t know how to deal with how horrible I am feeling and I don’t know what to do with myself. This is where the self-soothe box comes in.

My self-soothe box is all about the five senses which are touch, taste, smell, sound and vision. The behaviours I engage in are strong behaviours and so the self-soothe box needs to contain things that have a strong impact on my senses. It isn’t about what you like or dislike or what is deemed cool or uncool. A self-soothe box is simply about what will help YOU when you are struggling.

So what have I got in my self-soothe box?

  • A scented candle
  • A stress ball
  • Bubbles
  • Play-doh
  • Lip balm
  • Balloons
  • A colouring book
  • Word-searches
  • Photographs of people who mean a lot to me
  • A notebook
  • Chalk and chalkboards
  • Wool to make bracelets

Taste was a difficult one to include because having an eating disorder means that I don’t find taste very self-soothing but you could include mints or chewing gum. An extreme taste is pretty good to get the senses going so minty, sour or spicy food can be helpful but self-soothe is about what soothes you and if a bar of chocolate soothes you then put it in the box. Remember this is about YOU.

This is my self-soothe box:
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DBT: What Is It And How Has It Helped Me?

Recently I have had many people asking me on Twitter about DBT and it is really hard to describe it in 140 characters. My DBT folder is a good few inches thick and I’m not even half way through the treatment, there is a lot of information and so I decided to write a blog post about what it is and how it has helped me and could potentially help others.

DBT stands for dialectical behaviour therapy. I started DBT last December and my treatment involves attending a skills group every Monday for two and a half hours and then an individual session each week with my psychologist. I remember when I started DBT I just thought that it would be another treatment that would fail or that I would become too unwell and have to leave the treatment which has often been the case with me. I thought it was nonsense and it wouldn’t help me. Recently I have noticed that DBT is actually changing my life. I am still poorly and I still struggle but life is very different to how it used to be and I finally feel hopeful about the future. Everything has clicked into place, DBT has clicked into place and I’ve gone from thinking it was a waste of time to wishing that everybody had the chance to learn the skills that I am learning because they aren’t just life saving, they are life changing.

There are three modules in DBT, these are distress tolerance, emotion regulation and interpersonal effectiveness. There is also a strong focus on mindfulness with it being the foundation for all three modules.

What Is A Skills Group?

A DBT skills group is different to group therapy because behaviours should only be mentioned if it is to say that skills were used. The focus is on the positives, the times where skills were used and the skills there are to learn rather than focusing on the illness and behaviours. Many DBT groups are for those with personality disorders but I am extremely lucky that my Tier 3 eating disorder service offer a DBT group specifically for those with eating disorders.

At the beginning of every session we have skills feedback where each member of the group is given up to 5 minutes to talk about their effective skills use over the course of the previous week. For example coping with a stressful situation such as going out for a meal. We are supposed to have folders but being stubborn and hopeless I didn’t have one up until this weekend when I realised that actually DBT is doing something and the information I am being given is important.

The goals of skills training are to decrease relationship difficulties, intense and unstable emotions, acting on impulse and confusion about self and troubling thoughts whilst increasing interpersonal effectiveness, emotion regulation and distress tolerance as well as using mindfulness.

This is my DBT folder:

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Mindfulness

Mindfulness is all about being in the present moment. It’s about being aware of what is happening and what you are doing as well as observing what is going on internally and externally.

Mindfulness is not about your mind never wandering, mindfulness is about recoginsing that it is.

Mindfulness includes two sets of core skills. These are the ‘what’ and ‘how’ skills. ‘What’ skills are all about observing, describing and participating. ‘How’ skills are all about doing things effectively, non-judgementally and doing one thing at a time.

You can do almost anything mindfully including driving, eating, brushing your teeth, colouring and cleaning.

States Of Mind

The three states of mind that DBT focuses on are emotional mind, reasonable mind and wise mind.

Emotional mind is probably where most of us spend our time. In emotional mind our thoughts and behaviours are controlled by our emotions and therefore we can get thoughts that are unhelpful and distressing. It can be difficult to think logically and rationally when in emotional mind and facts are often distorted to fit with the current distress. In Harry Potter terms emotional mind would be Ron Weasley.

Reasonable mind is intellectual and scientific as it includes logical and rational thinking. Thoughts are based on facts and evidence and the person is able to plan how to respond. In Harry Potter terms reasonable mind would be Hermione Granger.

Wise mind combines both emotional and reasonable mind, it is the calm which follows the storm. Wise mind grasps the bigger picture rather than just parts. It ensures emotional mind is soothed whilst knowing that reasonable mind is correct. In Harry Potter terms wise mind would be Harry Potter.

The aims of DBT are to recognise emotional and reasonable mind and find wise mind to then appropriately address problems. Finding wise mind is not an easy thing to do and can take a long time to achieve. It is possible though. 100%.

Distress Tolerance

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Distress tolerance was the first module I did. It is all about getting through a difficult moment when you cannot make it better but without making it worse. For example if I am feeling upset about a situation in my life then I might restrict my intake in order to cope but that doesn’t get rid of the problem. In fact if we look at the bigger picture it has made the situation worse because not only am I upset about that situation but I now have to deal with the impact anorexia has on my life. Distress tolerance skills are crisis survival skills aiming to reduce suffering, not to get rid of the pain.

Wise mind ACCEPTS was the first skill we were taught. It’s all about distraction which is excellent but should only be used in the short-term. Wise mind ACCEPTS can be helpful to divert your attention from distressing thoughts. Choose things that grab your attention and keep you absorbed.

Activities: Such as baking, writing, journaling, nail painting, making an amazon wishlist, dancing, playing a game, collaging, colouring, reading etc.

Contibuting: For example blogging, tweeting, volunteering, making something for someone, look after a pet, smiling at someone etc

Comparisons: Be careful with this one, don’t make unhelpful comparisons. Perhaps compare yourself to a worse time and look at how far you have come.

Emotions (opposite): Create a different emotion by watching a comedy or fails on YouTube. Look at cute animals or baby photos. Find positive quotes.

Pushing away: Leave the situation behind for a while. Put it in a box and decide not to think about it.

Thoughts (changing): Change your thoughts by playing word games, doing a puzzle book, counting in 3s backwards, speaking another language or learning song lyrics.

Sensations: Focus on the five senses (taste, smell, touch, sound and sight) by using a stress ball, having a bath, using hand cream, listening to loud music etc.

Distress tolerance has a huge focus on pros and cons. What are the pros and cons of tolerating the distress? What are the pros and cons of not tolerating the distress? So basically what is good and what is bad about using skills compared to using behaviours?

Other distress tolerance skills include radical acceptance which is accepting what is happening at the time without making it worse or doing anything. There is also turning the mind which is all about turning your mind towards acceptance and willingness rather than willfulness.

I think for me the key parts I got from distress tolerance were self-soothing and distraction when distressed rather than getting angry or upset with people or harming myself.

Emotion Regulation

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Emotion regulation helped me to understand and name my emotions. Emotion regulation also decreases unwanted emotions and emotional vulnerability. These skills are important because they quieten the body, quieten behaviour, help to find wise mind and improve self-respect.

Emotion regulation takes a healthy perspective on emotions. We need to accept that we are emotional beings and that emotions are neither good or bad. It isn’t helpful to judge your emotions. Whilst it is okay to have an emotion, there is a difference between having an emotion and acting on an emotion. For example, it is okay to feel angry with your partner for lying to you but it is not okay to punch your partner in the face repeatedly because of it. Emotions are pretty good at convincing us they are permanent but they are not. Emotions come and go and get replaced by another emotion regularly. Emotions may feel like the truth but feelings are not facts.

Emotion regulation taught us to describe emotions. It gave us words that related to the emotion for example other words for anger are fury, rage, wrath and frustration. It also gave us prompting events for the emotion, for example seeing blood may make you feel disgust. It also focused on the biological changes relating to the emotion as well as expressions and actions and the after affect of the emotion.

Emotion regulation focuses on changing the emotion. Firstly it is important to check the facts. To notice and observe the emotion you are feeling and want to change, what event prompted the emotion, what your interpretations, thoughts and assumptions are. You should also ask yourself whether you are assuming a threat and/or a catastrophe and then think about whether your emotion fits the facts. If it doesn’t or if acting on the emotion is not effective then opposite action can be helpful.

Opposite action is acting opposite to your action urge. For example, the other day I had my sunglasses on because I wanted to hide from the world but realised this was coming from a place of emotional mind so then I took the sunglasses off. If the urge is to avoid then don’t avoid. If the urge is to attack then avoid or be nice.

Certain things in life can make us more vulnerable to emotional mind but there are ways to reduce vulnerability. The acronym ABC PLEASE can be used to remember these skills.

Accumalate positive emotions: In the short-term do pleasant activities that are possible in the moment. In the long-term make changes to your life so that positive events will happen in the future. Build a life worth living.

Build mastery: Do things that make you feel competent and effective to combat any helplessness or hopelessness you may be feeling.

Cope ahead of time with emotional situations: Rehearse a plan and prepare to cope skillfully with emotional situations.

PLEASE: Treat PhysicaL illness. Balance Eating. Avoid mood-Altering substances. Balance Sleep. Get Exercise.

Interpersonal Effectiveness

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I am only beginning the interpersonal effectiveness module now so I don’t have a huge amount of information on it. The aims of interpersonal effectiveness are to be skillful in getting what you want and need from others, for example getting others to take your opinions seriously or being able to say no to unwanted requests. Interpersonal effectiveness also aims to build relationships that are healthy, strengthen current relationships whilst also ending any destructive ones.

The three parts of interpersonal effectiveness are objective effectiveness which is about being effective in asserting your rights and wishes, relationship effectiveness which is about acting in a way that you maintain positive relationships and finally self-respect effectiveness which is about acting in a way that keeps your self-respect.

Myths can get in the way of interpersonal effectiveness, for example feeling like I don’t deserve to get what I want or need might make me not bother asking but interpersonal effectiveness gives challenges to these such as, ‘we are all equal and we all have the right to ask for what we want and need’. It is okay to ask for what you want and need and it is also okay for that person to say no but the person saying no doesn’t mean that you shouldn’t have asked in the first place.

Diary Sheets

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Everyday I have to fill in several diary sheets. I started off just filling in the standard DBT diary sheet which gets you to rate emotions, urges and behaviours from 0-5. However this has now been tailored to me so as well as filling in that sheet I fill in a mood and food diary and write down how much time I spend on myself in that day and what I have been avoiding that day. It is a lot to do every day and I spend the majority of my time thinking about it or recording things but that is a good thing because DBT is not one of those therapies where you only have to do it in the session, it can be applied to everything and should be used every day.

I understand that DBT may not work for everyone, the same as any other therapy or medication but I can honestly say with my hand on my heart that after a very lengthy battle with no signs of recovery or improvement I am on the road to recovery. DBT is changing my life.

Spending: The Silent Addiction

When most of us hear the word ‘addiction’ we probably think about alcohol and drugs. There are other addictions that float around society and we hear of from time to time such as video game addictions but for the most part addiction is often assumed to be to a mood changing substance.

I have a fairly addictive personality and throughout my battle with anorexia and bulimia I have also struggled with exercise addiction which is fairly recognised within eating disorders. I am also the type of person that will watch a film and immediately want it on again or I will listen to the same song on repeat for an entire hour. I will go ice skating for the first time and want to go the next day and the next day but these addictions are okay, they are enjoyable and do not have an impact on my quality of life. However, there is one addiction that I am silent about and today is the first time I am really admitting that this is a problem. I have a spending addiction.

I’ve struggled with spending for a very long time and for most of that time I have spent nights under the duvet googling away in the hope of finding some help and information on spending addictions but there really isn’t much out there. I cannot be the only person struggling with this and I know how isolating this feels and the horrible, scary feelings that comes along with this addiction and so I decided it was time to speak out about my troubles and to try and find the answers and share them in the hope that someone else under their duvet googling away in desperation can find some information.

I’ve hidden my spending problem for a very long time because I feared that people would judge me as greedy, self-indulgent, careless and selfish but in many ways it is similar to the binge eating I struggle with during my battles with bulimia. I don’t enjoy the food, I don’t taste the food, I don’t want to eat the food but I cannot stop myself and it is incredibly distressing. It’s the same with spending. I don’t want to spend, I have got life plans that I want to achieve, I have got food I need to buy and places that I need to go and money is vital for survival in this society. I don’t often look at the things I buy and they and their packaging end up hidden around my bedroom. I don’t want to fall asleep with the thought that my bank account has gone overdrawn and I’m getting charged £10 a day for it. I don’t want my life to be this way but at this moment I have not found a way to stop. I am working on it and trying different techniques because I am determined to beat this and help other people to beat this too.

Before I was sectioned last summer my spending hit the worst point it ever had and during my time in hospital I had bailiffs threatening to come to my home which was incredibly stressful and scary. I am a tidy, neat and organised person and I never wanted my life to reach that point and I’m terrified it will again. I was online shopping the other day and a bubble popped up saying, “How can we help?” and I honestly felt like typing in the bubble, “I have a spending problem, please help me.”

I am determined to beat this addiction now and the first step was admitting I had a problem. I am going to post my journey with spending addiction on here every time that there is an update because there really is not enough information out there and I am 100% certain that I am not the only one going through this.