I saw my psychiatrist today. Well actually, I saw two - first a junior doctor who took me through the standard are you eating/sleeping/enjoying life type questions, and then because I asked, my consultant. You see, the last time I saw her (well actually the last few times I've seen her) she threw out the possibility of an alternative/additional diagnosis. I've been reluctant to write about it for a couple of reasons - firstly and mainly because I wanted her to be absolutely sure before I go accepting a fairly hard core label, but also because it is such a tricky one both to diagnose and treat.
So here's how it came about. Part of the problem for me, consistently, throughout depressive episodes and when I've been well, is the rate at which my mood fluctuates. When I'm depressed it's really pronounced - I can go from ok to dangerously low to barely contained anger in a matter of hours. When I'm well, my mood tends to follow those around me - if I'm with people who are in good form, I'm in good form. If there's stress or angst around me, I take it on. As Therapist described it today, I'm a chameleon when it comes to mood.
Anyway, months back, before my psych went on leave, she had started talking about bipolar disorder, or cyclothymia. Bipolar has been ruled out on the grounds that while I have the depressive phase down, I don't get manic, and while I have experienced periods of elated mood, it hasn't been consistent enough to warrant a diagnosis of bipolar. Cyclothymia has similarly been ruled out - my mood is rarely consistent for any length of time and has most definitely been having an impact on my functioning, while most people who have cyclothymia can continue functioning and often don't notice that there may be a problem.
So, last month, when I saw my own consultant for the first time in 6 months she came up with a term that I hadn't heard before - 'affective instability'. Needless to say I came straight home and googled it, having no clue as to what it meant and not really having had the wherewithal to think of asking her at the time. What I found scared me, in so much as it was consistently associated with emotionally unstable personality disorder, also known as borderline personality disorder which, as labels go, sounds pretty nasty. I read as much as I could find online, which wasn't a lot - there are quite a few scholarly articles out there about it, but not so much for the lay person. But, what I did read made an awful lot of sense. Things started to click into place.
Since then, I've talked about it a lot with Therapist (who agrees very much with the diagnosis) my GP (who also agrees) and today, finally, with my psych. That was why I asked to speak to her personally earlier - I wanted her to explain it to me, and I think I needed her to clearly outline what she thought was going on before I'd be willing to even start accepting it. Or more to the point start working on starting to accept it. It's a big one and it's going to take time. She outlined what I had already read - the tendency for mood to fluctuate rapidly and to feel completely overwhelmed and blinded by it, the poor sense of self, the feelings of emptiness, the anger, the self harm and impulse control, the suicidal ideation, the black and white/all or nothing thinking.......there's a long list and this is just the start. I had some big questions - Is this a mental illness? Is it the same as depression, or part of it, or something else altogether? Will it go away or is it something I have to learn to live with? Will I always need to take medication? Answers? No, it's not the same as depression, it's a whole other ballgame, although exacerbated by depression. From what I've read, the two seem to go together quite neatly, although I've no idea whether one causes the other or how it generally works. It's something that I'll have to learn to live with and manage, much as I've been trying to learn to live with and manage depression. I'm likely to need medication long term. She said that generally when people with this disorder stop medication things get very bad very quickly (which I think I've demonstrated fairly emphatically the last few months) and that as it seems to be helping, it would be best to keep going with my current combination.
So there you have it. To be honest, I've had a bit of time to think about this and it doesn't seem as overwhelmingly impossible as when I first looked it up. Therapist told me it's a notoriously difficult disorder to both diagnose and treat, but now that I know what's going on, we can work with it. My treatment plan won't change - I'll continue with Therapist, I have my DBT group starting in a few weeks, I'm still under my psych and medication will be ongoing. More importantly, this diagnosis doesn't change me. I know there is huge debate out there about labels (there's at least one more post in that) but right now, I'm happy to know what I'm up against. It doesn't change me, or define me, any more than depression does. I'm no different to who I was before I got this label. All that's changed is there's now a name for how I feel. And for me, that's reassuring.
Labels: acceptance, affective instability, borderline personality disorder, DBT, functioning, labels, mental illness, psychiatrist, self harm, symptoms, terminology, therapist, understanding