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Depression or Something More?

by Kristina Randle, Ph.D., LCSW

I have concerns as to whether I am just a depressive person or whether I have BPD- I appreciate a diagnosis cannot be made via the site but advice on which direction to continue would be appreciated.

I am 34 married with one child. I have been together with my husband for 13 years – he is the only male I have never forced to walk away.

I have some very strong instincts that I was sexually abused by a non family male- although I don’t know who exactly or remember what happened. Certain things will trigger these memories white bedroom furniture- pink flowery items (like Cath Kidston).

Prior to being married I was in and out of relationships and had many sexual partners-but would always pick fights and make them leave- I thought that if they could put up with that they may be able to put up with me longterm. I also used to drink heavily my only habit now is that of the internet as much as 6 hours a night often lacking in sleep to fulfil what I want to do on-line. This is am sure contributes to my almost daily panic attacks- noises are a huge trigger- in part due to the rows that happened between my parents as a child I believe. My childhood was not great my mother basically neglected us after my parents separated my older siblings bring me up- she then fell pregnant and I was often left alone looking after a baby when I myself was under the age of nine whilst she went out -my siblings had either left to find work outside of the area or were also out running wild.

For many years I have had what I describe as out of body experiences – like watching myself on film. I also have periodic episode of self harm- usually when things feel out of control in my life. I tend to cling to what I know and dislike change immensely- even small changes such as having to change my route to work can aggravate me- lurching me into either panic or irrational anger. I have had or been diagnosed with three bouts of depression one aged 21 one aged 24 and then PND after the birth of my son- although I was quite low throughout the pregnancy. Due to family issues I sort help from my GP last summer who then referred me to a mental health nurse and subsequently to a psychotherapist for a 20 hour course of CBT.

Here I was told I have low self esteem and whilst that may be true I felt that there was something more. I tried broaching the subject with my therapist but was told they don’t deal in diagnosis as CBT is about the here and now. My CBT is now finished and I am dealing alone with the un-discussed transference issues that I had towards my therapist. On looking back through my life he is not the first person that I have idolised in this way and set out to find all I can (His address and phone number although not acted on either of these pieces of info).

I have times when I wont leave the house except for work and this has affected my relationship with my son. I am seeking to change this and am working with a post natal support group that my therapist referred me on to. My therapist(s) seemed pleased with my progress but I still feel a fake and a fraud. Aside from my husband ( who doesn’t help with my low self esteem) I have very little support one or two close friends who I see periodically and although I have a large family they seem hell bent on destroying me and like to add more pressure to my life my mother is an alcoholic and my father was absent for most of my life. I did the quiz thing via Sanity Score and scored at 157.

Does this sound as though I may have BPD or something else and should I try and get a formal diagnosis and continue in therapy- this would be a struggle due to current healthcare provision in the UK as I would most likely have to pay. What would be the most appropriate therapy for someone such as myself.
Many thanks for reading this.

Borderline Personality Disorder (BPD) may be a realistic possibility. You do match some of the symptoms. Another complication is the possibility that you were sexually abused. Further supporting this possibility are specific “triggers” that propel you into a panic attack.

The out-of-body experiences you have described are also characteristic of an abusive history. They are a form of dissociation. Dissociation is usually associated with a history of trauma.

I am not familiar with the UK healthcare system but if receiving a formal diagnosis is necessary to continue therapy, then you should pursue that option. In addition, it would be advantageous to undergo an evaluation to determine if BPD is an accurate diagnosis.

Cognitive behavioral therapy seems to have helped but 20 sessions does not seem to be enough. You continue to experience very problematic symptoms. If you do have BPD, CBT is typically not the first line of treatment. Dialectical behavioral therapy (DBT) is. DBT is an evidence-based and proven treatment for BPD.

In the meantime, you should learn all you can about BPD and its treatment. I would suggest reading books written about BPD by both mental health professionals and individual sufferers. All perspectives would be helpful. One book that many have found particularly helpful is I Hate You Don’t Leave Me. BPD workbooks exist that help individuals to deal with specific symptoms. You may also want to consider joining an online BPD support group/forum. We have one here on Psych Central. Face-to-face support groups may also be beneficial.

Do everything you can to get the help that you need. I wish you the best of luck.

Dr. Kristina Randle

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