Another weirdly positive psychiatrist appointment!

Sorry if this blog post doesn’t make a lot of sense- am currently feeling overwhelmed and totally exhausted but wanted to try to get some thoughts down before it all turns to mush!  I had an assessment today at the eating disorder service where I was inpatient from 2005-2007 and outpatient until 2010 which I was really, really nervous about beforehand but actually went surprisingly well.  Trying to get my brain into some sort of sense atm so if it seems a bit jumbled, I’m really sorry!  Haven’t been feeling great over the last few weeks and have had a lot of negatives thoughts/urges which have been really hard not to act on and my brain is pretty much total fuzz most of the time.

Was so, so nervous before the assessment- apart from visiting a friend a few months ago (which was also really weird and I found hard to deal with), I haven’t been back to the unit for nearly 10 years and it felt really strange going there this morning.  I was also extra-nervous because I’ve had a lot of contact with doctors over the last couple of weeks  because of feeling rubbish and spent a night in A+E last week which the doctor said he would pass on to the psychiatrist so I was a bit worried about what sort of impression I was going to make.

I decided to walk into town (about an hour and a half) in the hope that I’d calm down a bit before getting there but was still really shaky and feeling sick by the time I got there.  It took three loops of the road to actually get to the door and my brain was completely fuzzy by then- when I was filling in the forms in the waiting room, I kept getting spellings wrong including my own name!  Luckily I didn’t have to wait too long and the psychiatrist took me to a room which I’d thankfully not been in before because I think that would have been way too weird.

It was a new psychiatrist who I hadn’t seen before but I’d heard about him from a friend who also sees him, and he was really nice.  He had my notes from last time which was a big relief because I didn’t have to start totally from scratch, and he actually seemed to listen when I was answering the questions.  The initial assessment took nearly two hours then had to go for ECG and blood tests, then back for physical obs and a chat about the outcome of the assessment- LONG day and was absolutely exhausted afterwards but hopefully worth it.

The assessment was really, really thorough and so different to ED assessments I’ve had before.  He didn’t give me any screening questionnaires or quizzes to fill it (which was a definite relief because I HATE them and usually end up annotating them so I don’t come across as completely hopeless) and just asked lots of questions.  It wasn’t all about ED thoughts/behaviours either which was another big relief because most of what I’ve been struggling with recently is more mood-related and negative urges, and he kind of linked everything together which again was really positive compared to the really frustrating ‘boxes’ approach that I’ve experienced a million times before where ED doctors only talk about ED symptoms and other psychiatrists won’t talk about ED-related issues and usually I’d just get told that it’s all autism-related anyway.  But it wasn’t like that at all and he even seemed to ‘get’ what I was trying to say when I couldn’t find the right words to describe it!

ECG and blood tests went OK- my veins are rubbish so as usual, it took several tries, butterfly needles and dizziness before actually getting any blood but for once I didn’t faint which was a big relief!  Then back over the the unit for physical obs.  The results of the ECG were slightly abnormal so I have to go back for a ‘heart echo’ and have 24 hours wearing a heart strap which I’m a bit nervous about but my ECGs are often a bit weird so wasn’t too worried about it.  Physical obs were fine; I get a bit nervous about people being that close to my body and it must have showed because the doctor started talking about random stuff to distract me and it turns out he used to watch Bad Girls which is the TV show I’ve been obsessed with since I was 13 and is currently the only thing that seems to work to distract from negative urges!

After the physical checks, I had to see the psychiatrist who assessed me along with the consultant to discuss the outcomes.  Looking at it at first, it wasn’t anything earth-shatteringly different from what I’ve had before but the wording IS different which completely changes my treatment plan which is kind of a big deal.  He gave me a formal diagnosis of borderline personality disorder and atypical anorexia, and said that he is going to refer me to a dietician and for dialectical behaviour therapy.  The main difference is that he thinks the ED is part of the “bigger picture” of BPD whereas before, ED and autism have always been the ‘main issues’.  I’ve had BPD mentioned several times before (most recently at another relatively positive psychiatrist assessment: Positive psychiatrist appointments actually exist!!) but always as ‘traits’ instead of a formal diagnosis.  Having an diagnosis of it as the primary issue means that I can actually get specialised treatment for it which is a MASSIVE relief because for me, it’s the extreme moods, fixations on people, paranoia and suicidal thoughts/urges which are the hardest to deal with and I really do want help to learn to manage them.

I’m still trying to process it properly and am feeling v overwhelmed at the moment- overall, it took nearly 5 hours and was completely exhausted afterwards, but feeling strangely positive about it and especially about being able to access dietician support and DBT.  Even though my weight’s ‘normal’ thanks to medication side effects, I still find it hard to vary my diet outside of porridge and soup, binge on fruit most nights and can’t eat in front of people or outside of ‘set’ times which I really, really want to work on.  I’ve been teaching myself DBT skills for years now but it’s really hard to put in into practice on your own and I’m really hoping that being able to access it properly will help.

I fell asleep as soon as I got in from the assessment because I was so exhausted after it but this evening has been the first time in weeks that I’ve actually felt motivated enough to do something other than watch Bad Girls (again) or just lie on my bed feeling rubbish which has been most of my summer holidays so far.  So I’ve actually written a whole blog post (!), semi-cleaned my kitchen and going to try to stay up till at least 10pm instead of taking sleeping tablets so I can go to bed at 8pm which is what I’ve been doing over the last few weeks because evenings have been horrible and so hard to deal with.  Trying to keep hold of the positive feelings and really hoping it’ll last…!

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