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borderline borderline apparently, but I think I'm schizoaffective

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 Hi all. My current dx is bipolar disorder with a side order of gender dysphoria, but when I get handed back from the home treatment team to the community team they have to put a working diagnosis in the little box. The psych seems like he's edging towards a personality disorder rather than a psychosis disorder, and I'm not comfortable with that.


What I have had in the last two years...

*the whole range of senses of hallucinations but mostly auditories and tactiles

*delusions - I thought I was an international hero 

*hallucinations whatever my mood almost constantly for that time

*mood fluctuations


What I do not do/have

*haven't self harmed in 8 years

*don't split people

*short term friendships

*sex drive


Am I barking up the wrong tree?


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DX aren't cut and dry and no one here can diagnose you. If you're that concerned maybe get a second opinion.


^^THIS. Also a personality disorder is not the end of the world. It's an MI too and can be treated with therapy and sometimes meds. It doesn't make sense to me why so many people stigmatize personality disorders. We need to change our view of them big time.

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To clarify:


Is the pdoc from the home treatment team, or your CMHT?


For some reason, there seems to be a real reluctance to diagnose psychotic/schizophrenic disorders in the UK. Maybe the meds for it are licensed differently, maybe the stigma of psychosis remains here more, maybe we just aren't that educated about them. But of the diagnoses I have had over the years, Borderline Personality Disorder was given out far more readily than a pdoc would give out schizophrenia.


Borderline Personality Disorder is essentially about having difficult regulating emotions and coping with pain in healthy ways.  It is possible to have issues with dissociation and psychotic types experiences and have BPD. Because BPD is linked to trauma, and often people with trauma have psychotic experiences, it is a tricky one. Perhaps your gender dysphoria is being interpreted by this pdoc as an aspect of instable identity, who knows.


To have BPD, you need five out of the nine criteria so self harm and relationships are are just two aspects of some of those criteria. There is much overlap and debate about what is dysphoric/unstable emotional states and what is a mood linked to bipolar. Emotional swing lasting hours to days of crippling intensity are seen as a personality disorder thing, pervasive changes over weeks that last no matter what emotions you have are more seen as a manic or depressive thing.


If the home treatment team have become involved and are doing a first referral to the CMHT, then this situation is not uncommon. In a crisis six year ago, where my symptoms were mostly psychotic like yours, I got slapped with BPD too. I worked with a pdoc, who treated my bipolar and psychosis, but also helped me with the emotional problems that fit BPD.


Diagnosis in the UK is a bit of a mess. If you are getting a referral to the CMHT you need and someone listens there and you get time to investigate, it might be expedient to let the team crack on. It might be that once you are out of crisis, you can see things differently. If you are given a BPD diagnosis and the treatment afterwards is non existent/not suitable, then maybe speak to a mental health advocacy group/patient advisory liaison service to get some help.

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The pdoc is from the home treatment team. I'm worried on several counts. 


1. I don't think they'll want me on a ward or keep me in for as long as I need if there are questions over my diagnosis/suggestions of pd.

2. The stigma is huge. 

3. I don't feel I match up with the symptoms people think of as borderline.

4. I'm just about to move house and I'm scared about how much support will be offered in my new location.


I know that it can be changed, I'd just rather not be diagnosed with it in the first place when I feel it doesn't take account of my symptoms.


the way I see it, I'm fine, I just have long overarching meta mood swings with smaller blips inside and a truckload of psychosis problems.


At the moment my mood is up a little, and the fact that they plan to completely wipe out the bipolar diagnosis is very scary - I don't think I'm emotionally unstable all the time, I do have mood problems with a long cycle, mostly settling out a little low.

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BPD is basically the fear of being abandoned or alone. So they push people away and drag them back in by manipulation.

Is that right?


There's a lot more to BPD than what you've written here. It's a complicated disorder that manifests itself differently in every person who has it. You should read more about it and educate yourself before making blanket statements like this.

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Yep, that there would be an example of why I don't want that label. Stigma plus no mention of psychosis.


I'm getting more comfortable with the idea that there may be traits in me it'd get me some help with, but that reaction about sums up why I'm so keen to get a diagnosis that actually fits me. When I was in hospital at xmas, the psych I saw said that it was a shame hospital existed for people like me, and I assume he was referring to a diagnosis query on my notes. That's the kind of 'help' I don't need.

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