Locked out - Part one

Locked out again, I was ten minutes late!
You would think I would learn that this was my fate
"Go away" she would say, "you're not wanted here"
Those words are still ringing everyday in my ear.
I'd start by sitting outside the front door
But I would be numb from the frost on the floor
I'd walk and I'd cry and I'd hear a fox yelp
And I'd realise that I was alone without help.
I'd walk up the road and into the farm
Where maybe I'd be a bit safer from harm
I knew where the key was, the key to the shed
And I'd lock myself in there to sort out my head.
I'd sleep all alone on the broken down seat
Except for two dogs who provided some heat
They were my covers, I was cold to the core
My limbs stiff and hurting behind bolted door.
Frozen with fear and too frightened to stir
Except for the occassional stroking of fur
I would make sure I was sleeping before it got dark
I would wake when the cock crowed and be up with the lark
I would then make a fire out of sticks and old hay
And go fetch an egg that was laid on the day
I'd put some cold water in a rusty old tin
And I'd fashion a spoon with what I found in the bin.
I would lock up the shed and I'd smooth down my hair
And I'd make it look like I'd never been there
And then I'd go home and get ready for school
And nothing was said as I entered the hall...

Introduction to BPD

Back in May, I discovered that it was Borderline Personality Awareness month. I decided to post information about this illness every day throughout May on a social media site.  3 years ago, I was diagnosed with BPD myself but was told that I have probably had it since adolescence. It affects my life greatly and I wanted to raise awareness and let people know exactly what it is. I am going to put the information on this blog in hope that I can reach a larger audience and raise more awareness and understanding...

Day 1

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behaviour, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

- Problems with regulating emotions and thoughts

- Impulsive and reckless behavior

- Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Day 2:

Criteria:

This is the criteria for being diagnosed with BPD. You need to have 5 or more of these characteristics. I have all 9. Tomorrow I will go into more detail about each characteristic.

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Day 3:

Behaviour:

Yesterday I posted the criteria for having Borderline Personality Disorder. In order to be diagnosed with this illness, you need to have 5 or more of the 9 criteria.

People with BPD have longer, deeper and more extreme reactions to situations. They are susceptible to impulsive behaviour in an attempt to relieve themselves of the unbearable emotional pain they experience. They also take a lot longer to come back to base point than a person without BPD.

This emotion is backed by a very real fear of abandonment. For instance, I spend most of my time worrying about being left by the people I love the most. I have no friends and this is because I have made sure that I get rid of them before they can abandon me. I feel so lonely sometimes but would rather that than be abandoned.

We also have a pattern of unstable and very intense interpersonal relationships. I have had so much pain in relationships. People with BPD do something called "splitting" which means we view others as either all good or all bad. There is nothing in between. I can love someone one minute and despise them the next. It is so confusing not just for me but for others. For this reason I have decided that I cannot have another relationship, not ever.

We have intense mood swings. I often display inappropriate bouts of anger, I feel great sadness, panic or despair. My moods can change 57,000 times a day. It is confusing and frightening. Most of the time I can't tell how I am feeling, I can't label my emotions because I am feeling too many things at once.

Tomorrow I will continue. I am finding this really hard and almost wish I hadn't started but this is something I need to do. No- one knows about BPD and I have lived with it my whole life. I don't suppose anyone is even reading this but I will try my best to raise awareness.........

Day 4:

Causes:

I will start by saying.... May the fourth be with you.

BPD is likely to be caused by a combination of factors:

*Genes from your parent/caregiver may make you more vulnerable to develop it.

*Research suggests that some people with BPD have a number of regions in the brain with abnormal structure and function.

*Events that happened in your past, such as your relationship with your family and your upbringing appear to play an important role in BPD. Unresolved fear, anger and distress from childhood can lead to a variety of distorted adult thinking patterns. You may have BPD because of one of these factors or a combination.

BPD is often misdiagnosed. It is often confused with Bipolar Disorder. However, with Bipolar, mood changes last weeks or even months but with BPD, mood changes are much shorter and are often within a day! oh joy!

Co-morbidity means that BPD often occurs with other illnesses. This also makes it hard to diagnose because symptoms can overlap with BPD symptoms. Other illnesses include major depression, which I have, anxiety disorders, substance abuse and eating disorders among others. I personally have depression - hence not being diagnosed earlier with BPD, OCD, panic attacks and anxiety disorder. I used to have the cleaning type of OCD but that has developed into obsessive compulsive thoughts and ruminations. These are repetitive and disturbing and often quite horrific. I also have PTSD ( Post traumatic stress disorder) and something as simple as a noise can give me a flashback to a past traumatic event.

BPD is a serious mental illness and it is well documented that mental illness and physical illness can be related. A lot of sufferers have back pain, migraines and fibromyalgia amongst other things.

Sorry this has been a long one..........tomorrow people.

Day 5:

Personality Disorders:

There are 10 different personality disorders. 

These are: Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependant and Obsessive- compulsive.

You can have one type of personality disorder or if you're lucky like me, you can cross over into other types. When I was diagnosed, I was told I had personality disorder with borderline, avoidant and depressive features.

So I am a typical borderline with all the criteria of a borderline but I am avoidant.

Someone with Narcissistic personality disorder would have an inflated sense of self importance and someone with Antisocial personality disorder may be callous and cynical. These people may have that diagnosis alone or it may be mixed with one or more of the other disorders. To be a personality disorder, symptoms must have been present for an extended period of time ,are inflexible and pervasive and are not a result of drugs/ alcohol or another psychiatric condition. The symptoms can be traced back to adolescence or early adulthood and cause distress or negative consequences in different aspects of a persons life.

The Avoidant finds loss and rejection so painful that they will choose to be lonely rather than risk trying to connect with others. They feel it is better to keep silent than to tell others how they feel. I personally avoid everything. I don't like to go out, I don't want to socialise or have friends. I have a long pattern of withdrawal and self-hatred and sensitivity to criticism. I have social anxiety so remove myself from social situations to avoid being rejected or feeling ashamed. No-one would ever choose to live this lifestyle as it destroys virtually everything around them. I am aware that my behaviour is destructive but I feel unable to change it. I see danger in everything and I avoid things because of fear. I am scared of the world and the people in it. If I do have to meet anyone for any reason, they are scanned for any slight sign of rejection -a look, a sigh, anything at all. I will take it and see it as a sign that they hate me. Even the words they use in a conversation will be taken away and I will ruminate on them, over and over until I am convinced that I am hated. I feel unworthy and it is absolutely exhausting. These irrational thoughts then turn into self-hatred which makes me withdraw more. I have never even been able to post anything on facebook because I think I will be judged, or hated or it wouldn't be good enough or it will offend etc etc...I am a victim of my own mind.

Anyway I have no idea why I am going on about myself so much, it's meant to be about the illness. I'll behave myself tomorrow....

Day 6:

Triggers

People with Borderline Personality Disorder feel emotions more easily, more deeply and for longer than others do. They are also hyper-vigilant. Emotions repeatedly surge and persist for a long time. It takes longer than normal for BPD sufferers to return to a stable emotional baseline following an intense emotional experience. If most people's emotional baseline is 20 on a scale of 0 -100, then people with BPD are continuously at 80. What is sadness in most people would be overwhelming despair in a person with BPD. Anger becomes rage, fear becomes terror etc etc. BPD sufferers describe overwhelming, almost constant emotional pain. Strong emotions are very easily "triggered". Triggers are something that sets off a past traumatic event in our minds or causes us to have distressing thoughts. A sound or a word can bring us back to a place where we didn't feel safe and we may respond in the now with a similar reaction. 

These events can be external, something that happens outside of yourself, or internal, as in something that happens in your mind, like a memory or a thought. You may even have a trigger that sets off another trigger!

BPD individuals often behave in a way that is destructive to themselves and to those around them. This is called "acting-out". Those with, for instance, with Antisocial, Narcissistic and Histrionic personality disorders engage in this behaviour. 

However, I personally engage in something called "acting-in". 

I am more self-destructive than outwardly destructive. This is also known as being a "quiet borderline". All the emotions such as anger, aggression etc are internalised rather than verbalised or used to impact on others. This means that often people are unaware of the extent that I and other quiet borderlines experience pain and despair.

People that act-in often have a sense of isolation and a lack of connection to the outside world. They may spend lots of time rationalizing their emotions or harming themselves out of despair. There are inconsistent feelings, one minute self-hating and the next more confident. This inconsistency is common to all BPD sufferers but those with quiet borderline are more likely to hide this emotional reality from their loved ones in a way that becomes painfully isolating.

Day 7:

Wearing a mask

Some borderlines have learned to cope with their emotions by wearing a mask. Your real self is buried under the pain and the fear and has been left behind at the developmental stage at which you were last able to be yourself. For most borderlines, the separation from self happens at a relatively young age when emotionally there is too much pain.

The mask is put on as a defence mechanism to survive turmoil. Masks are walls that block not only the borderline from others, but also from themselves. Many make up for their lack of self-love by over compensating, fooling people into believing they are overly self confident and even happy.

I have worn a mask probably for my whole life. It was the only way I could cope and get through it. I had to pretend to fit in, never being my true self. Mirroring people so you get the correct response from them to get their acceptance. To fit in. Protecting the part of yourself that you are too afraid to show.

You don't know how to be yourself because you don't know who your true self is. I have spent a lifetime trying to make up for my self-hatred by doing all these things. I fooled my own children for years. I couldn't let them see who I really was. I wanted them to believe I was strong and capable and that they could rely on me. I wanted them to think I was ok. How could I tell them that behind my mask is a broken child, a terrified person who says "I'm fine" when I want to scream that I'm not fine, I'm hurting, please help me, but I always said "I'm fine". I panic at the thought of my fear and weakness being exposed. My mask helps me to act, to pretend.

We'll talk tomorrow, don't forget to vote....

Day 8:

Push/Pull

Most people with Borderline Personality Disorder go through a continuous cycle of push/pull. It seems we are incapable of adult emotional intimacy and push away the people we love the most.
This stems from childhood abandonment/neglect suffered at an early stage of development. The borderline hasn't matured enough emotionally to the degree required to have healthy adult intimacy. They have learned that their needs were not met by their mother/caregiver and they assume they will not be met by a partner. Sometimes the past and present are merged together and, because the damage from the past is carried into adulthood, something in a relationship will "trigger" them back into memories and they will respond to their partner as they would to their mother/caregiver.

The BPD sufferer will draw you close, perceive that you will not meet their needs, then push you away. This cycle continues and often the person with BPD does not even know they are doing it. It is absolute turmoil, not only for the borderline but also for the person on the receiving end. You love the person one minute and it switches to absolute hate. I mean you hate the way they walk, talk, eat, everything about them. You need to get that person away from you no matter what the cost. However, once they are gone, you miss them, want them back, love them again and then the cycle starts all over again.

I realised I was doing this in my mid 30s and tried desperately to control it or to stop it but couldn't. It got to the point where I just waited for it to happen, knowing it would, until I decided it was probably best not to have another relationship. Not to hurt or confuse another person. I tried once to explain it to a partner but it didn't go well. It is so hard not to take something like that personally. It is just another reason to be alone...

Day 9:

"Borderline"

Can I just start with a brief explanation of what the term "borderline" means. I don't think I gave a definition on day 1 and it is very important that I do.

For years, the condition was thought to be somewhere between psychosis and neurosis- on the borderline in fact. The term "borderline" didn't really describe the actual illness but the name stuck. Far more is known about BPD today, and it is now recognised to be a disorder characterised by intense emotional experiences and instability in relationships and behaviour.

Many experts are now calling for the name to be changed to a more appropriate name. Suggestions include Emotion Disregulation Disorder, Unstable Personality Disorder and Complex Post traumatic Stress Disorder.

So I just thought I would share that with you and if you don't mind, I will be back tomorrow. I'm not feeling too great today....

Day 10:

The Child Within

BPD sufferers are often prone to child-like behaviour. Their psychological/emotional maturity was "stuck" or trapped sometime in their youth due to some kind of loss, neglect or abuse. So from that point they have only had the identity components and relationship capacity of the child they were at the time of their trauma.Therefore, in the borderline individual, you have a physical/intellectual adult and a psychological/emotional child. The child in them is distressed, angry, scared and as this child matures, he/she builds a fortress (a mask) which gives the appearance of competence and security.

As they grow, the borderline can sense this facade and not much inside themselves feels real. This in turn makes then feel empty and hollow. The emotions and intellect are way out of sync. The borderline's intellect is aware that something is wrong but they can't control or identify what it is. This does not get better as they mature.

The maturity gap between the psychological/emotional and the intellect of a BPD person is extremely wide and pronounced which causes major interpersonal conflicts. They are continuously swinging between adult and disturbed child.

Day 11:

Identity

BPD sufferers may feel the need to feel in control of other people because they feel so out of control with themselves. They may be trying to make their world more predictable and manageable. They may also choose a lifestyle where choices are made for them e.g the military or may involve themselves in abusive relationships where they are controlled by fear. These are two conflicting scenarios. This is because borderlines have a serious identity disturbance.

This means they have a distorted or inconsistent view of themselves. This makes them act, speak or think in ways which are contradictory. Their thoughts can switch from self-serving to self-effacing. They can make healthy choices one minute and be self-destructive the next. They can appear capable in one area of their life but fall apart in another. It is extremely confusing and frightening.

One minute they may be energetic and the next lethargic and withdrawn. One day you decide to be an astronaut, the next a showjumper and then you want to move to the country to bake biscuits. You have no idea what you want. Because of the lack of a true sense of self, borderlines have sudden and dramatic shifts in self-image. They shift goals and values and change their opinions and plans. Their self-image is based on the fact they see themselves as bad, worthless people.

People have often told me that I am more than capable of doing X, Y and Z and why aren't I doing things with my life etc and it upsets me so much. I definitely have no idea who I am, what I want from life or where I fit in this world. This has made me feel guilty my whole life. I am only just beginning to understand it myself, I'm learning as I hope you are. Without knowing who I am, I suppose I can't develop a sense that I am worthwhile or deserving of respect. So for the people that have told me I am wasting my talents, that I'm lazy or making excuses, I hope you now understand that I didn't know how to answer you...

Day 12:

Suicide

Suicidality is a defining feature of Borderline Personality Disorder. BPD is the only personality disorder to have suicidal or self-injurious behaviour among its diagnostic criteria. Patients are at significant risk for completed suicide. As many as 80% of sufferers have suicidal behaviours and about 1 in 10 commit suicide.

Suicide stems from a desire to end your life, to die. Self-harmimg behaviours do not stem from a desire to die but some may be life-threatening. These behaviours include cutting,burning, head banging and other harmful acts. This may be done to help regulate their emotions, to punish themselves or to express their pain.

People with BPD are more likely to complete suicide than people with any other psychiatric illness. 8-10 per cent is the rate of borderline suicides and this is more than 50 times the rate of suicide in the general population. The reason for so many suicides?....

Emotional experiences are so painful that many would like to find a way to escape. BPD is a chronic condition which means it usually lasts for years and there may seem to be no other way out of it.

Suicide is a serious risk for people suffering with BPD that must ALWAYS be taken seriously.

Day 13:

Diagnosis

I'm afraid I am full of negative thoughts and have been for a couple of days. I'm telling myself that no-one is reading this, no-one cares. It doesn't affect them so why should they? I realise I'm going on a bit and it's only day 13!

I have never done anything like this before and I am feeling that maybe I should stop now. It is so difficult for me to do this. I have to analyse every word over and over and I worry what I will say tomorrow.

I appreciate the comments I have had so far and the few kind people that are reading about BPD. On the flip side, I did say I would write every day for the month, so I'm torn over what to do. I'm telling myself it's just a really bad day today. Maybe I will keep this one short...

I was diagnosed with BPD in 2012.
I realise I said it was 4 years ago, but actually it was only 3. For me it was a relief. To have an answer, a reason for all the years of odd behaviour. Believing myself to be a terrible person and to blame for everything. To know there were people who feel and think just like me but most of all that there is a reason that I think the way I do. I had an actual illness. It was real. Suddenly it all made sense. I'll be back tomorrow....

Day 14:

Stigma

Thank you so much everybody for your comments yesterday. It has given me a much needed boost to keep going. I may well have another wobbly day ( or two) but I won't give up!

The stigma of any type of mental illness, not just BPD, makes many patient’s problems worse. It has a negative affect on their lives because of prejudice and discrimination. It is so important that people with mental illness be treated with respect and dignity and not judged or labelled.

The attitudes of others can be as big a burden as the illness itself. The stigma can even keep people from being diagnosed in the first place. There is so much misunderstanding about mental illness, for example, that it is self-inflicted or that it reflects a weak personality. There are often negative and inaccurate portrayals of people with mental illness in the media which shape our ideas of what it actually is.

The mentally ill continue to receive negative attention due to ignorance and fear. People view them as "crazy", dangerous or unstable but that is simply not the case. Maybe that is one of the reasons I am writing these posts, so that people understand it more with the facts and accounts of someone going through it.

People need to be educated about it and others with mental illness may gain some courage to enable them to talk more openly about it.

Day 15:

Treatments:

There are various treatments for BPD but effective treatments can be hard to access. There are usually long waiting lists and of course, no guarantee that it will work. This is not a complete list and what works for one person may not be suitable for another.

Many BPD patients are treated by a Community Mental Health Team (CMHT). This is a team of people who provide day-to-day care. You may be seen by the whole team or one or two members according to your mental health problems.

You may be entered into something called a Care Programme Approach (CPA). This means that you have regular contact with a care coordinator. They will work with you to write a care plan. This service is for people with severe mental illness including personality disorder.

There are various different therapies: Psychotherapy, DBT, CBT and MBT.

DBT is Dialectical Behaviour Therapy and was designed to treat BPD. The goal is to make you accept your emotions as valid and acceptable. The dialectic part says it is important to be open to ideas and opinions that contradict your own. DBT uses a lot of mindfulness techniques. Mindfulness is all about paying attention to your breathing and to focus on your thoughts and emotions in the present moment.

CBT is Cognitive Behavioural Therapy and helps to change core beliefs and behaviours that underlie inaccurate perceptions of yourself and others.

MBT is Mentalisation-based Therapy. Mentalising is basically being able to think about thinking. To step back from your thoughts about yourself and others and look at them to see if they are valid.

Then there are Therapeutic Communities. This is a structured or "planned" environment where a group of people with long-term mental illness come together to interact and take part in therapy. The idea is to learn skills needed to interact with others.

Tomorrow I will say a few things about my experience of therapy...

Day 16:

Medication

I did say I was going to talk about my experience of therapy but I have a bit more thinking to do on what to say. So meanwhile, I will talk a bit more about treatment and medication. 

No medication is currently licensed to treat BPD. However, medications are often used if you have another mental health condition alongside BPD, such as depression or anxiety disorder. 

BPD patients are continuously in and out of crisis. A crisis is when your symptoms are really severe and you have an increased risk of self-harm. If you are in treatment, you should be given phone numbers to call in a crisis. Sometimes just talking to a member of a crisis team is enough to bring you out of it. 

Sometimes you can be admitted to hospital under the Mental Health Act for your own safety, but only in serious cases. This would only be for a short time until your symptoms improve.

Some people fail to respond to treatment and it can be because of three major problems. Firstly, inadequate management of medication. Secondly, an ineffective psychotherapeutic approach and lastly, an undiagnosed or ineffectively treated co-occuring disorder.

Unfortunately (or fortunately, I'm not sure) I have a morbid fear of medication. I have been prescribed various anti-depressants etc in the past but I cannot take them. I can't even take a paracetemol. 

This "problem" was touched on very briefly in therapy but it has never really been addressed. I think that it is another way of punishing myself. My anxiety just won't let me take anything. I tried twice and felt out of control, had a panic attack and swore never to take another pill. I still think that it is a need to punish myself though. I hope to explain more about that later on......  

Day 17:

The “Quiet Borderline”:

I thought it was really important that I talk a bit more about the "quiet" borderline. When I was in therapy, no-one ever told me about this. I didn't know there was such a thing. I thought we all were supposed to have the same presentation of the illness and was completely confused by all the people who were having difficulty keeping their anger inside. I remember briefly hearing the term "quiet" in reference to myself but just thought they meant that I was quiet! It was never explained to me so I researched it myself. Loads seems to have been written about the more classic presentation of BPD. It usually means someone is "acting out" by displaying angry outbursts, aggression and projecting onto others.

A quiet borderline does not do these things, in fact quite the opposite. They have exactly the same reasons for the diagnosis and fit the same criteria, but they do not rage or shout but they rage inwardly. Everything is turned in on themselves.

I have read various accounts of people who are quiet borderlines and of course I have my own experience and most accounts seem to be saying the same thing....

Therapists will be frustrated with their behaviour and they are often blamed for "not connecting with their feelings" or "not expressing their thoughts". They are sometimes provoked by a therapist to try to get a reaction, to release their inner rage. Therapists who treat BPD are used to seeing "acting out" behaviour and are at a loss to know how to deal with them. Quiet borderlines are mistakenly thought of as being able to function more than the "acting out" borderline but this is definitely not the case. Like myself, quiet borderlines find it hard to express anger so they supress it and keep it deep inside. I would argue that this is far more damaging behaviour. I have depression because it is anger turned inwards. Quiet borderlines do exactly the same as those that "act out" but they do it to themselves instead of others. 

When are mental health professionals going to recognise the different presentations of BPD? Even finding information about it has been difficult as most things about BPD describes the classic anger outbursts and lashing out. Both presentations are debilitating but it has to be known that quiet borderlines are screaming without a voice. Their suffering must be given expression so their lives can improve...

Day 18:

The Therapist

Because of the fragility and vulnerability of a borderline, a good therapist is vital. Some can do more harm than good and the therapist's behaviour can be destructive if the patient doesn't feel trust, feels rejected or does not feel safe. Remember, a borderline is constantly scanning another person for signs of rejection so, if a therapist just looks at their watch or a clock on the wall, this can trigger all kinds of emotions within the patient.

BPD patients are said to be one of the most challenging types of patient to treat. It is also emotionally draining for the therapist and they often dread or even refuse to treat someone with BPD. This is because BPD is much deeper in the very being of the person than any other mental illness. Borderlines test the skills of even the most experienced therapists. A BPD patient is almost always in crisis so it is difficult to get to other, deeper issues. Many BPD patients are outwardly angry or agressive which can frighten the therapist. Equally they can be frustrated by someone like me who is quiet and reluctant to talk. You are made to feel you have to prove how sick you are. You feel that the therapist is angry with you, disappointed or even disgusted by you. When a patient doesn't get better despite the therapist's efforts, patients may often be blamed for the lack of progress. If you can't talk, can't "participate", you are blamed. The greatest sin the patient can commit is poor response to treatment. So the therapist may blame the patient rather than admit that the treatment isn't working. Then they may be labelled as difficult, manipulative, a nuisance, dangerous etc etc which can make the patient even more traumatised. Because of all of these factors, patients are often written off with no appropriate treatment which leads to continued deterioration and even suicide.

I must point out that there are probably lots of therapists who are capable, professional and able to provide good treatment and this is just my experience. No therapists were harmed in the making of these statements!!.....