By A.

I am a woman in my mid-forties with a caring nature and love of musicals. I live with some obsessions around food as a result of past anorexia. I have no children and spend a lot of time alone. I hold down a ‘responsible’ job and am respected by colleagues for my diligence. I pay for therapy which has helped me to grow. While I accept who I am - a survivor - I know that others judge me for what I have done to my body and what this signifies for them.

My self-harm started in parallel to the anorexia. Weight loss took time whereas the outward mark from self-harm caused immediate change.  I did not invite anyone in to see the signs. It was only once I was an inpatient being re-fed that mental health staff noticed I hurt myself and saw it as a paperwork burden. Scars multiplied over the decades to the point of no return. All self-harm occurred in private, with no-one aware of the physical torture involved. Despite what medics assume, I am NOT “good with pain.”

I never knew as a teenager that most mental health professionals view self-harm as a ‘hallmark’ of ‘Borderline Personality Disorder’ - BPD (also known as ‘Emotionally Unstable Personality Disorder.’) I used to think that by self-harming, health professionals may take my distress more seriously. I had ‘non-psychotic’ difficulties with eating disorders and anxiety, it was only ‘risk’ that kept me on a caseload. I had no appreciation that what I was doing to warrant care, and to express the total anguish I was going through, would gradually be used as a weapon to destroy my identity.

The BPD diagnosis was given to me by a psychiatrist 21 years ago. No-one told me the diagnosis which resulted from Accident and Emergency (A&E) attendances, and when I found out they just minimised its importance. The Community Mental Health Team (CMHT) eventually discharged me by saying I was a ‘lucky girl’ to have been given 12 months of psychotherapy. There would be no return to the CMHT as any referral years later led to instant rejection with a stiff letter back to my GP.

Services said they had done all they could and had nothing more to offer. I was even given a label of a ‘Dependent Personality Disorder’ to help justify why I should never be seen again. Psychiatric Liaison services briefly got involved a few years ago but did nothing except to repeatedly send me home from A&E and add more harm after long waits in chairs. 

The legacy of long-term self-harm is a sense of shame, blame and scars which will never be erased. I never wear short sleeves or trousers. I live in fear of these long lengths rising even slightly, not least in front of colleagues and family I kept in the dark. I feel so desperate over the extent of the scars, the lost time and the ordeal which was every single yet countless encounter seeking treatment. Yet, I can cover up scars and live with them. I cannot live and be alright with the BPD label.

I have no chance of BPD ever being reviewed or removed. Psychiatrists only see crises or diagnose new cases, not someone like me who does not want this diagnosis around her neck. The label is a handy one for health services that have no time to listen. My upset over redundancies at work can be put down to my ‘intense emotions’. Now I am ‘managed’ by primary care, there is no concern, contact or follow-up unless I arrange to see a practice nurse for a new wound check.

No-one needs to listen or see me as their minds are made up. I am viewed under a lens of BPD and have no way of expressing myself that is not attributed to this label. I trust no NHS professional who has access to my medical notes. The judgement of psychiatrists from decades ago will trump any explanation I try to voice, after all, they were the ‘experts’ in my ‘condition’. I expect if I reach older age, even perhaps 70, to still have BPD dredged up.

Further self-harm reinforces the BPD diagnosis. The more self-harm I have done, the more I have felt ignored but even if I never self-harm again I remain untouchable. Logically I should forget mental health services and their damage, but my scars, dreams and memories do not allow this.

For some survivors the BPD diagnosis ‘makes sense’ and may lead to therapies they could not access without those three-four letters. I respect others’ perspectives and anything that works for them, though often they just see my position as being in denial. In truth, I wish that I had no idea of the politics around BPD, the service exclusion and professional disdain.

Self-harm should be understood as complicated, unique, pressing, about inner and outer pain. BPD does not cover it.