Currently, I’m diagnosed with anorexia, severe depression/ major depressive disorder and PTSD but then a personality disorder (PD) was mentioned by a nurse and now I’m confused. I have been assessed a few times for a PD (my request after a misdiagnosis and eating disorder admissions) and it came back that I didn’t. These are my symptoms;

For a few months during the year, I seem to experience;
– low mood, often tired and oversleeping
– poor concentration and impaired cognitive ability
– loss of interest in pretty much everything including usual hobbies
– irritable/ more snappy than usual
– self- isolating and more effort to communicate which isn’t like me as I’m usually quite sociable.
– loss of motivation and daily tasks are more difficult.
– passive thoughts of suicide and self-harm but not actually doing it (more out of desperation/ hopelessness).

On a day to day basis I’m pretty laid back with present/ future things but anything reminding me of past traumas, I try to avoid. I have a long history of traumas and understand I have a lot of unprocessed memories. Here are other traits/ symptoms;
– nightmares and night sweats
– hypervigilant
– avoidance of anything that may trigger me to remember difficult memories
– vivid and intrusive memories when triggered
– dissociative episodes when memories are triggered (I mentally and physically shut down but I feel utterly terrified).
– difficulty remembering past events.
– overanalysing everything.

In terms of relationships, I have some amazing friends who I’ve had for many years but no intimate relationships. I’ve had a couple with very kind and thoughtful guys but I really struggle with intimacy due to past trauma. I also struggle with my (lack of) self- worth which seems to have manifested into my anorexia, which is also my coping mechanism.

I know you can’t diagnose but I was wondering if this sounded like a PD or CPTSD rather than PTSD? I find it all very confusing! (From the UK)

I admire your resilience, bravery and grit as you have consistently dealt with these issues. I believe you have asked for help from us before — and it is a great strength of your to be so persistent in looking to find answers. I believe this may be the single greatest capacity to have during recovery.

I think any one of these diagnoses anorexia (losing weight by refusing to eat); borderline personality disorder (BPD) (usually characterized by unstable relationships and large emotional swings); Posttraumatic Stress Disorder (PTSD) with its intrusive thoughts of memories of the trauma, flashbacks, and or nightmares; or the difficult to diagnose, Complex Posttraumatic Stress Disorder (CPTSD), where the symptoms of a PTSD have had an impact on one’s personality or identity could be overwhelming, but to have each of their powerful impact balanced and evaluated in trying to come to a type of stability and balance is exceptionally courageous. My concern is that there are many people offering an opinion and treatment options, but what might be needed is a primary person to coordinate the medicines, therapy, and progress. I am say ing this because you’ve suggested that when you are recovering from the anorexia and begin trauma therapy the stress of doing that triggers the flashbacks and the need to not eat returns as it calms you down. This is a cycle that may be better managed with one person understanding all of the moving parts so that therapy and success in treating the anorexia are happening in concert with one another.

The list of symptoms you’ve identified and the possible conditions can be a confusing thing to accurately diagnose. What I think is more important is to find a single provider, most likely a psychiatrist, who can coordinate your care. Having too many providers helping can make the process more difficult and confusing.

Finally, you’ve mentioned something that is important to highlight. You have good friends. While I understand you do not have intimate relationships — the fact that you are maintaining good friendships is extremely important. It means that there is something you bring to a relationship that people respond positively to. I would capitalize on this. Once you find the provider who can coordinate all of your treatment I’d encourage you to find a group. Group therapy for each and all of the symptoms you are identifying would be warranted — and from your descriptions, this mode of treatment hasn’t been tried. It would be on the very top of my list now as the virtual format during COVID-19 would allow you to make connections while still being in the comfort of your own home. I’d highly recommend this approach.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral