'People see me as an articulate girl ... they don't believe I have a debilitating condition'

Anorexia, suicidal thoughts, self-harm and manic moods are what Sarah has to cope with in her life. The 29-year-old from Derby, wants to highlight her complex conditions – and find an outlet for her art. Wendy Roberts reports.

SARAH was just a teenager when she tried to take her own life. And between suicide attempts, she cut her arms, poured boiling water over herself and restricted her eating to lose dangerous amounts of weight.

For 16 years, Sarah has been fighting anorexia and a condition called borderline personality disorder (BPD). It is a daily battle.

"My life could be so much more," says 29-year-old Sarah, who lives in Derby. "I love to sing and have started to play my flute again. I'm teaching myself Japanese and I have many supportive friends.

"My family are fantastic – but there's no real help for someone like me. There's no money and Derby doesn't have the right sort of care available.

"I want to be well and lead a normal life. I want to be happy and free from these manic problems.

"I have severe mood swings, can have no rational thinking and experience dangerous psychotic episodes. I self-harm, hear voices in my head and feel very insecure."

Today is a good day for Sarah. She has got out of bed and is dressed. She is bright, bubbly and chatty. But tomorrow, things could be very different. She may not be able get up. She could feel low and depressed and be too frightened to leave her little bungalow.

What is important to the brave and brutally honest young woman is sharing her story. She wants people to read what she is going through and how she copes.

"I've been in and out of hospital for my anorexia but I've not had treatment for my borderline personality disorder," she says.

"Art has helped me to express myself and writing my story, which I'd like to get published one day, has been therapeutic.

"When you're faced with these problems, simply things can prove hugely difficult. My head is always full of stuff. I nap all the time because I'm so tired."

Sarah admits she struggles to cope on a daily basis. Doing simple tasks like cooking a meal can be impossible. And if she is feeling low, or upset or paranoid, she simply stays under the duvet.

Mood swings, from suicidal to manic, can pose real dangers for Sarah – and paranoia simply consumes her.

"Imagine waiting for the bus and when it doesn't come, thinking that someone is out to ruin your day and it's all part of the 'conspiracy' against you," says Sarah. "Everything is personal. I can be walking down the street and the voices in my head start telling me that I'm being followed. I 'zone out' and forget what I'm doing.

"I ran into town once and didn't even have my shoes or coat on."

Sarah takes a concoction of medication to try and easy her psychotic episodes and make her see the world through more "normal" eyes. She takes anti-depressants in a bid to lift her mood and she tries, desperately hard, to eat.

But the psychotic episodes are scary and Sarah never knows what she has done until she has come out of one. Once she woke up to find she had cut all her hair off.

Another time, she left her house unlocked and ran off, convinced there were dangerous men in her house. But the scariest incidents are when she believes there are people forcing her to harm herself. And if she fails to comply, they will take her away and torture her.

When times get really back, she calls for help. She has friends who come over and stay at her place. Her dad is a tower of strength. Her mum and one of her sisters also live locally and do all they can to help.

"I contact friends when I'm in a panic. They call for the paramedics if they think I've taken an overdose or harmed myself," she says. "I hate being such a burden to people."

Sarah has her own theories as to why she developed BPD and anorexia. She would like to keep some of the reasons to herself, but she says she has always felt like she is a very needy and insecure person.

She describes her childhood as loving, but says as a little girl she craved love and attention.

"I don't blame anyone," says Sarah. "I believe I was born with some of these problems. It's the way I'm wired, but that doesn't mean I don't want to be well. I'd love to lead a normal life.

Sarah's weight is stable – but she is still painfully thin. She tries to eat better these days but when she is having a really bad day, she just feels that she does not deserve food. Fighting that thought and making herself eat is exhausting.

"I'm still probably underweight," she says. "But I am definitely better than I was. I've been admitted to an eating disorder unit in Oxfordshire and Leicester, and it helped a lot. But whilst they concentrate on the anorexia, they have no idea how to address the BPD.

"I've been in psychiatric units too. But the problem flips. The team can keep me from self-harming but that is really just by locking me up. They didn't have time, expertise or the staff to actually treat BPD and they have no experience of eating disorders.

"Apart from one month, I spent the best part of 2010 in hospital. First Steps Derbyshire, the eating disorder charity, has been fantastic. I've had some support from the team and I still go to some events."

Sarah was a teenager when her mum first noticed the wounds on her arms. She took her to the doctor and was referred to the Child and Adolescent Mental Health Services.

"I had chronic feelings of emptiness and a complete lack of self-worth," she says. "I had distortion of reality and had started to self-harm.

"I'd been restricting my eating and would only allowed myself a cold shower as punishment.

"I must have had BPD then, but as the personality is not yet fully developed, it isn't diagnosed until adulthood.

"It was months later when I started to eat better. My parents were distraught to see how poorly I had become."

When Sarah was rushed to hospital following another suicide attempt in her 20s, she revealed the true extent of her problems. She was in Australia working on community projects, when she took a drug overdose.

Sarah left school with a bunch of GCSEs but when her health took a serious dip, she was forced to drop out of education. Struggling to maintain her weight, she spent time some time at home with her parents.

She says: "After a while, I enrolled at college and started my A-levels. When I had something to focus on, like education, I seemed to be able to control things better.

"I hated my time in the acute psychiatric ward. It was a horrible place to be.

"I had friends and family to visit me. And I made friends with another girl on the ward.

"I spent two months in the unit and was then transferred to an eating disorder unit in Leicester. I was then officially diagnosed with BPD. I had some fantastic sessions with a psychiatrist. He had a good understanding of borderline personality disorder and gave me just one-to-one support."

Sarah says there are no services available for people with BPD who live in Derby.

If she lived in Nottingham or Leicester, she says she might be eligible for more professional support.

But she discovered the one way she could express herself was through art. In 2007, she enrolled at the University of Derby to study creative expressive therapies.

She says: "I really loved it and the first two years went really well. In 2010, I had to put my studies on hold but I completed my final year in 2011. I got a first and I was thrilled.

"Since then, I've been thinking about organising an exhibition of my art. I'm looking for somewhere to display it. I'd really like to raise awareness of anorexia and BPD."

Sarah is managing her symptoms as best she can, but she is struggling with urges to harm herself.

Whenever she can, she surrounds herself with people who care about her.

Her mood changes and lack of stability make it impossible for her to get a job. She would like to join a choir or an orchestra but she lacks the drive to do it.

Her paranoia and psychosis has caused rifts with friends and problems with her family. And maintaining a romantic relationship would be impossible right now. Sarah's deep fear of abandonment and her erratic moods would certainly push someone away.

"Most friends and family only see me when I'm having a fairly good day," she says. "When it's bad, I shut myself away from the world.

"People who don't know me see me as an able, intelligent articulate girl. They don't understand or even believe that I have such a debilitating condition.

"I hope one day that the condition will be more understood and that there will be more treatment for it. I hope that others with the same condition can get the treatment they need."