Medical Literature

QUESTION:

Dear Dr. Heller,

I have a 13yr old daughter that has ADD, she is having a lot of trouble playing basketball although she exceeds at ball handling skills.  Does the ADD keep her from being able to perform or think during a game?

ANSWER:

No, although she’ll likely be more impulsive.  This is likely to manifest itself as shooting without thinking first and getting more fouls.  She may have a hard time remembering a coach’s instructions, particularly when there is a lot of noise and stimulation around.  She’s going to be more aware of movement, which can be a big plus.  Hyperfocusing will likely help her as well.  Psychostimulants such as Ritalin may be of enormous help in this regard.  If these medications are not acceptable to her league, alternatives such as Wellbutrin and Effexor may be a good choice.  I’d also recommend looking for other diagnoses, particularly the BPD and generalized anxiety disorder.  Fear and anger can cause behaviors that wouldn’t be chosen in a different time and place.

QUESTION:

Dear Dr. Heller,

Thanks for your time. I suspect I may have BPD and have suspected for some time. I know you can’t make an official diagnoses but I was wondering if you could tell me if it’s a possibility. I’m 26 years old and have very intense anger. It is mostly geared towards my husband who I lash out at and say horribly mean things to. It is black and white with him. When I get angry I almost always hit my head or bang it against the wall. I also self-mutilate, which I have been doing (along with hitting my head) for about 10 years. I’ve had terrible anger for the same amount of time and longer.

I also have an eating disorder. Mostly at night, I get extremely bored and have feelings of emptiness. But it depends. If I’m having a depressed mood, which can last for about 3 days before it goes away. If I’m depressed I feel empty anyway. But if I’m not, I still switch into rages and feel mostly empty at night. To counteract this I self-mutilate, scream and yell till I’m exhausted, or binge eat till I’m so full I can’t stand it. This is very intense for me and I have been very depressed.

On normal days, without depression, I don’t find I have mania. I just feel able to function normally. These usually last about three days also, going downhill as I get to the third day. My anger is very sudden though. I also get paranoid sometimes. Not to extremes though, or where I rule my life by it, just suspicions that I think probably aren’t true but don’t know for sure. Things like people listening in on my conversations in the house with walky talkies ( I have a baby monitor) or people knowing how awful I am, but being nice to me so they can set me up for a fall. My jealousy of my husband is extreme though and causes lots of grief.

Thank you for your time.

 

ANSWER:

Any time an individual has to deal with “intense anger” the BPD must be considered. Self-mutilation is a strong clue as well.

If you simply look at the official criteria, I think you’ll see that you fit it very well. The front cover of my first book “Life at the Border – Understanding and Recovering from the Borderline Personality Disorder” shows many of the symptoms those with the BPD have to deal with. There’s lots of information in both of my books and this Website that can be extremely useful to you. “Life at the Border” is on the recommended reading list at the National Institute of Mental Health. The front cover can be found on this Website.

The BPD is a treatable medical problem. I encourage you to find out more ASAP!

QUESTION:

Dear Dr. Heller,

I just found out that my 22 year old son has no pubic hair.  He is ADHD with learning disabilities and I believe has always had a chemical imbalance because he would always be super happy or super sad.  Would the ‘no pubic hair’ have anything to do with the imbalance and why does that happen?

ANSWER:

There is no relation with ADHD and lack of “secondary sexual characteristics” such as pubic hair.  Whether he has a “chemical imbalance” causing anxiety, depression or other psyche problems is unrelated. He needs to see an endocrinologist – someone who specializes in glandular function.

QUESTION:

Dear Dr. Heller,

I heard your radio show on WVLQ in Columbus, Ohio today (10/8/99) and went straight to your website. My question is how do I find a Doctor who can correctly evaluate, diagnose and treat my daughter thoroughly? My 12 year old daughter had been in counseling before depression and she is a classic ADD. While looking at your site and screening test, I saw myself as well. Hope to hear from you soon.

 

ANSWER:

I’m always looking for doctors to refer to who are doing similar work – making the diagnoses and treating them comprehensively. I’d be thrilled to make a section in my website for like minded individuals to recommend and possibly developing a dialogue with. I have two suggestions in the short term:

1. Read as much as possible about the disorders. “Biological Unhappiness” will be very helpful to you, and the studies I’ll be posting on the website should be of help to you.
2. Contact www.CHADD.org – an organization devoted to attention deficit disorder, they may be able to recommend someone in your area.

Does having the BPD make one unfit to be a physician?

QUESTION:

Dear Dr. Heller,

I lived 2 years with a person who suffers from BPD. I read Randi Kreger’s book “Stop Walking on Eggshells.” I can exactly confirm the experiences described in this book. I am a medical doctor and I have 10 years experience in my profession. As a physician, I am familiar with the description of the Inner World of the borderline individual.

After 2 years of living with a woman who has traits associated with BPD I must agree that it is a horrible feeling to realize I am the victim of someone who needs me to exist in the human society. I am feeling like a victim who was mentally abused by her.

At the beginning of our relationship I thought it was temporary, but now I have not seen any positive changes in spite of her 1-year psychotherapy. She is not able to accept the diagnosis of BPD.

She is going to become a medical doctor. Is it ethical to accept it? Can she take the responsibility for the patients as a doctor? She fulfills all the criteria of behavior that indicate BPD. I saw her out of control in the emergency room. It is not my revenge on her, but I think as a doctor I have to act and prevent the future disaster in support of the humans who are getting medical care from someone with BPD. Please send me your opinion.

 

ANSWER:

Many individuals with psychiatric problems gravitate to the health care professions. I’ve taken care of hundreds of borderlines who fit this category, although only a handful were physicians. One temporarily lost his license due to substance abuse.

If the diagnosis is accurate, stress intolerance will likely show up and cause problems. Of course it would help her enormously to understand the diagnosis and what she can do to succeed in every area of life – including relationships and being a physician. If her faculty members do not see a reason to withhold her degree, then it will up to her to find a way to cope, get treated, or choose a specialty more suited to her neurology – such as pathology. The BPD diagnosis does not exclude someone from being a physician. That she made it this far is a huge positive sign for her intelligence, creativity and perseverence.

As with everyone else, all the diagnoses need to be made and effectively treated. I’ve seen many individuals do phenomenally well when comprehensively treated medically.

I’d recommend the same to you regarding evaluating diagnoses – particularly why you would put up with abuse for a long time. The book “Are You the One for Me?” by Barbara DeAngelis may be particularly useful to you. I strongly recommend you listen to Zig Ziglar’s “How to Stay Motivated” series and learn these things for yourself. Not only will this reduce your future pain, but you will become a better physician as well.

 

1999 November Questions Ask the Doctor

QUESTION:

Dr. Heller,

For years I suffered from chronic depression and PMS.  Recently I was diagnosed with MS, and looking back, I can now see that the fatigue and mental confusion was a result of the MS and exacerbated by the other problems.  I am 52 now, and take Effexor for the depression.  I also now know how to manage the MS.  My problem is my ex-husband, who divorced me a year ago.  These things put a strain on our relationship and continues to, because he calls the MS my f…ing excuse.  It seems he almost tries to make things harder for me and it is impossible to talk to him about our son or finances without him getting angry.  He is 51, and off and on for 4 years now has been with a woman 23 years younger than he is who roller blades.  He gets extremely depressed when they break up, which is often.  I have tried to educate him about the symptoms I have and hope that someday he will see that it was the illness, and not me.  Is there any way to reach him so we can relate to each other as two human beings who are the parents of a teenage son?  We were married for 20 years.

 

ANSWER:

I know this sounds like a cop-out answer, but you’d be far better off working through this with a professional therapist.  The therapist can spend more time with you and give suggestions in this regard. One thing you can do is talk with your son.  People know when kindness and love are permeating your life instead of anger.  Your son can probably tell if what you say is done out of love.  You might consider telling your son that you have a disease of your nerve cells that has caused you lots of problems.  Showing him literature from MS organizations may help as well.  You can relate to your son that his father hates you because of your illness and that you want to get along for your son’s sake.  Ask your son for suggestions in this regard. Either way, you don’t need your ex-husband’s approval to be a successful person, or to treat your son kindly.