QUESTION:
Dear Dr. Heller,
Are there any drugs that affect Depo-Provera’s effectiveness?
ANSWER:
Depo-Provera is a long lasting contraceptive injection. It generally lasts 3 months, and prevents the monthly mood swings many women experience. Occasionally women feel ill on the medications. The only drug interaction is with “aminoglutethimide” – which will make the injection less effective.
QUESTION:
Dear Dr. Heller,
I have read a few of your responses about Depakote online. I have been taking 250 mg of Depakote for about 3 weeks, for Bipolar Disorder. I know that weight gain is a possible side effect. Is this due to a change in metabolism or an increase in appetite? I have been working out regularly and want to know what else I can do to prevent weight gain.
Thanks for your time.
ANSWER:
I don’t know if the exact mechanism has been worked out yet. At least part of the problem seems to be an appetite problem. Certainly exercise is an excellent idea. Timing of foods is often as important as what you eat. Your body is designed to survive – so having low blood sugar, not exercising, missing meals, and not having enough fiber will cause your body to gain fat. The “high performance diet” can be of help to you.
QUESTION:
Dear Dr. Heller,
Both my sister and I have this disorder…it has played havoc with her life but I fared much better, both personally and professionally except for when Im alone and I have a hard time becoming involved in activities or doing things “alone”…. I have never been treated medically for this disorder although when I was much younger I was in therapy for about 7 or 8 years…..can you offer any suggestions on how to deal with these feelings at times…..
ANSWER:
If you had strep throat or pneumonia, youd take medicine (an antibiotic). If you have the BPD, medication is again necessary. The medication information sheet I use for my patients will likely be of use.
Just like with infections, prevention is very beneficial. In mental health terms, this means interpreting things differently so they dont become so stressful. This is what psychotherapy and motivation can do.
Theres a great deal of information on the Website and in the books that can be of assistance to you. I hope this was of help.
How can I Deal with my Mother?
QUESTION:
Dear Dr.:
I’d like to know more about “fractured enjoyment”. I logged on to this Website to find out more about BPD because I was concerned that my mother may be suffering from it. As I read the information provided — the part that really fit were the fractured enjoyment bullet points. My main reason for looking into the possibility is that she has always been controlling, manipulating, SUPER sensitive, EXTREMELY low sense of self worth, always has to be “the victim”, but MOST of all — she absolutely cannot be reasoned with. She does not have severe mood swings, nor is she violent. Instead, when faced with any type of conflict or criticism, she clams up, pouts, manipulates an apology out of me or whom ever.
She has alienated most of the family from wanting to be around her — it’s just not worth it to them to have to walk around on eggshells. She doesn’t seem to be capable of being part of the family “team”, instead she purposely separates herself, but then punishes everyone around at time for “leaving her out”. Also, she feels it necessary to point out “how much she does” for everyone else — and no one does anything for her or thinks about her or cares about her, etc. Hence, all the pouting, and other behavior I mentioned earlier. I am 36 years old and this behavior of hers has and is taking up too much of my energy. Everyone else can ignore it and separate themselves from it — but I can’t “divorce” my mother. The fact that I am always concerned and worried about it only adds to my feeling of being manipulated by her. I, as well as other loved ones, have tried to talk to her countless times, but no one seems to be able to get through. I feel like a 5 year old would understand things that she either can’t or won’t. It’s REALLY frustrating! Help! Do you think she has a form of this BPD?
Thank you in advance for any comments or suggestions you may be able to offer.
ANSWER:
The term “Fractured Enjoyment” comes from the concept that their ability to be happy and enjoy life seems broken. Its more than the term “dysthymia.” It used to be called the “depressed personality disorder,” but this term is no longer used. The cartoon characters “Eeyore” and “Charlie Brown” are great examples. Whether your mom has the BPD or not isnt clear from your letter. She likely has at least one personality disorder, where she isnt acting out of her own best interests. The self-defeating disorder – which is not an official diagnosis – may fit. People like your mother are hurting very severely, and doing whatever they can to reduce their pain. It may not seem rational to you, but it often does to them. The best approach might be to get better yourself and lead by example. Hurting people are usually looking for answers, and if your mother sees you change and become peaceful, happy, serene, and unaffected by her actions, shell may ask you what youre doing and want to search for your path. I go into this at length in my books and in the retraining the brain section of my Website. I encourage you to get treated and learn all you can.
QUESTION:
Dear Dr. Heller,
I am trying to understand the concept and mechanism of dissociation. My wife has experienced “seizures” for year that have been diagnosed as non-epileptic (A.K.A. pseudo-seizures or psychogenic seizures) Is this considered to be a severe form of dissociation? If not what is it? I have had doctors tell me that it is a “conversion reaction.” Is there a difference between these two “mental states”?
Thanks in advance!
ANSWER:
Both conversion reactions and dissociation are defense mechanisms. Both can be present in those suffering from the BPD. Dissociation is easy to treat with mood stabilizers – especially Tegretol, and particularly when combined with Prozac. While the stressors for conversion reactions can be improved, its usually much harder to manage and doesnt usually respond easily to medication.
Dissociation is much more common. I believe dissociation is a defense that develops as a seizure initially in the limbic system, spreading to the temporal lobes where dissociative symptoms are located. It occurs mostly in the borderline disorder. There are case reports of individuals being eaten by a large animal – like a lion – and the individual dissociates. It protected the individual from the horror and pain of that attack. I believe BPD dysphoria and dissociation are seizures in that part of the brain.
Conversion reactions are a hysterical phenomenon. There are many types, including a “stocking glove deformity” where the individual loses sensation in just a hand (which is neurologically impossible). I had a patient who had pseudoseizures after real seizures developed, in that case because she liked the attention. It is also a defense mechanism that prevents the individual from feeling some feelings or dealing with stressful situations.
QUESTION:
Dear Dr. Heller,
My daughter is 19, she has had 4 self-cutting episodes since eighth grade. The last 2 were within the past seven weeks. She is now home from college. She had to spend 48 hours in the (good) psyche ward of our local hospital (her Psychiatrist wanted it) as a result of her last episode. There were dozens of light razor cuts on both arms – elbow to hand and one leg. She actually called us to come home from friends’ in the middle of the episode – she was in a very catatonic state for many hours.
ANSWER:
Self-mutilation is using a physical technique to temporarily stop the horrible sensation called dysphoria (anxiety, rage, depression and despair). Cutting doesn’t hurt, but stops the dysphoria much like scratching temporarily stops the horrible sensation of itching. It is almost uniformly a BPD phenomenon, and is effectively treated by treating the BPD with SSRI’ medications like Prozac combined with Tegretol and temporary antipsychotic medications like haloperidol and risperidone.
