Medical Literature

Does Going Crazy Run In The Family?

QUESTION:

Hi,

I’m 17 from Connecticut.  I suffer from a lot of things like anxiety disorder or all different kinds and depression severe at that.  Please I ask but I never get a answer am I gonna go crazy?  Does going crazy run in the family?  We don’t have any of that in my family.  My mother suffers from the same thing.  but I’m scared that I am gonna die can you please help me I don’t know where else to turn?

ANSWER:

Most mental health diagnoses have a “strong genetic component” – meaning that “running in the family” happens most of the time, but not necessarily all the time.  The BPD has approximately a 50/50 risk.  This also means that some anxiety disorders may be present in a less severe form in some family members, and that additional things happened to you.  It’s also possible your biological parents had milder forms of anxiety, and your combination became awful.  Another genetic example similar to this (but not a mental health diagnosis) is sickle cell anemia – where when parents have a mild case they’re protected against malaria, but their children with a severe case die from their genetic disease.

I think you’ll find that if you and your biological parents do the screening test I use for my patients, you’ll find many similarities and similar disorders – even if they aren’t as disabling as yours have become.

The great news is that almost all of the diagnoses can be effectively treated, and you can have a terrific life.  I encourage you to learn more.

Could This Be The BPD?

QUESTION:

Dear Dr. Heller,

My Mother took me by the hand and led me to your site four days ago.  She firmly believes I have suffered from BPD for the past 10 years.  I am now 32 – female, and beginning to discover that maybe I have this disorder.  I have been a functioning professional up until now, appearing confident and content (only my parents knew different).

10 months ago I encountered an unplanned pregnancy with my boyfriend of two years.  I was scared, but not unable to cope with the situation.  I was NOT, however prepared for the complete abandonment that followed from my partner, his words were “I want nothing to do with you or it”.  I believe my stress/anguish led to the miscarriage.  He returned weeks later to assure me he was only frightened, and he was terribly sorry.  I forgave the incident, but never recovered completely.

I started taking Paxil four months later, and three months into my medication I became pregnant again (not planned and clearly the stupidest thing ever)and again my boyfriend ran.  It threw me into a spin that was completely foreign to me: (In the past) I have gone into rages/threatened suicide/paced the room looking for things to throw/stalked/ or banged my head against walls when devastated, but this time was different, I calmly brought out my stash of alcohol and began to celebrate the end of my pain, I knew I was going to commit suicide that night.  I reached out by phone to my boyfriend at the last minute, but he didn’t believe I was capable of hurting myself…but I did.  I thought taking an overdose (90) pills of Paxil was going to kill me.

Unfortunately I simply ended up in the hospital throwing up for days.  I was “counseled” into an abortion, and now two months later I have been prescribed Wellbutrin and I am now wondering if I have BPD?  Or did the trauma of being so devastated trigger a depression?  Or has BPD been underlying all this time?  Will this medication help?  I feel like giving up.  If it wasn’t for my Mom showing me this site I think I would still be considering ending it.  I hate feeling crazy.  Is it possible that I unknowingly tried manipulating my partner that night?  If so, I seriously need some help.

Thanks from Canada.

 

ANSWER:

There are many reasons for attempting suicide.  The most significant one is feeling overwhelming pain, and genuinely believing there is no hope.  Depression, the BPD, overwhelming situational problems, bipolar disorder, and drugs and alcohol can all trigger suicidal behavior.  The BPD may be a cause, however the key is persistence of symptoms since early adulthood (usually beginning at puberty).  The official criteria may be enlightening to you.  It’s important to make all the treatable diagnoses and treat them.  My screening test may be helpful to you in this regard.

Could My 65 Year Old Mother Have Undiagnosed BPD?

    Could My 65 Year Old Mother Have Undiagnosed BPD?

    QUESTION:

    Dear Dr. Heller,

    My mother is 65 years old.  She was hospitalized 4 times for “nervous breakdowns” when I was a teen, during which time she suffered from severe OCD, panic attacks, depression, and agoraphobia.  Mom underwent a series of shock treatments about 20 years ago; currently on high doses of Prozac, Serzone and Xanax.  Incest is likely, but has never been addressed.  Mom underwent surgery for hyperthyroidism when she was about 32 years old and has a history of migraines.  Recently, she has had a series of physical problems such as eye trouble, joint pain, and stomach disorders that physicians have been unable to find the cause of.  Mom hasn’t worked in over 30 years, doesn’t drive, and has few hobbies or interests. I myself am in therapy to help treat anxiety and co-dependency (growing up, my mother and I were heavily enmeshed).  My new-found emotional “freedom” at the age of 37 has triggered behavior in my mother that I have never seen before.  She has angry/sarcastic outbursts at me or will hang up the phone if I confront her about her lying (which is habitual) or other boundary violations.  Also, I am not ‘allowed’ to talk about anything in the past — she doesn’t want to hear anything “negative” about my childhood (which she’ll deny ever happened), and it’s as though deceased family members never existed, and she has little memory of her own childhood.  I am also noticing that people (herself included) are either “all good” or “all bad;” she either adores or despises a person, depending how that person has treated her recently.  Most things are viewed in terms of how it personally affects her.  In my recent research on mental illnesses, I stumbled onto information about BPD.  Based on some of the things I’ve mentioned here, do you think it’s possible my mother is suffering from un-diagnosed borderline personality disorder?

     

    ANSWER:

    Absolutely.  I’d even say it’s likely, particularly with the history of multiple meds in high doses requiring ECT for improvement.  The addition of Tegretol to an SSRI could result in a profound improvement – I’ve seen this in many older individuals.

Separator (Biological Unhappiness)

 

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What Can be Done For a Chronic Cough?

QUESTION:

Dear Dr. Heller,

Looking at my screen you seem to give the impression you are experts in the field of chronic cough which I have had for 2 yrs. Please expand.

 

ANSWER:

The obvious answer is find all the reasons and treat them. It can be more than one thing going on. The most common causes include:

a) post nasal drip b) asthma / allergies c) sinus infections d) GERD (gastroesophageal reflux disease) e) heart problems like a leaky valve or heart failure f) chronic bronchitis g) chronic lung infections, including TB h) medications – especially ACE inhibitors i) something wrong with the vocal cords or bronchial tubes

Additionally, chronic coughing causes more coughing by irritating the bronchial tubes.

Depending on the age, the following tests are reasonable and should be done if coughing persists:

a) sputum culture (the material you cough up)
b) posterior nasal culture (getting the material that could be dripping down the throat)
c) chest X-ray and possible CT scan of the chest
d) CT scan of the sinuses
e) ENT direct visualization of the vocal cords and upper airway
f) bronchoscopy (looking directly at the bronchial tubes)

My Case Is Complicated, Could I Also Have The BPD?

QUESTION:

Dear Dr. Heller,

I am writing from England and after reading many of the FAQ’s on your site I felt compelled to write to you.  I feel that I am at my wit’s end and don’t know where to turn next with regard to my numerous medical problems.  It is hard to know where to begin really.  I had a lot of problems as a child being labeled ‘difficult’ and ‘rebellious’ by my parents.  I have never felt properly understood or part of society.  I often feel paranoid that I don’t fit in or that people don’t like me.  I have suffered with depression on and off since I was about 10 years old after being bullied at primary school.  I was fairly healthy until I reached the age of seventeen and got Shingles which I believe was caused by severe anxiety.  I then got Shingles again a year later and almost exactly 12 months after I got Shingles for the 3rd time.  I became bulimic at 16 which continued until I was 23.

I have in the past, hit my head against walls, thumped my arms and legs causing severe bruising and even to this day if I get any sores or spots in areas of my body, which would not be visible to others when clothed, I cannot stop myself from constantly picking them until they bleed leaving unsightly scars which I feel terribly ashamed about.  To most people I appear confident and outgoing but inside I feel terrible anxiety and when I argue with my partner I often accuse him of not loving or liking me anymore.  I think this is partly because one time when I was about 13 years old after upsetting my (very domineering) father I was crying and I said, ‘You don’t love me anymore do you?’ and he replied, ‘Of course I love you.  I have to love you – you’re my daughter, but I don’t like you anymore’.

I sometimes feel it is more important to be liked than loved.  I feel so confused and I cry everyday.  I have cut myself off from many of my friends and family and have an intense fear of picking up the phone to speak to them, and the longer I leave it the more worried I become.  I feel like I need some sort of crisis in my life all the time and I also feel I need something ugly about my body.  If I give up biting my nails I make a sore and pick it all the time.  If I allow that to heal, I make my feet sore and so it goes on.  I would love to be free of having to do something destructive to myself.  I am overweight and am the only person in my family to be this way.

I feel like I am plagued with ill health.  I gained 35 pounds in six months after I got married in 1989 at age 19 and everyone put it down as being content, but I have since found out that I have an underactive thyroid.  Over the years I have gained a further 40 pounds!  I eat very healthily but when people look at me I feel convinced that they imagine I sit at home eating cream cakes all day long!  Four years ago when my thyroid problem was finally diagnosed it was also discovered that I suffer from polycystic ovaries syndrome.  I found it very hard to cope with the shock of finding out I had two awful health problems.  It took nearly two years to find the correct dosage of thyroxine to help my symptoms and I was told the weight would ‘drop off’ but it never did.

Then in September 1999 I was diagnosed with having epilepsy!  I suffer grand mal and absent seizures and so far after trying five different medications I still cannot find a drug to satisfactorily control my condition.  I take nearly 6000 tablets a year for my illnesses and am so thankful that with our British National Health Service all of my medications are free to me – I could never afford it otherwise.  My current treatments are as follows:- 150mcg Throxine, daily (Hypothyroidism) 120mg Telfast, daily (Allergies) Singulair, daily (Asthma) 100mg Spironolactone (Polycystic Ovaries Syndrome) 300mg Neurontin, 3 times daily (Epilepsy) Becloforte, 2 puffs, 2 times daily (Asthma) Ventolin, 2 puffs, 2 times daily (Asthma) Serevent, 2 puffs, 2 times daily (Asthma) Nasonex, 2 puffs, 2 times daily (Allergic Rhinitis).

I find I suffer bad side effects from many of the drugs I take, or have taken and I feel sure that my body is very sensitive to some of the chemicals.  One doctor said he thought it was more to do with psychological response!  This makes me mad as how can I fake things like hair loss?  I also had a very bad reaction to Valium administered intravenously a couple of months ago (for vomiting) when I stopped breathing and went out ‘cold’  a couple of seconds after it hit my bloodstream.

I feel tired and weepy most of the time and totally isolated and full of despair.  What can I do?  I have tried Lamotrigine, Tegretol, Phenytoin, Neurontin and Topamax (in that order).  Lamotrigine made me have terrible mood swings and depression.  I was severely allergic to Tegretol causing me to be hospitalized for 10 days – I nearly died.  Phenytoin caused facial palsy and such terrible aggression that I felt I wanted to leave my partner of 6 years.  Then I tried Neurontin, but after feeling unhappy about the awful debilitating lack of energy I asked to try Topamax.  I have to admit that when this made me so ill after only 4 days I was completely gutted, as if I am totally honest with myself I had read that it sometimes causes Anorexia and I prayed that this would finally be the answer to my weight problem.  I know this was stupid but I felt so desperate.  After 4 days of being on it I could not speak properly, everything came out all jumbled up like as if I was dyslexic.  I couldn’t remember my name and spent all my time just crying hysterically in a corner of my bedroom completely terrified of the whole big bad world around me.  So I had to return to Neurontin for the time being and I have gained about 14 pounds in 7 months, precisely what I was terrified of in the first place.

I feel like everything is out of my control.  I am told that my excess weight makes my PCOS worse and yet my hypothyroidism, PCOS itself and the Neurontin all seem to ‘conspire’ against me.  I just want to be slim, healthy and happy and wonder if I could ever achieve even just one of these things in my lifetime.  I feel like I have wasted half of my life so far.  I turned 30 this year but inside I feel like a baby and yet physically I feel like an old woman.  Do you think it is possible that I have BPD?  What could I do if I have it?  I don’t think my doctors over here know about it.  I see you often recommend Tegretol but with my allergy to it, is there any alternative?  I really would love to come off all my medications but know this is just too risky, but I dream of the day when I can live a drug-free life.

Please help me.

 

ANSWER:

You could easily have the BPD, and the picking at the skin could be a form of self-mutilation.  There’s lots of information in the BPD sectionthat could be of help to you and your physicians.  Prozac is a very important medication.  If you can’t take Tegretol, the most commonly used alternatives I use are Depakote and Neurontin.  http://pks.947.myftpupload.com/AskDoc/First-Do.htm should be of help.

Can I be Both Codependent and Have the BPD?

    Can I be Both Codependent and Have the BPD?

    QUESTION:

    Dr. Heller,

    My doctor has already diagnosed me as being codependent. During my last visit, he said I have some of the symptoms of BPD. I read the entire list, and some of these I do not feel describe me at all. I have never taken part in self-mutilation, nor have I ever gone on reckless sexual excursions.

    I do suffer from bulimia, abused alcohol in the past, and I currently smoke a half of a pack of cigarettes a day. I do not like being alone, and I do try to avoid it because I generally become depressed if I am left alone to only think. I rarely lose my temper, but I also have been diagnosed as having TMJ because I clench my jaws a great deal, especially when I am under stress. Is it possible for me to be both codependent (which I have no doubt in my mind that I am) and BPD (I really do wonder about this)?

    Thank you for your answer.

     

    ANSWER:

    Of course, there’s no official definition of co-dependency, but it generally means being more concerned with others than with yourself rather than being in balance, putting up with and/or enabling others to do things that are harmful to both of you, and/or spending more time worrying about other people than taking care of your own needs. Co-dependency can be a learned behavior (such as from a dysfunctional family), the result of a biological process (such as the genetic generalized anxiety disorder), or an adaptation (like being in an abusive relationship and trying to keep peace in the home).

    Many individuals with the BPD show co-dependency for any or all of the above reasons. Avoiding pain and fear is of primary importance to an individual with the BPD. Of course, I don’t know whether you have the BPD or not. The official criteria are very specific and refer to a pervasive pattern since early adulthood – which includes adolescence. I believe the BPD begins at puberty when the limbic system goes into hyperdrive and an individual is at his/her greatest risk of seizures.

    From what you wrote, you likely fit criteria 4 and 1. You live your life. You need to determine if the criteria do fit you and your life. I encourage you to look at the BPD and the other diagnoses I described in the screening test – which should give you a great deal of information.

 

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