Medical Literature

Do I Have BPD Or PTSD?

QUESTION:

Dear Dr. Heller,

Hi.  I’m 22, female and live in the UK.  I think I fit the following criteria for the BPD.  However I cut only when depressed or hopeless, not usually when angry, I have feelings of emptiness only when I feel depressed, drink when depressed or angry and spend only when feeling relatively ok or when I was hyperactive when on Paroxetine.  My mood is unstable every now and again.  Depression seems to last weeks or months but anxiety only a short while.  Irritability is not as often as the others.  Does this still mean I fit the criteria?  4) Impulsivity in at least two areas that are potentially self-damaging (e.g.  spending, sex, substance abuse, reckless driving, binge eating) 5) Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior 6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) 7) Chronic feelings of emptiness 8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) I however am only occasionally angry but very intensely so.  My doctors will not tell me my diagnosis but I think it will be BPD which my friends agree with.  My Drs think therapy is the way to go and no medication.  My therapist thinks I suffer from PTSD.  I have strong suicidal feelings and feelings of hopelessness yet my Drs say there is nothing they can do.

I see a GP and a psychiatrist who I have seen twice and has told me to find an alternative career (I’m studying to be a doctor), make friends and live life to make me feel better.  He does not seem to care how bad I feel nor that I get very little sleep and am frequently suicidal.  He says I am taciturn and should talk to him but then says he does not see his role as helping me as such, merely overviewing my therapist and GP.

My psychiatrist said he dose not care if I cut myself, as long as I do not overdose.  I am at my wits end because I just want everyone to be honest with me but they avoid my questions about diagnosis and refuse to let me read my notes.  I am writing this in an attempt to ask your advice on how to handle this.

 

ANSWER:

It’s extremely common to have both.  Sometimes a medication trial can give a strong indication whether the BPD is present.  If Prozac (fluoxetine) for a week followed by carbamazepine (Tegretol and others) makes you profoundly better, you likely have the BPD.  Remeron (mirtazapine) can be very helpful for PTSD, particularly in combination with the Prozac – especially if the Prozac seems to be making you worse.

What Should I Do?

QUESTION:

Dear Dr. Heller,

I figured out that my friend was suffering from BPD, all on my own from observation and reading.  My friend raged at me and is not talking to me anymore.  I’m concerned about what my reaction should be if she ever comes back to me once she gets back in the white? Should I let her know that I know and understand?  Or?

Thank you.

 

ANSWER:

Once an individual with the BPD believes you’re a bad person, it can be very difficult to change their mind.  Memories from a psychotic rage are usually incorrect, but they “feel real” to an individual with the BPD.  The human brain is incapable of distinguishing actual events from those that were imagined with strong feelings.  They both are “remembered” as real.  Unless the individual is willing to be serious about treatment the wisest approach may be to say nothing and just smile and be pleasant.  http://pks.947.myftpupload.com/AskDoc/q1.htm can give you assistance in helping your friend.

What Causes BPD Mood Swings?

    What Causes BPD Mood Swings?

    QUESTION:

    Dear Dr. Heller,

    You wrote that we who have this emotionally dysregulated personality known currently as BPD can just go into the black “out of the blue”.  I know very well the experience of “the eclipse” and I used to think it came out of nowhere, but I’m not so sure anymore.

    I will track specifically what took place between feeling pretty good to despair, emptiness and sadness.  I can see and identify what triggered my mood to darkness .  Do you really think it comes out of nowhere?  I do feel physically taken by a wave and then swallowed by the undertow but I think there is a trigger for that to happen.

    Some communication I experienced in my environment – an invalidation from my mother happens first which then affects my brain chemistry causing self hatred and self doubting neurons to fire and there I go.  I then disconnect from everyone around me.  I take this emotional intermission where I space out because something made me sad.

    I do understand that our brains are different and we are lacking what others do not, but do you think that just blaming the brain is a way to avoid not confronting the pain that triggered our emotions or thoughts?  A way to avoid facing the pain a situation caused so it can have a better chance of not repeating itself?  A way for us to not get some control over ourselves, emotions and our reactions?

    I’d like to believe it was just a brain change and say I was powerless over it, but then I would sound like a drug addict blaming their “disease” rather than taking some responsibility and finding out how I could behave and think differently so these waves couldn’t get to me every time I was enjoying myself in the ocean.  Do you think the triggers out there in our worlds affect our brains or do you think it just starts to rain out of nowhere?

    Thank you.

     

    ANSWER:

    BPD mood swings are either provoked or unprovoked.  Provoked means they are triggered by some thought, smell or physical event that triggers the “trapped animal” instinct and the seizure that causes dysphoria (anxiety, rage, depression and despair) and dissociative symptoms (if it spreads to the temporal lobes). What you described are unprovoked mood swings.  I believe it’s due to an instability within the limbic system, again in the “trapped animal” response.  I’m highly suspicious glial cell malfunction is to blame – 90% of the cells in your brain are support cells (called “glial cells”), not neurons.  Prozac works very well and very quickly at controlling these unprovoked mood swings – in fact I gauge the Prozac dose on whether unprovoked mood swings, chronic anger, emptiness or boredom are persistent symptoms.  Prozac works far better than Zoloft and other SSRI’s – likely because of the positive effects Prozac has on those glial cells (which has been shown in the literature).  These unprovoked mood swings also trigger dysphoria (anxiety, rage, depression and despair).

Separator (Biological Unhappiness)

 

2001 June Questions

 

Ask the Doctor

 

Home

Isn’t BPD Just A Misogynist Label For PTSD?

QUESTION:

Dear Dr. Heller,

I was diagnosed with BPD about five years ago, about 2 years after suicidal behavior first manifested.  My first symptoms began in my early 30’s within a few months of becoming a lawyer and starting to practice law at a large national firm, where the stress was very high.  My history seemed to match the diagnostic criteria: I grew up with severe physical and sexual abuse, and with what could be classified as an absent parent – a mother who had MS, was quite mentally ill and incapable of acting as a parent (the limited resources available in my home were utilized by her).

The more I read about BPD, the more offended I became that the label had been attached to me.  They seemed to be the modern-day equivalent to Freud’s hysterics.  I then read Judith Herman’s Trauma And Recovery, and came to the conclusion that there is no such thing as BPD – only hard-to-treat PTSD.  I concluded that BPD was a misogynist label attached to women (I never met a male BPD in treatment) in a victim-blaming manner, and it seemed to give treaters an easy out when treatment failed (which it usually did).  It seemed a catch-all, almost “garbage can diagnosis” for women with trauma histories who were not responding well to treatment.

I just wanted to know your thoughts about this.

 

ANSWER:

While there are some areas where I agree with you, I totally disagree “that there is no such thing as BPD”.  I view the BPD as a medical problem, and recent studies showing areas of the brain that are smaller tend to confirm this concept.  So does the response to medications.  My ratio of females to males is 3:2.  I suspect the ratio is even, but more males wind up in prison and don’t get the medical attention they need. While many individuals with BPD also have PTSD, it’s not consistent. The BPD diagnostic criteria are not established by one’s childhood, in fact the diagnosis is independent of cause. I believe the BPD is a form of epilepsy (brain cells firing inappropriately and out of control) in the “trapped, wounded, cornered animal” part of our brain.  It causes enormous psychological damage.  It has profound genetic influences – likely close to 50/50.  It can be caused by emotional trauma, head injuries, brain infections and abuse. The BPD is not a label, it’s a diagnosis.  I agree totally the name of the diagnosis has to change.  I like “Dyslimbia” – which means malfunction of the limbic system.  Dyslimbia doesn’t carry the connotation a “personality disorder” diagnosis has.  The BPD is no more a label than being a diabetic, epileptic, or hypertensive. I agree there are some misogynists out there, but the BPD is not a diagnosis manufactured by misogynists who wish to label women with something horrible. Another area I agree with you about: Blaming the victim is extremely common and wrong.  No one with the BPD asked for it or caused it.  I believe strongly that the right daily medication combined with the right “as needed” medication gives the individual with BPD the opportunity to become the person he/she wishes to be.  I try to acknowledge to my BPD patients that they are indeed suffering.  I explain that they deserve to get that suffering under control, that it’s not their fault, and that they can have a terrific life.

How Can I Help My Friend Who Believes Her Own Lies?

QUESTION:

Dear Dr. Heller,

I have a friend that has been divorced for seven years (she is the one that wanted the divorce).  She will lie to her ex-husband, break up any kind of relationship that he tries to have, and is always trying to tell him that he was never there for her and the children.  When she was married she ran around on her husband while he stayed home and took care of the children.  As long a she has a man, any man, in her life, she will leave her ex-husband alone.  When guys find out that she has lied to them or is running around on them they dump her.  Of course it is always the other person’s fault.  What kind of behavior is this and is there any help for a person that lies and believe her own lies?

ANSWER:

The person can only be helped if she wants help.  Her story is consistent with the BPD, but doesn’t prove the diagnosis.  People with the BPD can believe their misinterpretations as very real, and “remember” things that didn’t actually happen as real.  It’s one of the cruelest effects of the BPD.  One of the issues to be dealt with in therapy (after the medications are working) is distinguishing which “memories” are real and which were misinterpretations brought on by psychotic thinking that can develop during dysphoria (anxiety, rage, depression and despair).  There are some FAQ’s in the “ask the doctor” section which can be of help.  This answer will be the: http://pks.947.myftpupload.com/AskDoc/q1.htm, The most important thing you can do is to assist your friend in getting information.

Why Do I Gain Weight On Antidepressants?

    Why Do I Gain Weight On Antidepressants?

    QUESTION:

    Dear Dr. Heller,

    I have depression and much-reduced BPD (it was a bigger problem in my teens and twenties).  My problem is that though medication helps me a lot, I can’t handle the weight gain.  I don’t believe that my anxiety level gets worse on SSRI’s.  Can you help?

    I am 42.  About 8 years ago I experienced a 50 pound weight gain with a tri-cyclic amines antidepressant, which I then became aware was not unusual.  After getting off it for about a year, and readily losing about 25 pounds, I took Prozac which helped me immensely psychologically.  I had no side effects of feeling more anxious.  It relieved my anxiety, agitation, and depression.  However, I put on another 35 pounds.  Then I got off Prozac (after about 3 years) and tried Paxil.  Once again I gained lots of weight (added another 10 pounds on my maximum weight).

    My sense is that I lose the ability to know when I am full – that I don’t get a sense of being “done” or even feeling “stuffed”.  I have trouble controlling my intake, and I also feel that even at the beginning there is a metabolism shift.  It feels if my skin is crawling.  Is this common, and is there a medication that is known to consistently avoid this effect?

    Thank you very much.

     

    ANSWER:

    Tricyclic antidepressants can cause weight gain, and can be used to stimulate appetite in those who are underweight or have lost their appetite.  In my experience, the most common cause for weight gain with the SSRI’s in an individual with the BPD is the generalized anxiety disorder (GAD).  Many individuals interpret their anxiety level as meaning the GAD, but actually the GAD is a genetic trait with primarily persistent worry, or the mind never shutting down.  Those with the BPD and GAD treated with an SSRI get some anxiety relief from the SSRI, yet at the same time their GAD is actually increased.  The increased GAD causes an increase in BPD dysphoria (anxiety, rage, depression and despair) – which can result in the skin crawling sensation and is often “self-medicated” with food.  Since the food is being used to “treat” dysphoria, there is no satiety effect.  I go into the GAD/SSRI/BPD phenomenon at length in “Biological Unhappiness.”  Many studies have been done on SSRI’s and weight gain/loss with no consistent findings.  I recommend looking at the screening test.

Separator (Biological Unhappiness)

 

2001 January Questions

 

Ask the Doctor

 

Home