Medical Literature

QUESTION:

Dear Dr. Heller,

I have job hopped as long as I can remember.  Is there something I can do to keep a job.  I have never really failed at any task I was given, nor have I had any co-worker problems.  I just can’t keep to one job after I get bored with it.  Is this a symptom of anything I should be aware of?

 

ANSWER:

The two most common mental health causes of inability to maintain a job are the BPD and attention deficit disorder.  Boredom is a common BPD symptom that goes away with SSRI medication, the most consistently successful one is Prozac.  The symptoms that go away with Prozac are the unprovoked mood swings, chronic anger, emptiness and boredom.  Dose increases can sometimes make the symptom go away in as little as a day.  The official criteria can be found at http://pks.947.myftpupload.com/DSM.htm. Attention deficit disorder causes an inability to stay focused and being easily distracted.  The official criteria can be found at http://pks.947.myftpupload.com/AD-H-Dcr.htm.

QUESTION:

Dear Dr. Heller,

When I was fifteen I was struck by a car.  It resulted in me being in a week long coma.  Can BPD be a result of this kind of head injury?  As a result of the accident, I also have physical problems.  I have epilepsy and narcolepsy.  Can you tell me what is the relationship between these illnesses and BPD?

Thank you.

ANSWER:

The BPD can indeed be caused or worsened by a head injury.  During the many BPD support groups I ran, approximately 1/3 had significant head injuries in their past.  I believe the BPD is caused by damage to the brain’s instinctual trapped, cornered, wounded animal response – located within the limbic system, and is likely a form of epilepsy (nerve cells firing inappropriately and out of control).  I don’t know of any link with narcolepsy and the BPD.

Is There A Link With BPD, ADD, Temporal Lobe Epilepsy And Thyroid Problems?

QUESTION:

Dear Dr. Heller,

A close friend recently went to see a psychiatrist as she was suffering from episodic memory lapses, emotional outbursts, breathing difficulties etc.  She was told that she could be suffering from temporal lobe epilepsy, and told to do an EEG to confirm.

Before my friend went to see the psychiatrist, I had thought that she was suffering from some form of personality disorder, e.g.  BPD or ADD, because she would, on occasions, act as though she were a completely different person – for example, she can’t remember me.  She was also very hyperactive, and some years back, was diagnosed with hyper-thyroid, although her condition (according to a recent blood-test) has since stabilized.  My question is whether there is a common link to all of these symptoms/diagnosis – thyroid, ADD, BPD and temporal lobe epilepsy.  If so, what exactly could be the problem?

Thanks.

 

ANSWER:

There is a strong link.  I’ve found approximately a 50/50 link with attention deficit disorder and the BPD.  Thyroid problems are common in those with the BPD.  EEG’s may or may not be abnormal, since the BPD is likely a form of epilepsy in the deep structures of the brain that cannot be detected by routing EEG’s.  If the seizure spreads to the temporal lobes then the EEG may be abnormal.

 

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QUESTION:

Dear Dr. Heller,

After reading many articles on the BPD, I’m convinced I have it.  I fit the profile very closely, including: 10+ years of chronic depression and hopelessness; fear of abandonment; identity issues; self-hatred; impulsivity in three areas of my life; 10 years of self-injurious behavior; suicide attempts; a history of sexual abuse; and a history of convulsions/seizures and headaches (plus other BPD symptoms).

Today, I’m 40, professionally degreed, married, and raising 3 year old twins (as a stay-at-home Mom).  I feel a whole lot better.  I’m no longer seriously depressed, but I frequently feel either sad, overwhelmed, restless, trapped, or bored.  In the last 13 years, I cut myself once (when I thought my husband was going to leave me), and lately I have dug my fingernails into my body when I have felt horribly overwhelmed.  I have started to fantasize about cutting, but stop short of doing anything.

I’m particularly concerned about being a good Mom to my children because they are (foreign) adopted and have started seeing a speech pathologist for language/communication disorders.  I feel like I’m getting angry more often (always a raging anger), although it usually subsides very, very quickly, but I’m always left with so much guilt and then depression knowing that these outbursts are emotionally affecting my children.  (I’m not spanking them, just throwing things!).

I have a ton of projects going, but very few completed.  I recognize my life is particularly stressful now–is this triggering or aggravating my BPD (assuming I have it)? I’ve had many years of therapy and really don’t want to start again, but I believe medication right now would even me out emotionally.  What do you think about medication without therapy (or prolonged therapy) in my situation, especially if I haven’t been officially diagnosed as having BPD?  Thanks for your interest and kindness.

Stressed in Dallas

 

ANSWER:

Yes, stress triggers worsening of BPD symptoms.  That you are experiencing enough dysphoria (anxiety, rage, depression and despair) that you’re considering cutting is a sign medication is desperately needed.  The last thing you want to happen is getting into trouble with state agencies for being so angry and depressed that you can’t take care of those children effectively.  I know you don’t want that for many reasons. I believe passionately that the BPD is a medical condition that needs medical treatment.  My website explains the medications I use and why. I think counseling is extremely important addition to medication.

QUESTION:

Hi, Doc.

I have book marked your great Website! I am a US Navy veteran. In 1991, while still in the service, I was diagnosed by a military psychiatrist with BPD after a single half-hour visit. I had presented with great depression and a desire to die. I was physically ill, as well, with a fever of 103. I had been working 100 hours a week and was exhausted. This was not addressed by the doctor, who seemed unconcerned about those issues. I was then hospitalized for a week in a military hospital psych ward. No medication was offered, nor was any follow-up therapy after my discharge. In fact, the entire experience was very negative. The doctor who diagnosed me was very condescending and seemed to regard me with scorn, as if I were a troublemaker. The hospital staff, while generally kind, basically regarded us patients as children to be babysat until we gave a satisfactory MMPI test result. Upon my return to work, I was treated like a pariah by my peers and superiors, and so I put in for a welcome transfer. I was honorably discharged in 1992. I never again sought care until last week, when I basically decided that I have had enough of feeling lousy. I called a local mental health office and made an appointment. Three questions: 1. Could the military doctor have been wrong about my diagnosis? 2. Can BPD be determined after talking to a patient for 30 minutes? 3. Should I mention this to my new doctor? Given that so many clinicians appear to dislike working with borderlines, I don’t want to get started on the wrong foot. However, I don’t want to withhold any important information either.

Thank you!

 

ANSWER:

Of course the doctor could be wrong. I often say my name tag says “MD” not “GOD.” 2) Yes, a short interview focusing on DSM criteria can clearly determine the BPD. I try to work together with my patients so that we are on the “same page” and come to the same conclusions. Since there are no blood tests, psychological tests, or imaging studies, the patient’s opinion and experience are what matter most to me. 3) I would recommend it to your physician. If nothing else you’ll find out if the physician will be honest and up front with you. Hiding things from your physician is rarely a smart choice. There is a wealth of useful and important information in my BPD section, particularly an article for primary care physicians. Both of my books, and the BPD section of this Website go into the BPD at length. My first book, “Life at the Border – Understanding and Recovering from the Borderline Personality Disorder” is on the recommended reading list at the National Institute of Mental Health. I also strongly recommend you review the screening test.

What Do You Think Of My Present Treatment?

QUESTION:

Dear Dr. Heller,

I have been diagnosed with BPD and am currently under a psychiatrist’s care for the past 4 years.  Although I’ve tried many meds, I am currently on 600 m.  of Serzone and 60 of BuSpar.  Occasionally, I have used trazodone at night but my Dr. has discontinued it’s use (she felt my symptoms were worsening with it).  I have abused alcohol to relieve my symptoms but am now sober.  What do you think of my present treatment.  Therapy is cognitive.

 

ANSWER:

Trazodone can actually worsen seizures, and since I believe the BPD is a form of epilepsy, trazodone is not a medication I prescribe often.  I’ve been very disappointed with Serzone, particularly in treating the BPD.  BuSpar is fantastic for the generalized anxiety disorder, although most patients don’t require such high doses.  I believe that individuals with the BPD need an SSRI – and Prozac is the best in my experience.  You also need, as needed, medications for when you crash.  The screening test I use for my patients can give you clues to other diagnoses that also need treatment.  In the BPD section I go over medications at length, and why I recommend them.

 

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