Medical Literature

QUESTION:

Dear Dr. Heller:

2.5 yrs ago I discovered that my husband was involved in an affair and I totally lost it. We’ve been together for 34 yrs. I was devastated. I never thought I could be hurt that much. It was overwhelming, but I started to fly into rages that even scared me. I never knew I could be that angry. I’ve never felt so betrayed. I even started to ask friends who had gone through the same type of situation if they had felt the same way, plus I started having problems with concentration, memory and thinking clearly, sleeping and eating. It has been horrid.

I asked my therapist if she thought there was more to my feelings simply because they were so severe. Everyone said they thought it was justified and understood. I haven’t been able to function completely normal and get over this yet and I’m wondering if I ever will. I’m overwhelmed with sadness and disappointment. It has affected other difficult situations that have come up and I seem to over-react and get too upset or angry. The affair was the straw that broke the camel’s back and this opened up a Pandora’s Box for me, I resented the lies and deception so much after all the yrs of ups and downs and I managed to remain faithful. I have been filled with hate. At this point we are considering divorce.

Does this sound typical or am I a closet BPD or do I have a biological unhappiness and it took this to bring it to the surface. Before this happened I was just an ordinary person with the regular bouts of anger, but nothing severe. I do think I have always been a melancholy person, but I have been ok. I’m grateful now for every little smile or laugh. I’m tired and I’m tired of crying. I’m so tired of these feelings and they concern me, I just want to feel emotionally sane and happy. Do I need help. Are my re-actions abnormal. My husband thinks so and has called me crazy and bizarre.

I’m hurt and confused, help.

 

ANSWER:

Nothing is unique to the BPD. It’s an exaggerated human response – even self-mutilation is something we all do when the noxious stimulation is severe enough (as in insect bites). You appear to be experiencing a profound, likely psychotic depression and overwhelming hurt. The way I explain the BPD is that fear/pain/stress need to be defended to protect against brain injury. The brain deals with the fear/pain/stress with psychological defenses. When the fear/pain/stress exceeds the defenses the individual experiences anger – which makes a hurt, powerless individual perceive he/she is strong.

When even anger doesn’t protect, psychosis can set it (interpreting reality differently to better cope with the situation). I try to use the following example to explain the BPD: picture a pet dog that ran into the street and got hit by a car, breaking it’s leg. The dog limps into an alley to lick it’s wounds. A friend sees the dog and reaches out to help. The trapped, cornered, wounded animal instinctually lashes out. When this instinct kicks in inappropriately, dysphoria and psychosis result. The diagnosis of BPD requires a “pervasive pattern” – which you believe is not present. I’d still highly recommend you do the screening test I use for my patients, and see whatever diagnoses may have been present before this happened.

Everything needs to be treated for you to get back on track. Part of your immense pain appears to come from the realization that you ignored the “ups and downs” with the expectation that he would only have sexual relations with you, and that your “sacrifice” of putting up with your disappointments was unrewarded. Unfortunately, this is an expectation that can never be fulfilled, and this expectation is hurting you severely. While your response is hurting him somewhat, it’s hurting you more. As the Chinese Proverb states “when you seek revenge, dig two graves.” He made a choice – that the positives he had with you weren’t worth the “sacrifice” of staying monogamous. You previously made a choice – that continuing the relationship and avoiding solving your problems was the best way to avoid pain. The book “His Needs, Her Needs” by Willard Harley may be enormously helpful to you. I’m in no way minimizing your pain, nor am I condoning his behavior. I believe strongly against adultery – particularly with today’s sexually transmitted diseases and the difficulty we have treating them. Having sexual relations with another, and then bringing the possibility of disease to your spouse is in my opinion morally wrong, and some day may be considered attempted murder, assault, battery or manslaughter. I hope for your sake that you’ve been tested for HIV, cervical cancer, hepatitis B&C and other sexually transmitted diseases.

I am suggesting you take charge of your own life. Once you realize the power belongs to you, your life can be rebuilt – hopefully without those “ups and downs” and your melancholia. It could turn out to be a blessing forcing you to change how you look at yourself, relationships and life. It may have been necessary for you to choose happiness rather than settle for less because you’ve invested time. It may be possible for you and your husband to re-establish a relationship, only this time based on better principles that honor both of your needs better. You don’t know how it will end up. You probably need medication, at least for a while. You also need to make peace and feel you have a life left. Life is too precious a gift to waste experiencing vengeance and hurt. I highly recommend the books “Happiness is a Choice” by Barry Neil Kaufman, “Your Erroneous Zones” by Wayne Dyer, and “Looking Out for Number One” by Robert Ringer.

I hope this was of help.

Is it BPD or Another Brain disorder?

QUESTION:

Dear Dr. Heller,

What are the characteristics that someone has BPD and not another brain disorder?

 

ANSWER:

The official DSM IV criteria are available and define the disorder. There are similarities with many disorders, but to me the “trapped” or “cornered” animal instinct inappropriately kicking in is the key.

Without stress borderlines have inappropriate mood swings, chronic anger, and emptiness. Under stress, dysphoria (anxiety, rage, depression and despair) and other psychotic problems occur. Patients can have both the BPD and other disorders.

 

1999 December Questions

 

Ask the Doctor

 

QUESTION:

Dear Dr. Heller,

I am a single mom with BPD.  The drug prescribed to me was Tegretol, 200 mg, 2 pills 2xs a day.  I am unable to work while on this medication therefore I don’t take it.  My question is whether I can get better on my own, without meds or therapy, if I just keep reading and learning about my illness?  I do okay must of the time, but the rage and loneliness I feel sometimes makes me crazy.  I look forward to your answer.

Thank you

 

ANSWER:

No.  The BPD is a medical problem that needs to be treated.  Without medication you will experience chronic mood swings, emptiness, chronic low level anger, rejection sensitivity, and dysphoria (anxiety, rage, depression and despair) under stress.  There are lots of ways to prescribe medications that won’t make you groggy during the day.  I believe strongly that Prozac or another SSRI is needed.  Most people who need Tegretol regularly can take it just at night to prevent waking up with dysphoria.  I encourage you to read about the medications I use in the BPD section of my Website.

Do I Really Have Epilepsy Or Is It The BPD?

QUESTION:

Dear Dr. Heller,

I’m 18 years old, and just a few days ago I was diagnosed with epilepsy.  I know that a woman wrote you about the link between epilepsy and BPD (December 99), but my problem is not exactly the same.  Mine is more of the opposite.  I think I got BPD before epilepsy.

I do think I have had BPD for a long time, but I’m just starting to read about it (so I’m just discovering that I might have it).  I’m also starting to read about epilepsy.  Ok, I won’t really tell you why I think I have BPD, because it will be too long, but I do think that I have it, along maybe with ADD and Fractured enjoyment.  Now, the epilepsy problem.  I’m from Montreal, I was treated at Montreal Neurological Institute (at the Epilepsy Clinic), which is one of the best places for epilepsy treatment.

My first seizure happened a year ago (July 99), while I was in a foreign country.  So what happened is I had a seizure while I was sleeping.  But I was conscious while it was happening, until I did lose consciousness, and I woke up at the hospital.  They asked me the usual questions: Did I take drugs that day (because when I came to the hospital they thought it was an overdose, because no one saw me while I was having my seizure).  They asked if I remembered my name, the date, etc…and I did remember everything.  I told them about the seizure, and they put me on Tegretol immediately.  I spent the night at the hospital.  The next day I had an EEG and a MIR.  The results were all perfect, I had nothing wrong.

So I came back to Montreal, and then I went to Montreal Neurological Institute.  I told them my story.  They taught that it was an isolated case (it seems it happens to many people – that you have only one seizure in your life, and it never happens again).  They said that it might have happened because I wasn’t getting enough sleep (and that’s true).  The doctor put me off Tegretol, so I could have another EEG and MIR without being on medication.  The results were again alright.

Nothing happened for a year – well not a seizure, but I did have little movements of the eyes, and also of the head, but these little things have been happening to me for 3-4 years.  I didn’t tell my mom (my doctor knows all this).  I also had one-time movements of my left harm, I couldn’t stop it.

I did not have any real seizures until 3 weeks ago.  I was also sleeping, but as I woke up I had a seizure, my friend was there and saw everything.  I saw myself having the seizure…again until losing consciousness….and I woke up in the ambulance.  I went to the ER.  They put me on Dilantin.  They sent me back home, but at 2am I had another seizure.  With that one I didn’t even realize I was having a seizure, and I woke up in the ambulance.  I spent the night in the ER.

So now I’m taking Dilantin, but not for too long, my doctor wants to switch medication.  So a week ago I went to my doctor, and I saw a neurologist also, I told all of my story again, and they both agree I have epilepsy – EVEN if my EEG and my MIR are perfect, so that’s why I don’t believe I have epilepsy.

But I do think (reading your writings) that maybe it has something to do with BPD.  I haven’t spoken to anyone about me probably having BPD.  I have another appointment with my doctor in 2 months…..so please, ANSWER me…..do you think it has something to do with BPD????  I hope my e-mail wasn’t TOO long, but I wanted you to have all the information.

Thank you in advance.

 

ANSWER:

You can have “regular” epilepsy with a normal MRI and EEG.  The EEG is often normal until the seizure is active.  The areas of “seizures” for the BPD are deep inside the brain, and do not show up on normal surface EEG’s. The BPD has specific criteria, and the epilepsy medication Tegretol has been shown to have a significant effect.  Dilantin rarely works for the BPD.  Depakote sometimes works – particularly for the anger. I think you should discuss the BPD with your physician, and show him some of the studies on medication use that are available in the BPD section of this website.

 

2000 October Questions

 

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Is There a Difference in Length of Life for Borderlines?

QUESTION:

Dr. Heller,

Does the life expectancy of someone with BPD differ from someone without the disorder?

 

ANSWER:

I’ve never seen any data, but it stands to reason that the length of life statistically is significantly shorter. The reasons include suicide, lack of compliance with medical advice, cigarette smoking and other substance use, self-destructive behaviors, obesity, AIDS, and the enormous toll anxiety, anger and depression take on the body.



 

1999 November Questions Ask the Doctor