Medical Literature

Are Borderlines More Susceptible To Hormonal Changes?

    Are Borderlines More Susceptible To Hormonal Changes?

    QUESTION:

    Dear Dr. Heller,

    Do you think women with Dyslimbia and Dr. Siever’s subset of this population more likely to have marked dysphoric reactions to hormonal changes, such as PMS, post-partum, post-abortion, and post-miscarriage?  What about women with bi-polar and OCD?  What is the best medication for OCD?

    Thank you for taking the time to answer these questions.

     

    ANSWER:

    Yes, individuals with the BPD (my term Dyslimbia) are much more likely to have bad reactions to hormonal changes such as PMS and post partum changes (including post abortion and miscarriage). There’s a debate about the best medication(s) for OCD.  Prozac and other SSRI’s work well.  So does the TCA “Anafranil.”  The B vitamin inositol in high doses (18,000mg daily) can be effective as well.

Separator (Biological Unhappiness)

 

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BPD Has Destroyed My Life, Will Medications Help?

    BPD Has Destroyed My Life, Will Medications Help?

    QUESTION:

    Dear Dr. Heller,

    Hi.  I have been diagnosed with BPD for about 6 years now.  Even though I have received various forms of treatment during this time, my self mutilation – particularly cutting, but also overdoses – has actually become worse this year.  I live in a small state of Australia (Tasmania), and finding someone to treat me is very difficult.  There is so much prejudice and stigma about BPD, even within the mental health system itself.  The nearby public hospital will not admit me for psyche reasons at all, not even if I am acutely suicidal.  I have lost my nurse’s registration, my chance to study medicine, and a lot of friends, due to this disorder.

    I am wondering if I should really be on any medications.  I stopped taking my medications about three weeks ago, and have not noticed any differences in mood etc.  I was taking Zoloft 200mg mane, Sodium Valproate(Epilum) 500mg mane and 1G nocte, and thyroxine 50 microg mane.  Will going back on these medications really help in the long run?

    Many Thanks.

     

    ANSWER:

    Yes, medications will absolutely help in the long run.  It’s also important to recognize that the BPD is not your fault, and it is treatable.  The BPD section of my website has lots of useful information for you.  I’m firmly convinced the BPD is a medical problem.  My preference is Prozac instead of Zoloft, and Tegretol (carbamazepine) instead of valproate (Depakote). If you need thyroid you’ll likely need it the rest of your life.

Separator (Biological Unhappiness)

 

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Do I Have The BPD?

    Do I Have The BPD?

    QUESTION:

    Dear Dr. Heller,

    I have been treated for depression with Paxil for the past year(since I was 23) , and it has literally changed my life, as previously I would have thoughts about dying (either listening to the international news on the radio wire I was about to hear nuclear war announced and imagining what it would feel like when a bomb went off, to attempting suicide myself). I would harm myself (i.e. hitting myself and cutting my face), and I abused drugs (mainly speed and alcohol) from the ages of 16 to 21. I would become very scared of people, even people I knew, and would not trust anyone. If someone became close to me I would push them away as I was scared that they would get to know the “real me”.

    I would constantly cry and say that I was worthless and unlovable. In relationships I would become insecure and jealous for no reason. I could not talk to people or eat in public (let alone talk!) without blushing. I would leave all my college work until the very last minute as I was scared of starting it and I got a kind of a rush from the danger of almost failing. This all started when I was 14 and until last year I had seen doctors and been to counseling to no avail. However, now I feel very much better and like a different person since I have been taking Paxil, which I began taking when I went to the doctor as everything had become unreal and I felt that I was seeing the world one step behind from where my eyes should be seeing it from.

    Do you think I had BPD? The reason I ask is that both my mother and my uncle have epilepsy which is controlled by Epilim (a UK drug – called “Depakote” in the US). I do not have epilepsy but I noticed that you seemed to mention a connection between epilepsy and BPD on you Website. Is there a connection, and will I pass either epilepsy or BPD on to my children? I feel I ought to mention my mother has also been to counseling and took Valium and beta-blockers since going through her divorce when I was 6 months old, and she used to cry for no reason, so could the link be environmental?

    Also, I know I am supposed to avoid alcohol whilst taking Paxil, but I find it hard to avoid social drinking without drawing attention to my treatment. I have cut down on my intake as I have become very aggressive when drunk and my irrational thoughts would return (i.e. I would accuse my best friends of not liking me and talking about me behind my back, and accuse my boyfriend of not loving me and only going out with me for a joke). The weird thing is that when sober I realize this is all rubbish, but when drunk I would truly believe these thoughts, in the same way that before I took the Paxil I believed that my bad thoughts were real and there was no hope, but when I felt temporarily better I could not believe that I had been thinking such things. Is drinking small amounts harmful, and if so, what excuse can I use to decline drinks in social situations (without appearing to be a recovering alcoholic!) I apologize for the long letter but I have never really got everything off my chest before!

    ANSWER:

    It definitely sounds like the BPD, and I’m very happy for you that the Paxil has worked. The SSRI medications (including Paxil and Prozac), have a dramatic effect on those with the BPD – and relatively quickly.

    Epilepsy is nerve cells firing inappropriately and out of control. The type of epilepsy depends on what part of the body is having the seizure. Some neurologists believe diabetic neuropathy is a form of epilepsy – which certainly makes sense. I believe the BPD is a form of epilepsy in the brain’s limbic system – especially in the brain’s “cornered” or “trapped” animal instinct areas. Epilim (valproic acid or Depakote) can work for this, although I believe carbamazepine (Tegretol) is far superior.

    The genetic link is strong. I’d also highly recommend you look into the possibility that you have attention deficit disorder along with the BPD.

    You need to know that drinking alcohol is extraordinarily dangerous to you, and can easily ruin your life due to these seizures. Your description of what happens to you is strong proof for what I just wrote. Imagine if you got angry while drinking and hurt someone – especially while driving. Knowing that alcohol affects you this way could cause a sense of guilt and shame that would haunt you the rest of your life, plus could put you in a legally dangerous situation. You could easily tell your friends “I don’t like how I feel when I drink alcohol” and simply stop drinking with them.

    Separator (Biological Unhappiness)

 

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BPD and the Elderly

    BPD and the Elderly

    QUESTION:

    Dear Dr. Heller,

    Where can I obtain information on BPD and the elderly? There is a lot of information online about BPD but nothing seems to address the specific needs of an older person who has this disorder. How does one properly place their parent in an adult family home or nursing care facility when it is necessary to do so?  Many caretakers know how to handle them.  Some are unwilling to do so.

     

    ANSWER:

    There isn’t a lot of information. I remember one study showing how elderly borderlines act self- destructively by acting passive aggressively in ways like refusing to eat, refusing to take pills, refusing to go on outings, etc. I’ve taken care of many elderly borderlines and I agree with that assessment. Many BPD symptoms remain, particulary the moodiness and misinterpretation of motives.

    Elderly borderlines are often referred to as “cantankerous” or “problem” patients. I treat them identically as younger patients. All the diagnoses need to be made and comprehensively treated, and I use my screening test for them as well.

    The only significant difference is that physicians usually have to start with lower doses and go somewhat slower. The advantage – in addition to them being happier and their loved ones less stressed – is that the individual is usually less sick from other causes and often needs lower doses of medication for high blood pressure, arthritis, and diabetes.

Could I Have The BPD?  (From The Netherlands)

    Could I Have The BPD?  (From The Netherlands)

    QUESTION:

    Dear Dr. Heller,

    Before you delete this mail because it is too long and you are a very busy man, please hear me out: It would mean terribly much to me if you would read it, cause I’ve seen your website, which made me believe that you might understand my problems better than anyone else could.  I do not know who else to turn to.  I am confused about my whole situation and I suspect I have reason to believe I (partly?) am a borderline.  My therapist has mentioned the word, but she’s quite vague about it and doesn’t seem to understand my need to know exactly what’s wrong with me.  I am a 22-year-old girl from the Netherlands and I have already sent you an e-mail last Thursday, but wrote it in a hurry and was not really satisfied with it.  Therefore, I would like to give it another try.

    CHILDHOOD: I was brought up in quite a protective environment.  I felt I had to please my parents and 5 older brothers and sisters, but didn’t feel I could.  We never used to talk about ‘feelings’ at home, but, still, I was a rather sensitive girl and had a great sense of imagination.  I was shy, insecure, a dreamer, already felt I didn’t fit in anywhere.  Back then, my 3 big wishes were: 1.  To learn to swim 2.  To learn to whistle 3.  To stop wetting my bed at night (did that till the age of 11, of which I was very ashamed).

    ADOLESCENCE: Though, as a child, I already felt like an outsider, it has gotten much worse during adolescence.  At secondary school, I felt lonely, horribly ugly, ‘less than zero’, shy, scared and I worried over everything.  Kids at school sometimes teased me and for about 2 years I did not have any real friends.  My ability to concentrate got worse: I usually put my homework off till it was almost too late, so I had no choice but to do it, I was scared to death to stay down a grade (new kids), which helped enormously to set myself in motion.  My unhappiness now and then burst out when I got home from school.  I think because I felt safer at home.  In particular in the presence of my mother (loved and trusted her), I was often thin-skinned, cynical and grieved.  I sometimes tried to talk to her about it, which didn’t work out, usually triggering an out-of-control mood – I was desperate, upset, cried, used harsh words (Why the hell did you put me on this planet?  – I am awful – everybody hates me, etc.).  Than I’d flee up to my room, where I cried, buried my face in a pillow, pulled at my hair and/or banged my head against the wall.  After an hour or so I used to calm down and started feeling guilty.  What got me through secondary school was, I think, my intelligence, the fact that I was very hard on myself, and my sense of imagination – I fled into fantastic fantasies starring a fantastic me and fantastic others who found me fantastic.

    AFTER ADOLESCENCE ; At 19, I went to a new school, far away from home, which forced me to find a place to stay in a city unknown to me, amongst strangers.  I was very, very scared but did not realize nor accept it.  In the 2 1/2 years to follow, I had a few ups and many downs but never dared to give myself a break.  When I had the prospect of a work placement of 5 months in England, however, I felt so horrible about that and the rest of my life that I sought professional psychological help.  I did not go to England.  They found my case ‘complex’, thought that I did not have enough basis (was too confused/weak) for therapy and thus sent me to a therapist who gave me supportive therapy; she had the task to make things clear for me (with my help), make me stronger first.  After a lot of waiting, talking and some tests, this was the diagnosis: Social phobia, agoraphobia, avoidant personality disorder, dependent personality disorder, depression, identity problem (underdeveloped identity), problems of adaptation.

    Supportive therapy hasn’t improved much (after almost 1 year), which is why I will most likely start intensive day therapy soon (activity program).  What isn’t helping me at all, is that I could not and still cannot accept that there’s something wrong, and that I am not just lazy and undeservedly drawing attention.  It is also hard for me to discuss it with my parents.  After my therapist had repeatedly requested medications for me, the psychiatrist finally prescribed Seroxat (paroxetine) to me.  20 mg did reduce my fears and made me more indifferent, but not yet more active and I still felt very guilty.  The dose was heightened to 40 mg, which has taken away a bit of the guilt feelings and has made me more active.  I also feel more indifferent since the 40 mg, though ’empty’ describes the feeling better, I think.  Sometimes I seem to feel happy, but it is more like a kind of hollow happiness, one that does not touch my soul.

    I often desperately want to get attention from other people, ALL people, and get very lonely, sad, miserable when I do not get any.  (For example, I sat by the river twice, waiting for someone to come and sit next to me, talk to me, love me, which never happened).  I also very quickly feel abandoned by people I should actually trust.  In moments of despair, I carve myself with a knife (about 1 time per 1 1/2 weeks), the last time was last Tuesday.  I do that because I have no other choice.

    A few times, I drink a lot of alcohol at once, but not often.  Lately I sometimes cannot stop myself from eating loads of cookies and/or candies.  I tried to throw up twice, in which I didn’t succeed.  Before I sought professional help, I also had a lot of those feelings and I had also cut myself once, because my boyfriend was being selfish, which made me lose it.  At the age 15-19, I also used to drink a lot (liquor mixed with other liquor) before I went out, in order to lose my insecurity.

    I do not know if the following is important: When I was 3 I fell real hard on my forehead, causing a very big bump that almost burst.  I have also had one (bad!) experience of vertigo (recognized it at your site!) at the age of 17.

    I sure hope you have read this.  My therapist has mentioned ‘borderline’ once or twice when I had told her how I felt and what I had done, but I still just don’t feel like I know anything much.  Do you think there is a chance that I am a borderline?  Could you please tell me what you think about the diagnosis (given before I started taking Seroxat), and the fact that I am taking Seroxat?

    I don’t think you can imagine just how grateful I would be if you would answer my questions.

     

Separator (Biological Unhappiness)

 

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BPD in Children?

    BPD in Children?

    I am often asked about the BPD diagnosis in children. By definition, it does not occur since the BPD is defined as developing since early adulthood. Since the problem appears to be primarily in the brain’s limbic system, and since the limbic system goes into hyperdrive at puberty, it makes logical sense that the BPD would begin at puberty. While some authors have made their own diagnoses of BPD in children, the literature has not shown consistent findings in this regard – and a study in the 1980’s showed that children diagnosed as having BPD in childhood did not have the diagnosis in adulthood.

    Many children show symptoms similar to the BPD: inappropriate moodiness, self-destruction, impulsiveness, impulsive aggressiveness, jumping to the wrong conclusions, chronic anger, lack of temper control, irritability, and rejection sensitivity. I’ve treated many, many children for similar problems, and successful treatment has never included diagnosing the BPD in pre-pubertal children. Attention deficit disorder, depression – especially with psychotic features, what I call “fractured enjoyment” (which is really the formerly diagnosed “depressed personality”), the generalized anxiety disorder, panic disorder, post-traumatic stress disorder, bipolar disorder, and the obsessive compulsive disorders. Bipolar in children is most likely to be confused as “childhood BPD.”

    Since most of these diagnoses are genetic, I will often have both biological parents do the screening test for themselves and prioritize treating the diagnoses that all three seem to have. This has been a remarkably effective technique, particularly for smaller children.

 

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