Medical Literature

Can Someone Get BPD at Age 40?

    Can Someone “Get” BPD at Age 40?

    QUESTION:

    Dear Dr. Heller,

    My friend has every sign you listed, except abandonment issues. One that I’m not sure about is binge spending, but not on himself, on family, friends, strangers. But he is 41. Also, he got violent when someone he had given HUGE amounts of money and help to, tried to take his car by saying he stole it. (long story).

    He suffered childhood abuse, a sibling committed suicide. Maybe something of an abandonment issue – he’s in prison and seems more interested in what he did to his dogs, although feels horrible and suicidal over people he hurt too, but mainly the dogs. Can someone “get” BPD at age 40? He showed all other signs before – Doesn’t “cut” himself but hurts himself other ways – alcohol mainly (not an alcoholic – didn’t have DT’s when he stopped drinking) Where can I find a doctor like you in CT?

     

    ANSWER:

    Unless a head injury triggered it, one doesn’t “get” the BPD at age 40. By definition, it’s a “pervasive pattern…beginning in early adulthood.”

    It can significantly worsen due to stress as an individual ages. Self-mutilating young women have had the most attention and research, but the BPD affects multiple individuals in many different areas.

    Incidentally, not getting the DT’s doesn’t mean an individual isn’t an alcoholic.

    Dr. McGlashan at Yale was a pioneer in BPD treatment, and believes in the biological underpinnings. I don’t know whether he is still working with borderlines or not.

Separator (Biological Unhappiness

 

2000 March Questions

 

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Does Combining Zoloft With Alcohol Make Their Symptoms Worse?

    Does Combining Zoloft With Alcohol Make Their Symptoms Worse?

    QUESTION:

    Dear Doctor, I am married to a woman whom I believe has either BPD or another personality disorder.  She is also an alcoholic, and although she knows she is, she seems to have no desire to help herself.  I see the depression start to set in for a few weeks at first, sometimes lasting several months.  Well, she was hit by a car crossing the street and saw a neurologist whom prescribed Zoloft and Amitryptilline. When she starts to get depressed she will start to drink as well.  Then I am to blame for all that is wrong in her life.  I have been stabbed and burned with cigarettes by her when she drinks.  I have seen her do some really self-destructive things as well, including suicide attempts and promiscuous behavior and plain hatred towards me.  Does the combination of Zoloft and alcohol cause an even more severe depression?

    ANSWER:

    It’s more likely the alcohol is making the BPD worse and interfering with Zoloft’s effectiveness.

    Separator (Biological Unhappiness)

     

    2001 November Questions

     

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Are Borderlines Unfit Parents?

    Are Borderlines Unfit Parents?

    QUESTION:

    Dear Dr. Heller,

    I am going through a child custody case with my ex-wife.  Our son was born several years after our divorce as the result of a hoovering attempt by my ex.  I believe he is living in a very explosive unstable situation.  I believe this evidenced by events during the 3-month marriage and each attempt to reconcile.

    My questions –

  1. Is it best to remove the child as early as possible from the BPD?
  2. Will he be unaffected by the BPD?
  3. Will living with the BPD subject him to the probability of becoming a BPD later on in life?
  4. Would you recommend to a court that custody of a minor child be given to an untreated BPD VS.  a non-BPD?

ANSWERS:

  1. It really depends on how severe the BPD symptoms are.  Violent behavior, raging, and substance abuse mandate removal of the child.  The same is true if self-mutilation or other self-destructive behavior is done in front of the child, or if the depression prevents the BPD parent from parenting properly.  This is particularly a problem if ADHD is also present. 
  2. There is a concept in child raising referred to as a “good enough mother.” Children will learn from their parent’s attitudes and behaviors.  Some will grow up determined to not be like the BPD parent, others will use it as an excuse to be dysfunctional themselves (similar to substance abuse problems, particularly alcoholics). 
  3. The genetics are high, but there are no identical twins separated at birth studies to really give this answer.  A fair percentage of borderlines are good people and try to be good parents despite their disorders.  Child abuse will definitely increase the risk of the child developing the BPD as well.  One potential problem is the anger and transference borderlines go through can harm the relationship between the child and the other parent, this is particularly true when the BPD parent has custody.  Since they can remember things that didn’t actually happened as true, they can be extremely convincing. 
  4. It depends totally on how severe the BPD symptoms are and what the mental and emotional status is of the non-BPD parent.  A high percentage have problems themselves. 

Separator (Biological Unhappiness)

 

2001 September Questions

 

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Are shock treatments appropriate for the BPD?

    Are shock treatments appropriate for the BPD?

    QUESTION:

    Dear Dr. Heller,

    Hello.  My younger brother (age 19) has been diagnosed with Borderline Personality Disorder.  I learned today that he had “shock treatment” and will have 4 to 12 more “treatments.”  What do you think about this method of treatment?  I thought it was a very dated concept!  Thank you for your time and consideration.

    ANSWER:

    ECT (electroshock therapy) can help with severe unrelenting depressions, at the cost of memory problems for a while.  It’s not outdated.

    It’s very unusual for borderlines to not respond to the Prozac/Tegretol combination, particularly if an occasional 3mg dose of Risperdal is added.

    Separator (Biological Unhappiness)

     

    2001 September Questions

     

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Do All Transsexuals Have BPD?

    Do All Transsexuals Have BPD?

    QUESTION:

    Dear Dr. Heller! While searching the web for some information about BPD and transsexualism I found “BiologicalUnhappiness.com”.  First of all I want to pay a compliment: great site with lot of information! Getting down to business, here’s my question: I am 26 and was diagnosed with BPD five years ago.  It’s not that I have doubts about that.  Lots of difficulties I had in every-day-life resulting from BPD I am able to deal different with today, but after six years of permanent therapies in hospitals as well as in ambulant treatments I still feel very uncomfortable with my sex and gender.  I never wanted to be a girl or be treated as one. Once I told a psychiatrist about my problem he said something like, “No, no, you are a borderliner and not a transsexual.  You must have been abused and that’s the reason for your problem, which isn’t really a problem After that I never said a word to anybody else… Do you think that BPD and transsexualism can occur in parallel? Neither my parents nor I can remember of any sexual abuse during my childhood.  Let us assume something has happened, could it in fact be the reason for my feelings?  And if so, what should I do now? It would give me great pleasure if you answered me! And sorry about my bad English, I am German 😮 Kind regards

    ANSWER:

    I’ve treated a few transsexuals who didn’t have the BPD, but most do have the BPD that I’ve encountered.  There is no reason one can’t have both diagnoses. Most transsexuals remember feeling trapped in the wrong sex body all their lives – which can be very traumatic and that trauma can trigger the BPD. Studies have shown that Tegretol can stop the desire for a transsexual existence.  I suspect these individuals just have the BPD with chronic dysphoria (anxiety, rage, depression and despair) and identity problems, and have found changing sexual identity improves their dysphoria. 

    Separator (Biological Unhappiness)

     

    2001 October Questions

     

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How Precise Are The Tests For BPD?

    How Precise Are The Tests For BPD?

    QUESTION:

    Dear Dr. Heller,

    What is the progression a new patient might encounter at the outset of seeking therapy?  How thorough and precise are the testing methodologies for diagnosing a patient’s condition?

     

    ANSWER:

    1)    This totally depends upon the doctor or therapist.  Some like to talk about what’s happening in life first, others like to do some diagnostic tests.  Some focus in on just depression first.  I do the screening test followed by going over DSM criteria, and I also do the Zung depression test. 2)    The testing methodologies are very imprecise, and they are not thorough at all.  The DSM IV criteria are excellent for making diagnoses however.

Separator (Biological Unhappiness)

 

2000 October Questions

 

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