Medical Literature

Can I Have BPD And Fractured Enjoyment?

QUESTION:

Dr. Heller,

I would like to know more about ‘fractured enjoyment’.  Can one suffer from BPD as well as fractured enjoyment?  Besides that, can these two be cured without the use of medicine?  Am I over-paranoid if I suspect that I have BPD?  I would appreciate it if you can answer my queries, especially the one on ‘fractured enjoyment’.

Thank you very much

ANSWER:

What I refer to as “fractured enjoyment” used to be called the depressed personality disorder.  It is profoundly genetic and responds quickly to Prozac. You absolutely can have both the BPD and the fractured enjoyment diagnosis, and they both respond well to safe medication.  It’s extremely unusual for an individual to do well without medication when those diagnoses are present.

Why Won’t My Therapist Listen?

QUESTION:

Dear Dr. Heller,

I am new to the idea that I have BPD.  But thanks to writings from you and many others on sites like Mental Health Sanctuary and other places I now have hope that I’m not just a crazy loser.  Other people share my struggle.  Other people have felt the same wild impulses and loopy ideas that have destroyed my life over and over.  The fact that others have recovered gave me hope I had forgotten I had lost.

Recently, after a year of functioning, holding a job and paying bills, I crashed.  I lost it on a customer at work and got fired.  I then saw an HBO special on depression with Mike Wallace, which made me realize I was putting out symptoms all over the place.  I only have the local county (Brevard–only about 90 minutes from Okeechobee!) facility called Circles of Care.  As far as free goes, it is excellent.  I made an outpatient appointment (they still remembered me) and by the time it came I had visited several sites online and found I fit the criteria for BPD.  People on Mixed Nuts (www.mixednuts.net) and The Healing Path (www.geocities.com/ubester) gave me encouragement and information that led me to believe I didn’t have to keep repeating the same cycle of striving and disappointment over and over again.  It was like I had a new way of looking at life.

The therapist I met was very disappointing.  She was competent and friendly, but reacted badly when I brought up BPD.  Prepared for this, I had a floppy disk with links and text on it but she shied away from it.  I probably came on too strong.  We discussed it for a few minutes, she was like “Why do you want to be THAT?” and I explained that it wasn’t that I wanted to be like this, but that it was reality and if I had this it would explain why I had failed at treatment so many times.  She seemed interested in having me bring printouts of the info, but chose to retain the old diagnosis of bipolar with schizoaffective tendencies that the last therapist had tagged me with (funny, I have never had a mania or a hallucination, and I know when my feelings and perceptions are out of whack–but I have several characteristic BPD traits).  She did prescribe the Neurontin and Prozac I had read work well for BPD.  I feel much better now.

Question.  How can I persuade her to spend the time and effort to learn what you research pioneers have found out about BPD and effective ways to treat it?  I realize it will be hard to break through the stigma and misconceptions surrounding BPD and harder still for others (bureaucrats) to become educated and devote scarce resources to it.

I almost feel like if the medication works and I can keep getting it there, I’ll be fortunate.  I gather the dialectical behavior therapy is long, involved, and time consuming.  I can’t see it happening on a fifteen minute appointment every two weeks basis, even though I’ll try.  I have missing years, and have long suspected some traumatic events in early childhood, like other BPD’s report, and don’t think dialectical behavior therapy the proper forum for deep digging.

Suggestions?

ANSWER:

I wish I knew!  I’ve been fighting this battle for 12 years.

The problem is old beliefs, and the incredible slowness of the medical profession – including therapists – to respond to the information.  Most medical information on the BPD is 7-14 years old.

You’re on target questioning the bipolar diagnosis if you’ve never been manic or hypomanic.

You might want to print up a few key studies to show her, or you might need to ask for another therapist.

I’m A Student On Paxil, Can I Drink Or Use Marijuana?

QUESTION:

Dear Dr. Heller,

Hello, I am in a bit of a situation and I was wondering if you would be able to give me some advice?  I just started taking Paxil, I am 16 years old and as being a teenager it is quite difficult to avoid alcohol.  But I actually do generally.  I am not a big drinker, but with the summer coming I had intended to drink a little bit (once in a while and only one or two light drinks).  I am also going to France to do my OAC English, and A big part of the life there is drinking, and I know the students are permitted to drink, I intended to have a glass or so of wine every so often, but I would really like to know if this would be ok?  As well what are the effects of drugs and Paxil (i.e.  marijuana, S/P?)

ANSWER:

The Paxil won’t be as effective.  If you’re depressed or needing Paxil for some other reason – particularly at age 16 – you shouldn’t be taking additional drugs like alcohol and marijuana.  They could trigger rage, worsening depression, or psychosis (losing touch with reality). If your self-esteem isn’t strong enough to say “no” – you probably should not go on this trip.  It’s a potential disaster for you, and something from which you may never recover.

What Can Be Done For My Hyper Kid?

QUESTION:

Dear Dr. Heller,

I have a 7 year old that can’t sit any more than 1 min.  He has so much energy that he can’t slow down.  Are there foods that make kids so hyper?  Is there a diet that I can put him on that will help him?  He does not like being so hyper all the time, but he can’t help it.

Please help me.

ANSWER:

You need to find out what’s going on.  Sometimes it’s ADHD, bipolar, allergies, post nasal drip, gastroesophageal reflux disease, chronic sinus or adenoid infections, diets low in fruits and vegetables, iron deficiency or other causes.  Get him checked out ASAP!

Always Hungry?

QUESTION:

Dr. Heller:

I have tried all the psych medications listed in your article they did not work —My life for 14 years has been life in hell. Please review and share your experiences of similar problems related to this one. Any feedback and guidance you can provide would be more than appreciated. I have experienced a long term problem that has been with me for 14 years (April 1985). One day suddenly I ate and did not get full. From that day to this day I have had chronic hunger pains which do not go away regardless of what I eat and when. I assume they are hunger pains, if not they are very similar to being hungry. The hunger sensation stays with me 24-7. For example visualize being hungry, well that feeling stays with me all the time. While I am eating the hungry feeling remains. The memories of being full does not exist any longer since I have had the hunger sensation for so long. I am very miserable and have tried many techniques and seen many doctors, specialists, healers, etc, etc., etc., etc,. If you can name it I have tried and seen the specialist. Nothing has worked, it will not go away. I’ve been told so many things, I think people just guess. This has been a very complicated problem feeling. Have you heard of this problem before? Other symptoms such as cannot drink water, water intensifies the hunger; lots of hair breakage; depression; insomnia, frequent bowel movements, lots of gas, serious pains in the stomach (feels like a knife is in the stomach cutting); sweating at night and very uncontrolling behaviors. My brain does not think as fast as I can talk. When I am thinking and not speaking, all kind of sentences and words appear. As soon as I start speaking, my vocabulary goes away. Seems I cannot talk and think at the same time. My brain locks up. Any information that you can provide would be more than appreciated. I weight 140 and height is 5″4″. I work out religiously to prevent getting fat. I do have the potential to be fat. I try hard to control the eating, but at times it takes control of me. I’ve tried many herbal appetite controllers and other on the market items, but they have no affect on the hunger sensation. Your help and consideration would be more than appreciated. Do you have any recommendations, your suggestions, comments and/recommendations will only be used to benefit me, please do not fear providing support of any kind.

ANSWER:

Most likely the reason the herbal or other appetite controllers haven’t worked is that the hunger center isn’t the problem, but some other problem is – and is being misinterpreted as hunger.

It’s not uncommon for sensations other than hunger to be perceived as hunger. It’s definitely a problem for me: I cannot distinguish between hunger and fatigue. I can be just as starved after stuffing myself as if I hadn’t eaten at all. Realizing this helped me with my weight enormously. Many individuals have a similar problem.

Please do the screening test at the top left of the home page and look for clues. I’m highly suspicious multiple psych diagnoses are present, and are contributing to the sensations and your irritable bowel syndrome. Something different needs to be tried, since what you’re doing is not working. You may also have nerve damage to your upper abdominal area, and this can often respond to epilepsy medications alone or in combination. Don’t expect any of them to work well until you get all the diagnoses treated successfully.

I’ve had many individuals tell me that they’ve been on all the meds before, but it’s often not the meds – but their sequence and dosing as well. I’m a huge believer that we treat diagnoses, we don’t administer medications. There is no mental health pill.

Why Is My Husband Worse?

QUESTION:

Dear Dr. Heller,

My husband was diagnosed three times this year by three separate psychiatrists.  First as Post Traumatic Stress Disorder, then ADD & Depression, and finally as Bipolar II & (tested with mild) ADD.  He went for help with depression, anxiety and drug addiction.  Now he is being prescribed Zyprexa as a mood stabilizer, Paxil for depression and Adderall for ADD.

The problem is that my husband has more problems with addictive behaviors now than six months ago.  He has become increasingly disinterested about work, our relationship, family, life in general, and completely lustful when it comes to eating, drinking and smoking pot (Zyprexa?).  He takes his Zyprexa after work and checks out. I am unsure about his diagnosis and treatment.  He and the doctors believe medication is working for him.  The doctor told me that diagnosis are never simple and clear cut, that PTSD was a catch-all and my husband was not in anyway Borderline.  But this treatment has changed our life together, entirely for the worst.  It would not matter as much to me if it were just he and I, but we have five children, and I need a husband, friend and partner in this.

Please help me.

ANSWER:

I would be highly suspicious of the generalized anxiety disorder.  This genetic “disorder” has an elevated 5HT1 receptor – which gets stimulated by Paxil and Adderall, increasing his anxiety.  I often have success with this population by adding BuSpar and then Remeron for a while. It’s important to know all the diagnoses, and I urge you to look at the screening test I use for my patients.