Medical Literature

QUESTION:

Dear Dr. Heller,

One of my close friends (non platonic relationship) was diagnosed with BPD. He takes Depakote and Zoloft (that is if he doesn’t think his medication is “evil” at the moment) He loves me one minute, hates me the next. Wants me to help him then pushes me away. I don’t know if this has anything to do with the disorder but he’s become obsessed with the Nazis regime and white pride. I guess it gives him the sense of being more powerful then he is. One minute he’s advocating racism and the next he’s totally against it.

I read somewhere that bpd’s look for people to rescue them and that you shouldn’t do that because they will bring you down with them. but I read that a little too late. It’s part of my nature to try to fix things and I’m afraid that if I don’t maintain my ‘savior’ role that he’ll either get hurt or stop associating with me all together.

How do you get out of this type of situation once you’re in it? ( other than leaving. I don’t quit ) Also, just a quick question. I also read somewhere that some BPD’s mirror people. If that’s true, then would loving a borderline actually be in part loving a piece of yourself being mirrored back to you? Isn’t that a bit fake?

ANSWER:

First of all, you can’t help someone who doesn’t want it. No matter how hard you try, you can’t make someone like you, love you, respect you, treat you well, or act out of their own best interests. As needed medications can make a huge difference, and I’ve not been impressed in general with Depakote.

The Nazi and hate groups story is a very scary one. The LA shooting in 1999 was likely someone with the BPD, chronic anger, and association with hate groups. This individual needs treatment ASAP! You described what’s referred to as “co-dependency” on your part. Sometimes the answer is within, not from without. People in your situation often forget there needs to be a balance between helping others and helping oneself. You seem to have lost that balance. Your identity is more than just as a rescuer.

Mirroring to me, is like the saying “imitation is the highest form of flattery.” Borderlines can have such profound identity problems that they will mirror someone in the hope it will become their identity. It’s not at all fake – it’s how children learn, and why apprenticeships have been around for millennia. It’s the same thing as choosing a role model. The keys here are treating the medical problems, and making sure the person chosen as the role model is someone that he/she would like to emulate.

Can You Help With Severe Hives?

QUESTION:

Hello:

I am looking for cures hives. My wife has them right now. She takes Benadryl, prednisone and such with little relief. She is avoiding foods that might cause the condition. In addition, she is under significant stress from multiple sources. Are there any recommendations that you could make? Help would be appreciated. Most pages offer many definitions as to what hives are. That is unfortunately no real help.

Thanks.

ANSWER:

The antihistamine “Zyrtec” can be very helpful, as can “Tagamet” (cimetidine). Tagamet works because it’s also an antihistamine that works at a different type of histamine receptor. Sometimes the “leukotriene inhibitors” such as “Accolate” can be helpful.

There’s no question that nerves can play a huge role. The screening test I use for my patients may be of significant help for you in this regard.

 

2000 April Questions

 

Ask the Doctor

 

QUESTION:

Dear Dr. Heller,

I have a daughter who is very ill.  What exactly is Histrionic Personality Disorder?

Thanks.

ANSWER:

The Histrionic Personality Disorder (HPD) is characterized by severe attention seeking and inappropriately excessive emotions.  They usually need to be the center of attention, can be sexually inappropriate – particularly about appearance, have rapidly shifting and shallow emotions, and are easily influenced by others.  They tend to be very dramatic, and their speech lacks details.  They tend to consider relationships to be more intimate than they actually are. The literature in Medline has shown no neurological abnormalities nor any good medical treatment for the HPD.  The HPD rarely exists by itself, and when other medically treatable diagnoses are successfully treated their histrionic nature tends to improve.  The screening test I use for my patients may be of assistance in this regard. The HPD is part of the “dramatic” cluster of personality disorders, also referred to as “Cluster B Personality Disorders”.  Some symptoms can be dramatically improved by SSRI medications like Prozac.

QUESTION:

Dr. Heller,

You are my last hope.  My son is falling apart.  He is only 16 y/o.  Last year he was attacked 7 times in one week, luckily he wasn’t hurt but since then he is totally unable to leave the house and has mass panic attacks.  He is sick at the thought of going out and is a totally changed young man.  I have spent the last few months on the phone and find it totally disgusting that no one seems to want to know.  Our doctor has just prescribed him half Inderal and referred him to a hospital again.  We have been waiting over a year to no avail.  It is breaking my heart and I find it hard to help him any more.  He is becoming suicidal as he thinks his life is over.  One main problem with the groups I have contacted is that Simon cannot go to them and they won’t come to him.  Please can you give me some positive advice.  I am terrified of what may happen.

ANSWER:

He likely has both panic disorder and post traumatic stress disorder.  There are medications that can work relatively quickly.  Usually Prozac (fluoxetine) combined with Remeron 30mg (mirtazapine) will cause a dramatic change quickly.  A benzodiazepine will likely be necessary as well.  The screening test I use for my patients may give you some clues about additional diagnoses.

QUESTION:

Dear Doctor,

I am romantically involved with a man who seems to choose lying over telling the truth for no apparent reason. I would like a more in-depth approach to the term “pathological liar” and would really like to know what, if anything, can be done to treat this disastrous disorder.

We are on the verge of breaking up due to his latest series of lies. But I would feel like a rotten individual if I am actually turning my back on a man who needs real help. He has cried hard and told me he simply cannot stop doing this and he does not understand. He wanted to break up with me to avoid hurting me any more with this absurd behavior. Please help. I need more info.

Thank you.

ANSWER:

While anxiety problems and attention deficit disorder can trigger lying, the term “pathological liar” implies a character disorder. This means the person considers lying to be a reasonable approach to life, not just an anxiety reducing behavior or acting without thinking. Currently, there is no medication or other effective treatment for lying. If the individual genuinely wants to stop this behavior, I highly recommend getting Zig Ziglar’s “How to Stay Motivated” tape series and see what happens. If the individual then disagrees with the importance of telling the truth, it’s unlikely that the behavior will change.

QUESTION:

Hi,

I don’t know quite what to look under. Well, my friends lies to us every day and it’s like when you ask her the truth she just looks at you funny and acts like a totally different person! It’s not like a once in a while–it’s like a daily thing. So I was wondering if you could tell me what to look up on it so I can help my friend!

Thank you!

ANSWER:

While those with severe anxiety and attention deficit disorder learn to lie to reduce their stress, it’s usually a “character disorder.” The screening test I use for my patients can be useful in looking for anxiety disorders and attention deficit disorder. There’s not much available at this time for character disorders.