Q. I want to ask a more esoteric question than you usually get; it is related to a comment in one of your documents in which you state that “Sound interpretation is impaired”.
I have a 23 year old son with BPD that was triggered by a head injury. The head injury also caused a rare sound perception problem called hyperacusis. It basically has to do with the brain’s misinterpretation of sound (it makes it too loud and painful). It is very interwoven with my son’s bpd. I want to know how many people the doctor has treated that have reported sound sensitivity issues.
Getting an answer to this question may be the key to helping him cope with this malady and offer some insight into treatment.
A. The “hyperacusis” is likely very similar to the epileptic phenomenon in the BPD. I don’t believe from what you wrote that it’s the same thing as the abnormal sound and language processing discovered with the BPD. Drs. Gardner and/or Cowdry at NIMH may be interested in doing some studies on his condition, or refer you to someone else who may be more interested.
I’ve never taken care of someone with this exact profile, but I have with a similar visual one after multiple severe head injuries. He finally got under control with a combination of epilepsy medications. I suspect the sound signals keep creating short circuits that make the sound worse, just like dysphoria worsens. If the head injury caused the BPD, the unpleasant sounds may be triggering dysphoria as well.
Based on my experiences, if he was my patient and didn’t have a reason not to try this, I would place him on Prozac and then one week later add Tegretol – even one dose in the mid day would be very informative about whether it will work or not.