Q. Thanks for your wonderful website. I am beginning to understand my diagnosis of BPD with the help of your website even if I am not yet ready to fully accept it. It helps me to see that I am not alone and that others like you are surviving and getting better. I am hungry for knowledge about BPD but it is sometimes difficult to read about it and see yourself in the mirror. Here are my questions for the Doctor.
I am a 41 year old male. I was diagnosed with BPD two years ago at the age of 39. I was also told I had dysthymia (I was told this often goes hand-in-hand with BPD) and elements of Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and some Avoidance Personality Disorder. I sought counseling and medical help and a 12-step group (SA) after a disastrous extramarital affair that almost destroyed my marriage, career and almost ended my life. Five years prior to this, I had severe panic attacks that led to my hospitalization and a heart catheterization and suicidal thoughts. Other background – I was physically abused by my mother as a child.
I am currently taking a daily dose of 450 mgs. of Nefazodone HCL (a generic for Serzone) under the supervision of a Doctor (Psychopharmacologist) and I participate in weekly counseling sessions with a therapist. The prescribing Doctor has told me he cannot medically treat my BPD, (“only therapy can do that”) but he is treating my dysthymia depression. My questions for you are as follows:
1. You make no mention of the drug Serzone in your writings on this web page. Have you found Serzone to be effective in treating BPD?
A. No. It can help with depression however.
Q. Is the generic equivalent just as effective?
A. Probably, but I don’t know for sure.
Q. 2. Have you had any success with St. John’s Wart and do you recommend it?
A. It sometimes helps with chronic pain, but I’ve not seen significant benefits for most people. I am extremely disappointed with it.
Q. 3. As a young boy, while under stress (such as during a school exam) I would often hear what I can only describe as voices yelling at me in my own head. I could never make out any words, only repetitive noise that got louder and louder. The problem all but went away in adulthood but occurred again within the past two years while under severe emotional stress. Is this what you would describe as an episode of psychosis and have any other BPDs ever reported this?
A. Unless new information comes out to change this opinion, it appears the BPD begins at puberty. What you describe sounds a great deal like a psychotic depression.
Q. 4. When first diagnosed with BPD, I was in denial. For example – I rationalized that I could not be BPD as I did not self mutilate. However, as a young boy (and to a much lesser extent now as an adult), I would chew my nails and bite/pick the skin around my nails until my fingers were raw and bleeding. Is this an example of self mutilation typical of some BPDs?
A. Possibly, but there are other explanations for this behavior, including anxiety problems.
Q. 5. I am functioning relatively well now thanks to the treatment I have sought and am receiving. One thing has been very difficult for me to accept though and perhaps you can help me better understand this aspect of my diagnosis. I have been very successful in my life in both my career and marriage. I always had feelings of emptiness and unhappiness but I seemed to function pretty well. Three years ago, I embarked unknowingly on what was to become an obsessive and tumultuous extramarital affair that was totally disastrous for me as a person. The woman I had the affair with is most likely a BPD as well and was emotionally and verbally abusive and demeaning toward me at times. I have had great difficulty in understanding why I “functioned” so well for most of my life with significant education and career accomplishments only to literally ‘come apart at the seams’ in such a short time. Was it that my Borderline Personality Disorder just became ‘active’ during this stressful affair or is it possible that all the ‘facades’ of my personality just came tumbling down? I have really struggled with this aspect, feeling like I just went crazy over a woman and have confused that with meaning I must have really deeply loved this woman. My counselor seems to dodge this issue and just told me it is possible I regressed during the stormy relationship.
A. If the diagnosis is correct, I doubt you functioned as well as you think in every area of life. Many borderlines have successful careers, but interpersonal relationships are a problem. The most successful borderlines I know hire others to do the work that the moodiness and anger interfere with.
If your marriage and personal life were so successful, why did you search for a new relationship without getting a divorce first? This is particularly so with a woman who seems so dysfunctional and abusive.
The BPD doesn’t go away, but the severity comes and goes depending upon stressors. I think if your BPD and other symptoms were effectively treated you’d have a different perspective on how well you’ve done during your adult life.
By the way, it’s critically important to get this terminology correct: no one “is BPD” – but one can have the BPD. Likewise no one is a strep throat, an appendicitis or a depression.