Q. My 23 year old daughter was committed to the state mental hospital last October primarily because she is severely bulimic. She was diagnosed with “mild” BPD several years ago while in a psychiatric hospital for alcoholism.
I have exhausted all insurance and financial resources just trying to keep her alive (87 lbs 5/9″). She has been treated at 3 inpatient programs for eating disorders — all but Renfrew Center forced her to leave for being “non-compliant”. When my money ran out she began stealing to support her binges. She is also alcoholic. She wants very much to recover but feels it is hopeless. Even now, she grabs food off the plates of other patients.
At age 9 she was diagnosed with “absent mal epilepsy” at Stanford Children’s Hospital – she didn’t have seizures and didn’t seem to “blink out” or disappear — she had “weird” feelings usually convinced she was about to die. She did well on Depakote but insisted on stopping when she started high school, convinced she was better. She went through HS as a healthy, attractive, popular volleyball star although she and I had many tense conflicts.
BPD was not diagnosed until she went away to college and I moved from CA to OR. She quickly spun out of control, multiple suicide attempts, binge drinking, etc. When she left Renfrew Center she was on Prozac and Ritalin and that’s when her behavior turned really off the charts…drinking, stealing. She is now on Prozac and Depakote and seems a little “calmer.” She will soon be discharged from the hospital where they don’t treat for ED and her Dr. says she is too focused on keeping her from dying due to electrolyte imbalances, to focus on BPD. I don’t think she’ll ever get control of bulimia until the BPD is addressed. I am terrified of what will happen when she’s released since we have no way to pay for treatment.
Are there any research studies on BPD that she might qualify or do you know of any way to get help for her? I have always paid for her care or had insurance and it’s very hard to be in this situation. Dr. Heller, she is truly worth saving. She has many wonderful qualities and a lot of potential. Any suggestions you have will be deeply appreciated.
A. Your daughter has a significant case of the BPD, not a mild one. While the Prozac and Depakote combination helped, Prozac and Tegretol would likely help more.
The Ritalin was likely used because of ADD. If your daughter has the generalized anxiety disorder (GAD), both Ritalin and Prozac can worsen her anxiety symptoms. Bulimic behaviors are often used to deal with stress and anxiety. I’d advise researching the diagnosis of the generalized anxiety disorder (particularly the cognitive component) and the OCPD. The key question for the GAD is “can your mind be quiet, like sitting and watching a sunset without constantly thinking?” The key symptoms of OCPD is “does everything feel like it’s life and death.” These are both biological processes that she would have been born with.
The key to all recovery is 1) make the right diagnoses (rarely only one), 2) take the right medication, and 3) retrain the brain. Too often one or two diagnoses are all that are made when more is present. Everything has to be treated successfully for your daughter to recover.
Bulimic behaviors usually diminish or go away (at least the severe ones) when the underlying problems are resolved, especially anxiety. There definitely is hope for you.