- Can You Answer Some Questions About My BPD Girlfriend?
QUESTION:
Dear Dr. Heller,
I’ve read through pretty much all of your archives – thank you. I do, however, have a few more questions. My girlfriend was diagnosed many years ago (maybe the late ’80’s?) with the BPD after many other diagnoses (including bipolar and some others). She was a self-mutilator, mis-interpreted the world around her, and fit the profile in most other ways. She was sexually abused as a child and was assaulted and raped once in her mid twenties, although I believe it was after the initial BPD diagnosis and treatment. She went through some chemical treatment (Prozac, other meds) and a lot of counseling.
On the outside, she appears to be doing well, but seems to have some tendencies that worry me and bring up some questions. 1) Your books – I feel like I understand what she is going through, and would like useful tools to interact with her. Would either of your books (or both) be helpful to me? 2) She’s not currently on any meds. How long do people with the BPD normally take Prozac? Do people ever completely recover? 3) Although she has not self-mutilated for years, she still has very strong urges to do so – she says it seems like it would be very relieving. Is this indicative of a need for medication? Does this urge ever completely go away? 4) She sometimes (maybe 4-6 times a month, usually for 1-2 hours, sometimes longer) has a “moody” bout during which she severely misinterprets the world and is very unhappy. She usually realizes that she’s going through such a bout and tries not to act on any impulses she has during this time because she recognizes that she’s probably misinterpreting the situation and things will seem different later. Helping her logically talk through the problem seems to work somewhat well to help her get out of it. Are there other techniques? Does Prozac/Tegretol help this? 5) She thinks of herself as a horrible person, although she can’t explain why and normally hides this from the outside world. She is in fact a wonderful person, very intelligent, nice, helps others for a living, and is incredibly capable. Do you have suggestions of ways that I can interact with her so that she will feel better about herself? I may order Ziglar’s tapes, but I would like all the tools I can to help her learn to love herself. 6) Finally, can you point me to any information about serotonin levels in people with the BPD? Is this why Prozac helps? Do serotonin precursors like 5-HTP ever help? Are things that could depress serotonin levels, dangerous?
I really love this woman – she’s absolutely wonderful and it seems like everyone in the world sees this but her. I’d like to help her get to the point of loving herself, seeing the world as it is, and not feeling like she should hurt herself.
Any help you can give is GREATLY appreciated.
ANSWER:
1) My books are written for borderlines and their loved ones, and have lots of information for both of you. “Life at the Border” is on the recommended reading list at the National Institute of Mental Health. 2) BPD patients generally need some medication the rest of their lives, although that may be stretched where only as needed medication is needed. Some patients recover enough to have a normal and successful life, but again will still need medication at times. 3) Self mutilation urges generally get better over time, but when the individual experiences dysphoria (anxiety, rage, depression and despair) they will do whatever works to make it go away. 4) See http://pks.947.myftpupload.com/dysphori.htm and http://pks.947.myftpupload.com/20a.htm. 5) Ziglar’s tapes are remarkably effective, as are affirmations. I go over this at length in both books. Brain retraining is most effective when the medications are working. 6) Not much is known about serotonin levels, and the exact levels are probably not the problem. More important is brain dysfunction, and in what areas, and how various medications improve the situation. Serotonin receptors, and combinations of neurotransmitters are equally important, and I believe the function of support cells called “glial cells” is also important. I’m much more in favor of Prozac than 5-HTP.
