ADD Miscellaneous * Biological Unhappiness – Dr. Leland M. Heller

Attention Deficit Disorder (ADD) Miscellaneous Information


Smoking and ADHD:

“Nicotine effects on adults with ADHD” Psychopharmacology (Berl) 1996 Jan;123(1):55-63 Department of Psychiatry, Duke University Medical Center, Durham, NC Levin ED, Conners, CK

“Attention deficit disorder in adults and nicotine dependence: psychobiological factors in resistance to recovery?” J Psychoactive Drugs 1996 Jul-Sep;28(3):229-40 Veterans Administration Medical Center, West Los Angeles, CA Coger RW, Moe KL

“Transdermal nicotine effects on attention.” Psychopharmacology (Berl) 1998 Nov;140(2):135-41 Department of Psychiatry, Duke University Medical Center, Durham, NC Levin ED, Conners CK

“Relationship of ADHD, depression, and non-tobacco substance use disorders to nicotine dependence in substance-dependent delinquents” Drug Alcohol Depend 1999 May 3:54(3):195-205 Department of Psychiatry, U of Colorado School of Medicine, Denver, CO Riggs PD, Mikulich SK

“Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity” Am J Psychiatry 1995 Nov;152(11):1652-8 Pediatric Psychopharmacology Unit, Mass General Hospital, Boston, MA Biederman J, Wilens T

“Does attention deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence?” Biol Psychiatry 1998 Aug 15;44(4):269-73 Pediatric Psychopharmacology Unit, Mass General Hospital, Boston, MA Biederman J, Wilens T

“Methylphenidate treatment for cocaine abuser with adult ADHD: a pilot study” J Clin Psychiatry 1998 Jun;59(6):300-5 Department of Psychiatry, Columbia University, NY Levin FR, Evans SM





Risperdal (risperidone) in Children – Medical Literature

Unintended Pregnancy Directly Related to Childhood Family Problems

According to the Journal of the American Medical Association, October 13,1999, when a child is exposed to childhood abuse or household dysfunction there is an increased risk of unintended pregnancy.

When two or more types of childhood abuse or household dysfunction were present, more than 45% of the women had unintended pregnancies. 2/3 of these women had two or more types of childhood abuse or household dysfunction. These types included frequent psychological abuse (40% increase), frequent physical abuse towards mother by her partner (40% increase), frequent physical abuse of the partner by the mother (40% increase), and frequent physical abuse (50%).

When four or more of these types of abuse were present, these women were 50% times more likely to have an unintended pregnancy during adulthood compared to adult women who were not exposed to abuse.

8 Things to do BEFORE becoming a grandparent raising a grandchild

1. Evaluate your finances.

Most grandparents are not financially strong. The additional burden of taking care of grandchildren is often enough to plunge both the grandparents and the children into dire financial straits.

According to the census bureau, 1/4 of the children being raised by their grandparents were “poor” IF the parent also lived in the home.  2/3 of those children were “poor” if the parent did not also live at home.  1/3 of these children do not have health insurance, and more than half are on public assistance. Before agreeing to be financially responsible, the financial arrangements need to be accurately assessed. Legal advice is usually a good idea. Prior to assuming the financial responsibility, grandparents (or other guardians) need to know exactly how much assistance they are eligible for, how much it will cost to take care of the children, what health insurance is available and at what cost, and know exactly how much the parents will be contributing to the financial burden of raising the child. It’s wise to factor in the possible future cost of psychological counseling. A written commitment from the parents is often useful to prevent misunderstandings.

2. Get a physical check up.

Age reduces our stamina and energy. Raising children can be exhausting and stressful. It’s wise to see your physician for a checkup, possibly including a stress test. Ask your physician about your physical fitness to undertake this responsibility, and how the stress will affect your current medical problems and risk factors.

3. Evaluate your time commitments

Children spell love T.I.M.E. The grandparent may have forgotten the time commitment needed to successfully raise a child. Meals together, trips, playgrounds, parent/teacher organizations, doctor visits and being a chauffeur will occupy much of the grandparent’s time. Many current activities will need to be abandoned, and which ones will need careful thought.

4. Get a mental health evaluation

Mental health problems contribute enormously to the problem. Since many are genetic, it’s wise for the grandparents to evaluate their possible diagnoses as well as the grandchildren. Stress makes everything worse, and the stress of raising a grandchild will worsen underlying mental health diagnoses, especially the ones discussed in “Biological Unhappiness.” The screening test I use for my patients will be very helpful in this regard, and will give clues regarding diagnoses. Don’t pretend these problems don’t exist, particularly because they may have caused you to be a parent again. The truth can be denied, but it can never be avoided. Alcohol and other drugs are often used to self-medicate these disorders and contribute to a continuing legacy of tragedy and suffering.

5. Get the important documents

You will need the children’s immunization record and other medical records, social security information, and likely a copy of the birth certificate. You’ll also need some legal document allowing health care providers to know that you are the legal guardian. Without that documentation, a physician may be unable to treat the child except during a life and death emergency.

6. Make preparations for giving the children back

Whether court ordered or agreeing to take over, issues should be handled IN WRITING to prevent misunderstandings and eventual hard feelings. When and under what circumstances the parents will get the children back is a crucial topic that must be handled carefully. Everyone, including the children, will be hurt by misunderstandings and hard feelings. A lawyer and/or therapist may be necessary in this regard. Seeing a therapist is often a good choice for the grandparent to sort out their actual feelings and desires. It’s also wise to have a clear visitation agreement for when the children are back with their parents, and under what circumstances you’ll take the children back.

7. Prepare for the parents getting a divorce

Grandparents rights are regularly being defined in the courts and possibly in the legislature. This is another area where the grandparents need things in writing, preferably from both parents. Children are often treated as pawns and sometimes as weapons during divorce fights. Do not let the children be injured in this regard.

8. Acquire knowledge

Children are growing up in a very different time, society and culture than their grandparents did. Most children don’t know about the Cold War (or the Soviet Union), the oil crisis, or life before AIDS and the Internet. They don’t even know about records, only CD’s. They face crime, gangs, sexual pressure, drug availability, and an array of options unlike any previous generation. Many involved in the television, movie, print media, advertising, and music industries have studied what “works” marketing to children and teens, and may not have the child’s best interests at heart. It helps for the grandparent to learn about what they face to help guide them through the stresses. It’s also a good idea to study techniques about parenting that have evolved over time. Being a great role model is crucial. Zig Ziglar’s tape series “Raising Positive Kids in a Negative World” (1-800-527-0306) is a very useful tool. Investigate organizations like AARP (American Association of Retired Persons) and books like “To Grandma’s House We…Stay” by Sally Houtman, M.S. Learn to search the Internet as there are many references regarding “grandparents raising grandchildren.” Knowledge is indeed power, and ignorance is rarely bliss.

Dr. Leland M. Heller discusses the Borderline Personality Disorder (BPD) – Biological Unhappiness

Dr. Heller Discusses BPD (11910 bytes)

Dr. Heller Discusses BPD (636 bytes)

“…Epilepsy was once thought to be a psychiatric problem, until the underlying neurological abnormalities were understood.  Researchers have uncovered medical and neurological abnormalities in borderlines.  Many symptoms are likely due to malfunction in the brain’s limbic system.  In my opinion, the borderline personality disorder is primarily a medical problem.  It can now be treated.

The Borderline Experience

Imagine you are faced with a minor stress – a flat tire, a clogged-up sink, or a trivial disagreement with your spouse, friend, lover, child, etc.  Instead of finding an acceptable solution, your mind seems to panic.  A sense of unease develops, possibly causing discomfort in the stomach or chest.  Feelings of anxiety complicate the increasing sense of uneasiness and restlessness.  This is followed by progressively worsening anger – eventually becoming a rage so strong it overwhelms you – even though you realize it’s excessive.  Over the next few minutes to hours, other negative sensations creep in – including memories of past hurts – until you are experiencing virtually every bad emotion a human can feel.

You feel trapped and vulnerable.  Your psychological defenses are overwhelmed by unbearable emotional pain.  You feel depressed.  You find yourself unable to cope as your mind and body are now in a full scale panic.  You lose proper perception of reality – jumping to erroneous conclusions in a futile effort to make sense of what’s happening.  As the pain continues to intensify the nervous system creates bizarre sensations such as emptiness, numbness, and unreality.  You become incapable of rational thinking as the panic continues to worsen.

Your mind now desperately tries to find a way out of the pain and searches for solutions.  It recalls past activities that have made you feel better.  Once a method is found, your mind frantically forces you to pursue that activity to a self-destructive excess – finally resulting in a biochemical rescue.  Brain chemicals are released that stop the pain and let you feel ‘normal’ again.

But how can you ever feel normal again knowing that such a horrible experience will return?  How can you feel normal again when your self-destructive and inappropriate behaviors are witnessed by family, friends, employers and/or co-workers?  How can you feel normal again when those behaviors result in financial, interpersonal, physical, or legal trouble?

For those not afflicted with the Borderline Disorder this is a nightmare we hope never happens to us.  Borderlines experience it over and over – especially when confronted with stress.  While individual borderlines may feel some symptoms differently, the horrible feelings described in the first paragraph (called ‘dysphoria’) intrude frequently into a borderline’s life.

Borderlines will do almost anything to make dysphoria go away.  Most impulsiveness and self-destructiveness is an effort to relieve dysphoria.  Some borderlines, especially those suffering very severely, will literally cut their bodies during dysphoria.  The self-mutilation is itself painless (the cuts don’t hurt), yet it relieves the dysphoria.

Borderlines also suffer from intense, frequent and unpredictable mood swings that can cause ‘dysphoria’ even without stress.  The mood swings cripple a borderline’s efforts to live a happy, successful life.  Borderlines are victims of an incredibly painful illness…

Like victims of epilepsy, muscular dystrophy, and neurofibromatosis (the ‘Elephant Man’s’ disease), victims of borderline neither asked for, deserved or caused their affliction.  The symptoms can be so unpleasant to those interacting with borderlines that feelings of compassion and understanding may be difficult or impossible to feel.  Borderlines desperately want to be loved, but their illness makes them at times seem unlovable.  They are terrified of being abandoned, yet are powerless to keep the illness from destroying relationships.

This is the borderline experience.

The Facts

…Genetic factors are important – borderline tends to run in families.  The risk of developing borderline is 6 times higher when a close relative has the disorder.  In studies of identical twins, researchers have discovered that many personality traits are genetically determined.  There is an association between some personality characteristics and blood type (called ‘blood group antigens’).

Borderlines commonly suffer from other disorders as well.  PMS, depression, hypothyroidism, vitamin B 12 deficiency, other personality disorders, anxiety, eating disorders, and substance abuse problems are the most common.  Intelligence is not affected by the disorder, but the ability to organize and structure time can be severely impaired.  There is no association with Schizophrenia.

…While many borderlines suffered from abuse or neglect in childhood, some developed the disorder from head injuries, epilepsy, or brain infections.  Early parental loss and incest are commonly associated with borderline.

The facts indicating a medical origin are impressive: Brain wave studies are frequently abnormal.  Neurological physical examinations are abnormal.  Sound interpretation is impaired.  Memory and vision are impaired.  Glandular function may be abnormal.  Sleep is abnormal.  The response to some medications is bizarre.  When injected intravenously, the medication procaine normally causes drowsiness, but a borderline will feel the ‘dysphoria’ described in the first paragraph.  If borderline was exclusively an emotional illness, why would all these medical neurological abnormalities be present?

Borderlines likely have abnormalities with the neurotransmitter ‘serotonin’ – an incredibly important brain chemical.  Serotonin problems can cause anxiety, depression, mood disorders, improper pain perception, aggressiveness, alcoholism, eating disorders and impulsivity.  Excess serotonin can depress behavior.

Serotonin deficiencies can cause many problems, especially suicidal behavior.  Low levels of serotonin increase the risk of self-destructive or impulsive actions during a crisis.  The most violent suicides (hanging, drowning, etc.)  are usually committed in patients with low serotonin metabolite (waste product) levels in the spinal fluid.  In those who attempted suicide unsuccessfully, 2% will likely be dead within one year.  If the serotonin metabolite level is low, that risk increases to 20%.


Due to new developments in medicine, borderlines can now be treated and often cured.  The medication fluoxetine (Prozac) usually stops most of the mood swings in a few days.  It is, in my opinion, as big a breakthrough for borderlines as insulin was for diabetics.  Borderlines generally see themselves very profanely.  I frequently tell my borderline patients ‘you’re not an *#%@*, your brain is broken.’ Once this concept is understood, the borderline patient usually feels an enormous sense of relief.  They need to know they have value as a human being.  Feelings of desperation and hopelessness are often replaced by optimism and motivation once Prozac stops the mood swings and the patient begins to realize that a happier, more successful life is possible.

All borderlines need psychological counseling.  It’s almost impossible to live for years as a borderline and not need psychological help.  While the underlying problems are probably structural within the brain, the borderline is left with a lifetime of bad experiences and inadequate skills for recovery.

No medication should be given without proper medical supervision.  This is particularly true for the drugs used to treat the borderline disorder.  Some medicines make the symptoms of borderline worse, especially amitryptilline (Elavil) and alprazolam (Xanax).  Possibly a third of borderlines may suffer from low thyroid (hypothyroidism) – despite a normal ‘TSH’ blood test.  They may need to take thyroid medication.

The antidepressant fluoxetine (Prozac), a serotonin increaser, virtually eliminates the mood swings.  Feelings of anger, emptiness and boredom are often eliminated or reduced as well.  Most borderlines I’ve treated consider Prozac to be a miracle.  While some need the medication indefinitely, many have been able to stop it after a year without the mood swings returning.  Side effects are rarely a significant problem.

Neuroleptics…have been proven effective.  They are remarkably helpful for treating dysphoria and psychosis, and can be preventive when the borderline is undergoing stress.  They seem to ‘put on the brakes’ when the thoughts are racing.  They should only be used as needed, like using an antacid for heartburn.  These medications can be effective at low doses, and must be taken with great caution.

While medications can help with some symptoms, the brain is clearly broken.  After a stroke, the brain needs therapy to let the healthy areas take over for the broken ones.  The same is true for recovering borderlines.  I feel strongly that the brain must be retrained.  Affirmations…will work, as the human brain can believe almost anything if told it enough times…

The psychology of positive thinking is very helpful.  I strongly recommend massive brain re-education.  Devote as much time as possible for 3-6 months reading positive self-help books and listening to motivational tapes – especially those by the motivational speaker Zig Ziglar…

Sometimes symptoms of ‘temporal lobe’ involvement (similar to epilepsy) complicate the disorder.  Common symptoms include unawareness spells, feeling like things are unreal, and numbness of body parts.  These symptoms are more common under stress, depression, severer dysphoria, and incest crisis.  They can be treated with the epilepsy medication carbamazepine (Tegretol)…

Borderlines are VICTIMS – they did not cause their illness.  They do not want their illness.  They want to be treated and possibly cured.  They deserve that opportunity.

The National Institute of Mental Health (NIMH) has been the single most influential source of unbiased study and information regarding the true biology behind the borderline personality disorder.

Landmark studies, such as those produced by Drs. Cowdry and Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and neuroleptics, and the dangers of Xanax (alprazolam).  This article was published in the Archives of General Psychiatry Feb 1988.  A subsequent article showed that conclusions of low brain serotonin in the BPD were erroneous, low levels were associated with suicide, not the BPD.

Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research.”

Permission by Leland M. Heller, M.D.

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A Possible New Name for BPD”


Many people would like to change the terminology of the “borderline personality disorder” to a new term that more accurately describes the illness. The term “BPD” in and of itself is as if the whole person (and the personality) is flawed, rather than looking at the BPD as a medical problem it actually is.

The term “borderline personality disorder” implies that there is no hope for treatment as many mental health professionals unfortunately still believe. There is thought that this illness borders on schizophrenia, thus the term “borderline.”

What then is borderline personality disorder? These questions have been posed to Dr. Leland Heller, expert in treating borderline personality disorder.

Q. What do you think about the term “borderline personality disorder”?

A. “I think it’s a horrible, insulting label for a real medical illness. The name alone reduces serious research, stigmatizes victims, and implies the person is crazy. It denies the medical nature of the process, and implies simply a personality problem.”

Q. Do you think “borderline personality disorder” is an accurate description?

A. “No I don’t. It implies a character problem. While I’ve encountered many people with a bad character who had the BPD, most borderlines I’ve treated (over 2100) do not have character problems. “Borderline” means patients live “at the border” between psychosis and reality. When borderlines are well treated medically, psychotic experiences are few and far between – and can be treated well. Borderlines don’t live at that border, they simply go into psychosis too easily under stress.”

Q. What is the BPD?

A. “The BPD is a medical problem, likely a form of epilepsy (brain cells firing inappropriately and out of control). The characteristic symptoms include inappropriate moodiness, chronic anger, emptiness, boredom, dysphoria (anxiety, rage, depression and despair) and psychosis. The other criteria are symptoms related to these medical problems.

ALL neurological disorders can have an effect on the personality, such as Parkinson’s disease which isn’t called the ‘shaking personality disorder.’ ”

Q. What does this term “Dyslimbia” mean?

“ ‘Dys’ means malfunction, and limbia meaning from the limbic system.

‘Dyslimbia’ is malfunction of the limbic system. While other neuropsychiatric disorders involve malfunction of the limbic system, the limbic system dysfunction is profound in the BPD. I chose Dyslimbia for my patients to take the stigma away. The BPD needs a new name, one that emphasizes healing not labeling.

I don’t care if it’s renamed ‘Dyslimbia’ or not, but a more honest, humane, and hopeful name needs to be made for this illness. Patients deserve to get medical attention for ‘Dyslimbia’ (or an equivalent name), rather than have doctors and therapists shun them because they are ‘borderlines.’”




Other Common Disorders Associated with Borderline Personality Disorder

Other Common Disorders

by Dr. Leland Heller M.D. – 4/98

The borderline disorder is usually associated with other neuropsychiatric problems. Attention deficit disorder is probably the most common one. Most of these “disorders” are really not illnesses at all, but traits that had advantages in a different time and environment – but they are a serious problem for patients in today’s society and it’s pressures. Successful BPD treatment requires successful treatment of all neuropsych problems:

1) Generalized Anxiety Disorder (GAD):

the body’s “flight or fight” system seems to be on all the time, causing fear related symptoms. One can experience mostly a “thinking” anxiety problem, called the “cognitive component” of the GAD, where the person is unable to sit peacefully with a quiet mind. This diagnoses is almost always the case when medications like Paxil, Prozac and Ritalin cause increased anxiety. Treating this disorder first is often necessary before successfully treating the other diagnoses.

2) Obsessive Compulsive Personality Disorder (OCPD):

like the BPD, it’s a medical problem, not a “character disorder.” In my opinion it is a condition people are born with. The body’s automatic switch that takes over when facing a life and death situation stay’s on all the time, constantly experiencing “life and death” sensations. Symptoms include inappropriate perfectionism, difficulty making decisions, inability to prioritize, and being a pack rat – all because the person feels literally like he/she will die if an error is made.

3) Obsessive Compulsive Disorder (OCD):

an anxiety disorder (and/or symptom) characterized by excessive and intrusive thoughts and ritual behaviors that help the person cope, such as washing hands excessively, repeatedly checking the door, etc. The B vitamin inositol in high doses can be as effective as standard medications.

4) Attention Deficit (Hyperactive) Disorder:

a reduced flow of blood to the brain areas responsible for staying focused on an activity or thought, and/or to think and consider before acting or speaking. Some patients have hyperactivity as well. It appears that the “disorder” does not go away at adulthood. I suspect a high percentage, if not a majority, of untreated or undertreated ADD individuals go on to get the BPD.

5) Rejection sensitivity:

along with dysthymia (rarely depressed, rarely happy – sort of in between) and irritability they compromise a syndrome I call “fractured enjoyment” (not a true medical diagnosis!). These symptoms collectively so far are only treatable with Prozac, and are the main reason Prozac has been so successful.

6) Panic Disorder:

results when the brain incorrectly assumes the individual is being choked to death. This is a true medical problem with a high suicide risk. Experiencing the body’s last ditch effort to avoid being “choked to death” is a terrible sensation, and the victim may live in terror that he/she will experience it again (preanticipatory anxiety).

7) Phobias:

irrational fears that limit the person’s ability to function, even though he/she knows they’re irrational. They are usually treatable medically, and include claustrophobia.

8) Cyclothymia:

is a relatively common mood swing disorder, similar to bipolar but with “mini highs” and “mini lows.”

(Dr. Heller’s book “Biological Unhappiness” explains the biology and treatment of these and other conditions).

Permission by Leland M. Heller, M.D.