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There are many locations to find the names of individuals treating those with the borderline disorder. The National Institute of Mental Health has one, the website BPD Central has one, and the BPD Sanctuary has one.

The biggest problems are that many don’t believe the BPD is a medical problem, that many believe psychoanalysis is the best option, that most don’t believe in making all the diagnoses and treating them comprehensively, and that most do not prescribe medications as needed.  I would be thrilled to hear of any like minded physicians/therapists who would like me to include their names and information on a list of mine, and/or have a professional dialogue.

QUESTION:

Doctor Heller-

My wife firmly believes that I have BPD after reading the information in your web page. I am not so sure. Based on your screening test I have some symptoms from several sections, but seem to fall into ADD more than the rest. I am moody, have a lack of joy, am a pack rat as far as tools, nuts and bolts, anything that could be used to fix something is involved. I quit drinking almost 20 years ago. I mention that because when I drank I did have the highs and lows, but since then I have had mostly “neutral” feelings, but I do have some depression that seems to work in about a 3 month cycle. I take B complex for the depression, and it does help.. I used to get feelings of doom, but haven’t had that in 6 or 7 years. I have to always be doing something, my mind is always working, am good at coming up with plans for business and stink at execution, I get lost in the details. On the DISC personality test I score High D/ High I. I also seem to drive everyone else “crazy”. I am 49 and have been this way all of my life. I guess I’m at the age where it’s wearing me out too. I hope that I have given you enough detail to form some opinion. Thanks for your web page–it’s very informative.

 

ANSWER:

You might have the OCPD and the GAD as well. You may be thinking you have to “choose” which diagnosis you have, like a multiple choice question. It doesn’t work that way. The criteria for many disorders can be found on this Website, and my new book “Biological Unhappiness” goes into them at length, including why they happen and how they can be treated. You may have a thyroid or B12 problem as well, which can be checked with a simple blood test – and is often not performed as part of routine labwork. . You can have a terrific life, successful in every area. You have to get all the diagnoses comprehensively treated and retrain the brain. I’m sure this Website will be of help to you in this regard. There is no question that being vitamin deficient causes problems. I will shortly have a section on this Website on what you can do to be healthy.

What Can Be Done For My Mood Swings?

QUESTION:

Dear Dr. Heller,

I am 49 years old, physically healthy, educated, and have a wonderful spouse and stepchild along with children of my own.  My spouse and I recently gave up the corporate life to start our own business because we wanted more flexibility and to have more control of our future.  We both were victims of corporate down-sizing.  Together we have a great opportunity for success.  However, I seem to be unable to clearly address the normal everyday stresses, and experience wide mood swings.

I read your description of BPD and it struck a nerve.  I could have written the description of symptoms if I was asked to explain how I feel.  Things have gotten so out of kilter at home and in our office that it has been suggested that I am not capable of handling the situation.  Some of it comes from me.  The rest from my spouse and our co-workers.  It is obvious to me that there is a problem that I am not being able to correct using normal stress reducing activities and self control exercises.

Early in my life, I tried to use antidepressants without success.  The side effects were worse than the condition for which they were prescribed.  But that was many years ago and we now have more information and better treatments, not to mention a huge array of new medications.  I began taking St Johns Wort last year and it seemed to help stabilize the slight mood swings but it did not eliminate them.  I stopped using it about six months ago when I began to develop sensitivity to sunlight.  I found it difficult to be outdoors without getting rashes on exposed skin.  Therefore, I discontinued use.  Since then, with the added stress of moving, starting a new business, and the usual day to day activities, I am at a point where I can’t relax and constantly feel agitated, overly sensitive, and rejected.  I sometimes search for out of the way places to just be alone so I won’t feel so uptight.  Can you comment?  I have too much to lose if I don’t find a way to get control of the emotional roller coaster that I feel I am on.

By the way, thanks for the website!?

 

ANSWER:

I suspect the stress of starting your own business has triggered the BPD symptoms to worsen.  To me, Prozac is clearly the best medication for the BPD – stopping the inappropriate mood swings, chronic anger, emptiness, and boredom.  http://pks.947.myftpupload.com/20a.htm explains the symptoms I try to treat medically.  If Prozac causes agitation or increased anxiety, the generalized anxiety disorder may need to be treated first, with BuSpar.  http://pks.947.myftpupload.com/AskDoc/First-Do.htm will also give you information that you need to get started.

 

2000 November Questions

 

Ask the Doctor

 

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QUESTION:

Dear Dr. Heller,

My PCP just prescribed Doxepin to control itching.  I swear that it made me extremely agitated.  I had been agitated for two days and I had started it two days prior.  When I stopped it, I found I was not agitated at all the next day.  Then I took it again one night and I became extremely agitated the next day.  Do you think there might be a connection?  I am afraid to take it (he prescribed 30 with 3 refills) and I stopped itching (probably a food allergy, but PCP thought I was allergic to Wellbutrin as I had started it two weeks prior to the itching and couldn’t think of any strange foods I ate).  But if itching comes back I am afraid to take it.  What should I do?  The Doxepin is taken one at night and then two Allegra in daytime (but I was only taking the Doxepin after the 1st day).

 

ANSWER:

Doxepin (Sinequan) and Elavil (amitryptilline) are very similar tricyclic antidepressants.  A study published in 1986 showed that Elavil made borderlines paranoid, aggressive, and agitated (Garbutt, J; George, A: “Paradoxical Effects of Amitriptyline on Borderline Patients.” Am J Psychiatry 143:12 December 1986). I’ve had many patients tell me the same thing.  There are many other antidepressants that can be taken instead.

QUESTION:

Dear Dr. Heller,

My daughter lies to me all the time.  She also has other problems.  For instance, she can make herself believe that her behavior is warranted.  If she wants to do something she will do almost anything to get to do it.  She has had 2 relationships w/ boys.  Both were VERY destructive to her self worth.  She has always been a pleaser, she used to want to please myself and any other adults in her life, but now she shows that same desire but it is toward her friends (boys and girls).  She seems to show no remorse unless she gets caught lying, but even when she knows she is caught she will argue her case even if she knows how hurtful her lies are.  She will perpetuate it to get herself off the hook or confuse me enough that I will drop it.  Also, if she thinks she isn’t getting her way she will try and do something to make me mad at my husband (her stepfather), so that I will jump on her side, feel sorry for her and give in to her wants.  (I am sure you realize this has worked for her before.)

I will admit that I was very protective over her when she was younger.  I think after she got to be around 13 she and I broke away from that but she still knows I won’t let anyone harm her.  She is now 17 years old, she got pregnant last year by her 2nd boyfriend.  She didn’t tell me.  She did tell him and all her friends.  She even told them that I knew.  She lost the baby at 3 ½ months.  She had dropped out of school 1 ½ months before she lost the baby and started in a private school.  After she had problems there she went back to her high school.  It seems as though everything she has ever been involved in, she somehow becomes a victim.

Her friends always pushed her around although she has gotten better about that.  She has a very large heart and although she doesn’t show remorse in her actions, she shows disappointment in her life.  She has no idea how badly her behavior effects her self worth.  She insists on not making the tough choices in life.  She wants what she wants when she wants it.  She is a master at manipulation.  She smokes cigs and drinks some but she doesn’t use drugs or sleep around.  She is very afraid of the unknown.  She is steadfast loyal to those she loves.  She shows very little interest in anything other than her friends.  It seems as if she is searching very hard for happiness outside of herself.

When she was 6 years old I had a therapist tell me she was the youngest codependent she had ever seen and that when she turned 13 she would be worse than I was.  I am a codependent but I am much better than I was before.  Her father is an alcoholic, he hasn’t been in her life much.  I did protect her from his behavior as much as I could without drawing attention to his problems.  She always felt sorry for him until he broke a promise he made to her when she was 13.  She told him “DADDY, YOU DON’T HAVE TO SPEND ANY MONEY ON ME FOR X-MAS IF YOU’LL JUST BUY MEGAN A PAGER.”  (Megan is her little sister.)  Up until then she never made him accountable for anything.  But instead of buying the pager, she overheard him and his mother arguing over his crack-head girlfriend that needed  to be bailed out of jail.  He bailed her out.  She has never forgiven him.  She says she doesn’t care if he lives or dies.  It was always okay for him to hurt her but her made a very big mistake and hurt her sister.  I hope you can help me to help her.  I get so angry sometimes and so depressed I just don’t know how to help her.

PLEASE HELP ME.

 

ANSWER:

You’re obviously going through a horrible time. The principles remain the same… 1)    Do the screening test for her and for you and her father, and possibly other siblings.  Genetics plays a tremendous role.  2)    Get her treated medically ASAP!  Nothing will likely be successful without the medical problems treated. 3)    Fet her and you counseling ASAP! 4)    Consider going with her to a weekend seminar such as Zig Ziglar’s Born to Win, or Barry Neil Kaufman’s Option Institute