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Is It Just A Phase?

QUESTION:

Dear Dr. Heller,

I have a 16 year old daughter.  She is the oldest of 4 girls.  My husband and I are happily married for 19 years and are financially secure.  Our daughter began to have problems in grade 9 (14 years old).  Her marks began to fall and she began to get into trouble at home due to her rebellion and acting out.  She frequently would lie about where she was going, since we would always drop her off and pick her up she was always found out.  She would be grounded, seen contrite and then almost immediately she would do the same again.

  We have since found out that she has been somewhat promiscuous and has been experimenting with marijuana.  In grade 10 her marks really fell to the point of failure and she was angry all the time.  She was diagnosed with depression and has been on 40mg Prozac since Nov 99.  She is regularly seen by a therapist but the problems continue.  She treats her sisters badly, she lies to us all the time even about the silliest things.  She has been taking money from our wallets and cars.  When she’s caught she always apologizes and seems sincere but again, the behavior continues.

She pines over kids who are not her true friends and desperately tries to fit into their groups.  It is truly heartbreaking for us to watch.  We love her and want to help but she seems to hate our meddling.  She has gained at least 40 pounds in the last 2 years..  She is 5’1″ and weight about 170 lb.  We signed her up at a gym that she wanted to go to but now she just sits in her room and eats.  She sneaks food out of the cupboards and spends the money that she steels on chocolate bars and cigarettes.

Yesterday was the turning point.  She blew up, hit me, screamed at both my husband and I and said she hates us.  Our Dr. says its a phase and she’ll grow out of it but she is tearing our once happy family apart.  Her sisters are afraid of her because of her anger and so I’m sure she feels shunned by them.  Everything we do to help doesn’t.  I’m wondering if she has been misdiagnosed.  Help us please.  She is a pretty girl and is able to behave for other people but for us she is a big concern.  If you have any thought on this I would be very grateful.

Thank-you, me.

 

ANSWER:

It’s not just a phase, and her entire life is at risk.  At minimum she almost certainly has the BPD.  I’d highly recommend you read as much about it as you can about it.  The addition of Tegretol to her Prozac could make a profound change within hours.  The screening test I use for my patients will be of enormous assistance to you as well, and I’d particularly recommend you look at attention deficit disorder.

 

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QUESTION:

Dear Dr. Heller,

I am married to a very bright woman of Italian ethnicity.  She is a Lawyer,  and was raised in a typical Italian household where children are “The apple  of their parent’s eyes”.  She has two siblings; a 30 year old sister with an  MBA, and a 27 year old brother who did not finish college, and received poor  grades in high school.  He works as a policeman.  The sister is married and will soon give birth to a child.  Their mother is a  full time pre-school teacher and homemaker.  Their father is an executive in a large Italian financial firm.

The problem(s) that I have encountered with my in-laws are these: They do  not communicate, and are very aggressive when they do.  I have sat at the  dinner table more than once, and not a word is uttered.  In the beginning I  thought they were just shy because of my presence.  But, I now see that they  are not communicative, and this has lead to a few problems.  First of all, my wife comes very much to life when she is alone with me.  But  whenever she is in the presence of her parent’s or brother’s, she too  becomes mute, and her personality takes a turn that I cannot recognize.  I   have brought this up to my wife on several occasions, and she agreed that  she feels intimidated and “Conditioned” by her mother, and tends to close   herself in.  I repeatedly have told her to be herself, and that she should   express her feelings to me more often.  (This, by the way appears to be a   serious problem in this family; lack of expression, or fear of it). 

In almost six years of frequenting this household, I have never seen any of   the family express themselves in a joyous or happy way, unless it was   Christmas or another major event.  I have never seen signs of affection such   as hugs or kisses, and instead, notice that if someone does say something,   one of the family members will either dispute it or ridicule it, and   therefore this leads to a loud argument that will last only a few moments,   and the winner will be the one with the loudest voice. 

My mother-in-law, for instance, will never say “Thank you” if warranted.    She has never admitted to being wrong whenever a rare debate arises, nor has   she ever told someone “You’re right!”.  I once played cards with her (at my  invitation) and she did not pronounce one single word during the entire   game, which lasted about 20 minutes.  She will become very aggressive if someone were to contradict her, and is  very sensitive if someone were to tease her.    

The brother is pretty much a carbon copy of his mother.  He still lives at   home.  The exception is that he has highs and lows in his moods, but this is   annoying because it is difficult to relate with someone whom you don’t know   how will respond to any given situation.  He is very aggressive the few times   that he expresses himself, and, maybe this is not relevant, he is very  stingy and self-centered, and does not share with anyone problems or daily  activities that may occur in his daily life.  He is pretty much in a cocoon, and  has no dialogue whatsoever with his father, who is a mild mannered 56 year  old who is complacent with everything,, but who too is very quiet and  inexpressive.  

I have told my wife many times that I am very uncomfortable with her family,   and that their lack of expression makes me uneasy, and I become very  anxious.  I consider myself to be a typical person who likes to talk, and  will do so on any subject, even though not proficient or very knowledgeable  of the subject matter.    When my in-laws came and spent Easter with me and my wife, I told them that  I did not put a television in the kitchen (as they have) because I felt that  at the dinner table one should talk amongst themselves, and that eating  together is probably the only time a family is together and reunited, and  therefore the time should be spent constructively.  

Do you think there is a problem here?  Are there issues that should be   discussed to alleviate any tension?   Would appreciate a rely from you.

ANSWER:

Of course there’s something wrong.  In the strongest terms possible I recommend you and your wife get into marriage counseling ASAP to get issues resolved before they become gigantic ones.  She likely has minimal skills at expressing herself, and silent passive aggressiveness could become the norm in your household someday without active intervention.  Peer pressure is incredibly powerful, and many believe it’s worse for adolescents today than it ever was.  In this case the family is the “peer.”  Even though you know what you’re trying to do is right for you (the TV in the kitchen) you’re still questioning yourself because of their influence.  Imagine what effect it has on your wife.  I highly recommend reading some books by Leo Buscalia about love and relationships.  He has a very different impression on Italian families than does your wife’s family of origin.  “Toxic Parents” by Susan Forward may be very useful for your wife as well.

QUESTION:

Dear Dr. Heller,

Could biological unhappiness be a throw back from the Vietnam and Gulf Wars era ?? Also, could a veteran of these wars apply for compensation with the Veterans Administration ??  (Post Traumatic Syndrome)

ANSWER:

By definition post traumatic stress disorder (PTSD) requires a life threatening situation (or similar experience) including combat.  The stresses and pain involved can cause PTSD.  Interestingly studies in the 1980’s showed that every Vietnam veteran who had PTSD had the BPD also, likely before going to Vietnam.  In other words those with the BPD prior to military action had the condition so badly worsened by combat that their lives became a nightmare subsequently. I’m not sure what the current VA rules are on the topic.  I had a patient in Lake Worth who was successful at getting disability from this exact situation, but it was a very, very difficult fight.

Is Klonidine A Good Choice For Stress?

QUESTION:

Dear Dr. Heller,

My doctor just gave me Klonidine for stress.  Is this a good choice?

 

ANSWER:

I assume you mean “Klonopin” and not Clonidine.  Clonidine is a high blood pressure medication that is sometimes used in children for behavior problems.  Klonopin (clonazepam) is a long acting benzodiazepine medication (like Valium) that is commonly used for panic and severe anxiety.  Like the other medications in the class they are potentially addicting and abusable, and they can impair you with driving or using machinery (even if you perceive they aren’t). I usually recommend for my patients that they do my screening test to determine what other diagnoses are present that could be treated to stop the anxiety.  Thanks Debbie

 

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QUESTION:

Dear Dr. Heller,

I was recently prescribed Paxil 20mg 1 per day mainly for depression.  However I also suffer form social phobia and OCD.  From your knowledge is 20mg of Paxil sufficient to also be treating my social phobia.  Also I was told by my doctor that I should begin feeling the effects within about 7-10 days but told by the pharmacist it will take only approx.  3-4 days, which is correct?

ANSWER:

Your pharmacist is probably correct.  Most patients do well very quickly on the SSRI’s, often in 3-4 days.  Paxil may work at 20mg – particularly for the social phobia, but in my experience much higher doses are going to be necessary for your OCD.

Is BuSpar Really Safe?

QUESTION:

Dr. Heller,

My cybernickname is Perkins.  I found your web site about BPD very inspiring!  It gave me some of my feelings of hope back!  It is sooo refreshing to see positive literature about BPD.  There are sooo few psychiatrists who think even a little bit positive about BPD.  There is just too much prejudice against those who have it out there.  I’ve heard sooo much negativity about BPD from even psychiatrists and social workers who should know better!  Lots of them refuse to work with people who have BPD!!  I should know..I found out the hard way.

Most therapists freak out when I tell them I have *traits* of it, but they calm down when I tell them that I do not meet criterion #5.  My former psychiatrist told me about three years ago that I have *TRAITS* of this disorder, but that it’s not a diagnosis because it’s not full-blown.  She added that it’s healthier to have just  traits of it as opposed to a full-blown syndrome or Dx.  I just needed to ask you about BuSpar…right now, I am taking 150 mg of Zoloft and half a tablet of Klonopin every other day.  I take Inderal PRN.  http://pks.947.myftpupload.com/AskDoc/doc699.htm This site says “BuSpar is one of the safest medications available.”  Do you still feel that way?  Doesn’t medication affect everyone differently?  What’s safe for one person may not be safe for another person?

BuSpar was one of the first medications that I tried out 3 years ago.(I was on Paxil and BuSpar at the same time).I had a VERY bad reaction to BuSpar during July 1997 so I asked my then-psychiatrist to take me off  it…when she did, the bad reaction went away totally!!  I am very sensitive to most psychotropics.  Anyway, this reaction took the form of jerky movements in my arms, butt, and legs..only when I was in bed.  That was the   first and last time in my entire life that I had ever experienced those  kinds of jerky movements!!  It was a scary experience!  I normally do NOT  experience any kind of jerky movements or seizures.  My then doctor told me  it was a form of Huntington’s Chorea???   Jack M.  Gorman, M.D.  also wrote in a book called “The Essential Guide to  Psychiatric Drugs” on pages 144-145 that theoretically, BuSpar MIGHT cause  Tardive Dyskinesia if taken for many years.  He goes on to say “In fact,  this has not occurred to patients who have taken it although the drug has  been on the market only about three years.”  The copyright info says this  book was published in 1990 and 1995.  I am not sure what year BuSpar got on  the market.   Just wanted to point that out.  I sure hope you don’t mind.   Again, thanks for writing a BPD web site that is full of hope and realistic  optimism.  It made me feel much better.:-)

Cordially,  Perkins

 

ANSWER:

First thank you for the kind words.  The problem with BuSpar is that it often makes patients worse before they feel better.  Those side effects are usually the same as those you would get from being very scared.  There are 15 different serotonin receptors, but elevations in #’s 1 and 2 (5 HT-1 and 5HT-2) are the problem here.  BuSpar will block #1 after initially raising it.  This is a genetic worry gene.  The 5HT-2 is more associated in my experience with post traumatic stress disorder. At this time BuSpar is still considered one of the safest medications on the market – considerably safer than not taking it if needed since anxiety causes profound effects on the body.  I had a patient take 250mg of them, and the poison control center told us to ignore it!  There’s no significant information that I’m aware of regarding tardive dyskinesia and BuSpar.  What I’ll often do for individuals like yourself is start with low BuSpar doses (perhaps as low as 2.5mg to start).  If these doses are a problem I’ll usually need to add Remeron or Serzone to block the 5 HT-2 receptor site.  Then the BuSpar and Prozac can be taken without side effects. Never, ever minimize the effects inappropriate anxiety can have on someone.

 

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