Category: Articles

QUESTION:

Dear Dr. Heller,

My sister (age 39) has been in and out of mental hospitals 4 times over the last 4 years.  Her first hospitalization occurred 6 weeks after the birth of her 3rd child.  There is a suspicion that there has been mental and emotional spousal abuse that has just come to light.  She has been diagnosed obsessive-compulsive, manic depressive and one therapist even said that there may be schizophrenia.

There is no prior mental illness in our family.  Her main symptom is that she has gone into a “religious” mode in saying that God doesn’t love her because she has been very bad.  This is all she can focus on.  She believes a demon has entered her body and at one time, upon hospitalization, she believed that she was Satan.  She is currently going through a divorce from a controlling husband, which is taking a toll on her mentally.

My question is this: Should we be seeking counseling from an abuse center, or continue seeking a psychotherapist?  No one has agreed on a diagnosis.  And if we continue seeking psychotherapy, how does one go about finding the best in the field, in our area?  She has seen 4 doctors, all who disagree on a diagnosis.  We are at our wits end and would like to see some progress.  I do know at this time, she is on Depakote, and other drugs.  Should these drugs be “helping” her, because I don’t see much improvement.

ANSWER:

You brought up the most important issue – what is the diagnosis (or what are the diagnoses). When everybody disagrees, the family and the patient are stuck in the dilemma you have.  This is a situation where you need to be knowledgeable.  Carry a DSM-IV with you to a psychiatrist or therapists office and ask why a diagnosis is being made, and review the criteria with the professional.  It’s very reasonable to ask why the diagnosis is being made.  It can be difficult finding someone you like and feel confident with.  Friends and others can give recommendations, but you may have to “shop” physicians to find someone you (or your sister) feel comfortable with.  Sometimes it’s worth traveling to an academic center for an opinion, like a University.

QUESTION:

Dr. Heller,

The books are on order from Amazon.com but, in the meantime: – my friend is a woman, 39 yrs., who I think may have BPD.  The symptoms match but she has suddenly gotten much worse since her GYN put her on a combination hormone to stop excessive menstrual bleeding.  She is supposed to take this all the time, NEVER stopping to have a period!  Do these hormones disrupt the serotonin and dopamine balances?  – Now her mood swings happen within minutes and she is angry most of the time; threatening violence to herself, her friends and her pets.  She is also confused, illogical and falls down frequently.  Is it BPD or a brain tumor?  Or both?  – She also takes: a T3/T4 thyroid replacement: Thyrolar, for low thyroid function, and glyburide for Diabetes I1 .

ANSWER:

A brain tumor is highly unlikely.  Both overtreated and undertreated thyroid can cause mood swings, as can some estrogen levels.  An “estradiol” blood test would determine the blood level of estrogen.  If she’s been moody and angry prior to these hormones, the BPD makes sense.  Hormone irregularities can make the BPD worse, but won’t cause them.

Can You Help With Severe Hives?

QUESTION:

Hello:

I am looking for cures hives. My wife has them right now. She takes Benadryl, prednisone and such with little relief. She is avoiding foods that might cause the condition. In addition, she is under significant stress from multiple sources. Are there any recommendations that you could make? Help would be appreciated. Most pages offer many definitions as to what hives are. That is unfortunately no real help.

Thanks.

ANSWER:

The antihistamine “Zyrtec” can be very helpful, as can “Tagamet” (cimetidine). Tagamet works because it’s also an antihistamine that works at a different type of histamine receptor. Sometimes the “leukotriene inhibitors” such as “Accolate” can be helpful.

There’s no question that nerves can play a huge role. The screening test I use for my patients may be of significant help for you in this regard.

2000 April Questions

Ask the Doctor

QUESTION:

Dear Dr. Heller,

One of my close friends (non platonic relationship) was diagnosed with BPD. He takes Depakote and Zoloft (that is if he doesn’t think his medication is “evil” at the moment) He loves me one minute, hates me the next. Wants me to help him then pushes me away. I don’t know if this has anything to do with the disorder but he’s become obsessed with the Nazis regime and white pride. I guess it gives him the sense of being more powerful then he is. One minute he’s advocating racism and the next he’s totally against it.

I read somewhere that bpd’s look for people to rescue them and that you shouldn’t do that because they will bring you down with them. but I read that a little too late. It’s part of my nature to try to fix things and I’m afraid that if I don’t maintain my ‘savior’ role that he’ll either get hurt or stop associating with me all together.

How do you get out of this type of situation once you’re in it? ( other than leaving. I don’t quit ) Also, just a quick question. I also read somewhere that some BPD’s mirror people. If that’s true, then would loving a borderline actually be in part loving a piece of yourself being mirrored back to you? Isn’t that a bit fake?

ANSWER:

First of all, you can’t help someone who doesn’t want it. No matter how hard you try, you can’t make someone like you, love you, respect you, treat you well, or act out of their own best interests. As needed medications can make a huge difference, and I’ve not been impressed in general with Depakote.

The Nazi and hate groups story is a very scary one. The LA shooting in 1999 was likely someone with the BPD, chronic anger, and association with hate groups. This individual needs treatment ASAP! You described what’s referred to as “co-dependency” on your part. Sometimes the answer is within, not from without. People in your situation often forget there needs to be a balance between helping others and helping oneself. You seem to have lost that balance. Your identity is more than just as a rescuer.

Mirroring to me, is like the saying “imitation is the highest form of flattery.” Borderlines can have such profound identity problems that they will mirror someone in the hope it will become their identity. It’s not at all fake – it’s how children learn, and why apprenticeships have been around for millennia. It’s the same thing as choosing a role model. The keys here are treating the medical problems, and making sure the person chosen as the role model is someone that he/she would like to emulate.