DO YOU HAVE ANY SUGGESTIONS FOR ME? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
DO YOU HAVE ANY SUGGESTIONS FOR ME? 
Question: At the urging of my therapist I read your book, and I can see why she suggested it. I would like to come see you but do not presently have the resources. I don’t know if you can help me, but this is what I learned from your book: I have all the symptoms of what you call “fractured enjoyment”. Dysthymia seems to be my baseline, and I have experienced several bouts of Major Depression. The first was caused by the breaking up of a relationship, which I interpreted as severe abandonment. That was 5 years ago and I have never been truly “happy” since, despite numerous and changing circumstances, including that relationship coming back together. In the Anxiety model, I have a bit of the cognitive type with insomnia, some nervousness, and the inability to quiet my mind. The main thing this interferes with is sleep. The most severe interference to my life has been Substance Abuse over the last 5 years. I have been hospitalized several times, and in and out of AA and rehab. I always liked to drink but in the last few years I turned to drugs and alcohol to cope with the constant pain and hopelessness that I feel. It is my only “real” escape. Fourteen years ago I had life threatening Anorexia (at age 13), but otherwise my childhood was generally happy. I am now 27 years old. I carefully read about Borderline and I know you do a lot of work with that. I’m not sure that I have that, but I do have some distinguishing factors. The biggest is self hate. When asked why I feel I am depressed, I would say that I have a deep innate sense of self hatred and don’t know why. I feel this is my biggest problem. After working the 12 steps of AA, I thought I had “fixed” this problem, but it quickly returned. I related to the dyphoria as it pertains to self mutilation, and enjoy the “pain relief” that comes with it. I have also engaged in self destructive behaviors as it pertains to eating, sex, substance abuse and spending in the past, but on a more intentional self loathing basis rather than impulsively. I have always been very conscience of my behavior and lack of self respect. I have had 2 suicide attempts in the past 2 years. I also generally feel empty and bored. I think it is important to mention that I am not presently engaging in self mutilation and have not for 6 months. That has not been difficult to stop but abusing substances has. I have been clean on and off with the longest period of sobriety being about 6 months. I also think it is important to mention that when it comes to Borderline I do not feel I have the following: dissociation, paranoia, rage, intolerance to change (I like it), splitting, or much anger. I also do not have mood swings-I am generally depressed and go through periods of worsening depression in conjunction with substance abuse and/or disappointments, especially failed relationships. I am extremely critical of myself and tend to go the opposite way with others. I do not believe I fit the other disorders in your book such as OCD, ADD, Bipolar (I have no mania), etc. I don’t know if you can help me but when I read your book it gave me some hope, which for me is hard to come by. I have never been on any medication for depression. I have taken Valium in the past, but it is not a solution for someone like me. I have recently put down drugs and alcohol and am willing do to so, as well as try medication in order to feel better. I have only seen my therapist once, and she urged me to get in touch with you. Do you have any suggestions for me as far as medication? The only side effect I would like to stay away from is weight gain. Thank you so much for any help and guidance you can provide. Dr. Heller’s Answer: 20% of individuals who have heart attacks have no chest pain. You don’t have to have every symptom to have a diagnosis. Your anger is clearly self directed. While I don’t know you, your description is very clearly that of the BPD – which is a seizure disorder in the trapped, cornered, wounded instinct part of your brain. The BPD affects 6% of the population. You probably also have the “fractured enjoyment” – which is a genetic depression and the cognitive generalized anxiety disorder. From what you’ve written you appear to at least fit BPD DSM IV TR criteria 1, 4, 5, 6, and 8. When I treat someone like you I will usually start with BuSpar first, then add in Prozac a few weeks later, and likely Tegretol a week after that. The sequencing of medications is as important as the medications themselves. There are other ways to do it, but this is a safe approach that usually works wonders over a month. I hope this was of help and thank you for the kind words. 
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Video DVDs now available! You can watch and listen to Dr. Heller in the comfort and convenience of your own home. Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. “Biological Unhappiness” “Open this book and it will open your mind. By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery. “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. 
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