QUESTION:
Dear Dr. :
Everything I have read on your site tells me that my daughter suffers from BPD. She is 17 and has been afflicted since the age of 13, shortly after her father and I divorced. She is very angry all of the time. We have tried counseling and Prozac which helped but she refuses to take “that crazy drug.”
Her symptoms include self-mutilation, angry outbursts w/ physical attacks, she also re-arranges her room and places things in precise areas only to completely change it all again in a day or two. She is verbally abusive to her 3 year old step-sisters to the point she has hurt them intentionally. She has no friends and will not associate with family much. She has insomnia and binge-eats. She says that she hates herself and blames others for her unhappiness. She has even threatened to kill us. Please help. Was Prozac a good start and just not enough? Where do we go from here? Is hospitalization far off?
ANSWER:
Prozac is a great start – its just not “the mental health pill.” Its extremely unusual in my experience for an individual with the BPD to do well without it or something similar to Prozac. She needs more than just Prozac, however. If she refuses to take medications, hospitalization may indeed be necessary. If she was on Prozac for a week shed be dramatically better in just 3 hours with Tegretol 200mg. If that didnt do it, Tegretol 200mg with Risperdal 3mg would have gotten her out of her dysphoric spell. Like everyone else she must have all her diagnoses made and comprehensively treated. The screening test I use for my patients may be of assistance.