QUESTION:
Dear Dr. Heller,
After reading many articles on the BPD, I’m convinced I have it. I fit the profile very closely, including: 10+ years of chronic depression and hopelessness; fear of abandonment; identity issues; self-hatred; impulsivity in three areas of my life; 10 years of self-injurious behavior; suicide attempts; a history of sexual abuse; and a history of convulsions/seizures and headaches (plus other BPD symptoms).
Today, I’m 40, professionally degreed, married, and raising 3 year old twins (as a stay-at-home Mom). I feel a whole lot better. I’m no longer seriously depressed, but I frequently feel either sad, overwhelmed, restless, trapped, or bored. In the last 13 years, I cut myself once (when I thought my husband was going to leave me), and lately I have dug my fingernails into my body when I have felt horribly overwhelmed. I have started to fantasize about cutting, but stop short of doing anything.
I’m particularly concerned about being a good Mom to my children because they are (foreign) adopted and have started seeing a speech pathologist for language/communication disorders. I feel like I’m getting angry more often (always a raging anger), although it usually subsides very, very quickly, but I’m always left with so much guilt and then depression knowing that these outbursts are emotionally affecting my children. (I’m not spanking them, just throwing things!).
I have a ton of projects going, but very few completed. I recognize my life is particularly stressful now–is this triggering or aggravating my BPD (assuming I have it)? I’ve had many years of therapy and really don’t want to start again, but I believe medication right now would even me out emotionally. What do you think about medication without therapy (or prolonged therapy) in my situation, especially if I haven’t been officially diagnosed as having BPD? Thanks for your interest and kindness.
Stressed in Dallas
ANSWER:
Yes, stress triggers worsening of BPD symptoms. That you are experiencing enough dysphoria (anxiety, rage, depression and despair) that you’re considering cutting is a sign medication is desperately needed. The last thing you want to happen is getting into trouble with state agencies for being so angry and depressed that you can’t take care of those children effectively. I know you don’t want that for many reasons. I believe passionately that the BPD is a medical condition that needs medical treatment. My website explains the medications I use and why. I think counseling is extremely important addition to medication.