QUESTION:
Dear Dr. Heller,
I was diagnosed with ADD, OCD and BPD by my former therapist who terminated me from therapy. The termination was followed by several months of me pleading with her to take me back and refusing to go to another therapist. A similar scenario occurred sixteen years prior where I was also terminated from therapy (I stayed away from therapy altogether between these incidents). Six months after being terminated from therapy, I gave in and accepted a referral to a new therapist. Finally, I am feeling a little better. I am also seeing a psychiatrist and taking Celexa. I’m wondering if the BPD diagnosis sounds correct and if I should be taking different medication. Also, I have an underlying problem that haunts me: Even though I am an adult in years, I feel like a child emotionally. I even spend a good deal of time fantasizing that I am a young child and a perfect mother is mothering me. My main question: Is there a possible diagnosis OTHER than BPD to explain this fantasy? I was not abused as a child and I do not engage in suicidal behaviors other than thinking about killing myself, and, saying that I will after I am abandoned. At other times, I think about it only in the abstract. I don’t mutilate myself (cut, burn, etc.) – unless you call being diabetic, weighing over 250 lbs. and eating large amounts of sugar daily a form of mutilation. I don’t, because I have never had any side effects or been hospitalized. It doesn’t hurt. Finally, my other big issue is spending money compulsively.
ANSWER:
You could easily have the BPD, although you didn’t give enough information to prove or disprove the diagnosis. The official criteria can be found at: http://pks.947.myftpupload.com/DSM.htm. There are lots of psychiatric explanations for feeling like a child – that are best addressed by a therapist. Since self-mutilation is simply an effort to stop dysphoria (anxiety, rage, depression and despair), if an individual eats excessively to treat dysphoria, then it is a similar problem. They are classified differently however, self-mutilation is criteria 5, whereas overeating as you do fits criteria 4. Eating like you do can be a sign of many diagnoses, including OCD. Celexa is a good medication for the BPD. It’s similar to Prozac and works for unprovoked mood swings, chronic anger, emptiness and boredom. In my experience patients who take Celexa who are switched to Prozac do much better on Prozac. I explain my medical management of the BPD in http://pks.947.myftpupload.com/20a.htm and http://pks.947.myftpupload.com/HowBPD-Y.htm. All your diagnoses need to be treated comprehensively.