Tag: Abusive

Can a Psychiatrist Have the BPD?

QUESTION:

Dr. Heller,

Have you ever heard of a Psychiatrist being borderline?? I have had a 7 year relationship with this man. I am 52, he is 61 and both have had previous marriages. I have done extensive reading and am convinced that he is afflicted with this problem.

When our relationship is on track, everyone we know envies us and considers us to be the perfect couple- true soul mates. About 7 times, perhaps a few more- he would rage at me for the most ridiculous reasons (actually no reason) and become so verbally abusive that once he even called the local police to have me removed from his clinic while I was trying to talk some sense into him about his accusations. Unlike a normal relationship where the two parties can have a dialogue, his rages are strictly a monologue.

Two weeks prior to the final rage, we were out of town at a family wedding (his side of the family) and he sang my praises – telling of how I was the most important person in the world to him – to his family and telling me in private that he was afraid that I was going to leave him for a younger man. A couple of days after Xmas, I found out through other means that he was lying to me about who we were spending New Year’s Eve with and because I am by nature a pacifist and because I am afraid to put him into a rage – I very gingerly approached the subject – like – is there something that you are uncomfortable about that perhaps we should talk about?? He screamed that he never wanted to see me again and he was tired of my “splitting.” From that moment on, I figured that he must know that he is borderline.

Under the circumstances of his being a health professional, do you think that he knows what is going on here?? Do borderlines ever have remorse or fond memories of their significant other?? Do they ever try to make amends? He is incapable of saying that he is sorry. I did get a CD of love songs placed in my mailbox which I know came from him. I ignored it.

Also, Dr., I have one more question. Do borderlines have a particularly difficult time with control and their children. The man in question has two adult adopted children whom he will not let out of his control. The boy and his wife even live with him – for no apparent reason – especially not financial. We are both attending the wedding of a friend’s daughter and I am really fearful about what to expect. To this point, he has come into my business and will not acknowledge that I am alive. I don’t know if I should ignore him, be civil. I don’t know what to do.

Thanks so much for listening.

 

ANSWER:

1) There is no reason an individual with the BPD can’t be found in any profession. I have treated many in the mental health professions for the BPD. Whether it’s appropriate for the individual to be functioning in a profession depends upon the individual’s perception of stress and therefore their ability to handle it. Studies show that untreated borderlines tend to do well in employment situations over time – particularly if they are smart and have financial resources.

2) He may or may not be aware of what’s happening. If he perceives the BPD is a death sentence, that it only fits self-mutilators, and that it can’t afflict doctors or other mental health professionals then it’s unlikely he’d recognize the disorder in himself. They can try to make amends, and it appears the love song CD was an example, although many people are extremely afraid of admitting a mistake or of being wrong.

3) Borderlines often have remorse and fond memories, but it depends upon what psychotic interpretations developed. If he/she believes someone truly behaved terribly, he/she will treat that individual with contempt subsequently whether that person is “guilty” or not.

4) The usual situation is problems with children. Control issues are common, and misinterpretation issues are extremely common. It’s rarely due to lack of good intentions. There’s a high likelihood that behaviors begun when they were small children will continue as adults, although it’s highly variable.

5) I can’t make any specific recommendations about what you should do, but there is a question I often ask my patients: “If your child was in your exact position, what would you recommend?” It’s usually smart to take your own advice.

 

2000 March Questions

 

Ask the Doctor

 

Why Does my Daughter in England Have BPD?

QUESTION:

Dear Dr. Heller:

Our daughter, now 28, was diagnosed as having BPD just a couple of years ago after 10 years of misdiagnosis, spells in psychiatric hospital, suicide attempts and desperate unhappiness for her and for the rest of the family seeing her suffer and not understanding why. Since the BPD diagnosis we have read many books including ‘Biological Unhappiness’ and we are now looking for a DBT therapist (we live in England) to help her to cope with her life.

Unfortunately her doctor, psychologist and psychiatrist are not interested in treating her for anything other than ‘depression’ which hasn’t helped her at all. As her mother, what I would dearly like to know is, why has she got BPD? There is no history of BPD in our family and she had a very loving non-abusive or violent in any way upbringing – her sister is perfectly OK. However, she was born 3 months premature, at 26 weeks weighing just 820 grams – a miracle baby, the smallest baby to survive in Australia at that time (1971). Could the trauma of that birth have caused her BPD? Do you know of any doctors in England who treat BPD as you do?

Kind regards.

 

ANSWER:

There’s no information about birth trauma that I’m aware of, but it’s a logical assumption – particularly in view of the information that head injuries can cause the BPD. Attention Deficit Disorder seems to cause the BPD as well. I don’t personally know any doctors in England, but the BPD section on this Website has a wealth of information that a concerned, open minded physician can use.

 

2000 February Questions

 

Ask the Doctor

 

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 – it’s just not “the mental health pill.” It’s 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 she’d be dramatically better in just 3 hours with Tegretol 200mg. If that didn’t 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.

Can I be Both Codependent and Have the BPD?

QUESTION:

Dr. Heller,

My doctor has already diagnosed me as being codependent. During my last visit, he said I have some of the symptoms of BPD. I read the entire list, and some of these I do not feel describe me at all. I have never taken part in self-mutilation, nor have I ever gone on reckless sexual excursions.

I do suffer from bulimia, abused alcohol in the past, and I currently smoke a half of a pack of cigarettes a day. I do not like being alone, and I do try to avoid it because I generally become depressed if I am left alone to only think. I rarely lose my temper, but I also have been diagnosed as having TMJ because I clench my jaws a great deal, especially when I am under stress. Is it possible for me to be both codependent (which I have no doubt in my mind that I am) and BPD (I really do wonder about this)?

Thank you for your answer.

 

ANSWER:

Of course, there’s no official definition of co-dependency, but it generally means being more concerned with others than with yourself rather than being in balance, putting up with and/or enabling others to do things that are harmful to both of you, and/or spending more time worrying about other people than taking care of your own needs. Co-dependency can be a learned behavior (such as from a dysfunctional family), the result of a biological process (such as the genetic generalized anxiety disorder), or an adaptation (like being in an abusive relationship and trying to keep peace in the home).

Many individuals with the BPD show co-dependency for any or all of the above reasons. Avoiding pain and fear is of primary importance to an individual with the BPD. Of course, I don’t know whether you have the BPD or not. The official criteria are very specific and refer to a pervasive pattern since early adulthood – which includes adolescence. I believe the BPD begins at puberty when the limbic system goes into hyperdrive and an individual is at his/her greatest risk of seizures.

From what you wrote, you likely fit criteria 4 and 1. You live your life. You need to determine if the criteria do fit you and your life. I encourage you to look at the BPD and the other diagnoses I described in the screening test – which should give you a great deal of information.

 

2000 March Questions

 

Ask the Doctor

 

QUESTION:

Dear Dr. Heller–

I have written you several times over three years ago. Your insight and guidance has been very valuable to me in dealing with BPD issues with my mother. Since then, I have kept current with the literature on BPD and have done extensive research on my mother’s illness. Having some professional experience in mental health issues (I am a pediatric dentist) it has been most helpful in understanding my mother’s plight, and understanding my role within my own family’s dynamics.

After almost 8 years of no communication with my family, my father telephones to inform me that my BPD mom is in end stage renal failure secondary to polycystic kidney disease. Without a transplant, my mom will not survive. To my knowledge, my mom’s BPD has still not been formally diagnosed. One large problem is that my mom self-medicates. Her physicians should know about this, as this problem may affect the outcome of a potential transplant. My father is a physician and will not disclose any of this to her caregivers. Since I am one who “triggers” my mother’s rages, my input is not welcome.

After several telephone calls and dialysis sessions, my mom appears to feel better, and again has become verbally abusive, blaming me for the expense of 5 years of her psychologic therapy, and not being compassionate about her illness! These conversations were in the form of questions on my part about my mom. I was glad she was finally getting help. I politely ended the conversation, and have not spoken to her since. It is obvious, due to my mother’s condition, some closure must be brought to this relationship, however I am not willing to do this in a setting, where I will be verbally abused by both parents. I have offered to provide a mediator to establish a dialogue, however my parents have declined, and continue blaming me for the severed relationship.

Any suggestions?

 

ANSWER:

It doesn’t appear you will get closure with her, you may have to do it yourself. The book “Toxic Parents” by Susan Forward may be of help to you. It may be of help to you to genuinely recognize that she’s very ill, and it affects how she sees things – no different than if she was in a coma. If you’re powerless to make things better, and dealing with the situation in person makes everyone worse, it may be in your best interests to stay away and make peace in your heart instead of in person.

Many children don’t have the opportunity for a prolonged parental dying process to enable them to make peace, and have to make peace without the parent present. One area where many individuals like you have problems is with the commandment “Thou shalt honor thy father and thy mother.” Honoring a toxic parent can be very difficult. You can honor her in an important way, however. Imagine that a magic pill became available that made her totally and completely mentally well. You need to be the kind of person she would then be immensely proud of. In other words, you can honor your toxic parent by being the kind of person he/she would be proud of if he/she were able to see things clearly and rationally. Sometimes this comfort is all you can get.

QUESTION:

Dear Dr. Heller:

My daughter is in an abusive relationship which she wants out of, but can’t summon the emotional means to make the break.  She fears the man she’s with.  He has anger problems, controls her like a slave, and she is afraid of what would happen if she breaks off the relationship.  He’s threatened her with what will happen if she leaves.  Her therapist is working with her twice a week, and she goes to DBT (dialectical behavioral therapy) group three times a week.  She’s not on meds. 

Is an intervention necessary here?  How can she be supported so that she can make the break?  She has completely altered her personality to please him, and is under much stress.  The stress causes panic attacks, and she cuts herself.  She’s been hospitalized a number of times.  I am 1600 miles away from my daughter, but talk long distance several times a week.  Any suggestions you have on how she can get out of this bad relationship safely would be appreciated so much.  I’m afraid the longer she’s in this relationship, the more dangerous it will be for her, and the harder to leave.  I know it must be her decision as to when and how to get out, but I feel she needs a support team to back her up.  Please help. 

Thank you.

 

ANSWER:

It’s obviously a difficult situation, and I don’t know all the facts.  Your interpretations of her mate may or may not be true as well.  He could be everything you wrote, none of it, or somewhere in between – I don’t know.  I’ve seen many situations where what you wrote was absolutely true, and where the patient only called the mother while the patient was psychotic and rageful.

Whether your perceptions are accurate or not, the most important thing from my standpoint is medications.  Individuals with the BPD under stress don’t do well without them.  That’s why it’s commonly incorrectly believed in the mental health profession that borderlines don’t get much better – because they don’t do well without the correct medications.  There’s lots of information in my books and on my Website that can help in this regard – including lots of scientific studies on medications.  Without medications she’s going to respond as if she were cornered, trapped and wounded.

The safety issue is another problem.  Many abusive people do indeed harm and occasionally murder those whom they love when the loved one leaves or threatens to leave.  This is a matter for the police, courts and family protection agencies.  Many communities have safe houses, and courts are helping to protect against abuse.  Many states require medical reporting of abuse, and require health care providers to be educated about it.