Tag: Childhood

Did I Cause My Son To Have BPD?

QUESTION:

Dear Dr. Heller,

My teenage son has every describable symptom for BPD.  He is at the last school in this city that will accept him and is due to be expelled from there.  He now has other people feeling sorry for him to the point that I am being thought of as the one who is at fault, even though I have two other children who are enjoying life and getting on well without attempting to destroy their lives.  I am a student mental health nurse myself and am sure I can spot when something is not quite right.  However this has escalated to the point that I am starting to believe that as a mother I am terribly inadequate.  This has come about since my son has had some close contact with a few very close friends of mine who had more or less insinuated that it is me that is at fault, (purely because he has ‘sucked them in’). Is it possible that such a ‘terrible mother’ can have two young children that just get on with life doing childish things that do not hurt others and one other that is intent on doing exactly what he wants regardless of the effect on other people.  This includes (at the age of twelve) sexually abusing a young girl and at the age of thirteen beating up another young boy and then throwing him into a canal, (this resulted in him being cautioned by the police). Please tell me it is not me that is ‘not well’ and in addition that this sort of behavior is not just (and I quote one of my friends), ‘normal teenage shit’.  thank you.

 

ANSWER:

There’s a term for what’s necessary for an average success called a “good enough mother.”  It’s likely you were at minimum that considering your two other children are doing well.  Even if you have significant problems yourself, your son’s behavior is up to him, and he clearly has his siblings as a role model. I’d look into the major diagnoses I go over in the screening test and also for childhood onset bipolar disorder.  The effective medications are dramatic, and it doesn’t matter how many medications one has been on, what matters is which ones, in which doses, and in what sequence. What’s in your heart is also very important.  If you honestly believe you did your best, you don’t need to answer to anyone.  Reading “Your Erroneous Zones” by Wayne Dyer may be of help to you in this regard.

 

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Could My 65 Year Old Mother Have Undiagnosed BPD?

QUESTION:

Dear Dr. Heller,

My mother is 65 years old.  She was hospitalized 4 times for “nervous breakdowns” when I was a teen, during which time she suffered from severe OCD, panic attacks, depression, and agoraphobia.  Mom underwent a series of shock treatments about 20 years ago; currently on high doses of Prozac, Serzone and Xanax.  Incest is likely, but has never been addressed.  Mom underwent surgery for hyperthyroidism when she was about 32 years old and has a history of migraines.  Recently, she has had a series of physical problems such as eye trouble, joint pain, and stomach disorders that physicians have been unable to find the cause of.  Mom hasn’t worked in over 30 years, doesn’t drive, and has few hobbies or interests. I myself am in therapy to help treat anxiety and co-dependency (growing up, my mother and I were heavily enmeshed).  My new-found emotional “freedom” at the age of 37 has triggered behavior in my mother that I have never seen before.  She has angry/sarcastic outbursts at me or will hang up the phone if I confront her about her lying (which is habitual) or other boundary violations.  Also, I am not ‘allowed’ to talk about anything in the past — she doesn’t want to hear anything “negative” about my childhood (which she’ll deny ever happened), and it’s as though deceased family members never existed, and she has little memory of her own childhood.  I am also noticing that people (herself included) are either “all good” or “all bad;” she either adores or despises a person, depending how that person has treated her recently.  Most things are viewed in terms of how it personally affects her.  In my recent research on mental illnesses, I stumbled onto information about BPD.  Based on some of the things I’ve mentioned here, do you think it’s possible my mother is suffering from un-diagnosed borderline personality disorder?

 

ANSWER:

Absolutely.  I’d even say it’s likely, particularly with the history of multiple meds in high doses requiring ECT for improvement.  The addition of Tegretol to an SSRI could result in a profound improvement – I’ve seen this in many older individuals.

 

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QUESTION:

Dear Dr. Heller,

I was wondering if you could assist me with a situation.  I am a fourth grade teacher.  One of my students has recently been going through some changes.  I just say, “It’s probably just a phase.” But his mother is quite concerned.  She calls me often, and I do not know the answers to her questions.  She asks me, “What is wrong with my boy?”, and I do not know.  He is a loveable boy.  Recently he has been lying at home and at school a little.  He said a swear word and then insists that he did not.  This kind of thing is going on at his home also.  He does something that is unlike him or inappropriate, and then he denies the actions.  Also he has been very quiet with his classmates.  His handwriting is getting sloppier and sloppier.  His grades are declining fast, and he was an A/B student.  Also, over the weekend, he ripped out half of his eyebrow.  What could this be?  Nerves?  A phase?  Please e-mail me with any conclusions or thoughts.

Thank you.

 

ANSWER:

Ripping out half of one’s eyebrow is not a phase.  The most likely diagnosis is childhood onset bipolar disorder.  http://pks.947.myftpupload.com/BiPlrKid.htm shows the questions I ask when trying to make a diagnosis.  The book “The Bipolar Child” by Dr. Papolos is invaluable. There may be other diagnoses going on, but childhood onset bipolar is the most concerning possibility.

QUESTION:

Dear Dr. Heller,

I was diagnosed with BPD about five years ago, about 2 years after suicidal behavior first manifested.  My first symptoms began in my early 30’s within a few months of becoming a lawyer and starting to practice law at a large national firm, where the stress was very high.  My history seemed to match the diagnostic criteria: I grew up with severe physical and sexual abuse, and with what could be classified as an absent parent – a mother who had MS, was quite mentally ill and incapable of acting as a parent (the limited resources available in my home were utilized by her).

The more I read about BPD, the more offended I became that the label had been attached to me.  They seemed to be the modern-day equivalent to Freud’s hysterics.  I then read Judith Herman’s Trauma And Recovery, and came to the conclusion that there is no such thing as BPD – only hard-to-treat PTSD.  I concluded that BPD was a misogynist label attached to women (I never met a male BPD in treatment) in a victim-blaming manner, and it seemed to give treaters an easy out when treatment failed (which it usually did).  It seemed a catch-all, almost “garbage can diagnosis” for women with trauma histories who were not responding well to treatment.

I just wanted to know your thoughts about this.

 

ANSWER:

While there are some areas where I agree with you, I totally disagree “that there is no such thing as BPD”.  I view the BPD as a medical problem, and recent studies showing areas of the brain that are smaller tend to confirm this concept.  So does the response to medications.  My ratio of females to males is 3:2.  I suspect the ratio is even, but more males wind up in prison and don’t get the medical attention they need. While many individuals with BPD also have PTSD, it’s not consistent. The BPD diagnostic criteria are not established by one’s childhood, in fact the diagnosis is independent of cause. I believe the BPD is a form of epilepsy (brain cells firing inappropriately and out of control) in the “trapped, wounded, cornered animal” part of our brain.  It causes enormous psychological damage.  It has profound genetic influences – likely close to 50/50.  It can be caused by emotional trauma, head injuries, brain infections and abuse. The BPD is not a label, it’s a diagnosis.  I agree totally the name of the diagnosis has to change.  I like “Dyslimbia” – which means malfunction of the limbic system.  Dyslimbia doesn’t carry the connotation a “personality disorder” diagnosis has.  The BPD is no more a label than being a diabetic, epileptic, or hypertensive. I agree there are some misogynists out there, but the BPD is not a diagnosis manufactured by misogynists who wish to label women with something horrible. Another area I agree with you about: Blaming the victim is extremely common and wrong.  No one with the BPD asked for it or caused it.  I believe strongly that the right daily medication combined with the right “as needed” medication gives the individual with BPD the opportunity to become the person he/she wishes to be.  I try to acknowledge to my BPD patients that they are indeed suffering.  I explain that they deserve to get that suffering under control, that it’s not their fault, and that they can have a terrific life.

BPD & Trying in LA

QUESTION:

Doctor Heller-

First off, let me apologize for taking your time on something that may seem trivial. However, I have searched for over six months for a psychiatrist or therapist in my area who is trained in DBT, and a psychiatrist that knows and understands your philosophy to BPD. You see, I am a successful licensed Marriage, Family, Child Therapist and after 15 years of struggling, have finally accepted the fact that I am BPD. It is not a self-diagnosis, but one confirmed by the many therapists I have worked with over the years. Your theory regarding DYSLIMBIA brings me hope that there may be end to the internal pain that I suffer. I am somewhat unusual in that I have held a successful career, however, I chose to leave my profession to “practice what I preach” and work on my own marriage and family. I have a wonderful husband and four children. I have all the criteria for BPD with one exception: I don’t go into any psychosis (that I know of). My childhood was extremely traumatic, with my mother–who SIed–cutting me along with herself, and trying to kill me on four different occasions. These things have all been processed and worked through in therapy~~however, the damage from the storm is evident. I desperately want to get on the appropriate medications and went to my Internist regarding the matter–loaded with the algorithms and the various articles you have written. She did not believe me. She did prescribe Paxil, and I had tried Prozac six months ago (was on it ten years ago and it was wonderful) but the Prozac stopped working. The Paxil gives me tremors, or shivers continuously and creepy crawly skin. I am interested in getting more information regarding Depakote or the other medications that you talked about, however, the psychiatrists that I have interviewed–and there have been more than several–are all from the “old school.” Do you know of ANYONE in the LA area who prescribes to your view regarding BPD? Anyway, after 20 years of struggling, I am certain that the “psychological” basis for my illness has well been dealt with but I cannot control my brain and the reactions thereof. I have migraines, IBS and TMJ and daily functioning is an ongoing struggle. I am as content as I can be in my life, and yet…I can never fully enjoy the wonderfulness of my life. I just want to not continually be in crisis. I hope you can help. Any referrals will be greatly appreciated. Blessings to you and your wonderful work,

BPD in L. A.

 

ANSWER:

I assure you it’s not “trivial.” I have learned that there are many, many wonderful human beings desperately struggling with BPD. What I’m doing is in no way unique – I’m simply making the medically treatable diagnoses and treating them comprehensively. I’m working very hard to make a difference, particularly by making this information available on the Net. I’d love to hear from colleagues who are like minded in this regard and I will add an area on my site for these individuals who do contact me. A psychologist in Canada may be teaching a course with my first book “Life at the Border” as the textbook. In my correspondence to other physicians I have explained my rationale about what’s going on. I modified it slightly and it will be in the “Borderline Personality Disorder” section under the title “How I Treat the Borderline Personality Disorder (BPD) and Why.” This may be useful to you as well. Like everyone else you need all the diagnoses I use in my screening test evaluated and treated comprehensively. Prozac doesn’t “stop working.” What happens is that either panic disorder develops or more commonly BPD dysphoria develops – anxiety, rage, depression and despair, which requires temporarily a dose of a neuroleptic and/or epilepsy drug. By far in my experience low doses of Haldol, Tegretol and Risperdal are the best.

Could I Have The BPD?  (From The Netherlands)

QUESTION:

Dear Dr. Heller,

Before you delete this mail because it is too long and you are a very busy man, please hear me out: It would mean terribly much to me if you would read it, cause I’ve seen your website, which made me believe that you might understand my problems better than anyone else could.  I do not know who else to turn to.  I am confused about my whole situation and I suspect I have reason to believe I (partly?) am a borderline.  My therapist has mentioned the word, but she’s quite vague about it and doesn’t seem to understand my need to know exactly what’s wrong with me.  I am a 22-year-old girl from the Netherlands and I have already sent you an e-mail last Thursday, but wrote it in a hurry and was not really satisfied with it.  Therefore, I would like to give it another try.

CHILDHOOD: I was brought up in quite a protective environment.  I felt I had to please my parents and 5 older brothers and sisters, but didn’t feel I could.  We never used to talk about ‘feelings’ at home, but, still, I was a rather sensitive girl and had a great sense of imagination.  I was shy, insecure, a dreamer, already felt I didn’t fit in anywhere.  Back then, my 3 big wishes were: 1.  To learn to swim 2.  To learn to whistle 3.  To stop wetting my bed at night (did that till the age of 11, of which I was very ashamed).

ADOLESCENCE: Though, as a child, I already felt like an outsider, it has gotten much worse during adolescence.  At secondary school, I felt lonely, horribly ugly, ‘less than zero’, shy, scared and I worried over everything.  Kids at school sometimes teased me and for about 2 years I did not have any real friends.  My ability to concentrate got worse: I usually put my homework off till it was almost too late, so I had no choice but to do it, I was scared to death to stay down a grade (new kids), which helped enormously to set myself in motion.  My unhappiness now and then burst out when I got home from school.  I think because I felt safer at home.  In particular in the presence of my mother (loved and trusted her), I was often thin-skinned, cynical and grieved.  I sometimes tried to talk to her about it, which didn’t work out, usually triggering an out-of-control mood – I was desperate, upset, cried, used harsh words (Why the hell did you put me on this planet?  – I am awful – everybody hates me, etc.).  Than I’d flee up to my room, where I cried, buried my face in a pillow, pulled at my hair and/or banged my head against the wall.  After an hour or so I used to calm down and started feeling guilty.  What got me through secondary school was, I think, my intelligence, the fact that I was very hard on myself, and my sense of imagination – I fled into fantastic fantasies starring a fantastic me and fantastic others who found me fantastic.

AFTER ADOLESCENCE ; At 19, I went to a new school, far away from home, which forced me to find a place to stay in a city unknown to me, amongst strangers.  I was very, very scared but did not realize nor accept it.  In the 2 1/2 years to follow, I had a few ups and many downs but never dared to give myself a break.  When I had the prospect of a work placement of 5 months in England, however, I felt so horrible about that and the rest of my life that I sought professional psychological help.  I did not go to England.  They found my case ‘complex’, thought that I did not have enough basis (was too confused/weak) for therapy and thus sent me to a therapist who gave me supportive therapy; she had the task to make things clear for me (with my help), make me stronger first.  After a lot of waiting, talking and some tests, this was the diagnosis: Social phobia, agoraphobia, avoidant personality disorder, dependent personality disorder, depression, identity problem (underdeveloped identity), problems of adaptation.

Supportive therapy hasn’t improved much (after almost 1 year), which is why I will most likely start intensive day therapy soon (activity program).  What isn’t helping me at all, is that I could not and still cannot accept that there’s something wrong, and that I am not just lazy and undeservedly drawing attention.  It is also hard for me to discuss it with my parents.  After my therapist had repeatedly requested medications for me, the psychiatrist finally prescribed Seroxat (paroxetine) to me.  20 mg did reduce my fears and made me more indifferent, but not yet more active and I still felt very guilty.  The dose was heightened to 40 mg, which has taken away a bit of the guilt feelings and has made me more active.  I also feel more indifferent since the 40 mg, though ’empty’ describes the feeling better, I think.  Sometimes I seem to feel happy, but it is more like a kind of hollow happiness, one that does not touch my soul.

I often desperately want to get attention from other people, ALL people, and get very lonely, sad, miserable when I do not get any.  (For example, I sat by the river twice, waiting for someone to come and sit next to me, talk to me, love me, which never happened).  I also very quickly feel abandoned by people I should actually trust.  In moments of despair, I carve myself with a knife (about 1 time per 1 1/2 weeks), the last time was last Tuesday.  I do that because I have no other choice.

A few times, I drink a lot of alcohol at once, but not often.  Lately I sometimes cannot stop myself from eating loads of cookies and/or candies.  I tried to throw up twice, in which I didn’t succeed.  Before I sought professional help, I also had a lot of those feelings and I had also cut myself once, because my boyfriend was being selfish, which made me lose it.  At the age 15-19, I also used to drink a lot (liquor mixed with other liquor) before I went out, in order to lose my insecurity.

I do not know if the following is important: When I was 3 I fell real hard on my forehead, causing a very big bump that almost burst.  I have also had one (bad!) experience of vertigo (recognized it at your site!) at the age of 17.

I sure hope you have read this.  My therapist has mentioned ‘borderline’ once or twice when I had told her how I felt and what I had done, but I still just don’t feel like I know anything much.  Do you think there is a chance that I am a borderline?  Could you please tell me what you think about the diagnosis (given before I started taking Seroxat), and the fact that I am taking Seroxat?

I don’t think you can imagine just how grateful I would be if you would answer my questions.

 

ANSWER:

The cutting and other symptoms imply that you could easily have the BPD.  The official criteria can be found at: http://pks.947.myftpupload.com/DSM.htm This FAQ can give you lots of information about what to do next:http://pks.947.myftpupload.com/AskDoc/First-Do.htm You need to get all your diagnoses made and comprehensively treated.  I have not been that impressed with Seroxat (called “Paxil” in the US), although it works for some patients with the BPD.  An explanation of the medications I use and why is available at: http://pks.947.myftpupload.com/20a.htm

 

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