Tag: Childhood

Borderline Personality Disorder: Allergy to Tegretol; What to Do

Q. I am a textbook Borderline and have been forever. I also chronically self-mutilate and have had a very bad childhood filled with abuse. At the age of 18 I was placed on Tegretol. I was not cured by any means but did show marked improvement in stability of my moods. As the years went on I went off and on Tegretol staying on it only a few months at a time until I showed improvement.

The last two times I tried getting on it I broke out in hives and had to stop taking it. I seemed to have become allergic to it. Is this known to happen with Tegretol? I have spent many years in some form of treatment or another and have tried many many different medications, including Prozac. I have found that Tegretol was the only medication that offered help. I have tried other seizure meds, anti-psychotics, anti-depressants, etc. None made so much as a dent. Do you have an understanding as to why I became allergic to Tegretol?

A. It’s such a problem when patients develop allergies to important medications. It just happens. There are many theories, but none have anything to do with you or the BPD. Hives must be taken very, very seriously.

A mistake patients commonly make is assuming a certain medication won’t work. It’s often the sequence, the dose, or the combination.

I’m not your physician, I don’t know you, and I don’t know all your diagnoses. I can make some suggestions that I often try on my patients with similar problems. First is Prozac, usually 20-40mg daily. After a week depakote can be tried – chances are you’ll have good results. Often the combination of depakote and Neurontin can help. It’s the combination you likely need, not just a specific medication. Timing is very important. If you haven’t been on Prozac for a week first before trying depakote and/or Neurontin you don’t know whether it will work or not.

Lamictil is potentially more dangerous but has helped a few patients dramatically – one a self mutilating borderline. The risks and benefits of inadequately treating self mutilation (which can lead to suicidal behavior) likely outweigh the risks. Discuss this with your doctor.

Treating everything else that’s wrong could be far more important as well.

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Will He Ever Come Back? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

WILL HE EVER COME BACK? Will He Ever Come Back? Ask The Doctor Dr. Leland Heller Biological Unhappiness Will He Ever Come Back? Will He Ever Come Back? WILL HE EVER COME BACK? Will He Ever Come Back? Question: Hi, I am from the UK and my ex-boyfriend has been diagnosed unofficially with BPD.  We were childhood sweethearts that got back together after 30yrs.  He told me he had never stopped loving me.  We were back together for nearly 3 yrs in which time I have had from him jealousy especially over my past, anger, moods, emotional abuse, push/pull.  He drinks.  I would say he is high functioning. Everyone else thinks he’s a great guy.  It was my fault for everything.  Accused me of things I didn’t say or did or looking at other men. The last 9 months we were together he said we could only be friends as he felt guilty as his kids did not know about us.  We acted as if we were a couple.  He knew he was hurting me.  I stayed with him because I thought he had depression and wanted to be there for him.  I love him very much. He was emotionally and physically abused as a child.  His brother committed suicide.  At times he would cry like a baby and say he needed me and then said he was trying to get rid of me. He met an American on a business trip and said he has never felt like this before and moved to the US.  I said goodbye at the airport and never saw him again.  Was told by text and a couple of tel. calls.  He says he does not want contact with me.  He told me I was one of life’s genuine diamonds.  He used to say we would always be in each others lives even as friends. My questions are: 1. Why can he not have contact with me?  2. Will he ever come back?  3. Does this woman mean more to him?  I’m still in therapy because of what he has done and can’t get my head round all this.  Please, can you answer these questions? Thank you. Dr. Heller’s Answer: While I don’t know the details or his side of the story, I might be able to offer some insight if he really does have the BPD.  Borderlines suffer extremely painful lives.  On a regular basis they have unprovoked mood swings, chronic anger/irritability, emptiness and boredom.  With a mood swing or under stress they get a seizure in the trapped, cornered, wounded animal instinct part of the brain resulting in dysphoria (anxiety, rage, depression and despair).  If the seizure spreads to the temporal lobes they can get deja vu and a sense of unreality. When an individual with the BPD falls in love the brain produces its own narcotic – endorphins.  These endorphins stop their emotional pain, usually for somewhere between 3 and 15 months, and borderlines can be pure love.  After this timeframe their symptoms come back just like they were before.  It’s not uncommon for them to blame their new mate for the symptoms returning.  If the borderline falls in love again those symptoms will go away again, usually for 3-15 months. I don’t have a crystal ball and I can’t predict the future, but when his mood swings and anger come back he’ll probably do the same thing to his “new love.” Sometimes they stay with the new person for good reasons.  Sometimes the new person also has the BPD and the endorphins are really flowing for a while.  A BPD/BPD relationship can persist because they both have fears of abandonment that keep bringing them back. Regardless, your faith in this individual has been crushed and you’ll never trust him again like you did before.  Without trust there can be no successful relationship.  You likely feel betrayed and that’s a hard feeling to overcome.  Your therapist can help you with that.  Don’t draw the wrong conclusion and give up on love, however.  I’d highly recommend reading “Are You the One for Me?” by Barbara DeAngelis. Will He Ever Come Back? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home Will He Ever Come Back? MENU: Will He Ever Come Back? 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Will He Ever Come Back?A Suicide Attempt Per Minute in the US Will He Ever Come Back?Grandparents raising Grandchildren Will He Ever Come Back?Information About Children Will He Ever Come Back?What Signs are there that Someone May ‘SNAP’? Will He Ever Come Back?TV & Cartoon Characters with Depression & Other Disorders Will He Ever Come Back?Dr. Heller’s Office Website Will He Ever Come Back?Dr. Heller’s Lectures Will He Ever Come Back?Mentally Healthy People Will He Ever Come Back?Retraining the Brain Will He Ever Come Back?Today is a Gift Will He Ever Come Back?Reviews Will He Ever Come Back?Links Will He Ever Come Back?Webrings Will He Ever Come Back?Site Index Will He Ever Come Back?Home Will He Ever Come Back? Will He Ever Come Back?   Video DVDs now available!   Will He Ever Come Back? You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. Will He Ever Come Back? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. Will He Ever Come Back?    Will He Ever Come Back? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)

Do You Have Any Suggestions For Me? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

DO YOU HAVE ANY SUGGESTIONS FOR ME? Do You Have Any Suggestions For Me? Ask The Doctor Dr. Leland Heller Biological Unhappiness Do You Have Any Suggestions For Me? Do You Have Any Suggestions For Me? DO YOU HAVE ANY SUGGESTIONS FOR ME? Do You Have Any Suggestions For Me? Question: At the urging of my therapist I read your book, and I can see why she suggested it.  I would like to come see you but do not presently have the resources. I don’t know if you can help me, but this is what I learned from your book: I have all the symptoms of what you call “fractured enjoyment”.  Dysthymia seems to be my baseline, and I have experienced several bouts of Major Depression.  The first was caused by the breaking up of a relationship, which I interpreted as severe abandonment.  That was 5 years ago and I have never been truly “happy” since, despite numerous and changing circumstances, including that relationship coming back together. In the Anxiety model, I have a bit of the cognitive type with insomnia, some nervousness, and the inability to quiet my mind.  The main thing this interferes with is sleep.  The most severe interference to my life has been Substance Abuse over the last 5 years.  I have been hospitalized several times, and in and out of AA and rehab.  I always liked to drink but in the last few years I turned to drugs and alcohol to cope with the constant pain and hopelessness that I feel.  It is my only “real” escape. Fourteen years ago I had life threatening Anorexia (at age 13), but otherwise my childhood was generally happy.  I am now 27 years old. I carefully read about Borderline and I know you do a lot of work with that.  I’m not sure that I have that, but I do have some distinguishing factors.  The biggest is self hate.  When asked why I feel I am depressed, I would say that I have a deep innate sense of self hatred and don’t know why.  I feel this is my biggest problem.  After working the 12 steps of AA, I thought I had “fixed” this problem, but it quickly returned. I related to the dyphoria as it pertains to self mutilation, and enjoy the “pain relief” that comes with it.  I have also engaged in self destructive behaviors as it pertains to eating, sex, substance abuse and spending in the past, but on a more intentional self loathing basis rather than impulsively.  I have always been very conscience of my behavior and lack of self respect. I have had 2 suicide attempts in the past 2 years.  I also generally feel empty and bored.  I think it is important to mention that I am not presently engaging in self mutilation and have not for 6 months.  That has not been difficult to stop but abusing substances has.  I have been clean on and off with the longest period of sobriety being about 6 months. I also think it is important to mention that when it comes to Borderline I do not feel I have the following: dissociation, paranoia, rage, intolerance to change (I like it), splitting, or much anger.  I also do not have mood swings-I am generally depressed and go through periods of worsening depression in conjunction with substance abuse and/or disappointments, especially failed relationships.  I am extremely critical of myself and tend to go the opposite way with others.  I do not believe I fit the other disorders in your book such as OCD, ADD, Bipolar (I have no mania), etc. I don’t know if you can help me but when I read your book it gave me some hope, which for me is hard to come by.  I have never been on any medication for depression.  I have taken Valium in the past, but it is not a solution for someone like me.  I have recently put down drugs and alcohol and am willing do to so, as well as try medication in order to feel better.  I have only seen my therapist once, and she urged me to get in touch with you. Do you have any suggestions for me as far as medication?  The only side effect I would like to stay away from is weight gain. Thank you so much for any help and guidance you can provide. Dr. Heller’s Answer: 20% of individuals who have heart attacks have no chest pain. You don’t have to have every symptom to have a diagnosis.  Your anger is clearly self directed.  While I don’t know you, your description is very clearly that of the BPD – which is a seizure disorder in the trapped, cornered, wounded instinct part of your brain.  The BPD affects 6% of the population. You probably also have the “fractured enjoyment” – which is a genetic depression and the cognitive generalized anxiety disorder. From what you’ve written you appear to at least fit BPD DSM IV TR criteria 1, 4, 5, 6, and 8. When I treat someone like you I will usually start with BuSpar first, then add in Prozac a few weeks later, and likely Tegretol a week after that.  The sequencing of medications is as important as the medications themselves.  There are other ways to do it, but this is a safe approach that usually works wonders over a month. I hope this was of help and thank you for the kind words. Do You Have Any Suggestions For Me? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home Do You Have Any Suggestions For Me? MENU: Do You Have Any Suggestions For Me? Do You Have Any Suggestions For Me?Screening Test Do You Have Any Suggestions For Me?“Ask the Doctor” Do You Have Any Suggestions For Me?(BPD)Borderline Personality Disorder Do You Have Any Suggestions For Me?Annual Updates Do You Have Any Suggestions For Me?Biological Unhappiness Disorders & Official Criteria Do You Have Any Suggestions For Me?Dr. Heller’s C.V. & Picture Do You Have Any Suggestions For Me?How Dr. Heller Got Involved Do You Have Any Suggestions For Me?If You Want to See Dr. Heller as a Patient Do You Have Any Suggestions For Me?Testimonials Do You Have Any Suggestions For Me?Table of Contents for the Book ‘Biological Unhappiness’ Do You Have Any Suggestions For Me?How to Order Do You Have Any Suggestions For Me?“Life at the Border” Do You Have Any Suggestions For Me?Why Read ‘Biological Unhappiness’? Do You Have Any Suggestions For Me?Goals Do You Have Any Suggestions For Me?AD(H)D and Relationships Do You Have Any Suggestions For Me?BPD, Bipolar or ADHD? Do You Have Any Suggestions For Me?Suicide Do You Have Any Suggestions For Me?What if BuSpar makes me anxious or ill? Do You Have Any Suggestions For Me?A Suicide Attempt Per Minute in the US Do You Have Any Suggestions For Me?Grandparents raising Grandchildren Do You Have Any Suggestions For Me?Information About Children Do You Have Any Suggestions For Me?What Signs are there that Someone May ‘SNAP’? Do You Have Any Suggestions For Me?TV & Cartoon Characters with Depression & Other Disorders Do You Have Any Suggestions For Me?Dr. Heller’s Office Website Do You Have Any Suggestions For Me?Dr. Heller’s Lectures Do You Have Any Suggestions For Me?Mentally Healthy People Do You Have Any Suggestions For Me?Retraining the Brain Do You Have Any Suggestions For Me?Today is a Gift Do You Have Any Suggestions For Me?Reviews Do You Have Any Suggestions For Me?Links Do You Have Any Suggestions For Me?Webrings Do You Have Any Suggestions For Me?Site Index Do You Have Any Suggestions For Me?Home Do You Have Any Suggestions For Me? Do You Have Any Suggestions For Me?   Video DVDs now available!   Do You Have Any Suggestions For Me? You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. Do You Have Any Suggestions For Me? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. Do You Have Any Suggestions For Me?    Do You Have Any Suggestions For Me? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)

What Do You Think of DBT? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

WHAT DO YOU THINK OF DBT? What Do You Think of DBT? Ask The Doctor Dr. Leland Heller Biological Unhappiness What Do You Think of DBT? What Do You Think of DBT? WHAT DO YOU THINK OF DBT? What Do You Think of DBT? Question: I am a therapist working for Devereux of Florida. I have been intensively trained in Dialectical Behavioral Therapy, which was designed by Marsha Linehan to work with Borderline Personality Disorders. Have you had any experience with this type of counseling? If so, how do you rate it? My understanding is that the literature of the day speaks volumes to how great it works, but I did not see it mentioned on your website. Dr. Heller’s Answer: I have enormous respect for what Marsha Linehan has accomplished, and I admire her work and her efforts. Although the study was not truly blinded for the absence of psychotropic medications, with DBT she was the first to show significant quantifiable improvement from psychological counseling in treating borderlines, with a 50% reduction in parasuicidal behavior (self-mutilation and suicide attempts). Dialectical Behavioral Therapy (DBT) has shown effectiveness in substance abuse and other psychiatric disorders as well.  Based on a Zen model (Dr. Linehan’s description), DBT principles can be used by any therapist, although the landmark BPD study used multiple therapists working as a team.  I’ve had some patients go through DBT programs and rated it very highly, particularly the reframing skills they learned.  I’ve also have a few who believed it didn’t help them. There are many references to DBT on my website, primarily in the “Ask the Doctor” and “Medline research on the borderline personality disorder” sections. I believe all borderlines need counseling, although a significant percentage can’t afford it.  Most BPD patients have told me that counseling was of minimal or no benefit until their medications were right. Once successfully treated medically, most borderlines have a difficult time finding a good therapist.  They need a non-judgmental, knowledgeable, optimistic, compassionate, dedicated, strong human being who is willing to be truthful and unwilling to be manipulated – whatever their specific school of therapy.  The focus needs to be on now and the future, with minimal emphasis on the past.  I congratulate you on your training, and hope you’re one of those people.  There are many borderlines out there who desperately need good therapists. To the best of my knowledge there have been no head to head studies of one form of psychotherapy versus another for BPD treatment, with or without medications.  Most research that I’ve encountered advocates some form of cognitive/behavioral therapy.  I am not trained as a psychotherapist. Dr. Gunderson from Harvard advocates psychodynamic psychotherapy, but only by an extremely well trained therapist.  He believes this form of psychotherapy “has been a serious disservice” to BPD patients when the therapist isn’t adequately trained or experienced. Psychoanalysis doesn’t work and usually makes borderlines worse, particularly those who experienced childhood abuse.  Many patients have told me this, and there is evidence for this conclusion in the literature.  Rehashing the past usually makes borderlines worse. Since I’m a strong believer in the BPD medical model, my preference is to get the medically treatable symptoms treated first.  I then emphasize recognition and medical treatment of dysphoric episodes, so that raging and self-destructive behaviors can be prevented, reduced or controlled.  Dysphoric episodes cause most of the damage and need to be treated aggressively.  All it takes is one bad episode to destroy a marriage or a life. I’ve worked for over 15 years with therapist Mary Sales.  She focuses on helping borderlines recognize when they need their as needed medications for dysphoria, affirmations, relaxation techniques, and cognitive/behavioral approaches.  I saw significant similarities to Ms. Sales’ approach when reading Marsha Linehan’s descriptions of how she interacts with patients. I’m also a big believer in motivational and “success” techniques that are used in the business and personal growth arena, particularly Zig Ziglar’s work.  Learning how to be a success in every area of life is a critical process for recovery from the BPD.  Borderlines often need training in social and life skills, particularly those who have been abused and/or those with ADHD.  Borderlines have to heal mind, body and spirit.  They need to “retrain the brain.”  There’s an old saying: no executive on his death bed ever said “I wish I’d spent more time at the office.”  The BPD usually deprives them of healthy love relationships.  I believe that eventually being able to have those kind of love relationships is an important goal of treatment. I’ve communicated with therapists, patients, family members and clinicians about DBT.  This communication combined with the medical literature from Medline (National Library of Medicine) and the books I’ve read (such as “Borderline Personal Disorder” – edited by Mary Zanarini, PhD from Harvard) shows that DBT can be helpful for many people, sometimes extraordinarily helpful.  Your statement “the literature of the day speaks volumes to how great it works” overstates what the literature actually shows, however.  Most DBT studies are short term, and the landmark study only showed a 50% reduction in self-mutilation and suicide attempts. I got involved treating borderlines because psychiatrists wouldn’t treat my patients, and I was having success – particularly after reading the medical literature and the conversations I had with NIMH researcher (and former acting director) Dr. Rex Cowdry.  I see 4-6 new BPD patients per week and probably 5-8 follow ups per day as part of my regular practice.  I’ve treated thousands of individuals with the BPD.  With the correct medications, I expect all unprovoked mood swings, chronic anger, chronic irritability, and emptiness to be completely gone.  I don’t consider any self-mutilation episodes to be acceptable.  Mary Sales and I have learned a lot over the years, and I believe a combination of what we’ve learned with many aspects of DBT could be sensational. What Do You Think of DBT? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home What Do You Think of DBT? MENU: What Do You Think of DBT? What Do You Think of DBT?Screening Test What Do You Think of DBT?“Ask the Doctor” What Do You Think of DBT?(BPD)Borderline Personality Disorder What Do You Think of DBT?Annual Updates What Do You Think of DBT?Biological Unhappiness Disorders & Official Criteria What Do You Think of DBT?Dr. Heller’s C.V. & Picture What Do You Think of DBT?How Dr. Heller Got Involved What Do You Think of DBT?If You Want to See Dr. Heller as a Patient What Do You Think of DBT?Testimonials What Do You Think of DBT?Table of Contents for the Book ‘Biological Unhappiness’ What Do You Think of DBT?How to Order What Do You Think of DBT?“Life at the Border” What Do You Think of DBT?Why Read ‘Biological Unhappiness’? What Do You Think of DBT?Goals What Do You Think of DBT?AD(H)D and Relationships What Do You Think of DBT?BPD, Bipolar or ADHD? What Do You Think of DBT?Suicide What Do You Think of DBT?What if BuSpar makes me anxious or ill? What Do You Think of DBT?A Suicide Attempt Per Minute in the US What Do You Think of DBT?Grandparents raising Grandchildren What Do You Think of DBT?Information About Children What Do You Think of DBT?What Signs are there that Someone May ‘SNAP’? What Do You Think of DBT?TV & Cartoon Characters with Depression & Other Disorders What Do You Think of DBT?Dr. Heller’s Office Website What Do You Think of DBT?Dr. Heller’s Lectures What Do You Think of DBT?Mentally Healthy People What Do You Think of DBT?Retraining the Brain What Do You Think of DBT?Today is a Gift What Do You Think of DBT?Reviews What Do You Think of DBT?Links What Do You Think of DBT?Webrings What Do You Think of DBT?Site Index What Do You Think of DBT?Home What Do You Think of DBT? What Do You Think of DBT?   Video DVDs now available!   What Do You Think of DBT? You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. What Do You Think of DBT? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. What Do You Think of DBT?    What Do You Think of DBT? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)