- What Can I Do For My BPD And PTSD Wife?
QUESTION:
Dear Dr. Heller,
Years before I met and married her, my wife had been the victim of a very violent and invasive attack. She healed physically but has recently begun seeing mental health professionals about PTSD and panic attacks. She also has been dealing with what she believes is fibromyalgia.
We work in a family owned business and the PTSD began after she was propositioned by an employee who when she reported the incident claimed he was only joking and she misunderstood him. Instead of apologizing and going about business he began a low profile war of rumor mongering about her and she became obsessed with the idea that instead of just being an obnoxious redneck, he was a potential Ted Bundy.
Her propensity to blow things out of proportion contributed to the family not taking her seriously. She sees things as all or nothing. Anyone who might even talk to the guy became an enemy. Anyone who did not see things the same way she did was a betrayer. Her constant anger and occasional outbursts had all of the employees walking on eggshells around her. She sees herself as a total victim. It is almost as if she does not remember these periods of rage or the hurtful things she says to people. The normal stresses which everyone goes through tend to overwhelm her and when that happens all of the old fears and hurts rise to the surface. When this happens, usually several times a week, she threatens divorce or worse. These episodes can last for minutes or hours.
The offensive employee was eventually terminated after it came out he had an affair lasting almost two years with a direct subordinate who broke it off after another teenage employee confided that the guy had been trying to coerce her into sex. There is a lot more to it but eventually the family asked her to resign. This was the ultimate rejection. She has been worse since then. She has no family locally and I want to help her but because I did not force the issue with my parents by threatening lawsuits I too am a betrayer.
She refuses to even consider the notion that she may have something other than PTSD or post concussion syndrome. I believe she may have BPD and perhaps other things as well but she is so anti-drug that the only thing she takes other than supplements is Xanax. I love her very much and want her to get well even if it costs me the marriage. She wants to get better, but on her terms, and anyone who disagrees with her she becomes unwilling to even talk to once they have become the enemy. Her mental health providers will not talk to me without her present, and if I bring up something like the possibility of BPD during a session I will be trying to turn her doctors and counselor against her. I want to get her help but I do not think that the people she is seeing have any idea that she may have other things to deal with. I want to help my wife. What can I do? I am at my wits end.
ANSWER:
It appears the BPD and PTSD may indeed be present. What I do in these situations is treat all the underlying diagnoses (http://pks.947.myftpupload.com/screen.htm), and add Remeron. Remeron works remarkably well for PTSD, particularly when combined with BPD treatment if the BPD is present. Almost all my fibromyalgia patients also have the generalized anxiety disorder, especially the cognitive component. SSRI medications worsen the GAD and in some patients can worsen the PTSD as well. This is due to an imbalance. In my experience these patients usually require an SSRI like Prozac along with BuSpar and Remeron. I encourage you to review the FAQ section and the entire BPD section.
