Question:
Dr. Heller,
We have been treating our
daughter 18 years old for the last 3 months as she had
tried to harm herself, she was hearing voices
and had panic and anxiety attacks that we had to
withdraw her from college in Indiana and bring
her back to Florida.
She underwent MRI and other tests for Thyroid.
She's currently under Bipolar medication:
Zyprexa and lithium and also on Effexor.
She has no more hallucinations of voices.
She still displays the following tendencies that
have been described in your articles for BPD:
inappropriate mood swings, chronic anger,
emptiness, boredom, emotional pain, and rejection
sensitivity. She is also manipulative
and creates crisis when things don't go her way.
It has become difficult to sustain her everyday
while we parents have to go to work.
Our current Psychiatrist is suggesting
"Menninger's" clinic as a possible
solution. Is that an option we should
consider for diagnosis and treatment?
We are a little confused and I read your
article and I am wondering if your method is a
possibility for identifying what she has a
borderline personality. Border line starts
with molestation? The Dr. ruled it out
after a number of visits.
Dr. Heller's Answer:
The BPD (borderline disorder) is a
definite possibility. Self harm is
usually correlated with the
BPD. Hallucinations are rarely a
part of BPD dysphoria, and could mean an additional
diagnosis such as schizophrenia or
bipolar mania if the BPD is present.
While molestation can cause the BPD, lack of
it doesn't mean an individual has the BPD nor
does molestation mean the individual has the BPD.
It's a high risk traumatic event, not
something that proves or disproves the diagnosis.
BPD criteria are very specific:
http://www.BiologicalUnhappiness.com/DSM.htm
and need to be
present since puberty. If she was fine
and didn't fit BPD criteria until 3 months ago,
the BPD would not be the diagnosis. Bipolar,
schizophrenia or schizoaffective disorder is much more
likely. The key here regarding the BPD
diagnosis is persistence of symptoms for years, even if
it's gotten worse lately.
If the BPD is indeed present, fluoxetine is
usually much more effective than Effexor, and at the
right dose will stop the unprovoked mood swings,
chronic anger and irritability, emptiness and
boredom. It will also dramatically lower
the rejection sensitivity and chronic unhappiness.
The Menninger Clinic has an excellent reputation,
however I am not familiar with their
approach to diagnosing and treating the BPD.
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