Question:
Dr. Heller:
Based on what I know from reading DSM-IV, and
attempting to evaluate my personal history (age 53),
I have an atypical case of BPD with mild paranoia
and moderate schizoid. I lost my health
insurance when I was fired (again), in October
'07. So, no health insurance. Also,
nothing available here in the Dallas, TX area
but psychiatrists at $200+/hour. Basically
unaffordable for me.
Here are the questions:
BPD appears exceptionally variable across its
symptoms ranges. I have none of the OCD
or addictive behaviors. Never did.
No smoking, no dope, no alcohol, no attempted
suicide, etc. Everything else in spades.
Your FAQ's and Archives discuss BuSpar and other
drugs. All of which have a high probability
of serious side effects. As bad, if not
worse than the underlying BPD.
You also cite Zig Ziglar - someone I listened to,
including in person, for more than 20 years.
To the best of my recollection, none had any
positive effect on me lasting more than a few to
several weeks. The question is...Now what?
Despite anecdotal reports (sorry, no offense
intended), even the scientific literature is
thin on the long-term success of any regime of
treatments for BPD in the limited number of
peer-reviewed clinical trials - including DBT
and other psychotherapies. I am not feeling
hopeful in the face of serious drug effects,
lack of treatment avenues and research, and my age.
Dr. Heller's Answer:
The medications work phenomenally well.
I have BPD patients I've been treating for over 15
years with the same medications who continue to do
well. The fluoxetine / carbamazepine combination
is amazing for the BPD.
The only medications I know of that help with the
schizoid personality disorder (assuming you do
indeed have that) are antipsychotic medications.
Individuals with the schizoid personality disorder
are generally considered to be on a spectrum with
schizophrenia. They act a great deal like the
Mr. Spock character in the original Star Trek series.
If you really mean schizotypal, there was an article
nearly 20 years ago that showed high doses of
fluoxetine dramatically improved those with comorbid
BPD and schizotypal.
Your information regarding the "high probability of
serious side effects" for BuSpar (buspirone),
Prozac (fluoxetine) and the other medications used
for treating the BPD is completely erroneous. I
don't know where you get your information, but you
might want to consider more accurate sources of
information.
Neither counseling (including DBT) nor listening to
Zig is likely to have any dramatic long term effects
until the medications are right. The successes
of DBT are not anywhere near as dramatic as the
medications, and in the initial DBT / BPD study a
high percentage of those individuals were taking
medications. I greatly admire what Marcia
Linehan was able to accomplish, but I don't believe
DBT's results are comparable to those achieved with
the right medication combinations. Once the
medications are right, I've found consistently that
the borderlines that listen to Zig the most do the best.
As always, making all the diagnoses and treating
them comprehensively (including as needed medications)
are crucial for successful BPD treatment.
Age has nothing to do with it. I frequently begin
BPD treatment with individuals in their 50's, 60's and 70's.
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