QUESTION:
Dear Dr. Heller,
Hi. I'm 22, female and live in the UK. I think I fit the following
criteria for the BPD. However I cut only when depressed or hopeless, not usually
when angry, I have feelings of emptiness only when I feel depressed, drink when depressed
or angry and spend only when feeling relatively ok or when I was hyperactive when on
Paroxetine. My mood is unstable every now and again. Depression seems to last
weeks or months but anxiety only a short while. Irritability is not as often as the
others. Does this still mean I fit the criteria?
4) Impulsivity in at least two areas that are potentially self-damaging (e.g.
spending, sex, substance abuse, reckless driving, binge eating)
5) Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior
6) Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than
a few days)
7) Chronic feelings of emptiness
8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights)
I however am only occasionally angry but very intensely so. My doctors will not tell
me my diagnosis but I think it will be BPD which my friends agree with. My Drs think
therapy is the way to go and no medication. My therapist thinks I suffer from
PTSD. I have strong suicidal feelings and feelings of hopelessness yet my Drs say
there is nothing they can do.
I see a GP and a psychiatrist who I have seen twice and has told me to find an alternative career (I'm studying to be a doctor), make friends and live life to make me feel better. He does not seem to care how bad I feel nor that I get very little sleep and am frequently suicidal. He says I am taciturn and should talk to him but then says he does not see his role as helping me as such, merely overviewing my therapist and GP.
My psychiatrist said he dose not care if I cut myself, as long as I do not overdose. I am at my wits end because I just want everyone to be honest with me but they avoid my questions about diagnosis and refuse to let me read my notes. I am writing this in an attempt to ask your advice on how to handle this.
ANSWER:
It's extremely common to have both. Sometimes a medication trial can give a strong indication whether the BPD is present. If Prozac (fluoxetine) for a week followed by carbamazepine (Tegretol and others) makes you profoundly better, you likely have the BPD. Remeron (mirtazapine) can be very helpful for PTSD, particularly in combination with the Prozac - especially if the Prozac seems to be making you worse.