QUESTION:

Dear Dr. Heller,

My friend has every sign you listed, except abandonment issues. One that I'm not sure about is binge spending, but not on himself, on family, friends, strangers. But he is 41. Also, he got violent when someone he had given HUGE amounts of money and help to, tried to take his car by saying he stole it. (long story).

He suffered childhood abuse, a sibling committed suicide. Maybe something of an abandonment issue - he's in prison and seems more interested in what he did to his dogs, although feels horrible and suicidal over people he hurt too, but mainly the dogs. Can someone "get" BPD at age 40? He showed all other signs before - Doesn’t "cut" himself but hurts himself other ways - alcohol mainly (not an alcoholic - didn’t have DT’s when he stopped drinking) Where can I find a doctor like you in CT?

ANSWER:

Unless a head injury triggered it, one doesn’t "get" the BPD at age 40. By definition, it’s a "pervasive pattern...beginning in early adulthood."

It can significantly worsen due to stress as an individual ages. Self-mutilating young women have had the most attention and research, but the BPD affects multiple individuals in many different areas.

Incidentally, not getting the DT’s doesn’t mean an individual isn’t an alcoholic.

Dr. McGlashan at Yale was a pioneer in BPD treatment, and believes in the biological underpinnings. I don’t know whether he is still working with borderlines or not.