QUESTION:

Dear Dr. Heller,

What problems/drawbacks will I have if my Psychiatrist won't treat my ADD as well as my BPD?

ANSWER:

Borderlines can only rely on their good feelings and memories - their bad memories and bad feelings are unreliable. They may be correct, they may be incorrect. They just can’t be counted on. This is especially a problem for women, who trust their emotions more than their intellect. Humans are more moved by emotion than logic, so it places an individual with the BPD at a significant disadvantage.

Those with ADD can’t rely on their thinking. Their neurology is like going to a department store with lots of video monitors - and the monitors keep changing. Their attention keeps changing, and the ability to think before acting is markedly impaired. They also tend to be incredibly creative and with rare exception extremely bright. The combination is brutal for the following reasons:

1) An individual who can’t rely on emotions or the ability to think before acting is at an enormous disadvantage in dealing with our complex society.

2) The individual will have tremendous impulsivity problems - both in dealing with normal stressors, and when upset or threatened.

3) Learning to think positively and in a happy way requires cognitive retraining, which will be markedly impaired by the inability to stay focused and on task.

4) Acting impulsively can cause stressful or self-hate inducing situations, which leads to dysphoria and further self-destructive behaviors.

5) The ability to think clearly despite feeling awful is the key for those with the BPD once the medications are correct.