QUESTION:
Dear Dr. Heller,
I HAVE BEEN SEEING MY PSYCHIATRIST FOR 3 MONTHS NOW. YESTERDAY I ASKED HIM WHAT HE HAS DIAGNOSED ME AS. HE STATED ADD (W/O HYPER.), MOOD DISORDER (COULD NOT DETERMINE MAJOR DEPRESSIVE OR BIPOLAR YET), GAD, AND PTSD WITH BPD CHARACTERISTICS. I, OF COURSE, TOLD HIM THAT I DIDN'T AGREE WITH PTSD, I WOULD HAVE THOUGHT IT WOULD HAVE BEEN JUST BPD. MY QUESTION IS: HOW CAN SOMEONE HAVE PTSD WITH BPD CHARACTERISTICS WITHOUT HAVING BPD? WHAT DOES THIS MEAN?
SINCERELY,
HOPELESSLY NEEDING AN ANSWER
ANSWER:
The criteria for both diagnoses are specific. To me the BPD is a medical problem, that
clearly responds to effective medications. I try not to use the phrase "BPD
characteristics."
A study in the 1980's stated that every Vietnam Vet they studied who had PTSD also had the
BPD before they went into combat. Occasionally I'll see a patient with primary PTSD
instead of the BPD. Since the BPD begins with early adulthood - and usually with the onset
of puberty - a pure PTSD case would have to develop after this time. An example would be a
woman raped at age 30, who then has PTSD subsequently.
There is no reason you couldn't have multiple diagnoses including ADD, GAD, PTSD, BPD
and even bipolar. They would all need to be treated.
