Can You Help Me, I'm 15 And Doing Poorly?

QUESTION:

Dear Dr. Heller,

I am a 15 year old female who has signs of several personality disorders mentioned on your site.  I am in tenth grade and take mostly all honors/High Performance classes.  I am extremely intelligent, but I just cant focus.  It has always been hard, but the demands of high school make me feel so helpless that I don't even attempt to complete work.  Most severely I have signs of Attention Deficit Disorder and Fractured Enjoyment.  I also have symptoms of Bipolar Disorder and Obsessive Compulsive Personality Disorder.  I have a history of "depression" (that was never further diagnosed as anything) and a few suicide attempts (never severe enough to require hospitalization).  I used to be a cutter.

There have been 2 deaths in my immediate family in the last 2 years (one of which was the suicide of a sibling with ADD).  I use drugs on almost a daily basis.  I never feel truly happy or truly sad anymore.  I didn't cry when my father died.  About a year ago I informed my mother that I thought I may have a problem like ADD and she told me that I just want attention.  I don't know where to turn.  I don't know what to do.  Once I took my friend's daily doses of Ritalin because it made me feel normal.  I didn't take other drugs or drink then.  I'm frantic for some sort of change.  Please give me some sort of recommendation of what to do here.  I know this is not supposed to be long, I'm sorry, but there's no short way to put it.

Thank you so much for your time.

ANSWER:

You need medications.  I see people with your combination of diagnoses all the time - and one of my employees has all of them as well, and is doing very well.  The key is to prioritize diagnoses first.  Usually I'll treat the BPD and bipolar first - combining Prozac with an antipsychotic medication like Seroquel for a week.  I then substitute Tegretol for the Seroquel.  Once the Tegretol is therapeutic, Ritalin can be used, carefully watching for signs of mania.  Many practitioners don't like to treat ADD in patients with bipolar. 

I don't have a solution for you and your social situation.  Hopefully this note combined with other information on the website or my books can be of help to you and your parents.