Q. Dear Dr. Heller,
I am under psychiatric care for chronic depression. I have not been diagnosed as a borderline, because, under normal conditions, I function pretty well and have only a few borderline traits, not enough to qualify as full-blown borderline. Like many borderlines and near-borderlines (those with some traits, I mean) I grew up with sexual, physical and emotional abuse.
My question is this: can a person who has some traits of a borderline temporarily become a full-blown borderline if placed under enough stress?
The reason I'm asking this is I had an annual exam recently in which I believe the doctor touched me in a inappropriately sexual way. This doctor is currently under criminal investigation as I reported his actions to the hospital commander (Army hospital). This event would have been stressful for any person, but it was especially stressful for me as it seemed to trigger memories and feelings from prior abuse.
So, ever since this happened, about seven weeks ago, I have not been functioning very well. I find that I am splitting (which I normally don't do - I am usually able to see gray as well as the black and white) and have intense fits of rage where I daydream about this doctor getting gang-raped by homosexuals. I find myself reacting irrationally to anything or anyone that is associated with the Army hospital here. I have moments of paranoia where I wonder if the hospital commander is secretly angry with me for bringing this issue up (although that doesn't make sense because HE initiated the criminal investigation, not me - I wasn't going to press charges, just wanted an answer about whether or not my perceptions of abuse were correct, based on my description of the touching involved.) and I worry about some sort of retaliation being done to my husband or me. I know this isn't realistic, but I'm not able to talk myself out of the paranoia when it strikes. I just lost my shrink - I'd been going to him for two years (we move to another post every three years, in the Army) and he's referring me to a civilian psychiatrist because he feels I am not able to trust him since he is associated with the hospital. And where did he get that idea? Well, for the first time ever, he forgot to put a prescription for my meds into the computer. When I went to the pharmacy to pick up the meds, there were none. And my shrink was gone that week. I fretted about it and worried about it and finally left a message on his answering machine asking him if he had done that on purpose as a form of punishment for having reported one of the doctors he is friendly with (small hospital, they all know each other well). Of course, I was being paranoid - he simply made a mistake, that's all. But I've lost him, and I cried a few times over the course of several days, found that I actually missed him and felt abandoned. I called up one of his staff and asked to pass a message along that my shrink should remember that I'm not a bad person, should think of what I was like for the two years before this happened and not judge me too harshly for having "lost it" recently. To sum it all up, I'm acting and feeling like a full-blown borderline.
Do you think it's possible for a person to go from "near borderline" to full-blown borderline if that person is put under enough stress, and then revert back to a higher level of functioning once the situation is resolved and some healing takes place?
Q. The answer to your question involves a change in the question. Can a person have a very mild case of the BPD which worsens dramatically under stress. The answer is clearly yes. The requirement is 5 criteria. Sometimes other conditions - such as the OCPD - can keep some of the symptoms from appearing present. Generally the individual perceives that some criteria are not present because they're not "severe enough." Severity isn't necessary for the diagnosis, just the presence of them.
I consider the inappropriate moodiness, anger problems, emptiness and stress problems to be the main physical sensations. The other symptoms are basically consequences of the disorder.
The abuse you mentioned is an enormous risk factor for the BPD.
I obviously don't know you and can't make the diagnosis, but hopefully the above perspective can help. Don't be afraid of the diagnosis. You didn't cause it and it's in no way your fault. Getting effective treatment is crucial.
What you're describing frequently happens when an individual is chronically dysphoric. I often refer to it as the cornered animal response. The individual lashes out, becomes very paranoid, and unfortunately very difficult to deal with. Most likely the other doctors are afraid of you and what you'll do, particularly if the first doctor is denying it and telling everyone else to watch out because you may do the same to them.
Fairness is not the issue. Getting you back on track is.
Borderlines in this situation almost always need tegretol. If prozac is on board, it will work dramatically in around 3 hours. If not, a week of Prozac first is necessary. Risperdal may be needed for a while to stop the brain chemicals that appear to be out of control.