Q. My 17-year old daughter is diagnosed with evolving BPD. We are Indians and this girl has lot of interest in Indian Movies, food, dresses etc. She was born here. Doctors thought she might be confused. She was a very sweet girl, not any more manipulative than other teenagers. In 1995, when she was traveling alone, she was kissed on mouth by a stranger. She has changed ever since. She is diagnosed with major depression, bipolar disorder, and now BPD. She is not suicidal any more. She started cutting herself after she started on Paxil, never before. With intense therapy and lot of anger from us she stopped doing that. She always did her homework and got good grades. Since this therapy, she will not take any directions from us. If we suggest homework, she stopped doing homework. If we ask her to get up on time, she will not. We are afraid to ask anything now. She did not have all these problems 4 months ago. She was on Paxil and Risperdal for a while, Effexor, Risperdal for a month, and only Seroquel for 3 weeks now. Now she is started in lithium. She is a completely changed person. Can BPD develop suddenly? This depression attack started when I got a job in a different state and she was supposed to stay with her dad during week days, and I coming home every Friday. I am desperate. I am not working now and my whole day revolves around her. This Honors student is now in special ed.
A. Barring a head injury or brain infection, I've never encountered anyone who abruptly developed the BPD at age 17. It begins at puberty.
If this happened abruptly with no apparent trigger, she needs a good medical workup including an EEG, MRI of the head, and labs including a thyroid profile. Schizophrenia needs to be included as a possibility.
The most common cause for a story like yours is a mild case of the BPD that worsened severely over some stress - your husband leaving is a possibility. Some sort of emotional trauma may have occurred, such as sexual abuse, that you may not be aware of.
The only times I've seen worsening BPD dysphoria with an SSRI medication like Paxil is when the cognitive generalized anxiety disorder was also present - all the serotonin levels are increased, including the S2 receptor. The increased anxiety can worsen the BPD, resulting in severe dysphoria and self-mutilation. The problem is not the Paxil, however, but additional diagnoses.