QUESTION:
Dear Dr. Heller,
I'm a 29 year old white female and single mother of one, living in Winnipeg, Manitoba, Canada. For as long as I can remember, I have had so many of the symptoms you have described in the following disorders; ADD, Depression, OCPD, Panic, Anti-social personality, but above all, your description of Borderline Personality Disorder seems to be me and has been for the last 9 years (maybe earlier?). I can't take it anymore.
I don't know what to do or where to turn any longer. My family physician diagnosed me with Anxiety Disorder with an underlying diagnosis of depression (what ever that means?) about 2 ½ years ago. She prescribed 50mg daily dose of Zoloft and initially it seemed to work, for about the first four to six months or so. However, in the past year my symptoms have appeared to have gotten worse or intensified. I have seen my doctor about every two months since about May of last year, with the complaint that things aren't going well. At that time she increased the dose of Zoloft to 100mg a day. I don't believe it's helping.
I have completely lost myself...again! I don't know if I'm coming or going with anything that I do anymore. I am second guessing myself constantly; nothing seems to make my happy. I changed jobs about three months ago thinking that may have been the problem. I'm constantly wondering if the relationship I'm in is part of the problem. I cry so easily because everything that is said or done to me, I react to like it's the end of the world or something. I never seem to be able to finish things I start at work, at home, etc. I lack the motivation that all most everyone I know has, when it comes to work, house cleaning, getting up in the morning - most everything. My sleeping patterns are all screwed up. Most times I feel so tired and fatigued, when the weekend comes I don't do anything and I don't go anywhere - I just lay on the couch. What kind of mother is that for an active 5 year old boy!
I can't seem to control my anger. The outbursts I have are now affecting my son. He has seen and heard mommy completely loose it but I can't seem to stop it from happening. When it does happen, I go into my bedroom or the bathroom, close the door behind me, sit down, put my hands through my hair and pull at the roots while rocking back and forth, whispering the words, "Please stop. Please make it go away." It scares me. I scare me.
I know that what I've been going through for the last year has profoundly affected my innocent and loving 5 year old son. I ask myself over and over again "How can I do this to him?". Why can't I control myself, if not for me, but for him? I try so hard.
I have now gained 49 pounds in the last year with losing some in the middle, only to gain it back again and then some. I can't stop myself from eating, it's compulsive. Sometimes I starve myself for 2-3 days and then binge, like I've never seen food before! I'll even hide food and then eat it secretly because I don't want anyone to see me eat or the amount of what I'm eating. I don't know what to do anymore.
I sit here in tears as I type this email. I am in desperate need of help. I don't think my doctor realizes how bad things have gotten even with the attempts I've made in telling her. I feel as though my life is never going to be happy or fulfilled and that no one will ever want me like this. I can't blame them.
I can count on one hand how many "good days" I've had in the last 3 months alone - on one hand. I'm lost and confused and don't know who I am anymore and haven't for a long time, or what will make me happy. I feel as though nothing I do is good enough for me or for anyone that I'm close to or even associate with. I don't feel normal and for that matter, I don't think I even know what or how normal is supposed to feel anymore; it's been so long. I know something is wrong with me.
Please help.
ANSWER:
You're really not difficult to treat. I doubt that you have the antisocial
disorder based on what you wrote, although you likely behave in an antisocial manner
during BPD dysphoria (anxiety, rage, depression and despair). The combination of obsessive
compulsive disorders with ADHD is a very difficult and stressful one because you are a
"disorganized perfectionist." The OCPD actually increases your chances for a
happy and successful life.
I did a small
study
that showed Prozac was superior to Zoloft.
People with obsessive compulsive disorders, ADHD and the BPD respond very well to high
doses of Prozac and stimulants (I prefer Ritalin). The addition of Tegretol may be needed
for a while. The use of as needed medications is crucial for successful BPD treatment.
