QUESTION:
Dear Dr. Heller,
I was diagnosed with BPD about two years ago (I'm 44). The only other things that are abnormal are: TSH 10.0, abnormal EEG for left temporal lobe, acid reflux (had major surgery for it last Oct. but still have it bad), PTSD and Major Depression. I have been hospitalized about 8 or 9 times in the last two years (ODs, etc.). This is the first time I have ever read that it might be a "medical" problem. They told me it was from child abuse. I only get intense rage from rejection or perceived rejection (not flat tires, etc.) My question- who has the "medical BPD" and who has the "psychological BPD". Which one do I have?
P.S. (Prozac did not work for me, nor any of the SSRI's. I am on Wellbutrin and my Doctor may put me on Prozac, as Wellbutrin will give that a boost).
ANSWER:
The BPD is a medical problem, a form of epilepsy (nerve cells firing inappropriately
and out of control). This epilepsy is in the limbic system, in the brain's
"trapped, cornered animal" response. There are alterations in the size of some
limbic system structures, and tremendous biological factors. The abnormal EEG is an
example. There is no "psychological BPD," although the BPD causes tremendous
psychological problems - as can the abuse.
Day to day symptoms include unprovoked mood swings, chronic anger, emptiness, boredom, and
feeling like one's best friend died. These are the symptoms that resolve with Prozac.
Under stress, borderlines experience dysphoria (anxiety, rage, depression and despair) -
which responds to Haldol 2mg / Tegretol 200mg / Risperdal 3mg as needed.
Prozac "not working" means one of three things:
a) You needed the epilepsy medication Tegretol with the Prozac.
b) You have the cognitive generalized anxiety disorder (GAD - mind
constantly going, persistent worry) - which is worsened by Prozac and requires the
combination of Prozac and BuSpar. Once the BuSpar has controlled the worry, Prozac can be
taken without it increasing anxiety and dysphoria (anxiety, rage, depression and despair).
In addition to low serotonins, BuSpar lowers the elevated serotonin 1 receptor that causes
the GAD.
c) Your PTSD may have been aggravated by Prozac for the same reason as
in "b" above. The addition of Remeron can prevent this and stop the PTSD
symptoms.
Your thyroid may be low as well, contributing to your problems.