QUESTION:
Dear Dr. Heller,
I realize you receive a lot of mail and are limited on time, but I am not able to see a doctor at this time and would greatly appreciate any help or advice you could give me. I am female and 30 years old. My life has been anything but normal for as long as I can remember. It is my understanding that a person can be both Bipolar and Borderline at the same time, and this could very well be my case - but I am not certain.
My question however is this: What, if any, illness would cause my personality to fragment, as I like to describe it. It's like I have been, and continue to be, so many different people throughout my life, never knowing which one is the true me, or if they are all just shattered fragments of the real me. However, I do not, and never have to my knowledge, experienced any amnesia or blacking out between personality changes. I just change for different reasons depending on the situation or stimuli, beyond the point of just being flexible, but to the point that I become basically an entirely different character with different thoughts, morals, and coping skills.
It is much more complicated than this though, and adding the other possibilities like Bipolar and Borderline - well I think you can see why my life has been anything but peaceful, which is why I am writing you now. If you could offer me any advice on this matter I would be so very grateful. I pray that you will see this letter and find it in your heart to respond.
ANSWER:
What you're describing is commonly referred to as multiple personalities, now
called "DID" - dissociative identity disorder.
I've seen many individuals with DID - and they all had the BPD as well, and there is
no reason bipolar can't be present as well.
What I've found helpful is to aggressively treat the BPD and other medically
treatable mental health diagnoses, with a few additions for DID patients: 1) keep a
therapeutic Tegretol blood level, 2) keep the person safe (having a large dog for company,
using a motion sensor to alarm the patient if someone is in the room, etc.), and recently
the addition of Remeron (mirtazapine) - which has been of incredible help to some DID
patients. You absolutely need aggressive psychological counseling with a therapist who has
experience with DID.