QUESTION:
Dear Dr. Heller,
In this case it is attributed to Borderline Personality (Traits). Luvox in the A.M. and clonazepam 1mg twice a day. In addition, my daughter has entered a DBT: Dialectic Behavior Training program. Have you any experience with DBT?
ANSWER:
I've seen some BPD patients who have been through DBT. Some were helped, some
weren't. It's a very intensive psychotherapy approach that I believe would be
phenomenally effective when combined with the medication approach I've found
effective and has been documented in the
literature.
Dysphoria (anxiety, rage, depression and despair) is a horribly painful experience.
Borderlines do what works to stop it, whether by cutting, eating boxes of donuts, driving
fast, using drugs, etc. In fact we all self mutilate when the neurological sensation is
unbearable - such as with mosquito bites or fire.
DBT emphasizes a cognitive approach to not cut. I believe in using as needed medications
for these dysphoria spells. Haldol 2mg / Tegretol 200mg / Risperdal 3mg as needed for
dysphoria (anxiety, rage, depression and despair).
http://www.BiologicalUnhappiness.com/20a.htm
and
http://www.BiologicalUnhappiness.com/dysphori.htm
are what
I give my patients. If the patient is stable and doesn't need Tegretol (or more
Tegretol), low doses of Haldol usually stop the dysphoric spell in 5-10 minutes. The
therapist I work with spends a considerable amount of time helping BPD patients to
recognize when the mood is dropping in order to take their as needed medications
effectively.
Patient who learn to effectively treat their dysphoria with medications do extremely well.
Counseling is always needed for those with the BPD.
