Should I Insist On The BPD Diagnosis?

QUESTION:

Dear Dr. Heller,

I have read every inch of information on BPD that you have on this site.  I was almost in tears through most it.  Two years ago I was diagnosed with BPD during a six month stay in a psychiatric hospital.  When I was discharged and went back to my home psychiatrist and therapist I was told that was not what I had.  I couldn't understand why they disagreed with the diagnosis because everything I read fit me exactly.  Now I am with a new psychiatrist and therapist and my diagnosis is major depression, GAD and eating disorder.  I take Effexor, Carbatrol, Seroquel and Klonopin (pretty much what you recommend for BPD).  My question is, how important is it to have the correct diagnosis?  I still believe my diagnosis should be BPD.  I am doing so much better on these medications, and with the new therapist.  I have made numerous copies from this site to give to her.  Should I insist they look into BPD as my diagnosis?

ANSWER:

Based on all the medical information that has come out on the BPD, I'm convinced more than ever that the BPD is a medical problem.  Accuracy of any and every diagnosis is crucial.  The stigma about mental health diagnoses has to change, as has happened for cancer.  The BPD is a medical problem that borderlines did not bring on themselves, they are victims of the disorder (as are their loved ones).  There is sufficient medical information about BPD treatment and brain abnormalities to justify the BPD being considered a medical problem for which patients deserve treatment.

I'm glad you're doing better on your medications.  While some patients do remarkably well on high doses of Effexor, I generally stay away from it due to side effects and greater effectiveness of the Prozac/Tegretol combination.  Carbatrol is a long acting Tegretol that approximately half of my BPD patients prefer to generic Tegretol.  BuSpar is great for the GAD (generalized anxiety disorder).

I also believe strongly in the importance of as needed medications for dysphoria (anxiety, rage, depression and despair).  Here is the sheet I give my patients.