Dr. Leland Heller Discusses BPD

(cont.)

The Facts

...Genetic factors are important - borderline tends to run in families. The risk of developing borderline is 6 times higher when a close relative has the disorder. In studies of identical twins, researchers have discovered that many personality traits are genetically determined. There is an association between some personality characteristics and blood type (called 'blood group antigens').

Borderlines commonly suffer from other disorders as well. PMS, depression, hypothyroidism, vitamin B 12 deficiency, other personality disorders, anxiety, eating disorders, and substance abuse problems are the most common. Intelligence is not affected by the disorder, but the ability to organize and structure time can be severely impaired. There is no association with Schizophrenia.

...While many borderlines suffered from abuse or neglect in childhood, some developed the disorder from head injuries, epilepsy, or brain infections. Early parental loss and incest are commonly associated with borderline.

The facts indicating a medical origin are impressive: Brain wave studies are frequently abnormal. Neurological physical examinations are abnormal. Sound interpretation is impaired. Memory and vision are impaired. Glandular function may be abnormal. Sleep is abnormal. The response to some medications is bizarre. When injected intravenously, the medication procaine normally causes drowsiness, but a borderline will feel the 'dysphoria' described in the first paragraph. If borderline was exclusively an emotional illness, why would all these medical neurological abnormalities be present?

Borderlines likely have abnormalities with the neurotransmitter 'serotonin' - an incredibly important brain chemical. Serotonin problems can cause anxiety, depression, mood disorders, improper pain perception, aggressiveness, alcoholism, eating disorders and impulsivity. Excess serotonin can depress behavior.

Serotonin deficiencies can cause many problems, especially suicidal behavior. Low levels of serotonin increase the risk of self-destructive or impulsive actions during a crisis. The most violent suicides (hanging, drowning, etc.) are usually committed in patients with low serotonin metabolite (waste product) levels in the spinal fluid. In those who attempted suicide unsuccessfully, 2% will likely be dead within one year. If the serotonin metabolite level is low, that risk increases to 20%.

Treatment

Due to new developments in medicine, borderlines can now be treated and often cured. The medication fluoxetine (Prozac) usually stops most of the mood swings in a few days. It is, in my opinion, as big a breakthrough for borderlines as insulin was for diabetics. Borderlines generally see themselves very profanely. I frequently tell my borderline patients 'you're not an *#%@*, your brain is broken.' Once this concept is understood, the borderline patient usually feels an enormous sense of relief. They need to know they have value as a human being. Feelings of desperation and hopelessness are often replaced by optimism and motivation once Prozac stops the mood swings and the patient begins to realize that a happier, more successful life is possible.

All borderlines need psychological counseling. It's almost impossible to live for years as a borderline and not need psychological help. While the underlying problems are probably structural within the brain, the borderline is left with a lifetime of bad experiences and inadequate skills for recovery.

No medication should be given without proper medical supervision. This is particularly true for the drugs used to treat the borderline disorder. Some medicines make the symptoms of borderline worse, especially amitryptilline (Elavil) and alprazolam (Xanax). Possibly a third of borderlines may suffer from low thyroid (hypothyroidism) - despite a normal 'TSH' blood test. They may need to take thyroid medication.

The antidepressant fluoxetine (Prozac), a serotonin increaser, virtually eliminates the mood swings. Feelings of anger, emptiness and boredom are often eliminated or reduced as well. Most borderlines I've treated consider Prozac to be a miracle. While some need the medication indefinitely, many have been able to stop it after a year without the mood swings returning. Side effects are rarely a significant problem.

Neuroleptics...have been proven effective. They are remarkably helpful for treating dysphoria and psychosis, and can be preventive when the borderline is undergoing stress. They seem to 'put on the brakes' when the thoughts are racing. They should only be used as needed, like using an antacid for heartburn. These medications can be effective at low doses, and must be taken with great caution.

While medications can help with some symptoms, the brain is clearly broken. After a stroke, the brain needs therapy to let the healthy areas take over for the broken ones. The same is true for recovering borderlines. I feel strongly that the brain must be retrained. Affirmations...will work, as the human brain can believe almost anything if told it enough times...

The psychology of positive thinking is very helpful. I strongly recommend massive brain re-education. Devote as much time as possible for 3-6 months reading positive self-help books and listening to motivational tapes - especially those by the motivational speaker Zig Ziglar...

Sometimes symptoms of 'temporal lobe' involvement (similar to epilepsy) complicate the disorder. Common symptoms include unawareness spells, feeling like things are unreal, and numbness of body parts. These symptoms are more common under stress, depression, severer dysphoria, and incest crisis. They can be treated with the epilepsy medication carbamazepine (Tegretol)...

Borderlines are VICTIMS - they did not cause their illness. They do not want their illness. They want to be treated and possibly cured. They deserve that opportunity.

The National Institute of Mental Health (NIMH) has been the single most influential source of unbiased study and information regarding the true biology behind the borderline personality disorder.

Landmark studies, such as those produced by Drs. Cowdry and Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and neuroleptics, and the dangers of Xanax (alprazolam). This article was published in the Archives of General Psychiatry Feb 1988. A subsequent article showed that conclusions of low brain serotonin in the BPD were erroneous, low levels were associated with suicide, not the BPD.

Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research."

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