QUESTION:

I have a sister with Borderline Personality Disorder and Schizoaffective Disorder, Post Traumatic Disorder, and Bipolar. She was tested in High school, 25 plus years ago, to have an IQ of 74. She just signed a contract for the DBT Program at the rehab she has been involved with for the past three years. Since last November she has been in the hospital for long treatment and in January started ECT treatments. She has had 17 treatments thus far.

My question and concerns for this program is this, that her intellectual level is so profoundly effected that she wont understand it and become frustrated and feel a failure. She is confused most the time, and does disassociate often. What complicates and makes her symptoms severe is the fact that she was abused well into her thirties by a family member. This abuse was sexual. It was upon this discovery and the end of this abuse that she showed the most severe part of her illness.

There is much change in her life one of which is her children are living with me now and she is for the first time living alone and it is not successful. Her mother and I feel she needs to be in an assisted living home.

DR. HELLER'S ANSWER:

I doubt if DBT will have much success if the IQ result is correct. To me, the borderline disorder is characterized by damaged emotions and good intelligence. When both are damaged, it's very, very difficult. DBT depends on a motivated patient with a good intellect.

It has been recognized the chronic dysphoria (anxiety, rage, depression and despair) and chronic dissociate symptoms such as "serialization" are powerfully associated with severe sexual abuse. These symptoms need the right medications.

One ray of hope: I've had a few patients with low IQ testing who had diagnoses interfering with the testing - such as the generalized anxiety disorder, attention deficit disorder, depression, and/or temporal lobe seizures. Once the disorders were successfully treated it became obvious that the IQ was not that low.

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