BPD and Splitting

Written by Dr. Leland Heller

QUESTION:

I have BPD and NPD (co-diagnosis). I've been in counseling for over a year and have made some major gains. However, I still have a serious problem with splitting. Even when I know, rationally, that I am splitting, the emotional reaction I experience (either all-love or all-hate) is overwhelming, and

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management for me often means leaving the situation before I go nuts. I would be grateful if you could point me at some resources for resolving/managing splitting.

DR. HELLER'S ANSWER:

It's primarily a medical problem.

For most borderlines, it's the "all black" that causes the most problems. The "all white" is problematic as well, but is much less of a problem when the baseline level of pain is gone, and when therapy and self-education is used.

When someone with the BPD is "in the black" they are generally experiencing dysphoria - anxiety, rage, depression and despair. Controlling this symptom is crucial, and usually requires low doses of neuroleptics like Haldol and epilepsy medications like Tegretol. The chronic mood swings, chronic anger, emptiness and emotional pain usually go away with SSRI medications, especially Prozac. When Prozac is ineffective, Tegretol usually needs to be added and the symptoms become much more manageable.

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