Personality Disorders Community

BPD, Epilepsy and Seizures?

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QUESTION:

I have an adopted child who was found malnourished in India at 2 weeks she is not 10-1/2 years old. She came home at 8 months, and has always had raging tantrums commonly lasting 45 to 60 minutes. She has a very intense love hate relationship with me, and she has tried to relieve pain by spending every penny of her allowance as soon as possible in a tense and addictive way (not just as a child with money burning a hole in her pocket). She has talked about dying since she was 7 years old, and this year at 10-1/2 she made 3 suicide gestures/attempts and spent most of May hospitalized.

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When the psychiatrist showed me the symptoms for BPD I was stunned this seemed to fit her exactly, she has all of the symptoms except I am not sure about the psychotic episodes. Is it possible that the abandonment at birth triggered the start of BPD which became full blow with the onset of puberty? Does she possibly have temporal lobe epilepsy and complex partial seizures? Are these conditions the same? What are the distinguishing features?

She being treated with Prozac and Depakote, and her therapist is using a cognitive type of therapy. We have seen marked improvement in the past two weeks.

DR. HELLER'S ANSWER:

There are many possible diagnoses. Bipolar, temporal lobe seizures, oppositional defiant disorder and psychotic depression are all possible, as is attention deficit disorder.

It can be difficult to diagnose the seizures. Some clues include staring essentially unresponsively and then coming out of it in a rage, the child describing that he/she is floating or things seem unreal, or that the individual states something like "I tried to stop it but I couldn't."

I have found most individuals with oppositional defiant disorder are either psychotically depressed, or have additional diagnoses such as the generalized anxiety disorder and ADD.

She's being treated for all of these, which is good. Your doctor seems to have things well in hand and is using some very effective medications. The most miraculous medication for individuals in this situation is Risperdal, and there are articles in the literature documenting it's effectiveness in children for aggression, bipolar, and psychosis.

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