QUESTION:

Dear Dr. Heller,

Is it possible that one episode of marital rape at age 36 (perpetrated by my then undiagnosed BPD husband when he was drunk) can trigger BPD in someone who does not have an abusive childhood background?

My ex-husband (father of my 3 children) is BPD - high functioning mostly, and definitely one who acts out rather than acts in. He has the childhood history (abandonment by mother at age 18 months, raised until age 11 by a physically abusive father and grandfather, senile grandmother as the only female "parent" during his formative years, a twin brother who was preferred and loved more than him, and from age 11 the court awarded custody of him and four siblings to his mother and resulted in the father's complete withdrawal from his children's lives).

His behavior / patterns fit all but one of the diagnostic categories. My childhood history is substantially different. After recall of the rape (which occurred during therapy for gambling addiction), I suffered an acute psychotic episode and subsequent identity crisis/break-down, during which my behavior has been much the same as that of a person suffering BPD.

We were married for 19 years and the rape occurred after we had been married for 11 years. My husband was verbally abusive towards our children and his co-workers, but the rape was the only time he was abusive towards me.

I would appreciate clarification on this matter.

DR. HELLER'S ANSWER:

By definition, no it won't cause the BPD since the BPD begins by early adulthood. I've seen head injuries cause the BPD in older individuals.

The most likely explanations are PTSD (post traumatic stress disorder) and/or a mild underlying case of the BPD which worsened profoundly with the rape. You don't have to grow up in an abusive home to get the BPD. The strongest correlation is with attention deficit disorder.

If the BPD is present (whether because of the rape or not) then Prozac should stop the unprovoked mood swings, chronic anger, emptiness and boredom. Tegretol and low dose neuroleptics can stop the dysphoric spells.

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