Can You Have Both ADD And BPD, And How Can I Prevent Drug Abuse?

Written by Dr. Leland Heller

QUESTION:

Dear Dr. Heller,

It was suggested that I write to you regarding my daughter. She was diagnosed at age 16 with BPD. At the time, she was being treated with Paxil due to her enormous anxieties. She was also being treated with Ritalin for her ADD. After a while, her rages became so intense that we had to send her to a residential for a 16 month period. Obviously, the residential did no good. She learned to mutilate herself there and snort her Ritalin. They did prescribe Seroquel which seemed to really help with the rage problem or so I thought. When she came home in September, she was able to re-enter her day treatment program at a school near our home. Things were going very well. My daughter came to me and told me she had been

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snorting her daily dosage of Ritalin and wanted help. I brought her to school the next day and explained to the doctor what had been going on. Since that time, the doctor has refused to give her Ritalin. I suggested Concerta since it only has to be given once a day and could be administered in school. They still refused and things have gotten so bad that my daughter had to be hospitalized for nearly three weeks. She is so impulsive without the Ritalin that our lives have been turned upside down. Please write back to me so that I can have written proof that her BPD and ADD do co-exist and that both problems must be treated.

Thank you so much.

DR. HELLER'S ANSWER:

ADD and BPD seem approximately 50/50 - half of those with BPD have ADD and half of those with adult ADD have the BPD. There are no official statistics, that's why I encounter in my practice. Dr. Rex Cowdry - formerly acting director at NIMH and a pioneering researcher on BPD has also written of this strong correlation.

Concerta is the ideal psychostimulant for abusers because it's formulation is unique - it can't be snorted or freebased. Particularly when problems are occurring because of the need for a psychostimulant, in my opinion it should be given to the patient. I would usually insist in a situation like this that the parent give the medication daily and that it be locked up.

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