QUESTION:

Hello Dr. Heller,

You have probably received thousands of emails with a subject like that from lots of people with BPD. I really need help in the form of advice or something that I can show to my husband or parents who are trying to help me. Here is a short version of my problem:

My mom tells me I'm one of the lucky ones with BPD. I made it through high school and earned a 4 year degree in only 6 years... yeah. I laughed too. But I did it. She told me that many BPD's can't do it, but I did.

I was diagnosed in August 2000 with BPD by Dr. Ahmed in Eau Claire, WI. I have all the DSM-IV symptoms of BPD. But after being on Prozac for 4 years, it stopped working. Then in 2000, I was put on Celexa which worked for another 3 years. Now I'm taking Lexapro. The medication is working pretty well, but after my boyfriend and I read your website and both your books, we talked to my doctor about putting me on Tegretol (S/P?).

The problem is, it's come too little too late. I'm 25 years old and now I can't find a job that I can hold. I've had 5 jobs in 5 years and my longest running job was for 1 year which I got fired from. My last job was a dream job - selling insurance, but the rate of rejection was really difficult. After being confronted by coworkers about my issues of "sensitivity" and "overreacting", I left the building crying and cursing. The next day I was told to pack my things and leave. I wanted to apply for SSI, but my father who also has BPD, has told me that this is not the answer and that I am fully capable to work. He wants me to start a lawsuit against my previous employer stating that they knew of my issues before they hired me and it was because of my issues that they fired me. And it was.

I realize that I am solely responsible for my own tantrums and my outbursts, but when I can't stop them, why is it still my fault? I want to go back to work. I want to find a job where people will understand that I have a disorder that messes me up. This is the short version of what I am going through. Can you please give me your input on this? I live too far away and have no income to be able to go see you, otherwise I would be in Florida in a heartbeat.

Thank you...

DR. HELLER'S ANSWER:

You are responsible for what your body does, but you didn't cause the BPD. Without the right medications you won't be able to control your mood.

You likely would benefit greatly by the addition of Tegretol (carbamazepine). Also having Haldol (haloperidol) available as needed makes a huge difference. Without control of your moods you're going to have a hard time holding a job. This is the dysphoria instruction sheet I give to my patients:

The dose of Prozac (fluoxetine) may be a problem. I use whatever dose is necessary to completely eliminate unprovoked mood swings, chronic anger or irritability, emptiness and boredom. Prozac (fluoxetine) doesn't "stop working" for the BPD. What happens is the development of chronic dysphoria (anxiety, rage, depression and despair) or an imbalance that requires the temporary addition of Wellbutrin (buproprion).

Approximately half of my BPD patients have attention deficit disorder, which could easily explain many of your symptoms. If ADHD or ADD is present it will need to be treated as well. Impulsive anger is a symptom of ADHD that borderlines must avoid.

You are young and when the medications are right you are capable of a very successful life. Please click here to see the Goals for my BPD patients.

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