Psychiatrist with Mental Illness (No-BPD)

Written by Dr. Leland Heller

QUESTION:

My wife is studying to become a Psychiatrist and is currently enrolled in a PGY5 (post-graduate) program. I need your help two areas. Diagnose the problem:

She tends to behave in a fashion where she (in my opinion) has a compelling need to fight or argue with someone. If she is not fighting with me, it's the kids, or the grandparents, or the baby-sitter. Sometimes the fights come out of nowhere and it seems that she has no self control. She does calm down afterwards, only to regret what she has said - usually

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something nasty. To give you an example, we were going into NYC for her graduation party, and the tunnel traffic was the worst I have seen. After sitting in the car and no movement, she exploded - how it's my fault for driving, how she should not have listened to me (coming home, changing, etc. rather than just going from work and I would meet her there). This was provoked for no reason, besides the fact that she was going to be late for her most 'important' day of her 4 years of residency.

She has self-diagnosed herself as having 'Intermittent explosive personality disorder'. I think it's bi-polar disorder. Wild mood swings.

What is the treatment: Even though she has done a self-diagnosis, she refuses to get treatment. She claims that therapy will help, but I have seen no concrete steps towards that. Any medications that might help? If she were to go on any medications, would any state licensing boards care?

DR. HELLER'S ANSWER:

The licensing boards are very unlikely to care, although on many applications she would have to explain her diagnoses. The intermittent explosive disorder is probably a form of epilepsy, and often responds to epilepsy medications such as Tegretol. The story you presented is consistent with many diagnoses including the BPD, attention deficit disorder, dysthymia, major depression, etc. Bipolar seems unlikely based on what you wrote.

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