QUESTION:

Dear Dr. Heller,

Although I am only 14 I have been in a psychiatric ward for attempting suicide and self-mutilation. I have depression and self-mutilation problems, and either body dysmorphic disorder or obsessive compulsive disorder. I am extremely moody, though I am on Zoloft 75mg and Remeron 30mg. They said it isn't working, so it will be changed. I thought it rare to have all these things wrong with me. I looked into it and I think I may have BPD, but I have no clue about it. I don't have intense relationships because I am shy and ashamed of myself, so I never really get close to anyone. I am very young and I need help soon. My therapist said that I don't have all of the symptoms, but I have most, and I really feel I may have it. Please try to answer as soon as possible.

Thank you.

DR. HELLER'S ANSWER:

With extremely rare exception, self-mutilation and suicide attempts in an adolescent are due to the borderline disorder (BPD.) It's important to understand that the BPD is a medical problem, and that you did nothing to cause it. The right medications can have an incredible affect on your life. I've had much greater success with Prozac than Zoloft. Remeron is a great add-on medication for post traumatic stress disorder and for sleep.

The combination of Prozac with Tegretol is a powerful tool for controlling BPD dysphoria (anxiety, rage, depression and despair) that leads to self-mutilation and suicide attempts. Self-mutilation is usually a technique to reduce the horrible sensation of dysphoria and it does indeed work, just like self-mutilation works for stopping the itching from a mosquito bite.

When I treat adolescents like yourself I usually like to add Seroquel or Geodon as well.

Making all the medically treatable diagnoses and treating them comprehensively is extremely important! My screening test will be of use to you.

Suicide happens when an individual is in more pain than she/he can handle and the individual genuinely believes there is no hope for it to go away. There is tremendous hope for you, and you can have a sensational life!

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