Diagnosing Borderline Personality Disorder And Finding Treatment That Works - Diagnosing Borderline Personality Disorder And Finding Treatment

Written by HealthyPlace.com Staff Writer

Rednebsaf: How do you feel about Dielectical Behavioral Therapy?

Dr Heller: How do I feel about Dialectical Behavioral Therapy in treating Borderline Personality Disorder? DBT is an excellent program, and I give Marsha Linehan tons of credit for developing a counseling approach that reduced suicide and self-mutilation attempts by half. It's difficult to replicate in the "real world" of managed care, limited funds, etc. Actually, Dr. Linehan's approach and mine are quite similar in a lot of ways. This is particularly true regarding validating what the individual is feeling, talking straight with them, making them aware of consequences even though the brain is leading them towards places they don't really want to go.

cypress: I was on Prozac 80, but have been cut back to 40, do you consider 80 a "mega dose"?

Dr Heller: No - it's within the FDA approved dose range. Mega doses would be above the FDA approved levels for dosing. But "mega" is an arbitrary term. I want success for my patients, and sometimes the economics and politics behind FDA recommendations must be bypassed.

David: A few more audience comments:

cypress: It's hard to deal with the stigma of having a mental illness.

Jocasta: Your focus is much on medication Dr. Heller, and true that must be treating for the biological disorder that lives along with BPD. But is it not true that once medications are even somewhat effective, intensive therapy dealing with interpersonal skills, and ways of dealing with BPD by practicing working at relationships, working on improving self-esteem, and getting to the nitty gritty part that being abused is not one's fault; this is all in the post medication treatment, which has helped me equally.

Dr Heller: Jocasta: absolutely - which is what I've written about at length in my books, my website, and in tonight's chat. It's the combination of medication, as needed medication, and retraining the brain that's needed.

Zppt2da: I have had unhealthy relationships that I feel they are all related to an issue back from childhood with father. I have opened up a wound of self mutilating form 8 years, I have read titles of cutting and self mutilating and why this happens (overwhelming), and I am finding it hard to find a therapist who will take me on. You are threatened with a contract of no self injury, I have taken Dielectical Behavioral Therapy (DBT), but I don't know where else to turn too for help.

David: Dr. Heller, Zppt2da makes a good point, and it follows on something you said tonight.

Dr Heller: To Zppt2da: The trauma may have been a trigger for your condition, but it doesn't have to rule your life. I don't use self-mutilation as a cause to punish someone. That individual is in pain and needs help.

David: You mentioned that many therapists and psychiatrists don't want to take on patients who are suicidal. Where does one go then to get the help they need?

Dr Heller: Why you are who you are now and how you got here is of minimal importance, compared with who you want to be and how you get there. And that also includes patients who self-injure. You literally have to search, you have to have the information in hand, and you have to ask questions. There's lots of material on line - particularly on my site - that can be of enormous help to patients - including those who self-injure. Be educated, and bring concise information in for the physician. Physicians who are open minded - including open minded skeptics - welcome the opportunity to know more and to help patients. This is particularly true when non-addicting medications aren't used. Family physicians prescribe most mental health medications in the US - and that's a good place to start. There is a suicide attempt per minute in the US - it's not just a topic for psychiatrists.

ssue32: I am on Depakote, Wellbutrin and Celexa in high doses. Are these good for treatment of BPD, and are there any risks in the higher doses?

Dr Heller: Depakote is the more dangerous of the group. High doses of SSRI's can cause "serotonin syndrome" - although usually only when combined with other medications such as tricyclic antidepressants. Depakote often works as well as Tegretol, just not as consistently. Wellbutrin is commonly used also - particularly as it's other brand name "Zyban" to help patients quit smoking. I don't prescribe it very often. I have some patients on Celexa, but most prefer Prozac in head to head combination.

Silent: When in treatment, how long should it take for a person to find relief, or some relief, or does it never happen?

Dr Heller: I haven't had an individual fail to have a significant response in years - particularly when all the diagnoses are made. An individual with the BPD should be dramatically better within 7 days or something else significant is going on.

David: It is getting late. I want to thank Dr. Heller for being our guest tonight and sharing his knowledge and expertise with us. I also want to thank everyone in the audience for coming and participating. I especially like getting the audience involved because we can learn from each other too.

Dr Heller: It's been my pleasure, and I hope I've been of help to you.

David: Here's the link to the HealthyPlace.com Personality Disorders Community. I encourage to you sign up for the mail list so you can keep up with community events.

Don't forget to visit Dr. Heller's site Biological Unhappiness, and check his books "Life on the Border: Understanding and Recovering from the Borderline Personality Disorder" and "Biological Unhappiness".

Thank you, Dr. Heller.

Good night everyone.

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