Diagnosing Borderline Personality Disorder And Finding Treatment That Works - Diagnosis and Treatment of Borrderline Personality Disorder

Written by HealthyPlace.com Staff Writer

David: Here are some audience questions regarding treatment:

TheDreamer: Why is Tegretol used most out of all the mood stabilizers for BPD? Is seeing images and hearing commanding voices a part of BPD? Is 2mg of Risperdal high enough dose to rid these symptoms?

Dr Heller: Tegretol works the best. It's been around a long time, so we know a lot about it. Dr. Cowdry at NIMH did studies published in 1986 and 1988 in the Green Journal that showed tegretol worked to reduce behavioral dyscontrol. This was in a double-blinded cross over study. I use it the most for one simple reason - it works! ...and it works well!

Hallucinations can be a part of the BPD psychosis experience, but it's very uncommon. Temporal lobe seizure symptoms such as deja vu, unreality and seeing things through someone else's eyes are more common.

When Risperdal is needed, 3mg is the usual dose in my experience. It doesn't work well when used every day - it's better as a "control/alt/delete" medication to reboot the limbic system when it's stressed out.

summertime: My doctor won't push Prozac dose over 60mg/day because it is max in Britain. What else could I try? I'm also on Tegretol 200mg twice daily and Haloperidol as required.

Dr Heller: About 10% of patients need 80mg, and a few need higher. Dr. Markovitz and others are prescribing very high doses of it and other SSRI's. Prozac will be generic shortly, which should simplify the process. The dose of Tegretol doesn't matter - what does matter is the blood level. That needs to be in the upper half to third of normal. Haloperidol as needed is sensational, as my "dysphoria instruction sheet" recommends. Just as crucial for treating the BPD is the other diagnosis, such as the General Anxiety Disorder, ADD (Attention Deficit Disorder), etc. Treating the Borderline Personality Disorder) alone rarely does the whole job.

Irene: How do you get help for a teenager who ABSOLUTELY refuses to get help and will NOT cooperate with a therapist?

Dr Heller: Another tough problem. After age 18, there's nothing you can do. Before 18, you're still the boss, even though the adolescent may believe otherwise. Worst case, the teen may need hospitalization. Once hospitalized, medications will be administered. Almost every teenager I've dealt with is willing to try if you present the disorder to them in a clinical and easy to diagnose manner. It's crucial to make sure they understand they neither caused their disorder nor chose it. Optimism about it's treatment is important as well. No matter how angry the individual with BPD is, they are still in pain and want the pain to stop. That "wounded" animal response is simply kicking in, and likely having a seizure. These seizures can be chronic as well. I tell my patients that I don't want them to believe me based on my words, because talk is cheap. I hope what I have said makes enough sense that they'll try the medication and see if I told the truth or not. I want results to speak for themselves.

David: For the audience, I'd be interested in knowing what treatments have worked for you.

Here are some audience comments on what has worked treatment-wise for you:

Marci: I was on Tegratol for several years which helped, and I was even able to wean off of it until a robbery recently which precipitated BPD rearing its ugly head again, and now nothing seems to help.

savanah: After my therapist dumped me, I got educated and began recovery on my own. I believe that you are accountable for how you feel.

ssue32: I have been on Depakote for many years and it has helped a lot plus I have begun therapy on abuse issues I never wanted to explore

David: I'm also interested in knowing from those of you with Borderline Personality Disorder; what is the most difficult aspect of having it?

Ona1: I find that my extreme mood shifts and behavior are the worst for me. That, and the self-injury aspect.

Silent: Not knowing what is wrong with you, but the constant feeling of being alone, the thought of wanting to die, is so depressing.

ssue32: For me, it is the self-injury and also believing at any minute I will be abandoned.

savanah: the most difficult aspect is trying to get loved ones to understand what it feels like to be BPD. It's like explaining to someone who has never had cancer what it feels like. Not easy!

Marci: I think for me the most difficult aspect is the stigma attached to Borderline Personality Disorder, and the difficulty of finding a professional to help you.

Rednebsaf: Trying to believe I don't have it every time I hurt myself

Ona1: I have recently been diagnosed with BPD and the most difficult thing has been the extremes of my behavior. I fight with it constantly.

donna2: The most difficult aspect of having BPD is not having a passion for anything. I see people with hobbies and collections and I have no interest in anything. All I do is survive from day-to-day.

cypress: I have also been recently diagnosed. Its hard to know whether or not the diagnosis is correct.

susie: Have been diagnosed with DID but many don't believe it. They say that I may have BPD.

David: One of the things that some have trouble dealing with are the extremes in behavior. What is your suggestion for dealing with that?

Dr Heller: The extremes in behavior are medical problems. The individual misinterprets reality, and acts reasonably based on that misinterpretation. The most important aspect here is medication, particularly as needed. The therapist I work with the most - and ran 3 treatment programs with - became interested when she attended some family support groups I ran. The therapist was amazed at how, as needed, Haldol worked. The family members saw the results.