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Diagnosing Borderline Personality Disorder And Finding Treatment That Works

online conference transcript

Leland Heller, M.D. is a family practice doctor who specializes in psychiatric illnesses. He is a Borderline Personality Disorder treatment expert and author of the books, "Life on the Border: Understanding and Recovering from the Borderline Personality Disorder" and "Biological Unhappiness".

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

BEGINNING

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope everyone's day has gone well. Our conference tonight is on "Diagnosing Borderline Personality Disorder (BPD) and Finding a Treatment That Works". Our guest is Leland Heller, M.D. His "Biological Unhappiness" site is located here at HealthyPlace.com. Dr. Heller is a family practice doctor. His office is in Florida.

Although he is a family practice doctor, during his residency Dr. Heller specialized in psychiatric illnesses and later became very interested in Borderline Personality Disorder. He has treated over 3,000 patients with BPD and has run a BPD support group for nearly 4 years. Dr. Heller has also authored two books: "Life on the Border: Understanding and Recovering from the Borderline Personality Disorder" and "Biological Unhappiness".

Good Evening Dr. Heller and welcome to HealthyPlace.com. Thank you for agreeing to be our guest. Because people in the audience may have different levels of understanding, please define Borderline Personality Disorder and it's affects on those who suffer from it.

Dr Heller: Good evening, It's great to be here. I have a way of explaining the Borderline Personality Disorder in layman's terms that might be useful. It's how I explain it to patients and their families.

Imagine you had a pet dog and it runs into the street and by accident it's hit by a car. The dog's leg is broken and it limps off into an alley to lick it's wounds. A friend of yours sees the dog and comes over to help. The dog is now feeling trapped and cornered - a "wounded animal" - and misinterprets the friend's attempts to help. The dog snaps at the friend's hand who is trying to help. The BPD (Borderline Personality Disorder) is a malfunction in the brain's trapped or "cornered" animal area. Under stress, a seizure develops in that area. That's why under stress, while raging, a borderline will say to him or herself: "Why am I doing this" - yet be unable to stop it. It's a seizure - nerve cells firing inappropriately and out of control.

David: And the cause of Borderline Personality Disorder?

Dr Heller: The BPD has many causes including head trauma and brain infections, but it appears that emotional hurts literally damage the brain. Most likely the brain's support cells - the 90% of brain cells called "glial cells" - are damaged by traumas, causing the person to overreact to stress once puberty strikes. During puberty the brain's limbic system goes into "overdrive" and adolescents are at their highest risk of seizures in their lifetime. "Sticks and stones may break my bones...but names cause brain damage." So does incest, abuse, severe trauma, head injuries, attention deficit disorder, and other causes.

David: From my understanding, one of the biggest difficulties facing individuals who have BPD is maintaining stable relationships. This is a great cause of consternation for those people who are on the other side of the relationship. What causes this?

Dr Heller: There are a number of problems. The three most significant are 1) inappropriate mood swings; 2) misinterpretation of motives; and 3) remembering those misinterpreted motives as real. Oftentimes self-fulfilling prophecies occur, and self-hate eventually leads to a significant other coming to the same conclusion - that the individual isn't worth being with.

David: I have received a few requests for the official criteria -- the DSM criteria for Borderline Personality Disorder. Here they are:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistent unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)
  5. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress related paranoia or severe dissociative symptoms

When a person comes into your office, Dr. Heller, are there any tests you do to determine if the person is BPD?

Dr Heller: I go over the DSM criteria. There are no blood tests, physical examination findings, or imaging studies that can give the information.


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Last Updated: 19 October 2015
Reviewed by Harry Croft, MD

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