Dr. Leland M. Heller discusses the Borderline Personality Disorder (BPD) – Biological Unhappiness
clogged-up sink, or a trivial disagreement with your spouse, friend,
lover, child, etc. Instead of finding an acceptable solution, your mind
seems to panic. A sense of unease develops, possibly causing
discomfort in the stomach or chest. Feelings of anxiety complicate the
increasing sense of uneasiness and restlessness. This is followed by
progressively worsening anger – eventually becoming a rage so strong it
overwhelms you – even though you realize it’s excessive. Over the next
few minutes to hours, other negative sensations creep in – including
memories of past hurts – until you are experiencing virtually every bad
emotion a human can feel.
You feel trapped and vulnerable. Your psychological defenses are
overwhelmed by unbearable emotional pain. You feel depressed. You find
yourself unable to cope as your mind and body are now in a full scale
panic. You lose proper perception of reality – jumping to erroneous
conclusions in a futile effort to make sense of what’s happening. As
the pain continues to intensify the nervous system creates bizarre
sensations such as emptiness, numbness, and unreality. You become
incapable of rational thinking as the panic continues to worsen.
Your mind now desperately tries to find a way out of the pain and
searches for solutions. It recalls past activities that have made you
feel better. Once a method is found, your mind frantically forces you
to pursue that activity to a self-destructive excess – finally resulting
in a biochemical rescue. Brain chemicals are released that stop the
pain and let you feel ‘normal’ again.
But how can you ever feel normal again knowing that such a
horrible experience will return? How can you feel normal again when
your self-destructive and inappropriate behaviors are witnessed by
family, friends, employers and/or co-workers? How can you feel normal
again when those behaviors result in financial, interpersonal, physical,
or legal trouble?
For those not afflicted with the Borderline Disorder this is a
nightmare we hope never happens to us. Borderlines experience it over
and over – especially when confronted with stress. While individual
borderlines may feel some symptoms differently, the horrible feelings
described in the first paragraph (called ‘dysphoria’) intrude frequently
into a borderline’s life.
Borderlines will do almost anything to make dysphoria go away.
Most impulsiveness and self-destructiveness is an effort to relieve
dysphoria. Some borderlines, especially those suffering very severely,
will literally cut their bodies during dysphoria. The self-mutilation
is itself painless (the cuts don’t hurt), yet it relieves the dysphoria.
Borderlines also suffer from intense, frequent and unpredictable
mood swings that can cause ‘dysphoria’ even without stress. The mood
swings cripple a borderline’s efforts to live a happy, successful life.
Borderlines are victims of an incredibly painful illness…
Like victims of epilepsy, muscular dystrophy, and
neurofibromatosis (the ‘Elephant Man’s’ disease), victims of borderline
neither asked for, deserved or caused their affliction. The symptoms
can be so unpleasant to those interacting with borderlines that feelings
of compassion and understanding may be difficult or impossible to
feel. Borderlines desperately want to be loved, but their illness makes
them at times seem unlovable. They are terrified of being abandoned,
yet are powerless to keep the illness from destroying relationships.
This is the borderline experience.
families. The risk of developing borderline is 6 times higher when a
close relative has the disorder. In studies of identical twins,
researchers have discovered that many personality traits are genetically
determined. There is an association between some personality
characteristics and blood type (called ‘blood group antigens’).
Borderlines commonly suffer from other disorders as well. PMS,
depression, hypothyroidism, vitamin B 12 deficiency, other personality
disorders, anxiety, eating disorders, and substance abuse problems are
the most common. Intelligence is not affected by the disorder, but the
ability to organize and structure time can be severely impaired. There
is no association with Schizophrenia.
…While many borderlines suffered from abuse or neglect in
childhood, some developed the disorder from head injuries, epilepsy, or
brain infections. Early parental loss and incest are commonly
associated with borderline.
The facts indicating a medical origin are impressive: Brain wave
studies are frequently abnormal. Neurological physical examinations are
abnormal. Sound interpretation is impaired. Memory and vision are
impaired. Glandular function may be abnormal. Sleep is abnormal. The
response to some medications is bizarre. When injected intravenously,
the medication procaine normally causes drowsiness, but a borderline
will feel the ‘dysphoria’ described in the first paragraph. If
borderline was exclusively an emotional illness, why would all these
medical neurological abnormalities be present?
Borderlines likely have abnormalities with the neurotransmitter
‘serotonin’ – an incredibly important brain chemical. Serotonin
problems can cause anxiety, depression, mood disorders, improper pain
perception, aggressiveness, alcoholism, eating disorders and
impulsivity. Excess serotonin can depress behavior.
Serotonin deficiencies can cause many problems, especially
suicidal behavior. Low levels of serotonin increase the risk of
self-destructive or impulsive actions during a crisis. The most violent
suicides (hanging, drowning, etc.) are usually committed in patients
with low serotonin metabolite (waste product) levels in the spinal
fluid. In those who attempted suicide unsuccessfully, 2% will likely be
dead within one year. If the serotonin metabolite level is low, that
risk increases to 20%.
treated and often cured. The medication fluoxetine (Prozac) usually
stops most of the mood swings in a few days. It is, in my opinion, as
big a breakthrough for borderlines as insulin was for diabetics.
Borderlines generally see themselves very profanely. I frequently tell
my borderline patients ‘you’re not an *#%@*, your brain is broken.’ Once
this concept is understood, the borderline patient usually feels an
enormous sense of relief. They need to know they have value as a human
being. Feelings of desperation and hopelessness are often replaced by
optimism and motivation once Prozac stops the mood swings and the
patient begins to realize that a happier, more successful life is
possible.
All borderlines need psychological counseling. It’s almost
impossible to live for years as a borderline and not need psychological
help. While the underlying problems are probably structural within the
brain, the borderline is left with a lifetime of bad experiences and
inadequate skills for recovery.
No medication should be given without proper medical supervision.
This is particularly true for the drugs used to treat the borderline
disorder. Some medicines make the symptoms of borderline worse,
especially amitryptilline (Elavil) and alprazolam (Xanax). Possibly a
third of borderlines may suffer from low thyroid (hypothyroidism) –
despite a normal ‘TSH’ blood test. They may need to take thyroid
medication.
The antidepressant fluoxetine (Prozac), a serotonin increaser,
virtually eliminates the mood swings. Feelings of anger, emptiness and
boredom are often eliminated or reduced as well. Most borderlines I’ve
treated consider Prozac to be a miracle. While some need the medication
indefinitely, many have been able to stop it after a year without the
mood swings returning. Side effects are rarely a significant problem.
Neuroleptics…have been proven effective. They are remarkably
helpful for treating dysphoria and psychosis, and can be preventive when
the borderline is undergoing stress. They seem to ‘put on the brakes’
when the thoughts are racing. They should only be used as needed, like
using an antacid for heartburn. These medications can be effective at
low doses, and must be taken with great caution.
While medications can help with some symptoms, the brain is
clearly broken. After a stroke, the brain needs therapy to let the
healthy areas take over for the broken ones. The same is true for
recovering borderlines. I feel strongly that the brain must be
retrained. Affirmations…will work, as the human brain can believe
almost anything if told it enough times…
The psychology of positive thinking is very helpful. I strongly
recommend massive brain re-education. Devote as much time as possible
for 3-6 months reading positive self-help books and listening to
motivational tapes – especially those by the motivational speaker Zig
Ziglar…
Sometimes symptoms of ‘temporal lobe’ involvement (similar to
epilepsy) complicate the disorder. Common symptoms include unawareness
spells, feeling like things are unreal, and numbness of body parts.
These symptoms are more common under stress, depression, severer
dysphoria, and incest crisis. They can be treated with the epilepsy
medication carbamazepine (Tegretol)…
Borderlines are VICTIMS – they did not cause their illness. They
do not want their illness. They want to be treated and possibly cured.
They deserve that opportunity.
The National Institute of Mental Health (NIMH) has been the single
most influential source of unbiased study and information regarding the
true biology behind the borderline personality disorder.
Landmark studies, such as those produced by Drs. Cowdry and
Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and
neuroleptics, and the dangers of Xanax (alprazolam). This article was
published in the Archives of General Psychiatry Feb 1988. A subsequent
article showed that conclusions of low brain serotonin in the BPD were
erroneous, low levels were associated with suicide, not the BPD.
Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research.”
Permission by Leland M. Heller, M.D.
“…Epilepsy was once thought to be a psychiatric problem, until the
underlying neurological abnormalities were understood. Researchers
have uncovered medical and neurological abnormalities in borderlines.
Many symptoms are likely due to malfunction in the brain’s limbic
system. In my opinion, the borderline personality disorder is primarily
a medical problem. It can now be treated."
The Borderline Experience
Imagine you are faced with a minor stress – a flat tire, aclogged-up sink, or a trivial disagreement with your spouse, friend,
lover, child, etc. Instead of finding an acceptable solution, your mind
seems to panic. A sense of unease develops, possibly causing
discomfort in the stomach or chest. Feelings of anxiety complicate the
increasing sense of uneasiness and restlessness. This is followed by
progressively worsening anger – eventually becoming a rage so strong it
overwhelms you – even though you realize it’s excessive. Over the next
few minutes to hours, other negative sensations creep in – including
memories of past hurts – until you are experiencing virtually every bad
emotion a human can feel.
You feel trapped and vulnerable. Your psychological defenses are
overwhelmed by unbearable emotional pain. You feel depressed. You find
yourself unable to cope as your mind and body are now in a full scale
panic. You lose proper perception of reality – jumping to erroneous
conclusions in a futile effort to make sense of what’s happening. As
the pain continues to intensify the nervous system creates bizarre
sensations such as emptiness, numbness, and unreality. You become
incapable of rational thinking as the panic continues to worsen.
Your mind now desperately tries to find a way out of the pain and
searches for solutions. It recalls past activities that have made you
feel better. Once a method is found, your mind frantically forces you
to pursue that activity to a self-destructive excess – finally resulting
in a biochemical rescue. Brain chemicals are released that stop the
pain and let you feel ‘normal’ again.
But how can you ever feel normal again knowing that such a
horrible experience will return? How can you feel normal again when
your self-destructive and inappropriate behaviors are witnessed by
family, friends, employers and/or co-workers? How can you feel normal
again when those behaviors result in financial, interpersonal, physical,
or legal trouble?
For those not afflicted with the Borderline Disorder this is a
nightmare we hope never happens to us. Borderlines experience it over
and over – especially when confronted with stress. While individual
borderlines may feel some symptoms differently, the horrible feelings
described in the first paragraph (called ‘dysphoria’) intrude frequently
into a borderline’s life.
Borderlines will do almost anything to make dysphoria go away.
Most impulsiveness and self-destructiveness is an effort to relieve
dysphoria. Some borderlines, especially those suffering very severely,
will literally cut their bodies during dysphoria. The self-mutilation
is itself painless (the cuts don’t hurt), yet it relieves the dysphoria.
Borderlines also suffer from intense, frequent and unpredictable
mood swings that can cause ‘dysphoria’ even without stress. The mood
swings cripple a borderline’s efforts to live a happy, successful life.
Borderlines are victims of an incredibly painful illness…
Like victims of epilepsy, muscular dystrophy, and
neurofibromatosis (the ‘Elephant Man’s’ disease), victims of borderline
neither asked for, deserved or caused their affliction. The symptoms
can be so unpleasant to those interacting with borderlines that feelings
of compassion and understanding may be difficult or impossible to
feel. Borderlines desperately want to be loved, but their illness makes
them at times seem unlovable. They are terrified of being abandoned,
yet are powerless to keep the illness from destroying relationships.
This is the borderline experience.
The Facts
Genetic factors are important – borderline tends to run infamilies. The risk of developing borderline is 6 times higher when a
close relative has the disorder. In studies of identical twins,
researchers have discovered that many personality traits are genetically
determined. There is an association between some personality
characteristics and blood type (called ‘blood group antigens’).
Borderlines commonly suffer from other disorders as well. PMS,
depression, hypothyroidism, vitamin B 12 deficiency, other personality
disorders, anxiety, eating disorders, and substance abuse problems are
the most common. Intelligence is not affected by the disorder, but the
ability to organize and structure time can be severely impaired. There
is no association with Schizophrenia.
…While many borderlines suffered from abuse or neglect in
childhood, some developed the disorder from head injuries, epilepsy, or
brain infections. Early parental loss and incest are commonly
associated with borderline.
The facts indicating a medical origin are impressive: Brain wave
studies are frequently abnormal. Neurological physical examinations are
abnormal. Sound interpretation is impaired. Memory and vision are
impaired. Glandular function may be abnormal. Sleep is abnormal. The
response to some medications is bizarre. When injected intravenously,
the medication procaine normally causes drowsiness, but a borderline
will feel the ‘dysphoria’ described in the first paragraph. If
borderline was exclusively an emotional illness, why would all these
medical neurological abnormalities be present?
Borderlines likely have abnormalities with the neurotransmitter
‘serotonin’ – an incredibly important brain chemical. Serotonin
problems can cause anxiety, depression, mood disorders, improper pain
perception, aggressiveness, alcoholism, eating disorders and
impulsivity. Excess serotonin can depress behavior.
Serotonin deficiencies can cause many problems, especially
suicidal behavior. Low levels of serotonin increase the risk of
self-destructive or impulsive actions during a crisis. The most violent
suicides (hanging, drowning, etc.) are usually committed in patients
with low serotonin metabolite (waste product) levels in the spinal
fluid. In those who attempted suicide unsuccessfully, 2% will likely be
dead within one year. If the serotonin metabolite level is low, that
risk increases to 20%.
Treatment
Due to new developments in medicine, borderlines can now betreated and often cured. The medication fluoxetine (Prozac) usually
stops most of the mood swings in a few days. It is, in my opinion, as
big a breakthrough for borderlines as insulin was for diabetics.
Borderlines generally see themselves very profanely. I frequently tell
my borderline patients ‘you’re not an *#%@*, your brain is broken.’ Once
this concept is understood, the borderline patient usually feels an
enormous sense of relief. They need to know they have value as a human
being. Feelings of desperation and hopelessness are often replaced by
optimism and motivation once Prozac stops the mood swings and the
patient begins to realize that a happier, more successful life is
possible.
All borderlines need psychological counseling. It’s almost
impossible to live for years as a borderline and not need psychological
help. While the underlying problems are probably structural within the
brain, the borderline is left with a lifetime of bad experiences and
inadequate skills for recovery.
No medication should be given without proper medical supervision.
This is particularly true for the drugs used to treat the borderline
disorder. Some medicines make the symptoms of borderline worse,
especially amitryptilline (Elavil) and alprazolam (Xanax). Possibly a
third of borderlines may suffer from low thyroid (hypothyroidism) –
despite a normal ‘TSH’ blood test. They may need to take thyroid
medication.
The antidepressant fluoxetine (Prozac), a serotonin increaser,
virtually eliminates the mood swings. Feelings of anger, emptiness and
boredom are often eliminated or reduced as well. Most borderlines I’ve
treated consider Prozac to be a miracle. While some need the medication
indefinitely, many have been able to stop it after a year without the
mood swings returning. Side effects are rarely a significant problem.
Neuroleptics…have been proven effective. They are remarkably
helpful for treating dysphoria and psychosis, and can be preventive when
the borderline is undergoing stress. They seem to ‘put on the brakes’
when the thoughts are racing. They should only be used as needed, like
using an antacid for heartburn. These medications can be effective at
low doses, and must be taken with great caution.
While medications can help with some symptoms, the brain is
clearly broken. After a stroke, the brain needs therapy to let the
healthy areas take over for the broken ones. The same is true for
recovering borderlines. I feel strongly that the brain must be
retrained. Affirmations…will work, as the human brain can believe
almost anything if told it enough times…
The psychology of positive thinking is very helpful. I strongly
recommend massive brain re-education. Devote as much time as possible
for 3-6 months reading positive self-help books and listening to
motivational tapes – especially those by the motivational speaker Zig
Ziglar…
Sometimes symptoms of ‘temporal lobe’ involvement (similar to
epilepsy) complicate the disorder. Common symptoms include unawareness
spells, feeling like things are unreal, and numbness of body parts.
These symptoms are more common under stress, depression, severer
dysphoria, and incest crisis. They can be treated with the epilepsy
medication carbamazepine (Tegretol)…
Borderlines are VICTIMS – they did not cause their illness. They
do not want their illness. They want to be treated and possibly cured.
They deserve that opportunity.
The National Institute of Mental Health (NIMH) has been the single
most influential source of unbiased study and information regarding the
true biology behind the borderline personality disorder.
Landmark studies, such as those produced by Drs. Cowdry and
Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and
neuroleptics, and the dangers of Xanax (alprazolam). This article was
published in the Archives of General Psychiatry Feb 1988. A subsequent
article showed that conclusions of low brain serotonin in the BPD were
erroneous, low levels were associated with suicide, not the BPD.
Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research.”
Permission by Leland M. Heller, M.D.
