Q. WHAT IS BPD VERSUS POST TRAUMATIC STRESS


A. Some authorities believe PTSD is only when one witnesses someone being killed, or they were almost killed themselves. Interestingly, the same medications plus counseling are recommended for PTSD as are used in the BPD. I suspect PTSD can occur from any severe trauma that overwhelms an individual's defenses.

I believe damage to the brain's "trapped" or "cornered" areas are the main cause of the BPD. Clearly PTSD fits this distinction. A study two decades ago implied that all Vietnam Vets admitted for PTSD also had the BPD. When this area of the brain "kicks in" then psychosis usually occurs.

"Doing bed" is a common choice for those with the BPD experiencing dysphoria (anxiety, rage, depression and despair).

I agree with her therapist that priorities of treatment must be established. The priorities I usually establish are 1) making all the treatable diagnoses (see the screening test I use at the top of my website http://biologicalunhappiness.com , 2) treating BPD dysphoria, 3) treating all the other treatable diagnoses, and 4) retrain the brain. Offering hope, encouragement, and optimism are important at each stage.

To a large degree I agree with not going after "the demons." I'm far more interested in my patients deciding who they want to be and how they can get there than who they are and why they got there. My focus on previous traumas is that the individual can use them as a springboard to get a great life, that they were awful and there's no point in reliving them, and how to medically handle the symptoms when they arrive. If there are stressors from the past that still exist in the present they will need to be dealt with, but that's the only significant issue regarding the past that I emphasize.

Individuals have very little "control" over others. You can't make them like you, love you, respect you, want to be with you, or treat you well. Sometimes an individual like yourself needs to step back and take care of oneself rather than devoting your life trying to change someone who needs to do it for herself.

Leland Heller, MD