Borderline Personality Disorder Chat Conference:

Guest Speaker:  Paul Markovitz M.D., Ph.D.  6/28/00

Page Three

Bardamu:

I think Freaked would like to know if Dr M. has had any experience with that type of situation. 

Dr. Markovitz: 

Bread is better than simple sugar. Potatoes are better than chocolate 

Freaked:  

If this DR has researched BPD he also would know the social ramifications of this disease...wouldn't he? 

Dr. Markovitz: 

Freaked, I missed your question. Ask again. 

Weepippo: 

the treatment of BPDs as gomers is very alive and well 

Tim:

Freak, but not the legal ones 

Freaked:  

I just wanted to know Dr if having BPD would stop me gaining custody of my step girls 
Tim I know it's legal but maybe he has known some similar cases 

Dr. Markovitz: 

No. If you behave in a socially acceptable manner, it will not. 

Bingle: 

Is anxiety a very common thing for bpd to have? 

VicHam:

what do you think of the new med reboxetine (coming out this fall)? 

Dr. Markovitz: 

Having an illness is not a grounds for keeping kids away. 

Tim:

Freak, its all up to a judge, but in showing that your in treatment your showing you know you have a disorder and want to be better 

Dr. Markovitz: 

Anything that can hurt the kids, is 

Ellie: 

Is psychodynamic therapy helpful for some bpds, doc? 

Dr. Markovitz: 

psychodynamic therapy probably does not help much. 

Weepippo: 

what is the difference between Risperdal and Remeron? 

Dr. Markovitz: 

They did a study in London about 10 years ago, and the suicide rate was 3x higher in the group with therapy vs. nothing 

Patty: 

I got much worse when I underwent "uncovery therapy." Got so depressed I had to take a leave from work. 

Entre2chaises:

WOW. That's incredible that the suicide rate was 3x higher WITH therapy. 

Ellie: 

Is cognitive therapy helpful for bpds? 

Snowonthemountain:

what is uncovery therapy Patty? 

Freaked: 

I’m just depressed now that I’m screwed up with no hope of getting rid of BPD for good

Dr. Markovitz: 

cognitive therapy seems to be the best. 
Freaked, you likely will be able to get rid of it with time. You have to make sure you start moving in the right direction now 

Bingle: 

what is the difference between the 2 types of therapy? 

VicHam:

Dr, how about reboxetine, any promise for BPD? 

Dr. Markovitz: 

cognitive makes sense. You say I do "A" and the therapist says lets figure a way to get rid of it or minimize it. 

Freaked: 

well I’ve started therapy 
just no meds 

Bardamu:

Dr M. what are the long term ramifications of no treatment? Do the symptoms escalate, or, does it remain the same and only remain affected by outside stimulus? 

Freaked: 

what is the best treatment for BPD?

Dr. Markovitz: 

Psychodynamic is trying to get to hidden (subconscious) agendas. It doesn’t work 

Bingle: 

thank you for the explanation Dr 

Weepippo: 

oic 

Dr. Markovitz: 

BPD decrease with time. Even if you got no treatment, its intensity lessens after 45 or so 

Gillian: 

Can you become a recovered bpd, and control symptoms throughout your life?

Snowonthemountain:

Dr.Markovitz, is it realistic to believe that we can go through this recovery thing without the need for hospitalization? 

Dr. Markovitz: 

Probably Gillian. Like any other disease, it lies along a spectrum. BPD's like any other disease come in different intensities 

Gillian: 

right, and I think I’m beating mine with DBT 

Freaked: 

DR what is the best way to treat BPD? 

Dr. Markovitz: 

You may never need hospitalization. If you do, so be it. It is not a failure, just what you need at that point in time 

Freaked: 

what kind of therapy? 

Entre2chaises:

I know that my diagnosis is "features of BPD" so I guess I'm on the "light" end of the spectrum. 

Dr. Markovitz: 

Best way to treat BPD is to get a good doctor and therapist that can work together, and start working 

Weepippo: 

I’ve read there is associations between bpd and MPD your take? 

Dr. Markovitz: 

I like Effexor XR, Serzone, and Zoloft, but others work too 

VicHam:

Dr M., I was diagnosed with BPD at age 45 . . . 

Entre2chaises:

I *love* Effexor XR... it has changed my life! 

Bingle: 

I love wellbutrin 

Dr. Markovitz: 

which they are. They may be part of same disorder, and just a different presentation 

Bingle: 

its a great diet aide also 

Entre2chaises:

Wellbutrin and I didn't get along. I hear that happens with any drug. 

Dr. Markovitz: 

I have had great luck recently with Provigil as an augmenting agent. 
It really helps with attention, and is not addictive or habituating 

Entre2chaises:

Freaked, I understand that DBT and cognitive therapy are best for BPD. Right? 

Gillian:

What do you think of the combination of Klonopin, Neurontin and Remeron? 

Dr. Markovitz: 

correct 

Freaked: 

thanks 

Dr. Markovitz: 

Gillian, if it works it is great. If it does not, get on something else. 

Snowonthemountain: 

yeah, I am 42- does that mean it will get better in a couple years?

Freaked: 

just when I think I can handle this 

Entre2chaises:

Freaked, I found a therapist who understands BPD and works closely with a psychiatrist who is flexible. 

Dr. Markovitz: 

snow, it is a statistic. It should get some better, but never totally without meds and therapy 

Freaked: 

I think I’ve found one too 
he's got me going to an anger management group 

Dr. Markovitz: 

your lucky freaked. The good ones are few and far between 

Patty: 

Freaked, check out my page on "cognitive distortions" in the "fun" section of the website. I think what you may be doing is "catastrophizing." 

Entre2chaises:

Freaked, the drugs I started on didn't help so I went off meds completely for about 6 mos. 

Weepippo:

Dr. m what is my Risperdal for? 

Anast:

Dr. M why don’t people know about bpd? I have even worked in psych and I have never heard of it until 2 months ago upon diagnosis. 

Bingle: 

mine is excellent also. He works closely with me my therapist and any info I might come across. 

Entre2chaises:

Freaked, then I had a "meltdown" and the pdoc put me on Effexor. 

Weepippo:

Haven’t needed to be in hospital for a year 

Dr. Markovitz: 

weep, it is used to either calm folks down or get rid of psychosis. 

Entre2chaises:

Freaked, it's been definitely both therapy and meds that have helped me. My symptoms are almost negligible. 

Snowonthemountain: 

does it cause weight gain, Dr. M.? 

Entre2chaises:

OK, maybe "negligible" is a little optimistic. :) 

Dr. Markovitz: 

all the meds can cause weight gain in many but not all cases. Provigil helps to decrease weight and Serzone does not increase weight 

Ellie: 

is a bpd "specialist" really any better than a great "regular" psychiatrist? 

Anast:

where do I sign for the Provigil? 

Entre2chaises:

Weep, I tried Risperdal for a brief time to help with the constant "picking" I did... I was always picking at my face. 

Dr. Markovitz: 

yes ellie they are. Just like a cardothoracic surgeon is better with hearts than a regular surgeon. 

Ellie: 

Risperdol caused me to lactate, weep. :P 
 thanks, DrM 

Weepippo:

some will not answer patty 

Snowonthemountain: 

with meds and therapy it is reasonable to think we can overcome bpd 
? 

Dr. Markovitz: 

common symptom week. You can take meds to get rid of lactation if the Risperdol helps 

Gillian: 

Where do you find them, bpd specialists, in a phone book under psychiatrists? 

Anast:

DrM, can I blame my parents for my BPD?

Patty: 

Yes, I know Ellie. Most clinician's don't have a clue about the BPD. 

Dr. Markovitz: 

yes you can blame your parents for the genes, but not much else. You have control of your life, not them. 

Anast:

but I have many abandonment issues 

Dr. Markovitz: 

best thing to do for BPD as of now is to call a University based program. 
They see a lot of BPD and tend to have a savvy staff 

Freaked: 

Dr What causes BPD? 
Am I asking questions that have already been answered? 
lol 

Anast:

I was actually being flip, 10 people died in my family from the ages of 5 until 15, including my mother and my brother 

Dr. Markovitz: 

We have no idea what causes BPD. It runs in families, even if the kids are adopted away at birth, they get it 

Gillian: 

oh how sad 

Ellie: 

no one in my family has bpd 

Weepippo:

mine either 

Snowonthemountain: 

Dr. M.- if hospitalization is required during recovery, do you think that it is helpful to be hospitalized more than a week or so? 

Freaked: 

does Abuse cause it 

Dr. Markovitz: 

OCD, Depression and bipolar can be lesser forms of BPD 

Freaked:

like sexual abuse and severe bullying? 

Patty: 

Do you mean Dr. that if a BPD mother gives birth to a child and that child is immediately adopted out to a family with no major mental health issues, that probably that child will have the BPD? 

Dr. Markovitz: 

I do not believe abuse causes bpd 

Entre2chaises:

I have seen for myself in my own life and by meeting people on the Internet that recovery from BPD is possible, but it's WORK. 

Gillian: 

that’s for sure 

Snowonthemountain: 

my therapist told me I was trying TOO hard! 

Dr. Markovitz:  

Patty, there are no hard statistics. However, the odds are increase that the child will still have bpd 

Ellie: 

freaked, I think DrM said earlier that abuse does not cause bpd 

Freaked:

lol I’m a bit dense tonight 

Entre2chaises:

Dr M, abuse may not *cause* bpd, but couldn't it exacerbate the situation, make the symptoms worse? 

Patty: 

Thank you very much Dr. That info is very important for a parent of someone with BPD. There is much guilt on the part of the parent. 

Snowonthemountain: 

did you see my ? about the length of hospitalization? 

Freaked: 

so basically those with BPD should not have kids? 

Drewbug: 

no one will diagnose me with anything specific, other than "depression"... what good is that? I recognize all the symptoms of bpd in myself, and have had t's admit that... but no diagnosis 

Dr. Markovitz: 

No freaked. Have kids. First, they may not get it. 
Second, it is treatable 

Anast:

OK, this is off the wall, I have suspected that my grandfather is crazy for a long time, he died in a mental hospital, the death cert. says his death was caused by Broncho pneumonia, secondary was a confusional state, what exactly does that mean? 

Dr. Markovitz: 

Third, it probably will be curable in the next 15 years 

Entre2chaises:

Snow, I was in a hospital for 3 weeks for depression and not told of my BPD diagnosis. The 3 weeks were just right for me. 

Opalene: 

I think that we are extremely sensitive and abuse affects us more than others 

Drewbug: 

entre... did you go in voluntarily? because I've been considering that for a while 

Entre2chaises:

drewbug, you don't need the diagnosis to get better. 

Dr. Markovitz: 

Opalene, abuse does effect you more. 

Patty: 

I would love for the Sanctuary to go out of business due to a cure. 

Dr. Markovitz: 

But, it does not cause the illness. 

Snowonthemountain: 

that is why I want to know 

Drewbug: 

entre... makes me feel like I’m making the whole thing up without a diagnosis

Snowonthemountain: 

after Lori had to go in last weekend after doing SO good- it made me think about it 

Ellie: 

I understand how you feel drewbug, totally 

Entre2chaises:

drewbug, yes, I did it voluntarily because of harmful thoughts. 

Snowonthemountain: 

I just think I need to have a plan if the meds quit working 

Opalene:

I think that someday they will find a mind/body connection 

Snowonthemountain: 

right now if I had to go in I wouldn’t because of being put in handcuffs 

Dr. Markovitz: 

If meds worked once, they will work again. Heck the fact they worked indicates that it is something chemical 

Anast:

ok so no one is listening 

Entre2chaises:

drewbug, sometimes having a specific diagnosis in your medical history can cause problems down the road. 

Opalene:

You just can't possibly live with the stress that BPD causes without it affecting other organs of the body 

Drewbug: 

Dr. m... you really believe that? what if they stop working and nothing else ever does? 

Dr. Markovitz: 

Our entire self and body is controlled by our brain, so Opalene is right 

Drewbug: 

entre... I’ve heard that... 

Dr. Markovitz: 

drew, you know what you have is fixable, or they never would have worked The only crazy thing you could do would be to hurt yourself or not take meds. 

Snowonthemountain: 

I am asking inappropriate questions aren't I patty? 

Drewbug: 

Dr. m... hurt myself a lot... and I don't believe it's fixable, sometimes... what if I just *convinced* myself that the meds were working? 

Tim:

Is it wrong to consider my self in recovery from BPD since I do everything I can to minimize the effects of it in my daily life?? 

Entre2chaises:

anast, I think "back then" they didn't know what to call things. 

Anast:

so I should delve deeper? 

Patty: 

It is not inappropriate if it is something you need to know. 

Entre2chaises:

I guess, but I don't know what else you would find. 

Ellie: 

no way Tim. :) 

Entre2chaises:

I know my maternal grandmother had problems with depression, that my dad, his mom and her dad all had problems with rage. 

Anast:

that the bastard was a crazy f*cker and he screwed up my innocence 

Entre2chaises:

I guess you just put the pieces together the best you can. 

Dr. Markovitz: 

No one fakes getting better on meds, or they would just keep faking. Meds work or they do not. Usually when they poop out, you just need more, or a different one 

Drewbug: 

what about a placebo effect? 

Dr. Markovitz: 

Keep fighting to be well. It will work at some point 

Patty: 

Yes, I believe we can all get better. 

Entre2chaises:

Anast, that's a whole another thing 

Dr. Markovitz: 

If there is a placebo effect, it would keep happening. In our controlled trials we had ZERO placebo effect 

Snowonthemountain: 

it is really a very anxiety producing issue for me right now- when your meds quit working as I suspect has happened and hospitalization is necessary- and you have been traumatized by handcuffs before- it is very difficult to think of that as an option 

Gillian: 

great 

Entre2chaises:

anast, sorry if I said anything... 
I was trying to help. 

Anast:

I know entre 

Entre2chaises:

I didn't know you were in a hard place. 
I've been there. 

Ellie: 

could two years of anorexia (age 14,15) have caused brain changes that may have led to my BPD diagnosis? 

Weepippo:

Snow I have been there also and I agree with you. trust is very hard after that 

Anast:

no entre its not you, I just wanted validation from the death certificates and I didn’t get it 

Dr. Markovitz: 

anorexia is usually a precursor to BPD, but not caused 

Snowonthemountain: 

then what do I do? 

Dr. Markovitz: 

the cause of BPD 

Ellie: 

okay, thank you 

Entre2chaises:

When my step-grandfather died, his molestation of children came out from the family members he had molested. 

Freaked:

ok this is getting a bit triggery for me 

Entre2chaises:

Sorry, freaked. Thanks for saying so. 

Dr. Markovitz: 

entre, it looks like molestation may be chemically induced, too. 

Ellie: 

yes snow 

Drewbug: 

has anyone had a productive experience in the hospital? or is the thought of taking a break from things just some kind of dream? 

Entre2chaises:

snow, there weren't any handcuffs where I was hospitalized. 

Skreee:

maybe we should slow the speed down a bit again? 

Snowonthemountain: 

I do not want to be put in handcuffs again! 

Gillian: 

My hospital stay a year ago helped me very much, or I wouldn't be getting the help I needed now 

Dr. Markovitz: 

psyche hospitals are emergency rooms. It is a tough place to be. Handcuffs are not part of our hospital. 

Patty: 

My experience in the hospital was extremely positive. It was also not a county hospital. When you are at the point in your life when you are unable to care for yourself, it is nice to be taken care of until you can become stronger. 

Gillian: 

nor where I went 

Snowonthemountain: 

my only choice is the state hospital 

Gillian: 

I found the county hospital had better therapy than the very nicely decorated one 

Drewbug: 

how would one go about checking into a hospital anyway? and what if I couldn't get back out again? 

Jedic: 

I was in a private hospital last time and they helped me the most of any hospital I've been in.

Snowonthemountain: 

that is what I am afraid of 

Patty: 

You become handcuffed when you call 911 if you are suicidal. They do that to protect yourself and them. 

Tim:

I grew up in psych hospitals I think working in the medical library for 2 yrs was a precursor for me becoming a nurse 

Gillian: 

no your not anast 

Dr. Markovitz: 

One or two good staff people at a hospital is all you need 

Anast:

Dr M I was one of those good people and where did it get me? 

Entre2chaises: 

I checked into the hospital by calling their help line. It was a private hospital but my insurance covered it. I had a great experience there.

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