A. If I understand your question correctly, you want to know whether you have borderline personality disorder vs. major depressive disorder (MDD). You seem to meet some of the criteria for borderline personality disorder and depression. It’s also possible that you have bipolar disorder (vs. your current diagnosis of MDD, not in addition to). Some of your symptoms match that disorder as well. Please keep in mind that I can’t be certain of your diagnosis. I would need to meet with you in person and review your extended personal history, but based on the information provided, borderline personality disorder or bipolar disorder are plausible diagnoses. These are possibilities, not definitive diagnoses.

You also want to know if it’s possible to be born with certain problematic traits or personality characteristics. This is a matter of long historical debate. It is a question of nature vs. nurture. In essence, you want to know if you were born this way or if your environment shaped your personality and led to a mental illness. Science has not determined the answer to this question. Some believe mental illness is purely a brain disorder and the problem is caused by a chemical imbalance. Some believe that behaviors are learned or that our parents and the way we are raised shape our personality. Many theories exist but none have been definitively proved. Many scientists believe that mental illness is a result of a complex combination of biological or genetic risk factors and environmental stimuli.

I usually try to discourage people from focusing on gaining an exact diagnosis. There are two basic “schools of thought” on whether a mental health diagnosis is helpful. On one hand, if an individual suffers from a series of symptoms and then learns there’s a name for this specific set of experiences, it can be a relief. It can also be a validation. On the other hand, learning of a specific diagnosis is not always very informative. Nor is it easy to know whether the diagnosis received is accurate. Mental health diagnosis is not an exact science. In addition, getting a diagnosis may make an individual feel upset, overwhelmed, hopeless, and even stigmatized.

What’s most important is that you find a way to relieve your symptoms and live a happy and fulfilled life. Troublesome symptoms make it difficult to function. It can make life miserable and you unhappy. You may not need medication but at the very least, consider individual therapy. You mentioned that you have problems managing your mood. Therapy can help with this. You also said that you are struggling with relationship/marriage problems. Again, this is the type of issue for which therapy could be very helpful. Try asking your general practitioner (I’m assuming this is what you meant by GP) or your psychiatrist about referral to counseling. You may also want to try searching this therapist directory. Thank you for your question and I wish you the best of luck.

After becoming aware of her condition, I tried to learn as much as I could about bipolar and realized that she meets every criteria there is except for the promiscuity and spending sprees.

My wife’s suffers from auditory hallucinations. In April, she tried to overdose on clonazepam. After telling me what she had done, she starting to throw things at me saying that she “needs a break” and made a beeline for the door. Since I was afraid that she might run into the street, I grabbed her pushed her onto the couch and called 911. Very little was ever said about this “incident” until much later.

A few weeks later, her new psychiatrist took her off all previous meds and put her strictly on Topamax. By the first of June, she began a downward spiral. She initially went into a deep depression and became very withdrawn. This was followed by countless days with very little sleep and an obsession with Facebook.

In early August I had to go out of town for work and had to send my wife to stay with family in Massachusetts for a week. Upon arriving, she informed me that she was never coming home to Florida because she was scared of me and didn’t trust me. She refuses to talk about us. She tells me that she loves me and she has never mentioned divorce herself. Yet she seems to be making irrational plans for her future that seem so permanent. She told me not to come visit her.

A few days ago she agreed to go to the hospital after the voices told her to harm herself. According to my wife, the doctor told her that she simply had Obsessive Compulsive Disorder and that the voices were her own thoughts because she worries too much. Yet he prescribed Zyprexa which I have learned is for schizophrenia.

What is wrong with her? Can the symptoms that I talked about have anything to do with OCD? Please help me. I love her so much and want her to be healthy.

A. Your wife was originally diagnosed with bipolar disorder but it may not be the correct diagnosis. You also said that your wife was told that she has obsessive compulsive disorder (OCD). She may have bipolar disorder in some capacity and she may also have obsessive compulsive disorder but there is a realistic possibility, given the symptoms you have described, that she also has schizoaffective disorder or schizophrenia. Schizoaffective disorder is like having bipolar disorder and schizophrenia. Typically schizophrenia or schizoaffective disorder is diagnosed when the individual experiences psychosis. Psychosis is a break from reality. It means that an individual no longer believes in things that are logical and rational. Psychosis presents itself in the form of delusions, hallucinations or paranoia. It seems that your wife is experiencing voices and paranoia. The paranoia is directed toward you. This may explain why your wife decided to abruptly leave you and move to another state.

I would advise you against taking her decisions personally. She is not thinking clearly. She is psychologically ill and is unable to form coherent thoughts at this time. I understand your fear and concern in this situation. Anyone in your position would feel this way.

I have several recommendations for you. I would advise you to read about bipolar disorder, schizophrenia and schizoaffective disorder. There is a realistic possibility that she has at least one of these disorders. Please keep in mind that from my vantage point it is difficult to know this for certain, but based on your description of her symptoms it may be a possibility.

The second recommendation, as I a mentioned before, is to try not to take her symptoms personally. This is difficult to do, especially as her husband. If your wife mentions that she no longer wants to be with you and wants a divorce, I understand it is extremely difficult not to be hurt by this, but please keep in mind that she is not rational. She is unable to make clear decisions and her thoughts are likely being driven by paranoia and delusions.

A third recommendation is that you surround yourself with support. If you don’t have friends and family for support (and even if you do) contact the National Alliance for Mental Illness (NAMI). This group is designed to help and support individuals who have a loved one with a mental illness. Many of the individuals who run the NAMI support groups are seasoned veterans of mental illness and the mental health system. They can be a great resource for you.

My fourth and final recommendation is that you try, when possible, to be involved in your wife’s care. She may not want you to attend doctor’s appointments or visit her in the hospital but you should go anyway. She reported to you that a doctor diagnosed her with OCD, told her it was this disorder that was causing her to hear voices and prescribed her medication for schizophrenia. As you pointed out, this information does not make sense. It may be that she does not fully understand what the doctor is saying, possibly due to her symptoms. It is important that you attend her appointments and hear what the doctor says versus having her tell you what she thinks he said. It is also important that you attend the appointments to ask questions and to get the doctor’s advice about how you should handle this situation. Whenever possible, speak to doctors and social workers, but keep in mind that you may have to ask her permission.

I hope this answer helped you in some small way. If you have further questions please do not hesitate to write back. I will do my best to answer any questions you have. I wish you the best of luck.

It’s very complicated, but I’ll try to explain as best as I can, because I desperately want to know what is wrong with me.

I am sad. All the time. I feel lonely, and needy. I loathe myself. I purposely push myself away from others, before they can reject me (which they surely would.). I hold things in for long periods of time and slowly let the pour out. I cry a lot.

Sometimes I cut myself. I’m not always sure why I even do it, but most times it’s to numb the pain inside me, to distract myself. I have picked on my younger sister since we were toddlers and I can’t seem to stop. It brings me all kinds of guilt. Thoughts come into my head, as if someone else is thinking them. I want them to stop, but they never do.

I have dreams that are very random and often disturbing. I think about ways to kill myself frequently, and occasionally about killing others. But I could never kill another person, I tend to empathsize with people to an extreme level. It seems like I am constantly looking over my shoulder, expecting someone to be there.

I seldom feel wanted. I don’t want to tell anyone, yet I desperately want help. I can’t hope, I believe it is stupid. I feel helpless, and lost. I feel like I am alone is this world. That I’ll never get better, that I’ll always be damaged and unwanted.

I am never hungry, yet I eat grand amounts. I stay awake at night and want to sleep during the day. I feel the need to distract myself from the real world, and hide my pain. If I read about famous people who feel or felt the way I do, I usually become obsessed. I have recently discovered that “my” goals, were actually just what my parents wanted, that my whole life I’ve just wanted to please them.

For some reason I can’t step on cracks and lines in the sidewalk or on tile. I don’t know why, I just can’t. It feels unsafe and scary. I am terrified of elevators. I take stairs if possible. If not, I squat in the corner, and that makes me feel more safe. I have a hard time trusting people, in fact I don’t even trust myself. Sometimes I have trouble focussing on one thing for long periods of time. I don’t like public areas or speaking in class or even to classmates because I know I’ll say something stupid. I am fat and ugly and worthless, at least in my eyes.

I know I’ll never amount to anything. I resent people who try to “help” me, or counselors at school who think they know how it feels to be me. I hate many things. Hate, not dislike. My sister has Bipolar disorder (She’s my half sister, but my cousin on the side we share has it, too.) and I think maybe that puts me at risk for similar disorders, I’m not sure. I don’t know. I really don’t.

I just want to know what’s wrong with me, and if I can find someway to get help. I’m not sure what I’ll do…. or if I even will… Sometimes I feel like I’m just putting on a show, that I want attention, but that is just a sad hope. I long to be normal and interesting. I wish I could accomplish something. Anything. But I usually talk myself out of doing things like that, to excuse myself from the embarassment it’ll surely cause.

Something most people don’t know is the year after my house burned down and we moved (four hours away from everything I love) My grandmother died. She was like a second mother… ANd everyone acts like it was no big deal.. Am I a baby for feeling so crushed over it? Everytime I think of her there is this sharp pain in my chest and I usually cry for an hour… I remember her promise she never got to keep (”I’ll be right back, honey. I promise.”) and how she looked while she was in her coma.

It seems like I latch onto people I love and I fear their death. I frequently end up crying from the mere thought of my family dying. I have these images that feel forced inside my head of them dying, or getting hurt. I have a friend that verbally,emotionally, and occasionally physically abuses me, yet I can’t leave her. She’ll be moving and it is tearing me up. Am I insane for feeling so attached and loving to her? She’s nice a lot of the time, and she’s the onl one who truly understands me… I don’t know. I’m just in this war raging inside of me. All I want is answers. I hope someone can answer them. (Sorry for the lack of organization of my thoughts, I’m bad at keeping my thoughts together.)

A: Hello and thank you for your letter:

It sounds like you are going through some horrible things right now and I’m sorry that you are suffering.  I could say something stupid like, you’re young, you’ll be fine, but in all honesty, you won’t feel fine for awhile. You are confused, scared, angry, tired, and very, very depressed.  Thoughts of killing yourself or someone else are normal when you are feeling this terrible.  You are absolutely right in saying that you need help. You do need some professional help, and maybe even some medications. School counselors are good at what they can do, but they are often limited by time and the ability to prescribe medications.

You are just entering adolescence, the hardest part of your life, and to have it complicated by losing your beloved grandmother, your home, your friends,  and all the pain you have suffered makes this time nearly unbearable. This time of your life is supposed to be about discovering life, yourself, and how to function in the real world. Unfortunately, right now you are grieving losses.

The good news is that you will work through these things. We never “get over” losses, but we grow through them.  It will probably take another year, but things will begin to look better.  You have every reason to be afraid of losing more people. You have learned too young and too deeply that tragedy can strike. It’s not fair, it’s really not. Being afraid of losing more things like your home, your friends and your family is a normal response to a very abnormal group of tragic events. That just makes us want to cling even more strongly to those things and people who are important to us. As far as being supportive, other family members and friends often don’t want to talk about things because they are hurting too.  They fear opening up wounds that are just beginning to heal, and avoid discussion. Not healthy, perhaps, but a very common way of coping.

You mentioned the mood swings and the fear that you may be bipolar. It may be possible. But the only way that you will be able to find out is again, by going to a doctor.  You should also get a medical checkup, since that can rule out things that can make you tired, etc. What I would suggest is that you ask your family to get you to a doctor who can diagnose what is going on with you and perhaps prescribe something that can help. A child psychiatrist would probably be best at this time, since your pediatrician probably doesn’t specialize in depression, loss and mood swings, let alone cutting.

Also, ask your parents if they will take you to a professional child therapist, and you can locate one in your area at Find A Therapist. 

But, understand this: if you take one thing away from what I have written, I want you to know that you are NOT damaged. You are depressed, wounded, and very sad. But not damaged. You are a very bright (yes, I can tell by your writing), honest, good hearted young lady and you deserve the best help that professionals have to offer.

I hope this helps,

Dr. Diana Walcutt

A. Therapy can help you. You fear it but you already know the expected outcome should you decide against it. You’ll likely continue to silently suffer as you’ve done throughout your life. Isn’t it time for the suffering to end?

You’re not emotionally stabilized. One day (sometimes even on the same day) you’re deeply depressed and the next you’re the exact opposite. It’s not normal to vacillate between emotional extremes. Though the description of your symptoms was limited in length and detail, it seems that a bipolar-type disorder may be present. I cannot diagnose you over the Internet but there is a bipolar aspect to the symptoms you’ve described.

What is remarkable and encouraging is that you’re able to cope with your children despite your highs and lows. The concern is that you won’t always be able to maintain this ability. If you are indeed “quite ill mentally” as you suspect, then you can’t be certain of how you’ll behave in the future.

Seeking treatment for your mood instability would be a wise decision. Do it for yourself and especially for your children. Children need and desire consistency in their caretakers. It makes them feel safe, secure and protected. Mood instability by its very nature is unpredictable and can promote feelings of insecurity in children. Children need to feel safe around their parents and in their home environment. It’s essential for healthy psychological development.

Getting help is nothing to be afraid of. Nothing bad can happen to you or your children. Quite the opposite is true. Therapy can help you learn how to control and stabilize your moods. Since you’re not a resident of the United States I don’t have a link or a reference to give you that would help you locate a therapist in your community. I apologize for this. I searched for a national website or reference but couldn’t find one. I hope you reconsider therapy and are able to find help in your community. Thank you for writing.

My husband is bipolar. We are just now discovering this. In reflection, it is obvious that this has been a problem over the 25 years we have been together but it escalated last year. He is getting treatment and wants to be well. There are many things that he is overly guilty about that don’t really matter and on the other hand he admits to being sexually promiscuous over the years (unfaithful countless times) and feels no remorse. He also says that he has no feelings for me, that our relationship has been farce. We have had a good relationship for 25 years, and we have been great friends, we have raised 4 children together. Is it possible that his disorder is affecting his perception of how he really feels about me? He still acts the same towards me as he always has, he is affectionate to me, and he not leaving us. But when we talk about our relationship he says he has no feelings for me and he never has. It doesn’t add up. Is this the disorder creating false feelings for some reason? Please advise, thanks.

A. Based on your letter, your husband’s statements are not consistent with his behavior. You’ve described your marriage as being very good over the past 25 years. You’ve been great friends and you’ve raised four children together. He’s in treatment and seems to be managing the bipolar disorder well. It’s unclear why he would continue to behave positively toward you if he truly meant the negative things he said. Perhaps there has been a miscommunication. Something is amiss and it may simply be that his words have been miscommunicated or misinterpreted. He may also have said something when he was angry and didn’t mean what he said.

It’s unclear what effect his bipolar disorder may be having on this situation. If he were symptomatic that possibly could explain the discrepancy between what he says and how he acts. I would need to have many more details about this situation to determine what if any effect bipolar disorder may be having.

The good news is that, despite what he says, the two of you continue to have a fundamentally strong relationship. He is affectionate, has not changed his positive behavior toward you and he has no plans to leave the family. As the adage goes, actions speak louder than words. He’s acting as though he’s happy with you and the marriage and that is encouraging. Marriage therapy may help the two of you rectify what seems to be a lack of clear communication. Thank you for your question.

A. You may be past the point of diminishing returns. There may not be anything left that you can do for your son. It seems as though you’ve tried to do everything for him and nothing works. He continually disobeys your rules and gets into trouble no matter what you do for him.

It’s very admirable of you to want to help your son and to want to ensure that he doesn’t wind up homeless. I can understand why you would want to prevent this. He’s your son and you don’t want to see him living on the streets. But you are doing this at the expense of the health and well-being of you and your husband. You’re doing all you can and it’s still ineffective. You are degrading your life to assist someone who may not be able to be helped, at least not at this point in time. You may have to make the difficult choice of letting go. I suspect that the help you are giving your son enables him to continually engage in problematic behavior. He may be bipolar but he is also an adult male who seemingly has no responsibilities. Has he never been forced to fend for himself? He’s probably never had to fully experience the consequences of his behavior.

I know what I’m suggesting may not be easy or what you want to hear but it may be the only correct way to handle this situation. Things may have to get worse for your son before they get better.

I would suggest that instead of or in addition to NAMI meetings, you and your husband consider seeing a therapist for guidance on this issue. It’s not going to be easy to change the way you interact with your son but it may be the only thing that saves his life and yours. If he won’t change his behavior then you must change yours.

In 2003, I sought treatment for what was the latest of several major depressions. It was a different kind of depression, as if I had been visited by every type of bad mood I had ever had, along with a sharp spike in my chronic insomnia. My primary care doctor prescribed Lexapro, but I did not improve. At six months, I was worse, and it was as if some irrational, bitchy, sleepless, weepy, hyperactive, anxiety-ridden woman had taken over my body.

After a year of this, I made an appointment with a psychiatrist and was diagnosed with bipolar disorder. It took almost another two years to get stable. My life was so awful, I found it almost unbearable, but the doctor, the therapist, and my husband all told me to be patient–the results would come. I got through it. My friends were not so resilient; they ALL bailed out as if they were embarrassed to know me. I was hurting, I was frightened, I was frustrated, but I was not badly behaved nor had I done anything to embarrass anyone except myself. Long before I got well, I realized I had been abandoned.

Overall, my life is better, but I still have no friends. I have acquaintances, I have an Internet friend who lives 800 miles away, and I have a lovely husband. My life is very busy and I work with people in a “helping profession” all day long, so I’m not isolated or withdrawn. I am terribly lonely, though, but I don’t know how to get past it. I can never, ever divulge that I have this illness. I know first-hand how well tolerated that information is. Having seen how quickly I was left alone by people who had known me for 20 or more years, I can’t see leaving myself open to that kind of betrayal again. It’s quite a conundrum. I am already exhausted from leading a life where I diligently manage an illness that can be unpredictable under the best of circumstances, so I can’t imagine how much trickier it would be to do that with someone who is new in my life.

How can I find a way to be more content with my situation? It’s really on my mind right now because I had a birthday this week and as is the way now, there were no greetings from anyone other than my husband, my mother, and my brother. Then again, that’s more than a lot of people get, right?

A. With regard to your friends leaving you after learning of your bipolar disorder, you did not specify the nature of those relationships. Were you all very close? Did you talk every day or only on special occasions? Did they live close by? Knowing the answers to these questions (and others likes these) might have provided some insight about what type of friends you were.

There may be several reasons to explain why they left. Maybe they weren’t your “real” friends. Sometimes people misjudge the quality of their relationships. It may be that you never really had a true friendship with them. If they were never “real” friends then the fact that they abandoned you isn’t surprising.

There may be other reasons to explain the behavior of your friends. It’s possible that you acted in a manner that drove your friends away. You mentioned that early on in your treatment you were “irrational” and “bitchy.” I am wondering how “irrational” and “bitchy” you were and in what ways? Perhaps it was partly your behavior that led them to end the friendship.

Another explanation is because you have bipolar disorder. I remember receiving a question from a mother a few years ago with regard to her daughter befriending an individual with a mental health disorder. The way in which the question was worded was essentially “how can I stop my child from being friends with this individual who has a particular mental health disorder?” I mention this because it was an example of stigmatization at its worst.

Unfortunately there continues to be a stigma attached to individuals diagnosed with mental health disorders. It’s a large part of the reason why some people never seek help for their mental health problems. You may have experienced this firsthand with your ex-friends.

Without knowing all of what happened, the nature of the relationships with your friends, exactly how you behaved towards those individuals, etc. my ideas about why your friends stopped contact are speculative.

With regard to making new friends, my general advice is not to reveal a mental health diagnosis early on in a new relationship. That’s because, as you may have experienced, it can be difficult for people unfamiliar with mental illnesses to fully understand mental illness. Unfortunately people still believe in myths regarding mental illness.

You desire more friends and are disappointed because you feel you do not have enough. Instead of being down on yourself for not having enough friends why not use this opportunity to find new friends? Are you engaged in social activities? This might be a good way to make new friends.

You also asked how you could be content with your current life as it is. Here is one way: Appreciate the reality of your life. I am not sure if you realize it but you have much to be thankful for.

You finally have the bipolar disorder under control. That took years. Now you’re stable. This is something to be happy about.

You are a physically healthy woman. Don’t take your health for granted. Realize that many people live with painful and horrific illnesses for which they’d give almost anything to live a day disease- or pain- free.

You have a loving husband. Many women cannot say the same. You’re very fortunate. You also have a career in a helping profession. This gives you an opportunity to help and be kind to others.

There seem to be many positive aspects about your life. Appreciating the personal richness of your life hopefully will help you feel content with what you have and stop you from focusing on what you believe you don’t have.

I have been treated for bipolar I for 12 years/now added dx of BPD. I am 54 years old & was have been treated for bipolar I disorder for the past 12 years with medication & seen different therapists on & off who have not been very helpful. The medications (I took a combo of 6) helped very much until I had a period of 5 mos. of hypo mania & didn’t report it to my meds provider as I didn’t know it was dangerous & it felt so good. My husband made a negative comment to me about the weight gain I have had (50 lbs.) since being on these medications & I overdosed. I had been relatively stable for 5 years before the episode of hypo mania & was seeing my provider every 6 mos. for check-ups since I was doing well.

I have had a very hard time with my moods since I was 15 when I had my first suicide attempt. My mother was also bipolar & committed suicide when I was 15 after many attempts & hospitalizations. My childhood was very chaotic with her (she was psychotic often). My brother claims she sexually abused him. I don’t know as I cannot remember much of my childhood at all except sort of “snapshots” of her calling me a whore (when I was 11 years old & didn’t even know what the word meant) & examining my genitals for venereal disease & locking me in the closet when she had her boyfriends visit or my father driving drunk & I would be crying & begging him to stop & he would be angry at me. In fact, he was very angry at me after my suicide attempt, too, as the boarding school where he had dumped us kids after my mother’s death made him take me home for 2 weeks “to get help”–which basically meant he left me alone while he went off to do whatever he was doing. He was an alcoholic & absent much of the time so sometimes I had to call the police when my mother was beating up my brother.

So since my overdose 2 1/2 years ago I’ve been in a mixed–moderate state & not doing too well (according to my meds provider’s diagnosis on the insurance form). She’s been changing some of my meds & I started dialectical behavioral therapy as someone in my support group said how helpful it was & I have found it to be VERY HELPFUL & VERY HARD to practice all that I am learning, but it is giving me such hope that I don’t have to live at the mercy of my out-of-control & over-reactive emotions. I am finally starting to get over my suicidal thoughts & making some progress in repairing my relationship with my husband.

He had no idea I would react as I did. He is remorseful & says we all have our faults & that our marriage is 90% good & we need to focus on that. We have companionship, etc. I can no longer even think about having sex with him as my self-esteem was destroyed with his remark.

I’m having a hard time trying to give the right info. so you can address my question! I have all the symptoms of bipolar–excessive spending, deep depressions & hypo mania (never full blown mania), mixed episodes, paranoia (thought my husband wanted me to kill myself) & delusional thinking (thought my husband was planning to poison me), insomnia, anxiety, etc. Also binge eat & binge drink & have feelings of unreality where I don’t feel “real”–like I’m a vapor or I look around & the world is not real. I “lose time”, have a very hard time being appropriate in that I reveal too much to people (blurt out info. about my mental illness or suicide attempts) so I feel like I’m not “safe to be out in public” & isolate myself. These do sound like symptoms of borderline from what I’ve read.

I’m very dependent on my husband’s approval & am constantly trying to read his facial expression or body language to see if he is “thinking bad thoughts” about me–though the DBT is helping me get over that. We have been married for 34 years & it is still hard for me to believe that he really loves me.
I started individual therapy with the therapist who is doing the DBT group & I noticed on my insurance form she put down the diagnosis of bipolar & borderline personality disorder. Can I have both or is she just seeing that because that is her focus?

I have been able to decrease my dosages of Lamictal & got off Abilify (caused weight gain) & Klonopin (mindfulness helping with anxiety) & Trazodone (insomnia is much better). Added Topa max to help maybe lose weight.

Since the symptoms overlap so much can I have both?–yet one is biologically based & the other has more to do with trauma (can’t remember any specific trauma though my therapist does say a lack of parental nurturing is trauma & I definitely did not have any nurturing or a feeling of safety in childhood or really any time at all except from my husband & that feels very fragile). And then there is the issue of treatment. Bipolar seems to require meds & borderline not. So do I need to take meds?

A. You’ve asked a number of specific questions but first I wanted to make a general comment about your letter. I hope that you are proud of your progress. You endured neglect and abuse by your parents. You were left to essentially fend for yourself as a child. No child should have to go through what you did. Your parents’ treatment of you (and your sibling) left you in the unfortunate position of essentially having to raise yourself. You had no guidance, no mentor, no stable individual in your life to teach you how to behave, to manage life, to think, to feel, to manage emotions, to encourage your psychological growth, etc. Now as an adult you have to heal yourself from all the damage your parents have done. It’s unfair but you are making a major effort to change and you are seeing progress. I hope you continue to work with your DBT therapist and support group.

With regard to your questions, it is possible to have bipolar disorder and borderline. They are similar in some ways but different in many others. Bipolar disorder may also be related to the trauma you’ve experienced.

Keep in mind that some believe that bipolar is biological whereas others do not. Science has not definitively identified the cause of this disorder (or any others). The same is true for borderline personality disorder. Some believe it’s biological but others would disagree. Until science has a clear-cut answer there will continue to be differing opinions.

Medications are typically helpful for individuals with bipolar disorders. Medications have been shown to be less effective for borderline personality disorder. The best treatment for the latter disorder is the one that you are currently engaged in, DBT. If your doctor believes that medication is helpful for the bipolar disorder at this time then it best to stay on the medicine, especially because it seems that you’ve finally found a medication combination that works for you.

Between your DBT, individual and group therapy and the medication, you seem to be engaged in all of the correct treatments. I would add that you should inform your therapist or your psychiatrist about the symptoms you continue to experience. Overall, however, you seem to be on the right track. Keep up the hard and effective work. Thanks for writing.

My husband has manic episodes…what is wrong with him? I am desperate. My husband has something wrong with him but he does not want to go to the doctor. I have read about so much and I still do not know what it is that is wrong with him. He has manic type episodes. He can be totally fine and then all of a sudden get mad about absolutely nothing, like losing a video game. He is a very religious and loving person but when he gets this way he curses god, says he hates god, says he wants everyone to die, tells me he’s going to kill me, hits me, chokes me, breaks things without any regard to what they cost. We have lived in our new apartment for a month and we already have two broken windows for example. He goes absolutely insane. It seems like he has no concept of reality. He says crazy things, talks a million miles a minute, screams, hits himself, scratches his face, pulls his hair out. The episodes last no longer than an hour and happen at least twice a month (approx.) After the episodes he is normal but tired. Most of the time the episodes end with him falling asleep. He never goes into a depressive state. No legitimate guilt to speak of. He doesn’t seem to understand the severity of his actions. About half of the time he is drunk during these episodes. The other half he is sober. He has been clean from crystal meth for about 6 months now…I’m thinking that may have something to do with it. What is wrong with him?

A. It’s not clear what’s happening with your husband. As you suspected, he may be having a manic or psychotic episode and much of it might have to do with the fact that he is using alcohol at times. These episodes may also be related to his past use of crystal methamphetamine. Yes, he is currently not using the drug but it’s possible that it’s still having an effect on him, perhaps because of brain damage. It’s difficult to know what precisely causes his episodes. He would have to be evaluated by a physician or a psychiatrist to know for certain.

You should also know that these periods of mania or psychosis are potentially dangerous for you. You noted that he goes “absolutely insane” and has “no concept of reality.” When these episodes occur he tells you he’s going to kill you, he physically abuses you, chokes you and destroys the apartment. Afterwards he has no recollection of what had occurred. The fact that he could engage in such destructive behavior and then have no recollection of it should be a major concern for you. He could “accidentally” hurt you or himself.

The next time one of these incidents occurs I would strongly suggest that you call for help. You may have to call 911 and have the police come to your apartment as a way to calm him down. The other option is to call the local crisis mental health team to help you deal with the situation. Please realize that this is a dangerous situation. He has episodes in which he loses complete control and attempts to harm you and himself. None of what you described is “normal” behavior. As I mentioned earlier, there may come a time where he actually does inflict great harm on you or himself. If you call the authorities or the local crisis team then they may be able to help you get him into treatment or at least, temporarily place him in a hospital where he can calm down and be evaluated by the appropriate mental health staff.

The truth is that he needs to be evaluated immediately. Please don’t risk endangering your life or his any longer and call for help when one of these episodes occurs. Calling for help when he has an episode may be the one and only way you can get him in for an evaluation or into some form of treatment. Thanks for writing.

After years of extremely abusing prescription pills and experimenting pretty much everything, my sister, age 27, has been diagnosed with Bipolar disorder. Until the past year, she was 100% functional, she went to school, work, and could have relationships with family and friends.

Within the past year and a half, she has quit school, moved home (in with me (age 21) with my husband and infant child), and became incredibly consumed in her drug life and the people whom that brings. This has caused many marital problems and we have asked her many times to move out. She straightens up long enough for us to say she can stay, and she goes right back to her old ways.

She blames ALL of her failures and problems on her Bipolar disorder, and cannot take responsibility for anything. She has been off work for a month, frankly because she talks her doctor (who is a Nurse Practitioner) into letting her been off work for weeks at a time. And when she is scheduled to go back, calls her doctor over and “emergency” and gets another week off.

She is EXTREMELY dramatic, and will do practically anything for attention. She says that no one in the family loves her and only her druggie friends are there for her.

Well, this week we have all cracked. We gave her the ultimatum to come home (she was incredibly wasted and couldn’t drive, so i offered to pick her up) or pack her bags, and she didn’t come home till the next day, so i called her and told her that she had to go. The next day she checked into a psych-ward in a neighboring town. You might see this as her trying to help herself, but i don’t. She knew that I have told the family that i am fed up. Fed up with her drama, her keeping drugs in my house, her causing problems, and her bringing questionable people around my child. My husband and I have never been into drugs, and felt sorry for her. She has used this against us.

My question in the end, even if the Bipolar disorder is “not her fault”. Could the Extreme pill addiction (that she still has) be affecting her Chemical imbalance??

A. You’ve done a lot for your sister. You gave her shelter when she needed it. You’ve taken care of her for longer than you probably should have given the fact that she was using drugs around your child and bringing shady people into your home. She might have bipolar disorder and that is unfortunate but she also is an adult who is irresponsibly engaging in drug use around your child. That type of activity endangers not only your child but also you and your husband. Given these circumstances, giving her an ultimatum was the correct choice. I know it was difficult because you’d hate to see your sister suffer but you have a family that you need to care for and protect. She was endangering your family and so she had to go.

I am not sure I understand your question regarding extreme pill addiction and how that might affect her chemical imbalance. If you are asking whether drug use worsens bipolar disorder the answer is yes, usually it does. It’s not clear whether the drug use led to the bipolar disorder or vice versa but undoubtedly drug use negatively impacts bipolar disorder symptoms.

It was very thoughtful of you to take in your sister when she needed help but it was the correct choice to make to ask her to leave when she began using illegal drugs in your home, around your child. Hopefully in the future she can get the help she needs and then it may be appropriate to allow her back into your home. You can and should support her in her attempts to get help even if they seem half-hearted. Addiction is a very difficult problem to overcome and it usually takes addicts many attempts to finally quit. With your love and support she might someday be able to beat her addiction. Thanks for writing.

After years of being treated for bipolar i may have been misdiagnosed. I’ve been taking lithium for bipolar disorder for over 7 years and for the last 5 years have been on the lowest possible dose that when i get my levels taken it shows a barely theraputic level. From about 15yrs old to 17yrs old i suffered with depression and social anxiety with no manic episodes whatsover. I was taking Zolaft and Busbar but not religously at all. i would skip and than over medicate myself while taking drugs and alchohal. During that time i had 1 major manic episode that landed me in the hospital. Since then I’ve been on lithium which the depression subsided after a year or so and I never had a manic episode again. my doctort says he would like to try and wean me off. He believes my original diagnosis of bipolar disorder may have been mistaken for a mild mood disorder. I was both happy and extremely frightened by his report. I would say the past 5 years of my life I’ve never felt more emotionally stable and happy. However; what if my doctor is wrong and i fall back into a major depression or have an episode? I went through a lot of pain and treatment until i finally got things right. Basically my question is what is the success rate when a patient with bipolar disorder is taken off of their meds via instruction and monitring of their doctor? Any feedback would be more then appreciated as this is one of the hardest decisions i am facing in my life.

A. I do not fully understand why your doctor wants you to come off the medication when you seem to want to stay on it. You said that for the last five years of your life you have “never felt more stable and happy.” There may be other factors involved in why your doctor wants to wean you off of the medication that you did not report in this letter. Are you having side effects from the medicine? Does your doctor feel the medication is harming you or holding you back? I am not sure I fully understand the reason he is advocating that you stop the medicine when it seems to be working so well for you.

On the contrary, your doctor is suggesting that you come off of the medication at a seemingly slow and well-controlled rate. He seems committed to monitoring every step in the titration process. For you this should be comforting. If he believes that coming off of the medication benefits you and he is willing to monitor this process and make adjustments when necessary, then it seems like it might be a very safe choice. If you begin to come off of the medicine and you develop symptoms I am assuming that you would be able to restart the medicine. If this is the case then this may be a “win-win” situation for you. If you come off of the medicine and feel fine then it’s great that you won’t need the medication any longer. If you slowly titrate off of the medicine and find that your symptoms return you can restart the medicine that you and your doctor have already determined keeps you stable. Based on the information you’ve provided in your letter, it seems like a “win-win” situation for you no matter what you decide. I hope this helps.

My best friend has self worth issues. I know that for a fact. She started dating this guy almost 3 months ago. He is a well known player so she was skeptic at first. He always pays for dates and he is always getting her gifts. Since their third date she has been showing up with bruises on her arms, sometimes bite marks. They started out little and worried me a little, but I trusted her judgement and dropped the subject. She went from becoming unsure about him to head over heels in love with him in one week. By the end of the next week she gave her virginity to him. From what I know of her and what she told me, he guilted her into it. She is very naive. She doesn’t hide bruises and shows me the ones on her stomache from him “tickling” her. She acts like the bruises never hurt when she gets them. Ever. He calls her a slut and whore all the time, but he is “just kidding”. He tells her he is cheating on her all the time also. (I know for a fact that this next part happened exactly as told.) They were at youth group and he jumped on her back for a piggy back ride and then started asking around for someone else to get on his back. He found someone and they ran and jumped on also, knocking her over. She needed stitches, but she is so afraid of needles that she convinced her mom to use some type of hospital glue instead of going to the emergency room. (I’m not entirely sure this incident occured as I was told.) They were sledding together and he accidentally pushed her into a thorn bush in his own yard. Her leg from her ankle to her knee was covered in pretty deep scratches and her jeans ruined from the blood. There were rumors going around school that he had cheated on her and when she found out she went straight to him and asked him about it. He was offended and for the next couple of weeks he was off and on nice to her. She has often wondered if he is bipolor because he can “has pretty intense mood swings”, according to her. I don’t know the guy personally. She still gets bruises on her arms and sometimes shows me her stomache. The bruises are normally quarter size give or take. I ask her about them, but she says she REALLY loves him and promises me he treats her great and he is the best boyfriend. Any boyfriend I have had would feel disgusted if they left bruises and would be careful not to accidentally hurt me. The other day she had a bruise from him pinching her that was the size of a fist on the underside of her arm. Her parents love the guy. The guys sisters have recently come to me and told me he treats her horribly at their house and asked why she is still with him. I am confused. IS IT ABUSE WHEN IT “DOESN’T HURT? It isn’t like she has black eyes. I know it hurts when he calls her names though and I wonder if she is worried about admitting the bruises DO hurt because of it maybe being abuse and then she would have to break up with him. She loves being in love and has a dream of marrying her high school sweet heart. Am I just reading into this way too much? Her parents have to see the bruises. She doesn’t hide the ones on her arms. Oh and he used to smoke pot, but I don’t trust his word. He quit “6 months ago”.

Sorry it is so long!

A: Is he abusing her? Yes! I don’t believe for a minute that bruises like you describe don’t hurt. You are a good friend indeed to be concerned. Your friend is in serious trouble. It sounds to me like this boy is increasingly abusive to see how far he can go. He’s already bruised and bloodied her. What’s next?

I’m very concerned that her parents somehow “love” this guy. If you’re right that they see the bruises, they ought to be even more concerned than you are.

Please consider having a confidential talk with your school guidance counselor or school nurse. An adult should step in and help your friend understand that love doesn’t require putting up with abuse and someone who loves her wouldn’t hurt her physically and verbally. It may be tough to talk her out of this relationship if she is so needy that she will accept this behavior in exchange for a fantasy that she has true love in her life. But someone should at least try. It might have some impact on the boy’s behavior if he knew that people at school are watching out for her.

I wish you - and your friend - well.
Dr. Marie

My 8 yr old is bipolar and is on 1000 ml of seroquel a day, clonodine, and 50ml of zoloft. He has been hospitalized in the past. The hospital released him after a 3 month stay. Since his release 1 yr ago he has had some good days and some really rough ones. He sees a therapist at his school 3 days a week but he still struggles to stay in class a full day and consequently misses a lot of school. I don’t know where to turn to for help with him especially when it comes to parenting a child with his needs. I fear that the already high dosages of medication may affect him negatively someday. I have a lot of concerns at this time and have no idea where to look for answers or whether i should be seeking counseling for the entire family. Please help.

A. Yes, you should absolutely seek counseling for the family. Medication-only in no way should be considered comprehensive. The family needs to be involved because your son’s issues affect the entire family. You did not mention if you have other children but if so they are to some degree affected by the challenges of your 8-year-old son. A good family therapist could be a real asset for you and your son in this difficult situation.

The medications that your son is taking are very powerful, especially Seroquel. Seroquel is an antipsychotic medication designed for the treatment of psychotic disorders in adults. The concern with an 8-year-old taking this medication is multifold. There has been little or no testing by the scientific community as to whether antipsychotics are safe for children. Antipsychotic drugs may not be FDA-approved for use with children. PBS recently aired a documentary on this subject called The Medicated Child. It’s worth watching. The documentary highlights the issues related to young children taking antipsychotic medications. It also explores the controversy that exists within the psychiatric community as to whether young children could legitimately have a bipolar diagnosis. The PBS website has many resources for parents. I would highly recommend that you view the video (which can be done online) and read the materials on the website.

A good counselor or family therapist could be what is needed to help you and your family in this situation. You did not detail the exact nature of the problem your son is experiencing but I can assure you medication alone will most likely never be a fully effective treatment. You should pursue counseling. Keep searching for a competent counselor until you find one that honestly helps you and your family. Antipsychotic medications have serious side effects and it’s unknown at this time exactly how they affect children. The side effects are potentially dangerous and irreversible. For this reason and others, it’s imperative that you search for a therapist or group of mental health providers that specialize in treating children and families struggling with the issues you and your family are dealing with. It will not be easy to find competent help but there is a good chance you’ll find it if you keep searching.

Hello. I have a 16 yo Step daughter who lives with me, my husband, my 9yo daughter, and our 2yo daughter. She used to be really close with me. When she moved in with us, she really acted out towards me at about 12. It has increasingly gotten worse. Her mom has diagnosed all her children as bi-polar and depressed. No doctors have as of yet that I am aware of.

Over the last year my step daughter was prescribed welbutrin. She was supposed to keep going to counseling, but when the counselor urged to have me come in, she no longer wanted to go. Her mom took her and got her the prescription and she hasn’t been since.

She keeps going off and on the meds. I keep telling my husband he needs to put a stop to it. Each time she does, she has horrible episodes of mood swings and crying bouts. Finally last night I told my husband to have her admitted to the hospital. He finally did and got her an appt today to be evaluated.

Now her mom is insisting we put her in homeschool because she cannot handle school. The problem is we all work so I don’t understand how that can help.

I feel if she is a threat to herself and needs help to cope, she should be in an in-patient treatment to get her tools for her condition. Her parents feel she should just be taken out of school, giving medication with counseling and be handled with care. Meaning not having any responsibilities and let to do whatever she wants.

Am I wrong or is this the wrong way to handle this? Even if my husband does not agree to home school, her mom will pack her up to her house and do it anyway so it doesn’t really matter what he says.

A: This is a painful situation for everyone. My heart goes out to all of you as you try to figure out how best to help this confused and upset teenage girl.

As difficult as it may be, this child probably isn’t going to get better until the three adults in her life sit down together and agree about what needs to be done. If you can’t do it yourselves, then you need to find a sympathetic counselor who can help you. Since the one thing you all agree on is that you love the daughter, I hope everyone can set differences aside and come to a clear decision about her care.

The doctor who is prescribing the Wellbutrin has made a diagnosis. I hope you and your husband will confer with that doctor about what it is he or she is seeing that led to a diagnosis of bi-polar. It’s also important that you provide the evaluating doctor with the prescribing doctor’s records.

Your husband needs to let the doctors know that his daughter has an involved dad who needs to be in on treatment decisions. However well-intended she thinks she is, his ex-wife shouldn’t be making these decisions on her own - especially since the girl doesn’t live with her. It’s a setup for treatment failure.

It’s unlikely that you will find an inpatient program. There simply aren’t many and most insurance companies discourage all but very short term inpatient stays. You might be able to work with the girl’s school to find a residential school that offers a therapeutic milieu as well as academics if she is truly too ill to manage regular school. But I can’t tell whether either kind of program (hospital or residential school) is necessary. It could be that a well thought-out treatment plan, agreed to and stuck to by everyone involved would give this child the structure and safety she needs to get better.

One last thing: A period of time during which she is excused of responsibilities may be what is necessary during crisis. But over the long run, letting her do whatever she wants won’t teach her how to cope. It will more likely teach her how to be demanding and self-centered. She deserves better than that.

I wish you all well.
Dr. Marie

I am experiencing a vicious cycle that I want to break away from. I have seen doctors and have been on medicine and nothing seems to work so I thought I would a forum to see if any outside source may help. My mother and grandmother are very negative people who believe everyone should be miserable if they are. My mother though takes it to a new extreme by extreme guilt trips and pushing all the blame on everyone but her (usually it falls in my lap or my grandmothers because we are convenient) She always also tells everyone what a bad guy I am and how I show her no respect. I have gotten to the point where I am trying to tell her how I feel and what it is doing to me. I keep telling myself maybe she might get it and I try to stay strong but cry every time because of how bad she makes me feel. I try to sound strong mentally but it is killing me.

I suffer with Bipolar disorder and am pregnant which doesn’t help matters. It is causing massive strain my home and work life. I have zero self esteem and apologize for everything. I also have tendency to pick fights for stupid things which if my husband wasn’t so understanding would of cost me him.

My mom makes me feel bad about everything. She still brings up my wedding (which was over 2 years ago) about how I did not include her and how I did not even want her there. She was mad I think because my dad was there. She lives over 300 miles away so she was not here and did not attempt once to come into town to help. She didn’t even see my ring until the night before the wedding.

My step mother and I became close during the wedding and now she has taken on the role of my mother in a lot of ways because she knew I needed help. Which before the wedding me and her never talked my mum used to tell me things that were very mean and used to play mind games with me and guilt me into not liking her.

I was very suicidal most of my childhood and got admitted three times into a psychiatric ward which my mum kept pulling me out of and taking me off my meds.

I though now am pregnant and she is already trying to tell me she wants nothing to do with the baby because my husband and I decided on a name without any feedback. She sometimes though acts real cheery and nice and I think she might of changed then the next day she goes nuts again. It is causing me though to get more and more down. I am trying not to show it and act like it isn’t effecting me but I am getting more and more depressed.

I have tried to tell her how I feel and she just says how I do not respect her and how no one cares and how it is my fault because of this. I am at the point where I do not think I do. I love her and want her in my life but at the same time I wish she wasn’t. I am starting to though do the same things she does to my husband and other people I do not want this to happen to my child.

I need to break the cycle but am unsure how to go about it. Please help. This is causing me to go nuts and might cost me everything. My husband loves me and is very supportive and says he never wants to leave me but I know if he did what I say and do it would be hard especially with a child now in the picture. I don’t want to be her.

A: I give you lots of credit for trying to break this pattern of mother-behavior. Your baby deserves better. You deserve to have the kind of relationship with your child that you missed as a daughter.

I worry that your mom has convinced you that you are responsible for making her unhappy and therefore you are responsible for making her happy again. You’re not. You can’t anyway. She sounds like one of those people who is happily unhappy. Take away her unhappiness and she is miserable. She needs treatment from a qualified therapist, not groveling from her daughter. You can’t change her (or your grandmother) and it’s way past time for you to stop trying.

There’s no need for you to act the way she does to put some healthy distance between you. Let her know that you absolutely do want her in your life but that you aren’t going to stick around if she is hurtful. Just quietly leave any time she starts in on you. Cut back on visits and keep them short.

Please don’t feel guilty about making a nice connection with your stepmom. I hope she offers you some of the support and affection that your own mother can’t. If so, consider it a gift. You have been given another chance to have a mother-figure in your life.

I hope you and your husband will consider getting some couples counseling while your motivation is high. A counselor can help the two of you learn how to draw healthy boundaries around your own family and how to support each other if you find yourself slipping into your mother’s patterns. You are young enough that you can learn how to catch yourself and how to do things differently. You have a lifetime of being a wife and mother ahead. It’s definitely worth putting in the time now to become the kind of person you want to be.

I wish you well.
Dr. Marie