Treatment and Prognosis: Will Abilify Help if I Have Borderline Personality Disorder?

Reader’s Question

Do I have Borderline Personality Disorder (BPD)? And if so, does Abilify help?

My parents frequently fought when I was a child, and I blamed myself for their troubles. I began to cut myself, drink, and lose weight when I was 11. As I got older I began using alcohol and other substances more frequently and sometimes alone. I constantly feel alone, numb, empty. Even when I am happy I have this deep dissatisfaction with myself. I have “down” periods where I have trouble knowing who I really am. But I also have “up” periods where I feel centered, motivated, and happy to a certain extent. When I am “down” I feel completely misunderstood, unloved, and alone, but when I am “up” I feel like my friends actually like me and my family really does love me. It’s a constant imbalance of ALL my emotions…either I feel them too much, or I don’t seem to feel anything at all.

My worst fear above all is being alone and unloved. I also am very quick to anger. I have tried to jump out of a moving car, ripped up books, and thrown plates when I am angry. I’m also incredibly impulsive. I also get this “not here” feeling. It’s the worst of all. I just feel incredibly detached. Everything seems surreal. Following a recent crash from an “up”, where I popped a lot of Xanax, Advil, and Valium, I had an episode in which I felt like a stranger to myself, and became incredibly angry all of a sudden. I had trouble talking, and I found myself not able to remember things I had just said seconds before. Later that day I went into my bathroom and the tiles appeared and disappeared, and my legs had this white line around them. I go to a very good school and am an honors student. I want to be successful, and happy, and centered, but I know I’m unstable and now I worry that I might be losing my mind.

My psychiatrist has diagnosed me with ADHD and Depression. I have a meeting in two days with him and my parents. He is planning on telling my parents that I should go on Abilify for BPD. I’m so scared because I know THIS is my mom’s worst fear (her sister has psychosis). I’m only 16 years old and I want a second opinion before I am diagnosed with what seems to be one of psychiatry’s most feared and confusing personality disorders.

Psychologist’s Reply

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Making an accurate mental health diagnosis including BPD can only be accomplished by comprehensive evaluation by a professional. That said, you are always free to secure a second professional opinion, and your health care provider should be comfortable with that. This forum can’t be suitably used to render an accurate opinion. However, we can address some general issues.

Some of the behaviors you describe not only fit with some borderline personality features, but also with some sort of mood instability. These days there are some very effective mood stabilizing medications available, including Abilify. It’s also not uncommon for individuals who experience mood instability to try and modify their moods with other substances, sometimes with quite adverse effects. Emotional lability and mood instability are often accompanying features of BPD. It’s also not uncommon for individuals who heavily abuse substances and/or struggle with BPD to have episodes of decompensated functioning, including brief psychotic reactions, that are generally reversible.

Sometimes people dread certain diagnoses like BPD because of the reputation they’ve gotten with respect to treatment and prognosis. But you can take heart. Treatment for the major medical illnesses is better than ever overall and even treatment for BPD has seen tremendous gains in recent years. The key is good, comprehensive care that includes medication for mood instability and impulse control deficiency as well as state-of-the-art therapies such as dialectical behavior therapy (DBT) or even psychoanalysis.

Some researchers view the borderline phenomenon not so much as a distinct personality type but rather a failure of personality integration and solidification. Within such a framework, not all borderline personalities are the same, nor do they face the same prognosis.

There are plenty of reasons for you to be optimistic, especially if you stop abusing drugs (which can not only exacerbate but also cause some of the problems) and commit yourself to treatment that is likely to involve more than short-term intervention.

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