1. “Do you know a psychiatrist or therapist near me who is experienced and skilled in borderline disorder?”

By far, this is the most common question that I am asked about borderline disorder. For my response to this question click here.

2. “My psychiatrist is very nice, has tried to be of help to me, and I trust him very much. However, he says he does not know much about borderline disorder. What should I do?”

I believe that the first reasonable step is to inform your current doctor of your desire to seek a second opinion from a psychiatrist skilled in borderline disorder. This will enable you to determine to what extent you suffer from the disorder, and to define the treatment alternatives most likely to be of help in your case. Once this is done, it is advisable that you discuss the results of this evaluation with your current psychiatrist.

The fact that you have a good and trusting relationship with him or her suggests that you may wish to continue your work together. He or she may be willing to consult with the clinician who evaluated you to obtain advice on medications and therapy.

He or she may also acquire additional information by reading, going to educational conferences, etc. However, if your psychiatrist does not wish to do so, you must decide whether to continue to work with him or her, or find another clinician who has expertise in the area. The psychiatrist who gave you a second opinion may be able to see you, or refer you to someone else with the required expertise.

3. “I believe a family member has borderline disorder, and may be willing to be evaluated. How should I approach this?”

I will assume that you have located a psychiatrist skilled in borderline disorder to perform the initial evaluation. If possible, have your family member review the symptoms of borderline disorder on this website, then take the borderline personality disorder test. Also, the symptoms are described more extensively, and examples provided, in the first two chapters of my book on borderline personality disorder. Finally, you may also benefit from reading Randi Kreger’s book, The Essential Family Guide to Borderline Peronality Disorder.

If they agree that they have some of the symptoms, suggest that an evaluation may be of help. Even if they say they have none of the symptoms, suggest that they might still benefit from an evaluation to determine what may be causing them distress. I find that preparing a patient in this way for an initial evaluation enables them to engage more fully and effectively in the evaluation process.

4. “I have borderline disorder, and frequently suffer from anxiety and panic attacks, as well as long periods of depression. The medications that I am on only help a little. What should I do?”

Anxiety disorder, panic attacks and extended episodes of depression co-occur frequently with borderline disorder. When they do, they require specific medication management and forms of psychotherapy to help bring them under good control. For more specific information on your alternatives click here.

5. “My teenage son has borderline disorder, but also has moderately severe ADHD that does not respond well to behavioral treatments. The antidepressant that he receives and his psychotherapy are helpful in improving some of his borderline symptoms. However, when he is treated with a stimulant for his ADHD, his symptoms and behavior deteriorate considerably. Is there a solution to this problem?”

ADHD co-occurs frequently with borderline disorder because of an overlap of some of the genes that place a person at risk for each disorder. Your son can most likely benefit from medications and other approaches that will reduce his symptoms of ADHD without increasing the severity of his symptoms of borderline disorder. However, this requires the specific use of specific medications and other treatments for both disorders.  Your son’s psychiatrist should be able to assist in this.

6. “We have a 23 year old daughter with severe borderline disorder. She has been in treatment for the disorder since she was 17 years old. She also chronically abuses alcohol and street drugs, including marijuana and cocaine. My husband and I have tried to help her in every way we know how, but nothing seems to help for very long. We are angry with her, worried about her, despair about her future, and frequently don’t know whether we are helping or enabling her. What can we do?”

It is my experience that this is one of the most difficult situations that confronts family members of a person with borderline disorder. For more information on this click here.