Input on borderline BD

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Any opinions/experience on what meds work well for female borderline PD? Teen(15yr) step daughter has hx. AD/HD + Conduct Disorder but as she ages it is looking (and feeling) more & more to me like BPD. She is currently on Concerta 54mg QD + Wellbutrin SR 100mg BID. Needless to say her behavior is exascerbating(totally reactionary, no thought prior to acting or speaking- very impulsive & manipulative & all the other lovely stuff involved with these sort patients. Way beyond normal teen behavior. Delusional in creating false memories of events which never happened. Habitual lying, etc.) to the point were I am thinking of suggesting perhaps a mood stabelizer such as depakote to her doc & see what the feedback is...wanted some opinions from others here on their experiences.

Thanks in advance

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Any opinions/experience on what meds work well for female borderline PD? Teen(15yr) step daughter has hx. AD/HD + Conduct Disorder but as she ages it is looking (and feeling) more & more to me like BPD. She is currently on Concerta 54mg QD + Wellbutrin SR 100mg BID. Needless to say her behavior is exascerbating(totally reactionary, no thought prior to acting or speaking- very impulsive & manipulative & all the other lovely stuff involved with these sort patients. Way beyond normal teen behavior. Delusional in creating false memories of events which never happened. Habitual lying, etc.) to the point were I am thinking of suggesting perhaps a mood stabelizer such as depakote to her doc & see what the feedback is...wanted some opinions from others here on their experiences.

Thanks in advance

A healthy dose of long term intensive 1:1 therapy. Of course research changes from day to day, but overall, I'm unaware of any gold standard med for personality disorders. However, if you are thinking of a mood stabilizer, perhaps start with something like an omega 3 fatty acid (perhaps in conjunction with depakote or the like). It (omega 3's has been shown to have some mood stab/emotional effects and has the added bonus of being good for one's cardio system.

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I agree with psychrn03.

There is no medication that can cure problems of personality disorder. Medications can offer temporary relief of symptoms (impulsiveness, depression, etc.) The main form of treatment of personality disorders is psychotherapy.

I feel for you. I work with adolescents in a psychiatric facility and those with personality disorders are challenging patients.

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May I add another element here? Yes, we look to meds for mood regulation but why not try some things that our generations in the past used. I'm talking about creative outlets. For example, singing has been shown to help moderate speed of brain waves... dancing... A friend of mine had her very unruly kid in Karote. At her age, the brain is still what we call "plastic" an malleable, and some of these "real life" experiences can be exceedingly helpful.

Working with animals also comes to mind. The human-animal bond can be very mutative. Many decades ago I worked with a dance therapist who was extremely well-trained in psychiatry. Such creative therapy can really help. Just make sure you go to someone with the proper credentials.

And yes, the omegas might help. Do this under a docs/ or NP's supervision-i.e.stick to the usual amounts stated.

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I believe a dialectical behavior therapy group is probably more effective for possible borderline personality disorder patients than either medication or individual therapy.

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A healthy dose of long term intensive 1:1 therapy. Of course research changes from day to day, but overall, I'm unaware of any gold standard med for personality disorders. However, if you are thinking of a mood stabilizer, perhaps start with something like an omega 3 fatty acid (perhaps in conjunction with depakote or the like). It (omega 3's has been shown to have some mood stab/emotional effects and has the added bonus of being good for one's cardio system.

I agree with psychrn03 and lucianne.

Marsha Linehan's Dialectical Behavior Therapy is the only empirically validated psychotherapy shown to work with borderlines. Linehan has written a great book on her technique and a number of programs have adopted her approach. But it's still a tough row to hoe.

Best wishes.

DL

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..
Any opinions/experience on what meds work well for female borderline PD? Teen(15yr) step daughter has hx. AD/HD + Conduct Disorder but as she ages it is looking (and feeling) more & more to me like BPD. She is currently on Concerta 54mg QD + Wellbutrin SR 100mg BID. Needless to say her behavior is exascerbating(totally reactionary, no thought prior to acting or speaking- very impulsive & manipulative & all the other lovely stuff involved with these sort patients. Way beyond normal teen behavior. Delusional in creating false memories of events which never happened. Habitual lying, etc.) to the point were I am thinking of suggesting perhaps a mood stabelizer such as depakote to her doc & see what the feedback is...wanted some opinions from others here on their experiences.

Thanks in advance

I would say that is a very good theory to check out - many bipolar II's end up manic in response to those meds!

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Specializes in Med-Surg, Geriatric, Behavioral Health.

You raise another good point. Bipolar II and BPD may even present similarly. Another visit to the doc requesting "a review" of her diagnosis may be in order, discussing it matter of factly, before adding new meds. Drug abuse also needs ruled out. Individual and group psychotherapy sounds very appropriate as well. Art, pet, music. dance therapies or classes may also be beneficial, especially if it requires her to interact with others in order to learn or improve interactional skills. Hope all turns out well.

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Many thanks for all the feed back. I realise I was brief with the original input on the situation, out of necessity...lol as I could list behavior & such all night. Currently she is removed from the home by the police & in residential treatment. She will however be transitioning back into the home soon. I have her scheduled for a full psych eval with her psychiatrist on the 29th. - she also has an appt. with the peditrician as her diet is simply horrible & no matter what I cook she will not eat. She only wants to eat junk food, pizza, McDonalds, candy or high sugar items. If I buy any sort of treat food such as ice cream, potato chips, etc for the family (we have 3 children) I must keep it behind locked doors or she will eat it in entirety. I will have full medical exam & bloodwork to r/o any medical reason for this eating pattern, however I already know she shows no signs or symptoms of say diabetes. Mind you it is possible the sugar craving comes from the depression but I doubt this is the root of this behavior. I have tried the Omegas in the past however she refuses to take them in any form, the gel caps, liquid. I ended up just taking them myself. We have had her in counseling for the past 4 & 1/2 years but she has only been on meds for the past 2 & 1/2 as we made every attempt at other things prior to starting meds. I have had her in gymnastics, soft ball, Girl Scouts, Chorus, playing the clarinet. Each thing she has dropped after a few weeks participation. She is an excellent artist & draws quite well so I encourage this outlet & keep her stocked with supplies-pencils, pastels, paints, paper, etc. I just finished fighting with the school to have her placed in the emotional support classroom this year as we have tried all of the schools suggestions & she is still struggeling, acting out there & failing academically. She has been tested & has no learning disabilities her IQ was 107 in 3rd grade & she is currently going into 8th. Financially I wish I could send her to alternative schooling with people well versed in handeling & teaching these sorts of kids but I can't & well you have to fight with the school every step of the way as they don't want to pay for it. *sigh* After this last lil episode in the home her psychatrist is now planning on starting her on abilify once this bloodwork is completed. I dunno I guess we shall she how she respond to it, I will however monitor her carefully for an mania as I am well aware of how bipolars can get in response to certain meds, somehow this just doesn't feel like bipolar to me...I dunno call it gut reaction *shrug* I could be wrong so I will remain open minded, it is a valid point & time shall definately tell. I just hope I can get this child back on track for the coming school year, my goal is to see her graduate & NOT DROP OUT as she wants. It is simply difficult as we have 2 other small children & they are being affected adversly secondary to her behavior in the home & consequent responses from the powers that be. My 3 & 1/2 year old being the worst affected as he just does not understand*sigh* the other is still yet too young to comprehend (4 months). We now also are getting in home family counseling which I feel may also be helpful. Hell at this point I am willing to try anything in the hope the situation improves.

Again thanks to everyone for the input & supportive replies.

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